Erbil Polytechnic University

Erbil Health and medical Technical College

Physiotherapy Department
Subject: Medical Surgical Physiotherapy
3rd Stag

2021-2022
Supervised By:
Dr.Samih Kakamam Hasan
Prepared By:
Shakar Mudrik Omer
Content page\ NO
Introduction to Vertebral compression fractures (VCFs) 3
Causes and symptom 4
Different Signs of Spinal Compression Fractures 5
Signs of Multiple Spinal Compression Fractures 5
Testing & Diagnosis 6
What are possible complications of a compression fracture? 7
Pathophysiology and Risk Factors 7
Nonsurgical Treatment for Spinal Compression Fractures 8
Surgical Treatment for Spinal Compression Fractures 9
Physical Therapy Guide to Spinal Compression Fractures 10-11
Can This Injury or Condition Be Prevented? 12
What Kind of Physical Therapist Do I Need? 12
Physical Therapy Exercises for Compression Fracture 13
Strength and Trunk Control Lumbar Compression Fracture Exercises 13
Osteoporosis Sleeping Position with Compression Fracture 14
How to Get Out of Bed With a Compression Fracture 15
Conclusion: How to Treat a Compression Fracture 15
Reference 16

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Introduction:
Vertebral compression fractures (VCFs)
of the spinal column occur secondary to an axial/compressive (and to a lesser extent, flexion) load with
resultant biomechanical failure of the bone resulting in a fracture. VCFs by definition compromise the
anterior column of the spine, thereby resulting in compromise to the anterior half of the vertebral body
(VB) and the anterior longitudinal ligament (ALL). This leads to the characteristic wedge-shaped
deformity. VCFs do not involve the posterior half of the VB and do not involve the posterior osseous
components or the posterior ligamentous complex (PLC). The former distinguishes a compression
fracture from a burst fracture. The implications of these compression fractures are related to the stability
of the resulting structure and potential for deformity progression. Compression fractures are usually
considered stable and do not require surgical instrumentation. The most common etiology of VCFs is
osteoporosis, making these fractures the most common fragility fracture. However, compression
fractures demonstrate a bimodal distribution with younger patients sustaining these injuries secondary to
high energy mechanisms (fall from a height, MVA, etc.). Due to the ligamentous and anatomical changes
noted as one travel from the thoracic to the lumbar level, inherent areas of instability make this a frequent
site of injury. For the spinal column, traditional teaching is that the column can be divided into three
sections: anterior column (anterior longitudinal ligament, anterior annulus, the anterior portion of the
vertebral body, middle column (posterior vertebral body, posterior annulus, and posterior longitudinal
ligament), and the posterior column (ligamentum flavum, neural arch, facets, posterior ligamentous
complex). If two of these three columns are compromised, the injury is considered unstable, and the
patient potentially needs surgery. Compression fractures by definition only involve compromise to the
anterior column alone. Thus, VCFs are considered "stable" fracture patterns. When the fracture pattern
involves the middle column they are classified as burst fractures and lack the stability of a VCF.

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Causes:
In people with severe osteoporosis (weak, brittle bones), a VCF may be caused by simple daily activities,
such as stepping out of the shower, sneezing forcefully or lifting a light object. In people with moderate
osteoporosis, it usually takes increased force or trauma, such as falling down or attempting to lift a heavy
object to cause a VCF. VCFs are the most common fracture in patients with osteoporosis, affecting about
750,000 people annually. VCFs affect an estimated 25% of all postmenopausal women in the U.S. The
occurrence of this condition steadily increases as people age, with an estimated 40% of women age 80
and older affected. Although far more common in women, VCFs are also a major health concern for
older men. People who have had one osteoporotic VCF are at five times the risk of sustaining a second
VCF. Occasionally, a VCF can be present with either minor symptoms or no symptoms, but the risk still
exists for additional VCFs to occur. People with healthy spines most commonly suffer a VCF through
severe trauma, such as a car accident, sports injury or a hard fall Metastatic tumors should be considered
as the cause in patients younger than 55 with no history of trauma or only minimal trauma. The bones of
the spine are a common place for many types of cancers to spread. The cancer may cause destruction of
part of the vertebra, weakening the bone until it collapses.

Symptoms

Along with back pain, spinal compression fractures also can cause:

• Pain that gets worse when you stand or walk but with some relief when you lie down

• Trouble bending or twisting your body

• Loss of height

• A curved, stooped shape to your spine

The pain typically happens with a slight back strain during an everyday activity like:

• Lifting a bag of groceries

• Bending to the floor to pick something up

• Slipping on a rug or making a misstep

• Lifting a suitcase out of the trunk of a car

• Lifting the corner of a mattress when changing bed linens

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Different Signs of Spinal Compression Fractures

For many people, a spinal compression fracture will hurt less as the bone heals. That can take up to 2 or
3 months. Other people will still have pain after the fracture has healed.

Some people feel almost no symptoms from spinal compression fractures. The cracks may happen so
gradually that the pain is relatively mild or unnoticeable. For others, the pain may turn into a chronic
backache in the injured area.

Signs of Multiple Spinal Compression Fractures

When you have multiple spinal compression fractures, your spine will change a lot. Part of your
vertebrae may collapse because the cracks mean it can’t support the weight of your spine. That can
affect how your body works. Symptoms include:

• Height loss. With each fracture of a spinal bone, the spine gets a little bit shorter. Eventually,
after several vertebrae have collapsed, you will look noticeably shorter.
• Kyphosis (curved back): When vertebrae collapse, they form a wedge shape, which makes the
spine bend forward. Eventually, you’ll have neck and back pain as your body tries to adapt.
• Stomach problems: A shorter spine can compress your stomach, causing digestive problems
like constipation, a weak appetite,
and weight loss.
• Hip pain: The shorter spine brings your
rib cage closer to your hipbones. If
those bones are rubbing against each
other, it can hurt.
• Breathing problems: If the spine is
severely compressed, your lungs may
not work properly and you can
have trouble breathing.

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Testing & Diagnosis:

While a diagnosis can usually be made through history and a physical examination, plain x-rays,
computed tomography (CT) or magnetic resonance imaging (MRI) can help in confirming diagnosis,
predicting prognosis and determining the best treatment option for the patient.

• X-ray: An x-ray produces a picture of a part of the body and can show the structure of the
vertebrae and the outline of the joints. It will also show bone alignment, disc degeneration and
bony spurs which may irritate nerve roots.

• CT or CAT scan: A diagnostic image created after a computer reads x-rays; can show the shape
and size of the spinal canal, its contents and the structures around it. This test may be performed
in conjunction with a myelogram of the spine to provide additional information. A myelogram
involves a spinal tap where dye is administered near the spinal cord. This diagnostic study is ideal
for showing bone detail including narrowing.

• MRI: A diagnostic test that produces 3-D images

of body structures using powerful magnets and
computer technology; can show the spinal cord,
nerve roots and surrounding areas, as well as
enlargement, degeneration and tumors.

• Dual-energy x-ray absorptiometry (DXA or

DEXA) or bone densitometry: This test is the
established standard for measuring bone mineral
density and can determine if osteoporosis exists.
The scanner painlessly and rapidly directs x-ray energy from two different sources towards the
bone being examined in an alternating fashion at a set frequency. A DEXA scan can detect small
changes in bone mass and is also more flexible since it can be used to examine both the spine and
the extremities. A scan of the spine, hip or the entire body requires less than four minutes.

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What are possible complications of a compression fracture?
Complications of compression fractures include:
• Fractured bones that do not heal after treatment, which can lead to damage of the nearby
vertebrae
• Blood clots in the legs due to decreased mobility
• Kyphosis (a deformity also called dowager’s hump or humpback) that can lead to severe pain
and problems with organs in the chest (such as the heart, lungs, and digestive organs)
• Spinal cord or nerve problems
• Chronic (long-lasting) pain

Pathophysiology and Risk Factors:

Vertebral compression fractures are recognized as the hallmark of osteoporosis, and many of the risk
factors are the same. Risk factors are categorized as those not modifiable and those that are potentially
modifiable. Nonmodifiable risk factors include advanced age, female gender, Caucasian race, presence
of dementia, susceptibility to falling, history of fractures in adulthood, and history of fractures in a first-
degree relative. Potentially modifiable risk factors include being in an abusive situation, alcohol and/or
tobacco use, presence of osteoporosis and/or estrogen deficiency, early menopause or bilateral
ovariectomy, premenopausal amenorrhea for more than one year, frailty, impaired eyesight, insufficient
physical activity, low body weight, and dietary calcium and/or vitamin D deficiency. Fracture rates are
lower in most nonwhite populations, but vertebral compression fractures are as common in Asian women
as in white women. Ironically, obesity is protective to fractures as it is to bone loss in general.Acute
fractures occur when the weight of the upper body exceeds the ability of the bone within the vertebral
body to support the load. Generally, some trauma occurs with each compression fracture. In cases of
severe osteoporosis, however, the cause of trauma may be simple, such as stepping out of a bathtub,
vigorous sneezing, or lifting a trivial object, or the trauma may result from the load caused by muscle
contraction. Up to 30 percent of compression fractures occur while the patient is in bed. In cases of
moderate osteoporosis, more force or trauma is required to create a fracture, such as falling off a chair,
tripping, or attempting to lift a heavy object. Of course, a healthy spine can sustain a compression fracture
from severe trauma such as an automobile crash or a hard fall.

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Nonsurgical Treatment for Spinal Compression Fractures:
Pain from a spinal compression fracture allowed to heal naturally can last as long as three months. But
the pain usually improves significantly in a matter of days or weeks.

Pain management may include analgesic pain medicines, bed rest, back bracing, and physical activity.

Pain medications. A carefully prescribed "cocktail" of pain medications can relieve bone-on-bone,
muscle, and nerve pain, explains F. Todd Wetzel, MD, professor of orthopaedics and neurosurgery at
Temple University School of Medicine in Philadelphia. "If it's prescribed correctly, you can reduce
doses of the individual drugs in the cocktail."

Over-the-counter pain medications are often sufficient in relieving pain. Two types of non-prescription
medications -- acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) -- are
recommended. Narcotic pain medications and muscle relaxants are often prescribed for short periods of
time, since there is risk of addiction. Antidepressants can also help relieve nerve-related pain.

Activity modification. Bed rest may help with acute pain, but it can also lead to further bone loss and
worsening osteoporosis, which raises your risk for future compression fractures. Doctors may
recommend a short period of bed rest for no more than a few days. However, prolonged inactivity
should be avoided.

Back bracing. A back brace provides external support to limit the motion of fractured vertebrae -- much
like applying a cast on a broken wrist. The rigid style of a back brace limits spine-related motion
significantly, which may help reduce pain. Newer elastic braces and corsets are more comfortable to
wear but don't work, says Wetzel. "There's an old saying, 'The inconvenience of the brace is directly
proportional to its effectiveness,'" he tells WebMD. However, braces should be used cautiously and only
under a doctor's supervision. Weakening and loss of muscle can occur with excessive use of braces for
lumbar conditions.

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Surgical Treatment for Spinal Compression Fractures:

When chronic pain from a spinal compression fracture persists despite rest, activity modification, back
bracing, and pain medication, surgery is the next step. Surgical procedures used to treat spinal fractures
are:

• Vertebroplasty

• Kyphoplasty

• Spinal fusion surgery

Vertebroplasty and Kyphoplasty These procedures for spinal compression fractures involve small,
minimally invasive incisions, so they require very little healing time. They also use acrylic bone
cement that hardens quickly, stabilizing the spinal bone fragments and therefore stabilizing the spine
immediately. Most patients go home the same day or after one night's hospital stay.

Vertebroplasty. This procedure is effective for relieving pain from spinal compression fractures and
helping to stabilize the fracture. During this procedure:

• A needle is inserted into the damaged vertebrae.

• X-rays help ensure that it's done with accuracy.

• The doctor injects a bone cement mixture into the fractured vertebrae.

• The cement mixture hardens in about 10 minutes.

• The patient typically goes home the same day or after a one-night hospital stay.

Kyphoplasty: This procedure helps correct the bone deformity and relieves the pain associated with
spinal compression fractures. During the procedure:

• A tube is inserted through a half inch cut in the back into the damaged vertebrae. X-rays help
ensure the accuracy of the procedure.

• A thin catheter tube -- with a balloon at the tip -- is guided into the vertebra.

• The balloon is inflated to create a cavity in which liquid bone cement is injected.

• The balloon is then deflated and removed, and bone cement is injected into the cavity.

• The cement mixture hardens in about 10 minutes

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Physical Therapy Guide to Spinal Compression Fractures:
Your physical therapist will perform a complete evaluation. They will gather information about your past
medical history, medications you may be taking, and your current symptoms. Your regular daily activities
and exercise regimen will be discussed. Your physical therapist will use this information to design a
treatment plan specific to your personal needs and goals.

When you experience a spinal compression fracture, it is very important to start physical therapy
immediately. If you are in too much pain to travel to an outpatient clinic, you can receive home care or
start physical therapy in the hospital. Your physical therapist will immediately teach you safety measures
to protect your spine. This information can help prevent more fractures of nearby bones. If needed, they
will also fit you for a brace for additional support.

Your physical therapist also will perform a physical examination of your spine. They may touch places
along your spine to locate any areas of pain or tenderness, and check your spinal movements. They will
test the strength in your spine, legs, and shoulders, and check your balance.

A compression fracture rarely requires surgery. In more severe cases, a surgeon may perform a
procedure (vertebroplasty or kyphoplasty) injecting medical cement into the collapsed vertebra to give
it support.

It may take weeks or months for a spinal compression fracture to heal. During the healing process, your
doctor may recommend that you:

• Wear a back brace.

• Take bone-healing medications.
• Reduce your overall activity level for a short time.
• Avoid intense activities, depending on the severity of the fracture

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While you heal and your activity is limited, muscles in the core, hips, and back can become weak. This
weakness can make it difficult to resume your regular activities. It may also increase your risk for falls.
It is important to help the muscles of the trunk and legs stay strong as you heal. Your physical therapist
can help.
Your physical therapy treatment may include:

Pain reduction. Your physical therapist may use different treatments, technologies, and manual
(hands-on) therapy to control and reduce your pain. These treatments can help you avoid the need for
pain medications, including opioids.

Movement guidance. Your physical therapist will teach you what movements and exercises to
gently perform, and not to perform. Avoiding certain movements will promote healing and help prevent
future fractures or collapse of the vertebrae.

Flexibility exercises. Your physical therapist may teach you gentle spinal range-of-motion
exercises for the neck, middle, and low back, and the hip and shoulder areas.

Strengthening exercises. Your physical therapist will prescribe gentle exercises to help stimulate
your bone strength and straighten the curve of your middle back. These may include upper- and lower-
body, stomach, and back muscle-strengthening activities.

Posture and spine sparing. Your physical therapist will teach you how to maintain safe posture
and spinal positions. This will protect the vertebrae from undue stress when you sit, stand, walk – and
even while you sleep. You also will learn proper ways to perform tasks at home, such as bending and
lifting.

Fall prevention. Your physical therapist will teach you exercises to improve your balance and steady
your walking to prevent falls. You may be instructed in the use of a walker or cane for temporary support
as you recover. You may learn how to do gentle exercises on a variety of surfaces. You also will learn
ways to make changes to your home to make it safer and reduce the risk of a fall.

Home-exercise program. Your physical therapist will design a personalized home-exercise

program just for you. Continuing the program at home after you have completed your formal physical
therapy sessions will help you stay strong and avoid further injury.

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Can This Injury or Condition Be Prevented?
There are several ways to prevent spinal compression fractures. Physical therapists recommend that
you:
• Maintain proper posture and body mechanics when performing activities of daily living.
• Avoid forward bending and deep or rapid twisting of the spine in daily activities and exercises.
Your physical therapist will teach you the right movements and exercises to perform to help
keep you safe.
• Reduce your risk of falls. Your physical therapist may recommend home modifications and
balance exercises.
• Exercise regularly. Include weight-bearing activities, such as walking and using light weights.
• Stop smoking. It slows down the healing process.
• Keep alcohol consumption moderate, as it impairs balance.
• Eat a well-balanced diet to promote bone health.
• Take calcium and vitamin D supplements as recommended by your doctor or dietitian.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat a variety of spinal
conditions and injuries. However, you may want to consider:

• A physical therapist who is a board-certified clinical specialist or who completed a

residency or fellowship in orthopedic or geriatric physical therapy. This physical therapist
has advanced knowledge, experience, and skills that may apply to your condition.
• A physical therapist who is experienced in treating people with spinal conditions and
trauma. Some physical therapists have a practice with an orthopedic or geriatric focus.
You can find physical therapists who have these and other credentials by using Find a PT, the
online tool built by the American Physical Therapy Association to help you search for physical
therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family, friends, or other health care providers.

• When you contact a physical therapy clinic for an appointment, ask about the physical
therapists' experience in helping people who have spinal conditions and injuries.
• During your first visit with the physical therapist, you will be asked to describe your
symptoms in as much detail as possible, and say what makes your symptoms worse. Here
are some tips to prepare for your visit.

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Physical Therapy Exercises for Compression Fracture:

recommend a compression fracture exercise program that includes a combination of postural,

flexibility, strength and trunk control exercises. The specific exercise mix is dependent on the
individual needs of my clients and I choose what is appropriate after an assessment.

Daily Postural and Flexibility Lumbar Compression Fracture Exercises

Each of these compression fracture exercises can be found in Exercise for Better Bones. I decide the
appropriate mix of postural and flexibility exercises based on my assessment of the individual.

• Chest stretch
• Chin tuck
• Arm lengthening or reach back
• Arm pull back
• Shoulder Stabilization

Strength and Trunk Control Lumbar Compression Fracture Exercises:

• Abdominal activation
• Wall push-ups
• Bridging
• Prone leg lift
• Squats
• Step ups
• Bicep curls
• Horse Stance
• Floor M
• Reverse Fly

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Osteoporosis Sleeping Position with Compression Fracture

Here is my recommended osteoporosis sleeping position for people with compression

fractures. This is likely the best sleeping position for osteoporosis of the spine:

• If you wear pyjamas to bed, choose silky material to help reduce friction and make moving
in your bed easier.
• ‘Log roll’ when turning in bed. Keep your knees bent, roll your shoulders and knees
simultaneously.
• Use extra pillows to ensure a supportive sleeping position.
• Use a heating pad to help your muscles relax.
• Consider wearing a waist belt to support the space between your lower ribs and pelvis.
• Use a pillow under your knees/legs when sleeping on your back.
• Keep your head pillow as low as you comfortably can when on your back.
• Use a pillow between your knees and ankles when sleeping on your side.
• If you are a side sleeper, make your head pillow wide enough that it supports your head in
a neutral position (i.e. that your chin is in at the level of the middle of your breastbone).
• Consider sleeping in your own bed so that you do not have the worry of your partner’s
movements jarring your back.
• Avoid sleeping in a recliner. Get as flat as you comfortably can so as to take weight off
your compressed vertebra.
• Avoid a water bed.
• Avoid a memory foam mattress if you keep your room cooler than 65 degrees Fahrenheit at
night (because they get too stiff).
• Medium-firm mattress is often recommended but you have to find the one that is right for
you. Make sure you spend at least 10 minutes lying on one at the shop. Wear the same
thickness of clothes you would at night.

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 How to Get Out of Bed With a Compression Fracture:

Here are my recommendations for patients with compression fractures who want to know
how to get out of bed with a compression fracture:

• Use your pelvic floor and deep abdominal muscles to brace your back when getting in and
out of bed.
• To get out of bed, ‘log roll’ onto your shoulder and then push yourself up with your hands
until you are in a sitting position.
• To get in bed, get in a sitting position. Carefully tilt down, lower yourself with your hands
and roll onto your shoulder until you are lying flat on your side.

Conclusion: How to Treat a Compression Fracture

We have covered a wide range of issues related to compression fractures. We learned why your spine is
at risk of a compression fracture and about physical therapy compression fracture treatment. Brenda’s
story shows that every person’s experience with compression fracture is going to be different.

We identified six symptoms that you might have a compression fracture. I have quite a few clients that
have compression fractures and do not even know they ever had them. I’ll ask them to get x-rays because
I’m trying to convince them to move safer. Some clients might have had a bit of back pain that goes away
after six to eight weeks. They’re the lucky ones. Their compressions fracture may not always stay like
that.

Brenda’s experience shows that you should find a health practitioner that you trust and has knowledge
in treatment of osteoporosis and compression fractures.

There are many things that you can do to make your life with a compression fracture. We covered these
in this blog post.

Safe compression fracture exercises and safe movement are critical to reducing your risk of another
compression fracture.

I hope that this blog does help make the life of listeners a little bit easier out there, and if anybody wants
to add their comments at the end the blog, feel free to do so.

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Reference:
1. https://www.ncbi.nlm.nih.gov/books/NBK448171/
2. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Vertebral-
Compression-Fractures
3. https://www.webmd.com/osteoporosis/guide/spinal-compression-fractures-symptoms
4. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=134&contentid
=12
5. https://www.aafp.org/afp/2004/0101/p111.html
6. https://www.webmd.com/pain-management/guide/spinal-compression-fractures-treatments
7. https://www.choosept.com/guide/physical-therapy-guide-spinal-compression-fractures
8. https://melioguide.com/osteoporosis-treatment/treat-compression-fracture/

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