By Ann Harman
Osteoporosis is a major public health problem, with 40 million Americans either affected or at high risk. It causes over 1.5 million fractures yearly. How can the massage therapist best help the client with this disorder?
I will address three ways that the massage therapist may be of benefit:
- Recognizing the client who is at high risk, and encouraging the individual to seek diagnosis and to address the problem.
- Refraining from doing those massage and bodywork techniques that might endanger the individual with osteoporosis.
- Performing and teaching techniques which encourage the preservation and building of bone mass.
Osteoporosis is called the silent killer. Most people have no idea that their bone density is dangerously low until they break a bone. By knowing risk factors and early warning signs, we can identify those who might benefit from seeking diagnosis and treatment.
Risk factors include:
- Age
- Female gender
- Slender small-boned body build
- Caucasian or Asian race
- Family history
- Inactive lifestyle
- Diets low in calcium and vitamin D
- Low estrogen in women(including being post-menopausal)
- Smoking
- Heavy drinking
Numerous medications may cause loss of bone density. These include:
- Anticoagulants (Heparin)
- Anticonvulsants (for seizure disorders)
- Cyclosporine A and Tacrolimus (Immunosuppressive drugs for organ transplants)
- Cancer Chemotherapy Drugs
- Glucocorticoids (Cortisone and its relatives)
- Adrenocorticotropic Hormone (ACTH)
- Gonadotropin-Releasing Hormone Agonists (Used for treating cancer, some gynecological problems, and for male to female transgender)
- Lithium (for bipolar disorder)
- Methotrexate (for rheumatoid arthritis, lupus, some cancers, and psoriasis)
- Thyroxine (thyroid hormone)
Red flags to watch for include:
- Hyperkyphotic (stooped) posture
- Mid-thoracic bone pain (they may unknowingly already have a thoracic compression fracture)
- Loose teeth (due to bone loss in the maxilla or mandible.)
By having an intake form that asks about medications, dental problems, history of broken bones, and observing their body build and posture, we can identify those who may be at high risk and suggest that they see their health care provider if appropriate. By using caution with our clients who may be at high risk, we can also avoid the danger of inadvertently injuring someone whose bones are more fragile than is apparent. If an individual at high risk is hyperkyphotic and complaining of mid-thoracic pain, and the spinous processes are tender to gentle pressure, there is a high probability that they already have a thoracic compression fracture. They should be advised to consult their health care practitioner as soon as possible.
What techniques do we need to avoid in our massage and bodywork for those who may have osteoporosis? There is very little information on this; however it is suggested that deep tissue work should be avoided. Use common sense to avoid doing moves that could endanger fragile bones. If you do techniques such as assisted stretching, avoid movements such as flexion, sudden forceful movements, and forceful twisting motions. If the individual has poor balance, consider helping them get up and down from the table and assisting them on the stairs to prevent falls.
What techniques can we do to help preserve bone mass and stimulate bone growth? NASA has done extensive research to address the loss of bone suffered by astronauts who have been in weightlessness. They have found that vibration is a powerful force to stimulate bone growth. Tapotement techniques can be performed in order to create vibration, and self-tapotement can be taught to those interested in self-care. Bones also respond to mild pressure, so putting gentle pressure on the bone (assuming that the bone is not so fragile that this would be dangerous) is another possibility. Poor posture contributes to bone loss and is a risk factor for thoracic fractures, so any work that improves posture may be helpful. And, massage can be used to help manage the pain of osteoporosis.
Osteoporosis is more common than we realize, and will become even more common as the population ages. We can play a more prominent role in identifying those at high risk, and improving quality of life for those with the disease.
Ann Harman will be teaching “Bones for Life” on Saturday, January 25, 2014 at Florida School of Massage. The class will include information regarding bone health, as well as exercises and self-massage for improvement of posture and stimulation of bone density. The major emphasis is on self-care; however demonstrations of hands-on techniques will be done. Self-massage techniques learned in this class may be performed on or taught to clients.
Ann Harman is a retired osteopathic physician, Certified Bones for Life© instructor, Guild Certified Feldenkrais Practitioner©, craniosacral therapist, and licensed massage therapist.
Suggested sources of information:
www.movementintelligence.org (Bones for Life© website.)
www.nof.org (National Osteoporosis Foundation)
www.niams.nih.gov/Health_Info/Bone/Osteoporosis/ (National Institute of Health)
