Sunday, May 23, 2010

Building & Protecting Bone: Odd Angle Exercise, Resistance, Movement (and shaking) Work

ResearchBlogging.orgA fear for many women is that as we age, we seem to be more vulnerable to the "Help Help, i've fallen and i can't get up" hip fracture and related. Awhile ago, i wrote about bone building, and what's known about strategies to keep it together and enhance it. Quick review: bone builds in response to demand. Woolf's law is "use it or lose it" - our bone is "remodeling" all the time. So while calcium, magnesium, zinc and vitamin d are all important, these nutrients alone don't really go into bone building mode unless there's demand on the bones. That means load. Likewise, even with strong bones, we don't stay upright if our movement is compromised by various aches and pains.

A new research survey on non-invasive approaches to bone building puts these points together in a really nice review called "Physical approach for prevention and treatment of osteoporosis" The nice thing is it's free.

Summary: Here's a summary of the approaches that look good for building up bone mineral density:
Resistance training - that's good but it's also site specific. In other words, lower body work helps the lower body (hip/pelvis); upper body work helps the upper body (including the critical spine).

Impact Training - this is stop and start and "odd angle" activities like soccer or squash (not running so much), but also for the more frail, even dancing and ball games have been proposed as ways to help keep demand up on bones.

Combinations. Meta analysis of research suggests that the best approach, unsurprisingly is a mixed approach of resistance training and impact training. Fortunately such practice can be fun and have bone building effect.

Vibration. the next time someone pooh poohs force plates, you might want to suggest that they've been shown - repeatedly - to help build up bone. It's not a HUGE gain, but it could be an excellent modality for the initially infirm:
A 1-year prospective, randomized, double-blind, and placebo-controlled trial of postmenopausal women demonstrated that 20 minutes of a low-level vibration applied during quiet standing can effectively inhibit bone loss in the spine and femur. Placebo subjects lost 2.13% in the femoral neck over 1 year, whereas treatment was associated with a gain of 0.04%, reflecting a 2.17% relative benefit of treatment. In the spine, the 1.6% decrease observed over 1 year in the placebo group was reduced to a 0.10% loss in the active group, indicating a 1.5% relative benefit of treatment (40).

BALNANCE - Physical and Hormonal
T'ai Chi - does nothing for bone building at all, BUT helps get on with movement and balance and the breathing can help destress, so hormonally very helpful in supporting staying safe.  Research has mainly focused on T'ai Chi for these effects, but it might be interesting to consider that other approaches that emphasize mobility, balance, de-stressing, and the whole sensory motor apparatus might not benefit here too?

New & Approved. The review also considers several other forms of "physical agents" like Low Intensity Pulsed Ultrasound (LIPUS) that has been shown to stimulate bone repair. Electrical stimulation has also now been approved by the FDA for "bone repair."

Experimental.  Pulsed electro magnetic fields (PEMF) is a newer approach, nothing conclusive there yet. Low Level Laser Therapy is also being trialed in animal models, but again nothing yet in human studies.

Role for Movement Practice & Assessment?
Where we seem to be at is that concern about bone mineral density has two components: first is to ensure practices for maintianing and building BMD, but second is the development of practices to help people feel stable and mobile rather than vulnerable to falls - improving range of motion, visual accuity and balance.  It's not just Range of Motion - thought that's important - it's the whole sensory-motor awareness package.

It doesn't matter if we're younger or older - we can have issues with our movement that can compromise our ability to respond with agility to a tricky situation. The entire functional movement screen program is based on the premise that there's no point building strength on top of dysfunction, hence the screen for movement issues.

But likewise, we can have issues with our balance or visual accuity or our brains ability to perceive our selves clearly in motion. Indeed, i've written quite a bit about the benefit of just kicking off our restrictive shoes to get more info to the brain about where we are in space, and how doing so has pretty big benefits for movement and also feel of one's own mobility (as the feet move more and better, it seems so do other joints). 

So it seems pretty basic that as part of our quest for better bone health, a related quest for optimizing our body's ability to move in space is pretty important. I've said before, this awareness development is part of why i like I-Phase so much: it's prepping the body for the Real.

In other words, as we build better bones, there's a real benefit in openning up our body's awareness of itself in space, and simultaneously, it's ability to respond better to what's happening. 

Simple example: better range of motion combined with better practice of movement into multiple positions, and better balance and visual processing means the brain has more knowledge about its being able to Zig rather than having to Zag around that wet spot on the floor, and thus, us not going for a tumble.

Stronger bones PLUS less risk of falling in the first place (and not being able to get up) - that seems to be more a complete package.

Conclusion: Why is osteoperosis such the women's issue?
 One advantage that guys have is the size of their muscles puts more load on their bones so that the bones are under more demand.  More demand on the bones, more continued adapting to load.

Women have not been encouraged to do as much manual labour or high resistance workouts as guys.
Similarly our formal worlds are increasingly desk bound, so less movement is part of our daily lives. As we age, this decrease in multi-plane motion seems to increase. Let us say phooey to this increasingly restricted mode of being.

It will be interesting to see as the culture shifts towards it being ok for gals to work out, and as muscle tissue can be built up at any age, that perhaps hip and related fractures will become a fate of a by-gone age.


Lirani-Galv√£o, A., Lazaretti-Castro, M. (2010). Physical approach for prevention and treatment of osteoporosis Arquivos Brasileiros de Endocrinologia & Metabologia, 54 (2) DOI: 10.1590/S0004-27302010000200013

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