hello, iâ€™m margaret martin. if youâ€™renot familiar with me or my website, i encourage you to go to blog.melioguide.com where youâ€™llget lots of information on osteoporosis and exercise.todayâ€™s talk is a summarized version of a talk that i gave recently in montreal onosteoporosis and bone health. and since it was so well received, i decided to share itwith a broader audience. so, welcome. a little more about me. my career journeystarted in st. johnâ€™s, newfoundland. although i am a mcgill graduate, i went over to st.johnâ€™s did rotations in icu, nicu, and neuro rehab. then across the country into youngadult long term care. life brought me to middle of canada in torontoin peds, ortho, pulmonary rehab, and then
onwards to five years in the area of health,fitness and safety in a large corporation. then went down and worked in california fornine years where i went back into a hospital setting in spinal cord rehab, burns, inpatient,outpatient ortho, neuro, and then finally brought the family back to canada in ottawa,which is where we are currently located and where my clinic, function to fitness, is locatedand the head office for melioguide.com. so one thing in reflecting on my career isthat i came to realize is that the one common denominator of all my clients is that theyhad a skeletal system. so often when i was addressing their stroke or was addressingthe range of motion in the burn client i wasnâ€™t always considering their skeletal system.and so thatâ€™s the purpose of todayâ€™s talk
is for you, regardless of the setting thatyou are working in, is to give a deeper consideration to your client's health and that deeper considerationis their bones. i'm not going to spend a lot of time lookingat bone physiology but the one thing i do want you to think about is our bones undergoa constant modeling and remodeling and if my big toe was a good representation of myskeleton at 50, my big toe would take ten years to totally regenerate.fortunately, it's only going to take about a year. it's about six months old since myinjury in this photo but the osteoblasts and osteoclasts are always working to make adaptationsto our skeleton based on the stresses of the skeleton.in our youth there's a whole vibrant time
of going modeling which then starts to entera more remodeling phase. in today's talk i'm really wanting the messageto get across of the different stages of life. in thinking of those different stages andkeep getting the idea that would stick in your mind. with my menopause i went back andthought what movie sticks in my mind. eat, pray, love sticks in my mind.let's look at bone health with that same concept. eat, move and greed. the nutrition that wetake into our body. what we do in terms of skeletal movement and challenges to our bones.then what is happening to our hormones and as physical therapists we are more in controlof asking somebody what their menstrual cycle is like. if their sexual urges are more natural.we are going to be looking more at the estrogen/testosterone.
there are many other hormones that impactbone health but primarily as physical therapists those are the ones that we should at the veryleast be paying attention to. in today's talk we look at bone health fromutero to university, from kids to careers and visit big chunks of time in our life thatthe next one is post menopause to post-op. we're going to look at these as stages ofbone health through my eyes because these are clients that i got to see. let me sharewith you some of their case histories. their photos are obviously not truly them exceptfor some of the clients but to protect their health.let's start with the first picture of bone health, from utero to university.two clients that i want to bring up, molly,
who was presented to me with upper back painand kim, who came to see me because of knee and hip pain, mostly in her sport which wasbasketball. both these young ladies were in their late teens when i first saw them. theirfindings on first observation was that molly was on a vegan diet.i'm not going to go into the positives and negatives of each because this will take anhour long talk but know that each one of the things that i'm bringing up is because thesethings have either a positive or negative impact on bone health.kim was on a low protein diet, no omega 3. both of these diets have challenges when itcomes to bone health. molly was working with a personal trainer which technically shouldhave been a positive thing except the type
of exercises that she was being given thatwere inappropriate. kim was doing daily basketball practice andshe had games on weekend which is great for your bones except that there was a disproportionateamount of energy output for her energy input. she was just having way too much breakingdown, not enough anti-inflammatories in her diet to support the level of intensity thatshe was training at. molly had irregular menstrual periods. kimwas on depro provera birth control which causes cessation of menstrual periods. if you havea female who is entering a female athlete triad type scenario you don't actually knowif their body weight is problematic for their cycle and whether or not their entering inamenorrhoea as well, as the drugs have other
issues.molly presented in a teen with a cephalic posture that was not able to be correctedso it's quite concerning and kim had good spinal alignment but with high level sportsmovements. she had poor hip and knee alignment. i had some serious concerns with molly. idid send her back to her doctors and ask for a spinal x-ray before seeing her again. sureenough the x-ray came back with fractures at t6, 7, and 8. she went on to have a bonemineral density which showed severe osteoporosis and yes, she was still in her teens. thenwent on within two weeks time to have vertebroplasties done at t6, 7, and 8. let's look at the bone health from utero touniversity for molly and for kim. molly's
mother wears religious coverings significantin meanings in regards to vitamin d. kim's mom is a physical therapist, outdoorsy, alittle more ability to absorb the vitamin d. molly was premature, whereas kim was afull term baby. very different in terms of the health of the bone even years later.molly had benign hypotonia whereas kim had normal growth and development. because ofthe hypotonia molly had very limited outdoor playing. no sports. she didn't actually startwalking until the age of two and had sustained an ankle fracture when she had started walking.kim was very active in very many sports. molly didn't start her period until she was14 whereas kim started at a younger age, at 11. given the number of years within a woman'slifespan that they've had their periods is
going to positively impact bone health.the last thing molly had a fracture at her elbow and at the patella from falling on ice.so simple which is still considered a puglian fracture when she was 15. kim because of theconcern, as i mentioned earlier, in regards to the female athlete triad and although shehad a lot of good bone health leading up to her late teens, she was starting to have somenegative changes and had a hairline fracture at 17.what was the intervention for both of these young ladies? molly, as i mentioned, did havevertebroplasty. following her vertebroplasty she did work with a nutritionist. the exerciseintervention was very much around not modifying her daily activities, isometrics and graduallywe introduced more weight bearing and strength
training.an important component for molly was the education to gain weight, to maintain her weight, tomaintain her normal periods so that she'd have not only the nutrition, the eat. notonly the move, the exercise but also the greed. the hormones working in her favor for optimizingher bone health. kim was really quick in terms of modifying.i was comfortable in looking at her protein requirements, her omega 3 requirements. sheupped those. she modified some of the exercises we were giving to her. we worked on hip andknee alignment and she's done great. she's made the provincial team and one other recommendationfor her bone health was to make a consideration about the birth control of choice that shemade so that it would not negatively affect
her bone health.here's a great example of two young women where as a standard physical therapist wewould see them, take care of their issues but not always regard the bone health. inorder to allow these two young ladies to enter the next phase of life with as much bone intheir bank as possible, i think we need to make clear definitions.we are musculo-skeletal specialists and we need to look at those skeletons. let's moveon into the next phase of life where eat, move and greed is very important from kidsto careers. a really busy time in a woman's life wherewhatever they choose to eat. they are really often making meals on the run and they'renot only making them for themselves but for
their family. the movement is very limitedto activities with kids or activities when you're running to or from work. then greedthe effect of pregnancy and lactation on hormones and then obviously the effect on bones.i'm going to introduce to you simone who is a client that i thought wow, she's a clientwho has really got it together. she's got a well balanced diet. she was exercising 60-90minutes a day. she had regular menstrual periods. birth control was taken care of by her husbandwho had had a vasectomy. but she came to see me with vertebral compression fractures, wheni first saw her. the vertebral compression fractures were asa result of tobogganing with her kids. wow, then you start looking back. what is it thatis missed in this ladies bone health? let's
go back in her bone remodeling.she had three fractures as a child. obviously, no one noticed that as a red flag so therewas no intervention done other than taking care of the fractures, healing and thingswent on. she was undiagnosed until her late 40's thatshe had had celiac. so many years really her life of not absorbing all of her nutrients.she had had three children which wasn't an issue except that she had them later on inlife and she had had them fairly close together. she had not only the years she was pregnantbut she also nursed each of them for two years. she had a long period of time and then shedidn't have a lot of time before going into menopause.these are things that affect bone modeling.
her activity it was great that she was activeso much but most of her activity was around swimming which we know it isn't as weightbearing as it could be and walking her dog or her dog walking her and that was a reallybrisk pace. we know we need a brisk pace in order to affectbone health, at least at the level of the hip. last thing, an important thing, as aprimary school teacher simone was always bending forward. a lot more weight bearing on theinterior vertebral body of the vertebrae and we know in the interior vertebral body thereare less trabeculae than in the posterior vertebral body so there's already possiblysome micro-fracturing occurring but was just stressed to a much higher level with the tobogganingan caused a vertebral fracture.
my intervention initially with simone waspain management, teaching her body mechanics both for safety and for pain management. thenwe went on to gait retraining and exercise hoping that she will have enough time to rebuildher bone back. she's going to have to have some intervention. possibly some hrt.things she'll have to discuss with her doctor but bringing her into the next phase of life,the post menopause to post operative period because now we know that just with strictlyloss of estrogen this is a significant time where people actually start thinking aboutlow bone health, low bone density, osteoporosis because of the decrease in estrogen.it's also a time in people's lives in their 50s, things start to break down and we haven'tbeen optimizing our healthy choices and so
medications get introduced and core morbiditieshappen. there are many medications that have a lotof influence on bones. the depro provera i mentioned. glucocorticosteroids, medicationfor anti-seizures, medication chemo therapy meds. there's a long list of medication thatcan have a negative impact on our bones. just to put any other assault to our bodythat affects movements, so strokes, parkinson's, copd, so many things that will affect theability to stress our bones that then obviously will then lead to lower bone density.food intake, most people get older, they're not preparing foods for their family anymore.they're just making small meals. they might not be ingesting as much protein, calcium,the nutrients, they're not out in the sun
as much so their vitamin d absorption as wellas their aging skin doesn't absorb as much vitamin d.the weight bearing and strength training if it has not been part of their life beforea lot of people don't start taking it on. but, it's such an important thing to do especiallyas we enter this last phase of life. lastly, in this stage, we most of us as physicaltherapists are thinking fall prevention, great but we need to be considering at a deeperlevel all the other things that we brought up.if you haven't met babs before, babs is somebody who i feature a lot on my website and in myblogs and she's a dynamic 97 year old. we've worked a lot through strength training, flexibility,balance.
with babs she was a unique case study wherei got to work with her twice a week. we worked on agility training. similar to what you dowith football players and the progression was just phenomenal. when we started to introducethis to local hospitals, and giving them services around ottowa and montreal. the therapiststhat have been using this on a daily basis have just found it really exciting and findingreally good results with their clients and fun to do for them as well.i encourage you to think about your bone health, whether your clients are in the stages inutero to university, kids to careers, or post menopause to post-op, learn a little bit more.come and take my free course; blog.mealio.guide.com. come to this page with hundreds of articlesthat you can search for in the search box.
click on the free course and encourage youas a musculo-skeletal specialist to take into consideration the skeleton of your patients.thank you very much for tuning into melioguide today. it was a pleasure sharing this withyou.