Managing your bone health with Pilates

Jane Arlow • June 20, 2021

Did you know that your skeleton is alive?

You’ve probably seen those skeletons hanging up in a biology lab at school, or in a doctor’s surgery in the old days (blimey, who even remembers going to the doctor’s surgery these days?!).

When you see them hanging up like that it’s hard to imagine your skeleton as being made of dynamic, living tissue that’s constantly being broken down and remodelled.

And while you probably think of your bones as just something to hang your skin and muscles on, they’re so much more than that.

Did you know that:

• Your bones help to maintain mineral homeostasis in our bodies by releasing stored minerals, such as calcium, into our bloodstream?

• Your yellow bone marrow acts as an energy store?

• They have a rich supply of nerves, blood and lymphatic vessels?

• They’re constantly changing throughout our lives

Building your bones up and breaking them down

There are two main types of bone cells that aid regeneration of bone, called osteoclasts and osteoblasts.

Osteoclasts break down old bone; act as bone dissolving cells; and are responsible for bone resorption. They also act as a calcium reservoir if you have a mineral deficiency.

Osteoblasts on the other hand replace the bone.

Between our mid 20s and 30s our bone mass density (BMD) remains relatively stable with osteoblasts and osteoclasts both doing their jobs.

However, after the age of 35, there is a natural gradual loss of bone. This loss is more pronounced in women than men because falling levels of the hormone oestrogen cause the osteoclasts to work harder than the osteoblasts.

Osteoclasts also act as a calcium reservoir if you have a mineral deficiency, because calcium levels must be controlled to ensure proper blood clotting, nerve, and muscle function.

When blood calcium levels are low, osteoclasts break down bone and release calcium into the blood.

This action of breaking bone down makes bones less strong and more prone to breakages.

You may have heard of “osteopenia” and “osteoporosis”. These both refer to levels of bone density. The former means that you are more likely to fracture a bone than the average person, but less likely to fracture a bone than someone with osteoporosis.

What can we do to improve bone density?

In order to ensure that our bodies aren’t breaking down our bones for their calcium, we need to get enough calcium in our diets and enough vitamin D (which promotes the uptake of calcium) through either supplements or from sunlight.

This is particularly important for women to maintain our quality of life as we get older. If you’d like to know more about how to improve your hormonal health through diet, we had a workshop on this topic in Virtual Studio earlier this year. Keep an eye out for more workshops coming soon!

How does Pilates improve bone density?

We know that Pilates is great for building core strength, connecting breath with movement, posture and alignment as well as our mental health.

But did you know that Pilates is good for your bones too?

Ok, in fairness, it’s not just Pilates - more or less any form of weight-bearing exercise will be of benefit.

But the reason why Pilates is so great is that it encourages your bones to become stronger in response to the mechanical stress of the pull of skeletal muscle against gravity. This action leads to increased mineral deposition and production of collagen fibres. That is to say, the osteoblasts are kept active rather than the osteoclasts!

Without any stress on bones – for example being bedridden – you can lose up to 1% of bone mass every week.

The Royal Osteoporosis Society(ROS) recommends regular weight bearing or resistance exercise to mitigate your risk of osteoporosis and osteopenia, or to treat the existing condition. Movement has proven to be one of the most effective ways of slowing bone loss. Some studies even show it can aid in the regeneration of bone tissue.

Can you do Pilates if you already have osteoporosis or osteopenia?

A study on the effects of clinical Pilates exercises on bone mineral density, physical performance and quality of life of women with postmenopausal osteoporosis, concluded that: “Pilates is effective to increase BMD (bone mass density); QOL (quality of life) and walking distance and is also beneficial to relieve pain.

Physiotherapists can use Pilates Exercises for subjects with osteoporosis in clinics.”

If you are already suffering from osteopenia or osteoporosis and are considering trying Pilates to slow down and improve your condition, please speak to your Pilates teacher before starting a class.

Are there exercises I shouldn't do if I have osteoporosis or osteopenia?

There are some exercises that your teacher will modify for you to ensure that you have the best comfort and benefit from them. There are also some common movements in Pilates that you’ll want to avoid:

Curling up from the mat or rounding the spine e.g. the hundred, rolling like a ball, roll ups/ roll downs (“spinal flexion”)
Spinal flexion coupled with side bending and rotation.

With osteopenia and osteoporosis, the hips, spine, and wrists are the areas that need the most strengthening. Many Pilates exercises specifically target these areas.

It’s also good to focus on strengthening the back and shoulders, hips, and deep core muscles to take pressure off the spine.

What exercises should I do for osteoporosis and osteopenia?

While we’ll always pay special attention to proper alignment, it is especially important if you have osteopenia or osteoporosis.

It’s also important to incorporate standing exercises into the workout, as the bones need vertical force to rebuild.

Some excellent exercises for osteoporosis include:

• Side lying exercises, like the one pictured, to strengthen the hips;

• Exercises in all-fours kneeling, such as pointer, donkey kicks, fire hydrants and leg-pull front prep (with special attention to maintaining neutral spine);

• Abdominal exercises lying on the back such as toe taps, single leg stretch, and double leg stretch (always with the head down)

• Standing exercises such as Lat pull and other shoulder and back exercises with resistance.

If you already have osteopenia or osteoporosis, it’s essential that you let your teacher know and follow their guidance.

Exercise, especially Pilates, is very important when a diagnosis of osteoporosis or osteopenia is made.

Once signed off by your specialist, make a Pilates class a regular part of your rehabilitation protocol.

Thiw ill help you in maintaining your bone mass, improving strength and flexibility, and improving balance. This in turn reduces the risk of falls and therefore risk of fractures.

More resources for osteoporosis and osteopenia

The NHS has some videos sharing some great exercises that you can access here

The ROS produced this booklet about Pilates & osteoporosis.

If you've got questions, please email me, happy to help!

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