Vertebrae are bones which contribute to the makeup of the spine. The part at the front of each vertebra is called the vertebral body. This is usually made up of very strong bone. However with time, and certain conditions, this can weaken, and then potentially fracture, or get ‘squashed’; this is called a vertebral compression fracture. These are very common. This is often defined as the height of the vertebrae being decreased by 15-20%.
Compression fractures can occur in vertebrae anywhere in the spine, but they tend to occur most commonly in the mid back (thoracic spine), and the upper aspect of the lumbar spine (lower back).
Many compression fractures can occur without any symptoms at all and the person being totally unaware. However, some can cause back pain, ‘trapped nerve’ symptoms in the arms/legs, mobility difficulties, breathing difficulties, and postural changes (stooped posture/kyphosis).
The most common compression fractures are known as ‘wedge’ fractures, due to their appearance on medical imaging (X-ray, CT/MRI scan), with just the front part of the vertebrae typically affected causing a wedge shape. However, there can also be ‘crush’ fractures (If the entire bone breaks) and ‘burst’ fractures which can affect the front and back of the vertebrae.
‘End plate’ fractures are similar and involve damage to the layer of cartilage between the vertebra and the disc. They can cause pain, but generally recover very well and do not have the height loss of bone from typical compression fractures.
Osteoporosis is the most common cause and is a disorder of the bones leading to reduced strength/density, therefore becoming more likely to break. Approximately 3 million people in the UK are thought to have Osteoporosis, and there are over 230,000 fractures in the UK each year as a result.
If the fracture heals fully, the pain will usually go away; if not there may be continued pain. You may require a DEXA scan if Osteoporosis is expected, to understand the level of your bone density and to see if you require medication to help e.g. calcium supplements.
Your Physiotherapist will take a detailed history of your symptoms and perform a comprehensive physical examination so they can provide you with a diagnosis and ensure the most effective treatment can be initiated straight away. By understanding your symptoms and challenges they present, your Physio can put you at the centre of the decision making and help you create personalised goals for your treatment. If a compression fracture is suspected, your Physio will usually recommend a referral for imaging to help confirm the diagnosis.
Your Physiotherapist will educate you on your symptoms and offer advice on how you can mitigate the likelihood of spinal compression fractures. You may be given recommendations on how you can maintain a healthy diet with adequate calcium and vitamin D (vitamin D is also produced when the skin is exposed to sunlight). Smoking is a known contributor to osteoporosis and your Physio can signpost you to support services that can help you stop smoking. Taking regular exercise is vital for bone strength, function and overall health, particularly weight-bearing exercise such as walking and strength training.
It is important that you have recovery time so that healing can take place. Your Physio will offer recommendations on pain relief and may make contact with your GP or a Pharmacist to discuss this.
Your Physiotherapist can work with you to design a bespoke management and home exercise programme to help manage your symptoms, improve your strength & function, and, improve your bone density in a progressive way. Regular re-assessment of your strength and function will help gauge your progress and can allow your Physio to make adjustments to your exercise plan. We provide ongoing advice and support so that you feel confident in managing your symptoms and can maintain your exercises to mitigate the chances of deterioration of your bone health and strength.
In severe cases where the structural integrity of the spine is affected, surgery can be indicated. This is something that will be discussed should it be necessary.
NHS Osteoporosis – http://www.nhs.uk/Conditions/Osteoporosis/