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OSTEOPOROSISTHERE

ISSOMETHING YOU CAN DO ABOUT IT!

FOCUS ON BRACING WITH THE

SPINOMEDSPINAL ORTHOSIS FOR OSTEOPOROSIS

THE MEEKS METHOD

that, someday in this country and, indeed, around the world, any person, no matter their age, gender, lifestyle, ethnicity, musculoskeletal condition or any other factor, that that person can go into any environment where exercise 

and movement are being taught and be given a program that is

Ideally, it will also be therapeutic.  Although there is more awareness now than when I began teaching 12 years 

ago, there is still a lot to be done. By taking this course, you will help me fulfill my dream.  

As you learn more about movement that is

you can help me take the message of safety and therapeutic intent in movement and exercise into your own life and

into the lives of others.

WHATISTHE

MEEKS METHOD

ACOMPREHENSIVE12-POINT

PHYSICAL THERPYINTERVENTION Developed around a population of patients diagnosed with osteoporosis

useful for many diagnoses designed with a primary

objective of safety in movement from and for the bones--S.A.F.E.*

*Skeletally Appropriate For EveryoneComplements the use of the Spinomed

Orthosis for Osteoporosis

IS THEKEY

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©2000 SARA MEEKS SEMINARS

PATTERNS OF POSTURAL CHANGE

Prevent, Arrest or Reverse

ALIGNMENT

PERCH POSTURE HIP HINGE STANDING POSTURE

INTERNAL PLUMB LINE

SIT-TO-STAND & STAND-TO-SITFUNCTIONAL MOVEMENT

Inability to stand up out of a chair unaided is linked to a 2 fold increase in hip fracture risk Cummings et al 1995

Weakness of lower extremities linked to impending physical frailty Judge et al 1996 Guralnik et al 1995

Low femoral neck bone mineral density is significantly associated with a low sit-to-stand performance assessed by measurement of maximum rising strength in healthy adult women. Blain et al 2008

SIT-TO-STAND CHAIRWWW.ENDORPHIN.COM

FRONT

BACKBONE

OF

THE

PRINCIPLES OF THE MEEKS METHOD

DECOMPRESSION

FRONT of the Backbone

T E N S I L E F O R C E Single Best Exercise for Most Back Pain

UN‐LOAD the Vertebral BodiesJRF GRF Site‐Specific Exercise BRF

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What

IS

OSTEOPOROSIS ?

A musculoskeletal disorder with compromised bone

strength that predisposes an individual to increased

fracture risk

NIH Consensus Development Panel onOsteoporosis Prevention, Diagnosis, and Therapy.  

JAMA 2001: 285:785‐795

•Bone Density•Bone Quality

•Architecture•Mineralization•Micro damage accumulation

BONE STRENGTH

Milner, Colin. Making Bone HealthA Priority. The Journal on Active Aging.May June 2002.

OSTEOPOROTICBONE

NORMALBONE

PRIMARY CONSEQUENCE OF OSTEOPOROSIS IS 

FRACTURE

PRIMARY OBJECTIVE OF THERAPY AND BRACING IS TO PREVENT FRACTURE

• Occurs in 1 of 2 women; 1 of 4 men• Happens every 20 seconds• Can be immediately life‐altering and life‐threatening• Annual Fracture Incidence

– Vertebral—700,000– Hip—300,000– Wrist—250,000– Other Sites—300,000

• Cost – >$46 million per day– By 2020– >$178 million per day

OSTEOPOROSIS‐RELATED FRACTURE

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•Bones of spine usually first to show signs of osteoporosis•Primarily trabecular bone•Fractures occur during movement that includes

TRUNK FLEXION

VERTEBRAL BODY

•After one vertebral fracture, the risk for having a 2nd

vertebral fracture increases 5 fold!•1 woman in 5 will sustain a 2nd vertebral fracture within 1 year

•Only 20-30% of all compression fractures are symptomatic1

International Osteoporosis Foundation 2005Report of the Surgeon General on Bone Health Oct 2004

1www.nih.org accessed November 30, 2011

CLINICAL CONSEQUENCES OF SPINE FRACTURES

SYMPTOMS SIGNS FUNCTION FUTURE RISKS

Back Pain (acute/chronic)Sleep DisturbanceAnxietyDepressionDecreased Self EsteemFear of future:  Falls and FracturesReduced Quality of LifeEarly Satiety

Height LossKyphosisDecreased Lumbar LordosisProtuberant AbdomenReduced Lung FunctionWeight Loss

Impaired ADL’sDifficulty Fitting ClothesDifficulty Bending, Lifting, Descending Stairs, Cooking

Increased Risk of FractureIncreased Risk of Death

Source:  Papaioannou et al. 2002.  Reprinted from The American Journal of Medicine, Diagnosis and management of vertebral fractures in elderly adults.113(3):220‐228

Bone Health and OsteoporosisA Report of the Surgeon General October 2004

COMPLICATIONS FROM COMPRESSION FRACTURES OF THE SPINE

Constipation

Bowel Obstruction

Prolonged Inactivity

Deep Venous Thrombosis

Increased Osteoporosis

Progressive Muscle Weakness

Loss of Independence

(Increase in Thoracic) Kyphosis

Crowding of Internal Organs

Atalectasis/Pneumonia

Prolonged Pain

Loss of Body Height

Low Self‐Esteem

Emotional & Social Problems

Increased Nursing Home Admissions

Mortality

Old JL.  Vertebral Compression Fractures in the Elderly Am Fam Phy Jan 2004

QUESTIONS?

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?VERTEBROPLASTY

AND

KYPHOPLASTY

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THE

PROCEDURES

Vertebroplasty•First Use—1995

•Large bore needle to cannulate the pedicle(s), followed by injection of polymethylmethacrylate into the vertebral body

Ananthakrishnan et al. Clinical Biomechanics 20 (2005) 25-31

Kyphoplasty

•First Use—2001

•Large bore needle to cannulate the pedicle(s)

•Placement of inflatable balloon tamp within the vertebral body

•Balloon inflated under fluoroscopic visualization, which creates a void in the cancellous bone and elevates the endplate

•Procedure reduces some of the deformity and height loss associated with the fracture.

•Because specific void is created, injection pressure is lower and bone filler viscosity higher which likely reduces incidence of cement leakage

RESULTS

•Good immediate pain relief

•Immediate return to function

•Improvement in both thoracic and lumbar spinalalignment

•Restoration of vertebral body height

•Adjacent fracture is a side effect and appears to be related to the condition and not to the procedure; higher rate of subsequent fractures compared withnatural history for untreated fractures

•Cement augmentation places additional stress onadjacent levels; patients should be carefully evaluatedfor subsequent fractures

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PHYSICAL THERAPY MANAGEMENT OF PATIENTSWITH

VERTEBROPLASTY AND KYPHOPLASTY

•Generally the same as for patients with osteoporosis without surgical procedures

•Goal is prevention of further fracture

•Therapists should contact surgeons performing these procedures to inform them of the benefits of specific physical therapy

intervention

Bracing is part of a comprehensive approach to the management of

patients with

osteoporosisand/or

compressionfracture

PURPOSES OF BRACING

Support and protection Control of motion Prevent fracture

Allow weight-bearing activities

Bracing usually associated with weakeningof body part it is designed to protect

SPINOMED Spinal Orthosis for Osteoporosis

After TreatmentNo Brace

After TreatmentClam Shell

After TreatmentSpinomed

Advantages of the Spinomed

oLightweightoCan be worn under clothing -

inconspicuousoEasy to Don and DoffoStrengthens rather than weakens— if

the patient experiences discomfort from muscle activation, he/she may have to shorten wear time when first starting with the brace

oCan be fit to very severe thoracic hyperkyphosis

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Details of Fitting & Wear of the SpinomedoMake sure the brace is long enoughoDo not cut the straps too earlyoWear

oWhen people are up and active, can also be worn when sitting but more benefit obtained when up and active

oWhen walking, working out, as well as when “puttering” around the house, doing gardening, housework etc

oFit is critical o should conform exactly to curves of the back o pelvic strap below iliac crests o abdominal support in lower abdomeno serpentine strap DOES NOT pull shoulders back

Other Details of the SpinomedBacked up by a peer-reviewed research study

Michael Pfeifer, Bettina Begerow, Helmut Minne 2004

Ordered by Physician

Fit by Orthotist – orthotist should make sure patient understands how to don/doff Spinomed before leaving the office

Physician, Orthotist, Physical Therapist, & Patient work together for ultimate best fit and satisfaction

Combine with The Meeks Method Exercises for optimum results

Covered by Medicare

BRACING (with the Spinomed® brace)

– 2 Groups of Women with Osteoporosis and Compression Fracture

– 6 month trials with and without the brace

– Women who had been wearing the brace did not want to give it up

Pfeifer, Begerow, and Minne 2004

BRACING with the Spinomed®

–73% Increase Back Extensor Strength–58% Increase Abdominal Strength–11% Decrease Thoracic Kyphosis–25% Decrease Body Sway–7% Increase Vital Capacity–38% Decrease in Pain–15% Increase in Well-Being–27% Decrease in Limitations ADL’s–Increase in Body Height

Pfeifer, Begerow, and Minne 2004

BRACING WITH THE SPINOMEDSpinal Orthosis for Osteoporosis

“The Spinomed orthosis is the single, most significant advancement in the conservative

management of osteoporosis and compression fracture EVER.”

Sara M. Meeks, PT, MS, GCS

Use of the Spinomed is part of thecomprehensive approach of

The Meeks Method

Goal of Management is to Prevent the Next Fracture

Protocol for Compression Fracture Management

PROTOCOL FORCOMPRESSION FRACTURE MANAGEMENT Start early – on day of fracture if possible UN-load the spine – position in supine or as close to

supine as possible, hips and knees bent and supported to relieve pull of leg muscles on the spine

Position from least to most compression – supine, side-lying, prone, standing

Pain relief with positioning, ice, moist heat, electrical stimulation along erector spinae muscles

Isometric Back Extensor, Gluteus Maximus, Abdominal Exercises

NO OUT-OF-BED-TO-CHAIR ORDERS If seated, use reclined chair, avoid “hammock” effect Initiate weight-bearing with standing, weight shifting, gait

training using rolling walker or other support as soon as possible

Consider bracing with Spinomed-Spinal Orthosis for Osteoporosis

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Habitual Posture Best Posture Best Posture – 1 Hour Later

JAMESThoracic Kyphosis

The World’s Osteoporosis

is

Ticking

Chan et al. Bulletin of the World Health Organization 2003, 81 (11)

!! TAKE ACTION NOW !!

Best way to diffuse the world’s

OSTEOPOROSIS TIME BOMB

is to

THINK

BONEWHEN YOUR PATIENT

FIRST COMES THROUGHTHE DOOR

“BOTTOM LINE”

PREVENTION

OF THE

NEXT FRACTURE

WHAT IS

YOURNEXT STEP?

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Mikki

Rosie

Raven

For PDF’s of

PowerPoint (color) Presentation Slide on Compression Fracture 

Management  Re‐Alignment Routine (beginning 

exercises of The Meeks Method)send email to

sara@sarameekspt.com

Reference list available through www.ptseminars.net

Check website www.sarameekspt.com for more seminars by Sara Meeks, PT, MS, GCS

Additionally, for books, DV D 

and other products designed to enhance your practice 

please visit 

www.sarameekspt.com

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