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Osteoporosis

Physical Therapy and Fitness for Prevention and Treatment of Osteoporosis Dehghan Manshadi , PT,Ph.D Rehabilitation Faculty,SBMU 21/ Shahrivar /1390. Osteoporosis. While you cannot change your genetics or heredity, skeletal frame, gender, race or age , you can control other Risk Factors.

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Osteoporosis

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  1. Physical Therapy and Fitness for Prevention and Treatment of OsteoporosisDehghanManshadi ,PT,Ph.DRehabilitation Faculty,SBMU21/Shahrivar/1390 Dr.Dehghan Manshadi

  2. Osteoporosis While you cannot change your genetics or heredity, skeletal frame, gender, race or age, you can control other Risk Factors Dr.Dehghan Manshadi

  3. Prevention • The prevention of osteoporosis should begin in childhood. • Identification of individuals at high risk for developing osteoporosis is important in prevention. • The preventive approach to disease ideally begins before patients are symptomatic, as this is the optimal time for positive treatment outcomes. Dr.Dehghan Manshadi

  4. Types of Prevention * Primary -Aims to remove the cause of a disease *Secondary • Aims to detect asymptomatic dysfunction and treat it early to avoid progression *Tertiary - The treatment of existing symptoms to prevent progression of a disease Dehghan FM.

  5. Levels of Prevention for Osteoporosis • Primary Prevention strategies such as Exercise, adequate calcium intake, vitamin B intake, drug treatments, smoking cessation, and no/decreased alcohol intake. • Secondary Prevention of osteoporosis focuses on screening. This level of prevention targets women who have osteopenia or osteoporosis. • Tertiary Prevention focuses on calcium and vitamin D intake, exercise, drug therapy and fracture prevention. This level of prevention is aimed at women with histories of fracture due to osteoporosis. Dr.Dehghan Manshadi

  6. 10-20 Year Olds Prevention • In adolescence, the focus is on primary prevention strategies : • 10-20 years old is the time to make deposits in the “bone bank”. A Calcium rich diet, including plenty of dairy products and green, leafy vegetables, vitamin B intake, drug treatments, smoking cessation, and no alcohol intake. • Young women need to be concerned about maintaining Regular Menstrual Cycles , Dr.Dehghan Manshadi

  7. 20-35 Year Olds Prevention • In 20-35 years old bones are at reach peak strength. • Maintaining a calcium rich diet and the habit of a regular, moderate exercise program are tremendous defenses against Osteoporosis. • Primary and secondary prevention strategies for these ages aim to maximize peak bone mass minimize bone loss Dr.Dehghan Manshadi

  8. 35-50 Year Olds Prevention Individuals may already have started to lose bone mass. Continued emphasis on a Calcium rich diet and regular, Moderate Exercise is a healthy strategy. In addition, during this time you might want to consider bone density screening. Dr.Dehghan Manshadi

  9. Over 50 Prevention • Postmenopausal women may be losing bone mass at a rate of 1-6% per year. • Risk becomes greatest for men also. • calcium rich diet and a healthy lifestyle which includesExercise of at least 20 minutes at least 3 times per week ,can diminish the effects of Osteoporosis • . Dr.Dehghan Manshadi

  10. Treatments

  11. The goals of the treatment of Osteoporosis • Minimize bone loss • Decrease falls and the resulting fractures • There are two types of treatment: • Pharmacologic and Nonpharmacologic. • The non-pharmacologic treatment includes: • Exercise and Fall Prevention Dr.Dehghan Manshadi

  12. Physical Therapy Assessment (1) Initial Evaluation (History Taking) • Medical history • • Fracture history • • Falls history • • Exercise/physical activity history • Family History Dr.Dehghan Manshadi

  13. Physiotherapy Assessment(2) • Joint Range of Motion • Anthropometric and Spinal Mobility • Flexibility • Pain Control (if necessary) • Muscle Strength and Endurance • Posture and Gait • Exercise/Aerobic Capacity • Balance & Functional Testing • Daily Activity • Quality of Life Dr.Dehghan Manshadi

  14. What physiotherapists can help…. • • Pain Relief/ Pain Control • • Postural Correction • • Weight-bearing Exercises: High, medium, • Low impact • • Reduce joint stiffness • • Increase muscle strength/ endurance • • Improve balance • • Prevent fall and fracture Dr.Dehghan Manshadi

  15. Exercises • Exercise affects bone density, size and shape,Turner (2003). • Exercise results in mechanical strength improvement. • Exercise causes stimulation of osteoblast activity (NAMS, 2002). Increased BMD by exercise is thought to be due to the suppression of bone resorption (Kohrt, 1998). Exercising regularly in childhood and adolescence can ensure that you will reach peak bone density. Need to participate in weight bearing exercise. For example, walking, dancing, jogging, stair climbing, racquet sports and hiking. Dr.Dehghan Manshadi

  16. Benefits of Exercise for Osteoporosis • Increased bone density/bone remodeling • -Increased muscle strength • -Increased posture • -Increased flexibility • -Increased endurance • -Increased Quality of Life • -Decreased risk of falls • -Decreased pain Dr.Dehghan Manshadi

  17. Design Exercise Programs • Safety! Safety! Safety! • Be practical and achievable • Is supervision required or not? • Progression: when and how? • Is it simple to follow? Dr.Dehghan Manshadi

  18. Before Starting Exercise • • Know their abilities • • Seek medical advice if appropriate • • Wear proper sports attire and shoes • • Select suitable venue • • Drink water • • Do exercise on a regular basis • • Exercise daily for 30 to 60 minutes • • The exercise programme should cover all types Dr.Dehghan Manshadi

  19. Recommended Exercises/Activities • Weight Bearing activities*** • Resistance training • Postural training • Low impact aerobic exercise • Balance training • Flexibility and ROM • Gentle Yoga • Sit to Stand exercise or squats • Walking (with or without weights) • Jogging • Low impact aerobics • Dance • Stair climbing • Any weight bearing sports (bowling, tennis, badminton, volleyball etc.) Dr.Dehghan Manshadi

  20. Types of Exercises for Osteoporosis • 1.Stretching & Flexibility Exs./Warm Up • 2.Postural Corrections & Body Mechanics • 3.Weight Bearing & Exs. -High impact: skipping, stairs running, ball games -Medium Impact: Hiking, Line dancing, Fast pace social dance • 4Aerobic /Low impact: walking, Tai Chi, Slow space, social dance, Physical activities in standing position,Raquet Sports,…. • 5.Balance & Co-ordination Exs. • . Dr.Dehghan Manshadi

  21. Warm Up (Exercise to Mobilize Joints) Bend the neck sideways Turn the trunk to left & right Shoulder forward circles Dr.Dehghan Manshadi

  22. Warm up (Exercise to mobilize joints) Arm backward circles Tiptoes circles Stepping (can hold on a chair) Dr.Dehghan Manshadi

  23. Stretching and Flexibility • Lose flexibility with age due to inactivity and poor habits • -Stiff muscles and joints = increased pain and restricted movement • * Increasing Flexibility and Range of Motion (ROM) can increase ADL function and overall independence Exercise Suggestions (wands->) muscles after exercise and wrist rolls Practice flexibility daily! Dr.Dehghan Manshadi

  24. Warm up (Stretching exercise) Triceps LatissimusDorsi Biceps & forearm muscles Dr.Dehghan Manshadi

  25. Warm up (Stretching exercise) Hip flexors Hamstrings Calf Dr.Dehghan Manshadi

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  28. Postural Training • - • Helps to decrease risk of compression fractures • Practice both sitting and standing posture • Exercise Suggestions • Back extensions • Open up chest • Core strengthening • Shoulder strength and mobility • Isometric back strengthening • *Reinforce posture with all exercises Dr.Dehghan Manshadi

  29. Proper Standing and Walking Posture Dr.Dehghan Manshadi

  30. Wall Arch To stretch your shoulders and calves and tone your back and abdomen: (1). Stand facing the wall, arms at your sides, feet 6 inches apart and 6 inches from the wall. (2). While inhaling, flatten your stomach and stretch both arms up to touch the wall, Exhale and lower both of your arms to the starting position. While inhaling, reach up with your right arm and stretch down with your left arm (3). Exhale and lower your right arm to the starting position. Switch arms. While inhaling, reach up with your left arm and stretch down with your right arm Repeat each movement five times. Dr.Dehghan Manshadi

  31. Chest Stretch To stretch your chest and straighten your back: (1). Sit with your feet flat on the floor. Keep your back erect and look straight ahead. Stretch your arms out to the side, keeping them level with your shoulders (2). Bend your arms at the elbows and bring your hands toward your chest Repeat five to 10 times, depending on your ability. Dr.Dehghan Manshadi

  32. Chin tuck To straighten your head and shoulders: While seated, look straight ahead. Pull your chin in toward your neck, but keep looking straight ahead; don't let your head bend forward. Push your hands down on your thighs to help straighten your back. Hold this position for a few seconds. You'll feel a stretch in the back of your neck. Repeat this exercise five times. Dr.Dehghan Manshadi

  33. Back Posture Exercises Dr.Dehghan Manshadi

  34. Stretch your chest and strengthen your Upper Back Muscles (1). With your feet flat on the floor, sit slightly forward in a sturdy chair, keeping your back and neck straight. Look straight ahead, bending your arms at the elbows (2). Gently move your elbows and shoulder blades back as far as you can and still be comfortable Hold the position for five seconds while breathing normally. Return your arms to the starting position. Repeat this exercise five to 10 times, depending on your ability. Dr.Dehghan Manshadi

  35. Back and Shoulder Stretch Dr.Dehghan Manshadi

  36. Regular Weight Bearing Activity • Feet and legs supporting weight • -Bones and muscles work against gravity • Increases the load/force on the bones • *Increased load over time, increases bone mass, while decreased load over time, decreases bone mass Dr.Dehghan Manshadi

  37. Resistance Exercise • Creating resistance with weighted objects or own weight • -Strengthen muscle groups which, in turn, strengthen bones • Increased weight = • greater impact on bone building • Progress with weight: • low 􀃆moderate 􀃆heavy Dr.Dehghan Manshadi

  38. Core exercise (Muscle strengthening exercise) Lift weight overhead Biceps curl with weight Wrist up and down Hold fist Dr.Dehghan Manshadi

  39. Core exercise (Muscle strengthening exercise) Step forward and raise both arms Knee extension in sitting Chair stand Raise thigh sideway Dr.Dehghan Manshadi

  40. Upper Back Lift Sitting Knee Extension Pelvic Tilt Dr.Dehghan Manshadi

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  42. Core exercise (Muscle strengthening exercise) Bend hip in standing Bring hip backward Bend knee in standing Lunge walking with weights Dr.Dehghan Manshadi

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  44. Aerobic Exercise • Increase Breathing & Heart rate without compromising ability to breathe • -Increased Endurance required for ADL’s & household tasks • -Decreases Pain associated with osteoporosis • -Keeps Heart & Lungs healthy • Exercise Suggestions • -Brisk walking • -Walking with weights • Moderate intensity cycling • Low impact aerobics Dr.Dehghan Manshadi

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  46. Balance Training • Shifting weight to move centre of mass over the base of support (BOS) • -Can decrease falls and risk of falling • -Improves reaction time and coordination • Exercise Suggestions • -Manipulating BOS • -Tai Chi • -Reaching exercises • -Leg strengthening • -Core stability Dr.Dehghan Manshadi

  47. Balance training (Walk 5 min. for each exercise) Walk on toes Walk on heels Tandem walking Dr.Dehghan Manshadi

  48. Balance Training Dr.Dehghan Manshadi

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