OP has now become a common bone disease in persons over 60 years old. Fracture is the most serious result of OP and becomes a cause of death. Vertebral fracture is one of the common sites. A study shows that spinal morphometric fracture is 10.7/1000 persons in women and 5.7/1000 persons in men over 50 years old in Europe[2]. More than 17 million dollars were predicted for OP in 2005 in America, and about 27% of total were cost in vertebral fracture events[8]. This increase loads of the society and families, and the amount increases continuously with increasing old persons. These conditions attract a lot of concentration from governments and health-related institutions.
Now a lot of treatments have been used for OP effectively, such as calcium, Vitamin D, calcitonin, bisphosphonates, bracing, surgeries, etc. They all have positive effects on the physiology, function, and quality of life[9-11].
However, the outcomes remain not favorable. High risk of fracture, and pain results in limitation of function, low motor capacity, and poor quality of life. Motor function loss remains a main complaint from patients and their families after discharged from hospitals. They cannot move freely, and they may fall, take part in some community activities and be limited at home.
The loss of motor function can be attributed to a lot of factors. Among all of them, impairment of spinal stability after fractures is a main factor. Vertebral compression fractures not only injury the integrity of bone structure, but also the surrounding soft tissues, altering the state of neuromuscular function, and seriously injury the stability of spine. Spinal stability is defined as the ability to maintain the patterns of displacement under physiologic loads and carry out the loads[12]. It is a crucial basis for function performance of body, including spinal and extremities movements, such as walking and lifting. A lot of function deficits can be attributed to poor spinal stability (may be also called core stability sometimes). Spinal stability is a basis of movement for spine and extremities[13]. After vertebral fracture, the patients cannot move the spine and extremities freely. Pain is aggravated even a small movement of spine or extremities.
According to the theory raised by Panjabi[14], the stabilization of spine mainly comes from three subsystems, which consist of spinal column (passive subsystem), spinal muscles (active subsystem) and neural control unit. Vertebrae compression fracture damages the spinal column and the surrounding soft tissue. The loss of spinal stability not only comes from the vertebral fractures, but also from the injuries of tendons, ligaments, muscles nerves and weakened neuromuscular function. It is very important to realize and understand the role of neuromuscular system in the spinal stability. Previous study showed that the spine could only carry out 90 N[15], much less than 1800 N in vivo[16], which indicated that the neuromuscular system had contributed a lot to that the spine stability and the amount of loads that the spine could carry out. So it is hypothesized that improving the neuromuscular function may be helpful for patients with vertebral compression fractures.
In the present study, the study group received conventional therapy and individualized stabilization training, and the control group received conventional therapy alone. We attempted to explore whether spinal stability training is helpful. Three parameters were evaluated, including NPGS, TUG and OFLI before and after 4 weeks of treatments.
NPGS is a good method to measure the intensity of subjective pain with a good reliability. It has been widely used in clinical measurement of pain. TUG is another instrument used to measure the ability of movement, balance and motor control of patients, and the result can also be used to predict the risk of fall. The slow TUG time indicates that the patients suffer from severe impaired mobility and high risk of fall[17-19]. OFLI is a form used to measure the amount of limited ability related to back pain[20]. The three parameters were used to analyze whether the spinal stabilization training could be helpful for the patients with osteoporotic vertebral fracture.
Results from the present study showed that the TUG time of the study group was significantly shorter and OLFI was lesser than the control group (P < 0.05), indicating that improving the stability of spine increases the mobility and the capacity of spine carrying out the loads.
Moreover, there was no difference in the changes of NPGS between the two groups (P > 0.05), which was incompatible with the improvement of function. But the level of NPGS might be measured based on difference levels of movement because the study group had less limitation in motor function. If the patients do the same level of activities, the study group may experience less pain than the control group. However, of course, the truth also may be that stabilization training does not benefit in reducing pain on the basis of conventional treatment.
On the other hand, even though three patients complained pain increasing during treatments, these events were treated successfully through some altering of training, indicating the spinal training protocol was safe only if individualized and careful plan.
The results were consistent with previous studies. It is understood that patients with vertebral osteoporotic fractures should receive exercises as early as possible, because rest in bed or modification of movement results in faster loss in bone mineral density[21], atrophy of the muscles and loss of motor functions. It is believed that blood supply and tissue requirement greatly influence the speed of healing. So it is accepted that early exercises could restore the motor capacity and accelerate the healing of the injured muscles, ligaments and fracture bones.
Stabilization training is effective for improving the function, preventing injuries during movement[22], and reducing the chronic low back pain[23]. The above results show that spinal stabilization training could ameliorate the model of muscle working and improve the function, and can be helpful for the patients with vertebral osteoporotic fractures.
Spinal stability is a basis for motor function, which may attribute to the loss of function after vertebral osteoporotic fractures. Results from the present study indicated that spinal stabilization training had a favorable effect on retaining and improving motor function and reducing the level of pain of patients with vertebral osteoporotic fractures. The individualized and well planned program achieved better effects.
However, the trail was limited by the study methods and the size of samples. Therefore, further studies are required.
