Ask the Experts - Injury

Answers from Sean Fyfe:

Q. I read your article  "What all physiotherapists should know , but don't" in Peak Performance with great interest. I am a 71 year old triathlete, in the British Team for my age group.  I am fit and train for around 2 hours per day. For some time now I have experienced varying degrees of back pain. Recently I had a scan and discovered that I have osteoporosis in my lumbar spine, together with slight lateral curvature.  I am now taking calcium and vitamin D, plus Risedronate sodium. Your example of a rehabilitation program for a tennis player with a lumbar stress fracture struck me as being an ideal program for me to adopt to stimulate a strengthening of my lumbar spine. I would be interested to hear your comments.  I am very familiar with
free weights.

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Firstly we should clarify the nature of osteoporosis – a loss of bone mass and a disturbance of boney architecture.  Osteoporosis in itself is not necessarily responsible for pain.  If the osteoporosis leads to a fracture which is common, then that will be a direct source of pain.  I suspect that the osteoporosis is part of a more complex lumbar spine problem which would most likely include a loss in stability and flexibility and that is the source of pain.

So keeping that in mind, I believe the program outlined in my article would be of benefit in two ways.  Firstly to help correct any stability deficits, as the program is designed to train stability of the entire lumbopelvic region.  Secondly, resistance training has been shown to have a positive effect on bone mineral density.  There is also evidence to suggest that this effect can be local.  In your case, I would definitely advise resistance training to the lumbar spine. 

There are two more points I think are important.  Firstly, you should see a Sports Physiotherapist to be assessed.  This is particularly important with regard to your flexibility, as good flexibility is required for some of the exercises ie squats and deadlifts and for lumbar spine to function optimally.  Secondly, you should ensure that you have a specialist assess your technique on the more difficult exercises.  Even though you are very familiar with free weights, a specialist may still be able to offer some advice as it is very difficult to assess your own technique.