Compression Fractures and Kyphoplasty
Running is one of the simplest and most effective exercises you can perform. It’s effective because it engages the entire body at once, strengthening muscles as well as promoting cardiovascular health. It’s simple because it requires no additional materials: just a pair of running shoes and a road. With these factors in mind, it’s no wonder so many people choose to run regularly for fun, health, and sport. The enduring popularity of this timeless exercise is a testament to its effectiveness.
However, with any full body exercise such as running, injuries can occur. These injuries can happen for numerous reasons: improper form, rough terrain, insufficient muscle strength, preexisting conditions, genetic factors, or just bad luck. Similarly, any body part involved in running is at danger of being injured. The most common body parts injured when running are the ones located on the lower half: the legs, ankles, thighs and feet. However, one area particularly prone to injury when running that is often overlooked is located a bit higher up, just above the pelvis. Consider your lower back when running, as it is at risk of injury from running in the form of a compression fracture.
What Are Compression Fractures?
A compression fracture is a term for a specific kind of bone fracture that occurs in your spine. The lumbar region of your body, located on the lower back, is susceptible to injury due to many reasons. In the case of a compression fracture, excessive force applied to the lumbar region causes compression, resulting in a fracture. They commonly occur among the elderly, but any runner is potentially at risk. Compression fractures can be devastating, causing painful nerve damage, severely limited mobility, and potential paralysis. For these reasons, it is vital to understand the nature of compression fractures, how they occur, and how to treat and prevent them.
Some of the common symptoms that come with a compression fracture are common among a variety of back injuries, such as soreness to the touch, a dull ache, and limited flexibility. If you are experiencing these symptoms, you will need to rule out some of the false positives listed below to ensure what you are experiencing is actually a compression fracture. Some more specific symptoms you can look for are pain during seemingly unrelated activities, such as coughing or sneezing. Additional symptoms associated only with a compression fracture are pain in unrelated areas, such as the arms and legs. If you feel pain, numbness, or paralysis in your limbs, the fracture has affected the functionality of your nerves.
Symptoms of Compression Fractures:
- Difficulty walking
- Difficulty bending back
- Difficulty bearing weight
- Pain when sneezing, coughing
- Pain or numbness in extremities
- Trauma: The primary cause for a compression fracture is trauma. For a runner experiencing compression fracture, this can be caused by a fall that caused severe impact to your lower back. Additionally, trauma can come about over time due to poor posture, such as kyphosis.
- Osteoporosis: Runners suffering from osteoporosis in particular are highly susceptible to compression fracture. The loss of bone strength that comes about from this disease will increase the likelihood of a fracture, even without any drastic change in running activity or tension placed on the back.
- Metastasis: For runners who have struggled with cancer, metastasis can also cause the weakening of spinal bones that can bring about the fracture. In a situation where structural integrity of the spine has been compromised due to a metastatic disease, compression fractures are likely.
A common risk factor for compression fracture is a lack of bone strength. If you have a diet that is insufficient in vitamin C, this can be the culprit. Muscle strength can also be a risk factor, especially if your back muscles are weak due to lack of exercise or improper posture. The elderly are at a higher risk of developing compression fractures due to degradation of muscle and bone strength over time. Additionally, elderly women are more susceptible than elderly men, due to deficiencies brought about from menopause.
Individuals at Risk for Compression Fractures:
- Infrequent or inexperienced runners
- Individuals with poor posture
- Individuals with poor diet
- The elderly
- Post-menopausal women
- Osteoporosis sufferers
- Cancer survivors
Some injuries are similar to compression fracture, but have different causes and require different methods of treatment. It is important to rule these injuries out when determining if what you are experiencing is a compression fracture. If you fail to do so, you can waste a great deal of time and money treating your injury inaccurately. That’s the best case scenario: the worst case scenario is that you end up making your injury worse, causing complications.
- Herniated Disc: Back pain that causes leg pain can also be caused by a herniated disc. In this condition, no fracture is made, but a portion of your spine can dislodge from the rest of your spinal column. A major difference between a herniated disc and a compression fracture is the pain felt in your lower extremities extending past your legs and into your foot, as well as potential loss of bladder control in some rare cases. The use of imaging technology such as an MRI can effectively rule out a herniated disc as the cause of your back pain.
- Degenerative Disc Disease: If back pain is chronic and wasn’t caused by an injury or trauma, you may be dealing with degenerative disc disease. In this case, pain was caused by a gradual degradation of your spine’s structural integrity, rather than one traumatic event. Both injuries are commonly experienced in the elderly, but the primary differentiator between the two is whether the pain was sudden or gradual and chronic.
- Arthritis: Often confused with compression fractures, arthritis is a completely different condition with somewhat similar symptoms. In cases where pain is felt in the lower back and extremities, the possibility is there for compression fracture, but arthritis affects more areas of the body, such as the hands and feet. Additionally, the majority of the pain can be felt in the joints, rather than the lower spine.
It is vital to properly treat a compression fracture when it develops. If you fail to do so, your injury can worsen into one of many different possible complications. To avoid any of these more dire conditions, be sure to properly treat your compression fracture by consulting a medical professional and using the treatment methods listed further down this article. However, some cases of compression fracture may be so extreme that they bring on these complications, so be sure to ascertain if you have them in your standard diagnostic process.
- Thoracic Kyphosis: The full medical name for this condition is hyperkyphosis, as the human spine normally has a curve to it, known as kyphosis. However, in the case of thoracic kyphosis, the curve is more severe, resulting in a stooped posture. This condition is common in the elderly who fail to properly treat compression fractures.
- Lumbar Lordosis: Another posture affecting condition of the spine, lumbar lordosis is when the lower back has an unusually extreme curvature. It can be seen in a posture where the lower half of the body is at an odd angle: visually distinct from thoracic kyphosis. Lumbar lordosis is common not just among the elderly, but among any sufferer of a spinal compression fracture that doesn’t properly treat their injury.
- Deep Vein Thrombosis: This is a condition where blood clots form in the body’s deep veins; usually in the legs. It can be identified with excessive pain or swelling in the leg, but in some cases there are no visible symptoms. Deep vein thrombosis is a potentially life-threatening condition, and it can come about as a result of compression fracture.
- Paralysis: Fortunately, this is a very rare condition to come about as a result of compression fracture, but the possibility is still there. In cases where the fracture is so severe that it affects the spinal cord, it is possible to lose feeling or movement ability in your extremities.
How Do You Treat Compression Fractures?
Before beginning treatment methods for a compression fracture, it is best to ensure without any doubt that what you are experiencing is in fact that injury. The best way to do that is to consult a medical professional in order to receive a thorough diagnostic.
There are a few methods a doctor will try when diagnosing your condition. First, the doctor will ask you personal questions about your medical history and daily habits. This is to construct a profile of your overall health, so they can determine what may have caused your injury and if it has something to do with a spinal compression fracture. The next stage is when the doctor conducts a more thorough examination of your body. They may lightly touch different areas of your body to determine where pain and numbness are located, and they will also analyze the shape of your back to determine if any complications have developed. From there, additional examination will usually involve some sort of imaging equipment.
Imaging Methods for Diagnosing Spinal Compression Injuries:
- X-Ray: This is a common procedure, and usually the first course of action when diagnosing back pain. It is fairly rudimentary as far as imaging technology goes, since it can only see bones, but it can be used to see whether a fracture has occurred.
- MRI: Short for Magnetic Resonance Imaging, this machine takes a full view of the soft tissue in your body, but not your bones. In the event that the fracture has caused damage to your tissue, or if the pain is caused entirely by tissue damage, this machine will determine that.
- CAT Scan: This is an imaging process that works a bit like a combination of MRI and X-Ray scanning. It can take cross-section images from multiple angles, as well as capture accurate images of soft tissue alongside bone. It is more effective at performing scans than both, and is usually reserved for cases where it is necessary to properly diagnose an injury similar to spinal compression.
- BMD Test: BMD tests, also known as bone material density tests, are used for patients at risk of osteoporosis, one of the major risk factors for spinal compression. This test uses a type of X-ray called a DEXA scan to study the calcium content in your bones.
- Nuclear Bone Scan: Commonly used on cancer patients, nuclear bone scans are often utilized when diagnosing back pain in the case of a fracture. After injecting a radioactive solution into the affected area, highly detailed images develop that can provide intimate detail into the nature of a fracture, as well as determine when the fracture may have occurred.
After a diagnosis has been made and your doctor is certain that you are experiencing a spinal compression related injury, treatment can begin.
This is a method to reduce pain and swelling in any injury, although it won’t do quite as much for a back injury as for other running conditions. However, this is an effective first step for treatment, especially if your doctor recommends extended rest. Alternating various methods of heat therapy and cold therapy is the most effective, switching between the two every 20 minutes. Varying degrees of intensity in cold and heat therapy may be used, depending on the severity of your pain.
Forms of Cold Therapy:
- Ice Pack: This is the mildest form of cold therapy when treating running injuries. If you don’t have an ice pack at hand, bagged frozen vegetables or a Ziploc bag filled with ice can be used as a substitute. Regardless of what you use, be sure to wrap the source of ice in a fabric of some kind, as the extreme temperature can damage your skin. For the same reason, you should limit the use of ice on your skin to 20 minutes every hour.
- Cold Compression Therapy: A slight variation on the standard use of ice packs is to apply compression. This can be done with special cold compression sleeves, or by fashioning one yourself. This method applies two of the four principles of RICE treatment: ice and compression. In addition to relieving pain and swelling, cold and compression used together can speed up the recovery process.
- Ice Massage: An alternative use for ice packs is to make an ice cup, useful for applying an ice massage. This is particularly helpful with treating back injury, since it combines the anti-swelling effects of ice packs with the pain relieving effects of massage.
- Ice Bath: Bathing in a tub of ice-cold water, as well as taking cold showers, has terrific benefits to recovery. In addition to helping treat injuries, many runners use cold water submergence to recover from intense exercise. The effectiveness of this method has been proven in scientific studies; it has been shown to improve the metabolic ability of muscles, speeding up recovery.
Forms of Heat Therapy:
- Heat Pack: Using a dry or moist heat pack on the affected area helps a great deal in minimizing muscle soreness, as studies have shown. In the case of a compression fracture, muscles can be sore and painful if your posture is affected, so this can help reduce pain during a recovery process. It is recommended to use heat for 15 to 20 minutes on average, although more severe injuries may require applying heat packs for upwards of 30 minutes, with a maximum of 2 hours.
- Hyperthermic Conditioning: Whether it’s a hot shower or a sauna, slowly acclimating the body to a high temperature environment is an effective recovery methods. The benefits of regular sauna use are numerous and well documented, but the benefits that apply to treating your spinal injury are increased protein synthesis, increased oxygen flow, and anti-aging effects. These will speed up recovery in your body, reduce pain, and may even prevent compression injuries from occurring in the future if you keep up with sauna treatment after your injury is cured.
- Infrared Radiation: This is also known as FIR, which is an acronym standing for Far Infrared Radiation. Specialized saunas or heat lamps can be used to focus heat on a particular part of the body, with great effectiveness. Equipment for FIR therapy can be purchased for home use, or a physical therapist can apply the treatment at their office.
During the recovery process, pain felt in the affected region can be unbearable, even with the aid of cryotherapy. Fortunately, there are many different medications you can take to soothe the pain. Some can be obtained over the counter without a prescription, but more serious medicine may require a prescription from a doctor. Depending on the severity of your injury and the pain that comes with it, there is a form of medication that can accommodate your specific needs.
- NSAIDs: Short for Non-Steroidal Anti-Inflammatory medicine, these are mild pain relief medicines that are usually implemented to prevent swelling, with pain relief as a side benefit. They are effective in milder cases of compression fracture, often more effective when used in conjunction with other pain-relieving methods such as cryotherapy. Some common NSAIDs are Aspirin, Tylenol, Ibuprofen, and Acetaminophen.
- Corticosteroids: Although they are commonly used for degenerative disc diseases, corticosteroids can also be effective in both relieving pain and promoting recovery from compression fractures. They are highly effective at increasing protein synthesis, meaning they will soothe pain relating to muscles in a similar, but more extreme, fashion to sauna treatment. Some common corticosteroids used for lower back treatment are Dexamethasone, Prednisone and Cortisol.
- Muscle Relaxants: These are most effective at treating complications from spinal compression injuries rather than the root cause. However, muscle relaxants may still be prescribed when treating a compression fracture since they can prevent muscle spasms, which are a risk both during the onset of the injury and after surgical treatment. Common muscle relaxants are Baclofen, Carisoprodol, and Diazepam.
- Opioids: These are the most extreme forms of medicine that may be prescribed to patients when recovering from back pain. They are often reserved for use after particularly intense surgery, and should only be used for a maximum of three to four weeks in order to prevent the possibility of addiction. Opioids and narcotic medication provide a great deal of pain relief over an extended period of time, and are one of the most commonly abused medications. Some common opioids prescribed for back pain are Oxycodone, Morphine, and Fentanyl.
- Alendronate: This is not a pain-relieving drug, but it is often used when recovering from a compression fracture. Usually it is used to treat osteoporosis, but the effects it has on your bones makes it effective at recovering from spinal compression as well, since it promotes mineral build up in your bones, strengthening them.
There are cases of spinal compression injuries where an extended period of rest will resolve the issue, allowing you to continue running normally. However, some extreme cases will require surgical treatment. Depending on how severe your injury is, a few surgical procedures can be performed.
- Lumbar fusion is a less invasive surgical procedure, used in cases where movement is the cause of the pain. If the fracture was caused by a weak spine, or if complications with posture develop from a spinal compression injury, this is the surgery that will heal these issues. With lumbar fusion, an incision is made from the front, back or side of your body so that your spine can be accessed. Rods are applied to two of your vertebra. They are then fused together in a similar procedure to welding, using smaller pieces of bone as a graft. The aim is for movement to be limited between the two vertebra that are fused together, with the additional bone material added eventually solidifying into bone. In a case where bone material can’t be used for the graft, sometimes artificial bone material or ceramic is used. Once the surgery is complete and the incisions are stitched back up, your will need to be immobile for a period of time while the bone sets. To accomplish this, you may have to wear a brace for several weeks or additional pins may be installed in your back by your surgeon. Pain medication will be prescribed for the subsequent weeks as your body slowly recovers and adjusts to the changes.
2. Vertebroplasty and Kyphoplasty are surgical procedures specifically for treating compression fractures, designed to relieve stress on the nerves, reconstruct fractured vertebrae, and restore mobility and strength bearing capabilities of the spine. Vertebroplasty is used in situations where the fracture is painful but minor, without many complications. In the event that posture issues, misalignment, or kyphosis develop in the spine, kyphoplasty will be required instead. For this surgery, the surgeon will use imaging technology such as an X-ray to view your spine while performing the procedure. They will insert a hollow needle in the area of the fracture. From this point, one of two things will happen, depending on if you are undergoing vertebroplasty or kyphoplasty. With vertebroplasty, bone cement is injected in your back through the needle to harden and provide support. With kyphoplasty, a balloon is fed through the needle into your spine first. The balloon is used to create a space for the bone cement and to realign your spine. After the balloon is inflated, bone cement is injected in the gap. Pain medicine may be prescribed, but recovery time is much faster, with some patients able to resume walking within hours after the procedure.
How Do You Prevent Compression Fractures?
Whether you have successfully treated previous cases of spinal compression, are at risk for developing a compression fracture, or simply want to avoid the possibility of compression injury altogether, you will want to take steps toward preventing this injury from occurring in the future. This is especially important for the elderly, since they are at a greater risk of developing this injury. Many of the methods below are geared toward strengthening bone and muscle, especially in your back.
In order to promote bone health, there are vital nutrients the body requires. Many of these vitamins and minerals, such as calcium, can be found easily in common foods. However, you may need to take supplements in order to receive adequate levels of other necessary minerals.
Vitamins and Minerals that Promote Bone Health:
- Calcium: This is the most essential nutrient for bone health. It is directly responsible for strengthening bones and teeth, as well as regulating other systems in the body such as nervous system activity and blood flow. The elderly are at risk for calcium insufficiency in the body, which will weaken bones as the calcium is taken out of them in order to regulate bodily functions. Calcium can be found in dairy products, sardines, salmon, tofu, and leafy green vegetables such as kale, broccoli and cabbage.
- Vitamin D: Vitamin D is the second most important nutrient for bone health, as it works in conjunction with calcium. It is used to help the body absorb calcium so that it can strengthen bones and muscles. Your body can obtain Vitamin D through sunlight and food. However, in recent times the amount of Vitamin D found in food has decreased, and people spend less time in the sun on average. For these reasons, the best way to receive an adequate amount of Vitamin D is through supplementation. In food, Vitamin D can be found in fish or in products that are Vitamin D fortified by the manufacturers, such as cereal and milk.
- Vitamin B12: Insufficient amounts of B12 in the body is a major risk factor for developing osteoporosis, which can lead to compression injuries. It is mainly used for DNA synthesis and the production of proteins and red blood cells, but it has also been linked to bone health due to the osteoporosis connection. Vitamin B12 can be found in fish, beef, ham, chicken, and eggs.
In conjunction with proper diet and supplementation, exercise will help prevent a great deal of running injuries, not just compression fractures. This includes general strengthening exercises and stretches that will increase flexibility. Performing these exercises and stretches regularly will help prevent spinal compression injuries, as well as providing other benefits such as better posture. This is done by strengthening both your back and your core, which work in tandem to bear the weight of your upper body. Some of these exercises may require additional materials, such as a mat or exercise ball. Expect some soreness when performing these exercises, but stop immediately and seek medical attention if you feel sharp pain.
Back and Core Strengthening Exercises:
- Hip Lifts: Lie on your back, using a mat or rug, with your arms and back flat on the ground. Bend your legs so that your feet are flat on the ground and your knees are pointing toward the ceiling. Slowly lift up your lower back so that your body forms a straight line from your knees to your upper torso. Hold this position for ten seconds, then slowly return to the starting position. Repeat five times. For extra resistance, use an exercise ball to prop up your legs while keeping them straight.
- Planks: Lie flat on your front with a mat or rug. Keeping your legs and back straight, use your forearms to prop up your upper body. Hold this position for thirty seconds to a minute, then relax. At first, you may need to lift your butt up slightly to provide extra support to your back, but for future planks you should try and keep your body completely straight. You can try to hold this position for longer times to increase the intensity, but don’t exceed two minutes.
- Side Planks: This exercise is similar to regular planks, but instead of putting the weight on both forearms you must turn your body to one side and support your weight with one forearm. Keeping the rest of your body straight, hold this position for thirty seconds to one minute on each side.
- Crunches: Lie flat on your back with a rug or mat. Rest your feet on an incline, using a chair or exercise ball. With your hands behind your neck, slowly lift your upper body towards your legs, crunching your abs. Hold for a few seconds, then slowly return to the starting position. Perform three sets of ten reps.
- Prone Knee Stretch: Lie flat on your back, using a mat or rug. Slowly lift one leg, bending your knee towards your torso so that the elevated leg is parallel to the ground. Grab the elevated knee with both hands and gently pull it towards your upper body until you feel tension. Hold this position for ten to twenty seconds, then slowly return to the starting position. Repeat this movement three times with each leg.
- Prone Back Stretch: Lie flat on your front, using a mat or rug. Keeping your legs straight, lift your body with your hands so that your torso and arms are upright. The upper half of your body should be perpendicular to your lower half, curving your back like a seal. Hold for ten seconds, then return to the starting position. Repeat this movement five times. When starting out, you can curve your back at a less extreme angle by resting on your forearms instead of your hands.
- Seated Spine Stretch: Sit on the ground with your legs spread to either side of your body, wider than your hips. Lower your head so your chin is touching your torso, and slowly lower your upper body, balancing yourself with your hands on the ground. Bend only as far as you can feel slight tension in your back. Hold for five to ten seconds, then return to the starting position. Repea this exercise three times.
As far as running injuries go, back injuries can be one of the most painful and inconvenient. The only reliable method of treating these injuries is an extended period of rest, and possibly surgery for extreme cases. Because of this, taking steps to treat it quickly and prevent it from occurring in the future is the best way to avoid losing running progress from extended inactivity. Running may be fun, but running injuries certainly aren’t, so be sure to exercise caution when running and you should be able to avoid compression fractures in the future!
The information contained in this article was found through many online sources. Most of these are written by doctors or other medical professionals, but the contents of this article should not be considered professional medical advice. Always go to a doctor if you are experiencing pain.
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