Guest: Renee Garrison – Therapeutic Services/Physical Therapy
Host: Dr. Marcy Bolster – Rheumatology & Immunology
Welcome to an MUSC Podcast
Dr. Marcy Bolster: Hello. My name is Marcy Bolster. I’m a professor of Medicine and a rheumatologist at the Medical University of South Carolina. I’m the medical director for the Center for Osteoporosis and Bone Health. I have here, today, Renee Garrison who is a physical therapist. She and I will discuss the role of physical therapy in osteoporosis and bone health.
Renee Garrison: Thanks for having me.
Dr. Marcy Bolster: Can you tell me about the role that physical therapy has in bone health as well as osteoporosis?
Renee Garrison: Well, one of the best things for osteoporosis and bone health is exercise, and that’s where physical therapy can come into play. We can teach people appropriate exercises to increase their bone density as much as possible, and keep them healthy and strong, keep them balanced and in good posture and, most importantly, keep them from getting a fracture that can cause problems down the line.
Dr. Marcy Bolster: So, you talk about exercise and its role, as well as balance and strengthening. I wonder if you could elaborate a little bit, first, on the balance and strengthening and what role that would play in a patient’s bone health.
Renee Garrison: Absolutely. Well, the first thing we would do in physical therapy is evaluate the individual patient. Everyone is different and everyone will come into physical therapy with a different level of strength, a different level of balance, so we’ll want to look at those things doing various tests, asking someone to stand, for example, on one leg or to hold weights against gravity, and just kind of get a baseline of where we’re starting from. We would then take that information and design a program for the specific patient to help them, as much as possible, gain strength wherever they have limitations and improve their balance, if they have any balance limitations. Most people can benefit from a balance program as none of us have perfect balance.
Dr. Marcy Bolster: And that makes good sense because it seems that if you can improve a patients balance and stability, they would be less likely to fall.
Renee Garrison: Definitely. You know, one of the biggest problems with osteoporosis is fracture, obviously, and the sequelae, the negative sequelae, from a fracture. If we can keep someone from falling, we may be able to keep them from fracturing their wrist or their hip, and keep them as healthy as possible.
Dr. Marcy Bolster: That’s a great point. I think that’s a really valuable point. I think the public is aware of the importance of exercise for health, and for bone health, but I think, also, reducing the risk of a fall is a very valuable point.
Renee Garrison: The strengthening can also help with postural changes that sometimes go along with osteoporosis. Whether it’s due to an actual vertebral fracture, the bent over type posture that people associate with osteoporosis, physical therapy can help by stretching anteriorly, and then strengthening posteriorly, in other words, stretching the chest and strengthening the back to counteract those changes that might occur with osteoporosis. And, also, just good posture helps you, again, with balance and with pain. For example, if you have pain from a fracture, if you lean into that poor posture, and lean into that, what we call, kyphosis, the rounded spine, that can cause more pain. If you’re in a better position, it might decrease pain.
Dr. Marcy Bolster: Okay. Now, let’s go back to what you mentioned before about exercise. I know the public is aware that exercise is good for your health. Would you say that any type of exercise is good for bone health, or can help patients that have osteoporosis? Do you want to comment on that?
Renee Garrison: The best exercise, that we recommend, is weight-bearing exercise. So, something like swimming, it’s very good for your cardiovascular health, but it’s not going to do that much for your bone health. Your bones need to be stressed with weight bearing. So, that would be walking, dancing or, some people can jog, anything where the bones have to take weight. That type of exercise is much more beneficial for people with osteoporosis.
Dr. Marcy Bolster: And what about weights with exercise, what do you recommend there?
Renee Garrison: That can help. The only time we would not recommend doing that is if those weights are too heavy for them and it’s causing them to stand or walk in a poor posture, or poor position. In other words, if someone who’s not that strong tries to hold four-pound weights in their hands and take a 30-minute walk, they’re going to start having problems holding that up. But, having some wrist weights on would be fine for someone to go walking and get a little bit of upper extremity work along with their lower extremity work.
Dr. Marcy Bolster: When a patient with osteoporosis goes to see a physical therapist, I understand that you teach them about stability, balance, and strengthening, as well as instruction on a weight-bearing exercise program. Are there things that you can talk to the patient about in terms of, maybe, reducing their risk of a fall, or reducing their risk of a fracture?
Renee Garrison: Absolutely. Home safety is very important, and educating the patient on how to make their home as safe as possible is something that we can help with. For example, removing throw rugs from the floor, making sure there are lights on at night when they have to get up to get to the bathroom. There are small changes that they can make in their home to make it a lot safer for them, to avoid falls, things like pets, keeping the pet out of the room at night because when you get up to go to the bathroom, you’re dog can run across your path, and you fall, then you have your fracture.
So, home environment is very important. Also, addressing the posture at home, making sure that they’re sleeping properly, their spine is supported in a good position while they’re trying to sleep, that can help with pain and with alignment, keeping them in a good position overnight. And then just sitting posture, if someone is going to be at a computer for a long period of time, they should make sure that they’re sitting in a good posture to keep them upright, to keep their back muscles strong, and to keep them from having discomfort and getting into a poor posture.
In physical therapy, we can tell people the appropriate movements and exercises they can do. There are some things that are actually contraindicated, for example, bending over forward. If you are at risk for a vertebral fracture and you bend fully forward, you may injure yourself. We can teach people how to use grabbers to reach for things, or put their shoes on a slightly different way so that they’re not flexing their spine, which is bending they’re spine, so they’re not putting themselves at risk for a fracture. There are a lot of different things. They can use corsets. They can use braces, reachers, grabbers, for support, things that make life a little bit easier and decrease their risk of fracture.
Dr. Marcy Bolster: I’ve heard you say before, when you talk to patients, there are certain adjustments that can be made to their daily activities, something as simple as tying their shoe, that don’t put their spine at risk for a fracture.
Renee Garrison: Absolutely. We can teach them the proper way of moving and holding their body, and balancing, to avoid a fracture as much as possible. We want to decrease the amount of risk to the spine.
Dr. Marcy Bolster: Renee, I have patients that I want to refer to you for physical therapy and the question arises as to whether or not the exercise program, in physical therapy, for osteoporosis would be covered by their insurance.
Renee Garrison: Yes. Physical therapy for osteoporosis would be covered because the types of things that we’re doing in physical therapy are therapeutic exercise, posture training, strengthening, all of these things. So, whatever your insurance would normally cover for physical therapy, it will cover for this osteoporosis program.
Dr. Marcy Bolster: And what should a patient expect in terms the number of visits to a physical therapist to learn about the exercises for osteoporosis?
Renee Garrison: Our program, right now, is a four-week program. The patient comes twice a week for those four-weeks, so it’s a total of eight visits. There is an evaluation as well. That’s at the beginning. There’s an evaluation, and then twice a week for four weeks, essentially nine visits with the evaluation.
We are individualized. If we find someone who needs more than that, we can certainly ask the physician, or referring physician, for more therapy. If someone is very deconditioned, or very weak, has very poor balance, they might need more intervention than that four weeks, and we’ll discuss that with the physician and ensure that the patient gets exactly what they need.
Dr. Marcy Bolster: It’s great to know that you coordinate your care with the physician who’s taking care of the patient. I’m sure that’s very reassuring for the patient.
Renee Garrison: Definitely.
Dr. Marcy Bolster: So, if a patient is interested in attending a program for exercise through physical therapy, how would that appointment occur?
Renee Garrison: They could ask their physician, whoever is treating their osteoporosis, whether it’s their general practitioner, a rheumatologist, or immunologist, if they could refer them to physical therapy so that they can learn the appropriate exercises to help them through their daily life.
Dr. Marcy Bolster: Well, its sounds like a very important component of the care of a patient’s bone health. It also sounds like the patient would need to have a referral from their physician to physical therapy.
Renee Garrison: Yes. We like for them to be referred from a physician to our program.
Dr. Marcy Bolster: It’s great to know that we have a close alliance with Physical Therapy at MUSC, at the Center for Osteoporosis and Bone Health. We have the capability of referring patients, once their seen in the Center for Osteoporosis and Bone Health, to be seen in Physical Therapy and undergo an exercise program to help protect them, as well as to strengthen them and give them more independence in their own exercise regimen. Renee, thank you so much for being here today. It was very educational. I appreciate all the information you provided.
Renee Garrison: You’re very welcome.
Thank you for listening to the information about the Center for Osteoporosis and Bone Health at the Medical University of South Carolina. In order to get an appointment, patients may self-refer or they may be referred by their physician. The scheduling number is (843) 876-2663 (876-BONE.) I hope this information is helpful to you.