Osteoporosis Fractures: PT and Pain Management

From the WebMD Archives

Having osteoporosis makes your bones more likely to break. The spine is the most common area where weak bones can give way.

Many fractures hurt, so treatments will ease the pain and help heal a broken bone. You can recover and come back stronger.

Treating Pain

Good news: Pain usually does get better.

It may take time, though. "It can take a couple of months," depending on how deep the damage to the bone, says endocrinologist Ann Kearns, MD, of the Mayo Clinic in Rochester, Minn. While you're healing, there are pain treatments that don't call for surgery. They include:

  • Pain medicines. These include acetaminophen (Actamin, Anacin AF, Tylenol), nonsteroidal anti-inflammatory medicines (NSAIDs), and prescription opioids. If you use opioids, it should be for a short time: "If possible, four weeks or less," says Chad Deal, MD, of the Cleveland Clinic. All drugs have side effects, so speak with your doctor about what’s best for you.
  • Hot or cold compresses. Applying heat or cold may help. "Some people like heat, some like cold," Deal says. "Whatever feels best."
  • TENS (transcutaneous electrical nerve stimulation). A TENS system includes a small, battery-powered machine, connected by wires to a pair of electrodes. The electrodes are connected to your skin near the pain source. A mild electrical current travels through your skin and goes along your nerve fibers. It may reduce pain by changing the way your brain perceives pain, experts say. One session takes about 15 minutes. "TENS is sometimes helpful -- not a game-changer but worth a try," Deal says.
  • Massage. This may give your muscles relief. Get your doctor's approval first, only get massage from a qualified therapist, and make sure the therapist knows about your osteoporosis and your fracture.

Other options that you and your doctor may consider as your fracture heals include using braces and muscle-relaxing prescription drugs. Some cases also involve taking calcitonin or parathyroid hormone, but that’s less common.

Surgery Options

Not every broken bone calls for surgery. For example, some wrist fractures do need a surgeon's care; others heal with only a cast. Even with a broken hip, some people only need to be monitored by a doctor.

Continued

If you have a fractured vertebra that is persistently painful, your doctor may offer two kinds of procedures, Deal says:

  • Kyphoplasty. The doctor inserts a tiny balloon to expand the broken vertebrae, fills the space created by the balloon with bone cement, and then removes the balloon.
  • Vertebroplasty. This procedure is similar to kyphoplasty, but without the balloon.

Like all surgeries, there are risks. There has been some concern about the bone cement leaking, as well as pain and other complications to nerves from this procedure.

Deal says he uses these approaches "judiciously." When used in appropriate cases, he says, "it does result in remarkable improvement of pain."

Physical Therapy

Once your pain is under control, physical therapy can help you get back to your normal activities and avoid another broken bone.

Your plan depends on which bone is affected. You may need to rehab the injury and strengthen certain muscles.

For example, if you break a wrist, you may need to build your upper body strength and strengthening your wrist muscles, says Sherri Betz, PT, a physical therapist in Santa Cruz, Calif. She chairs the American Physical Therapy Association’s Bone Health Special Interest Group.

For the spine, Betz evaluates how well someone can get into and out of bed, lift an object less than 10 pounds, reach overhead, sit in a chair, and rise to standing.

If those activities are tricky, Betz works with the person on positioning ''so they can sleep, sit, rest." Using pillows and propping, she helps people find ways to get comfortable. She teaches them breathing and stretching techniques to help control pain.

This exercise helps to avoid a hunched-over posture:

  • Sit in a chair with a soft ball behind your back.
  • Lift up your chest.
  • Put your hands behind your head
  • Continue to lift the chest to avoid rounding of the back.

After hip surgery, Betz says it's important to get the legs strong again so that they can get back to their normal activities.

If balance is an issue, she recommends tai chi to help prevent falls. This ancient Chinese martial art is known to improve balance.

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People with spine fractures may go to six or eight physical therapy sessions, Betz says. For hip fractures, people often get eight to 12 weeks of physical therapy.

She gives people homework and encourages them to continue doing their exercises after they finish their PT sessions so as to stay strong and active.

WebMD Feature Reviewed by Brunilda Nazario, MD on January 10, 2013

Sources

SOURCES:

Sherri Betz, PT, physical therapist, Santa Cruz, Calif.; chair, American Physical Therapy Association Bone Health Special Interest Group.

Ann Kearns, MD, PhD, consultant in endocrinology, Mayo Clinic, Rochester, Minn.

National Osteoporosis Foundation: "Medicines That May Cause Bone Loss."

Chad Deal, MD, head, center for Osteoporosis and Metabolic Bone Disease, Cleveland Clinic.

American Academy of Orthopaedic Surgeons: "Osteoporosis and Spinal Fractures," "Alternative Methods to Help Manage Pain After Orthopaedic Surgery," "Distal Radius Fracture," "Hip Fractures."

National Osteoporosis Foundation: "Managing Your Pain."

American Bone Health: "Do It Right and Prevent Fractures."

FDA: "Bone Cement in Vertebroplasty and Kyphoplasty Procedures."

PubMed: "Tai Chi for Osteoporosis: A Systematic Review."

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