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Ask the Expert: How do I safely and effectively teach and program for osteoporosis clients?

Designing programming and teaching osteoporosis clients

Merrithew Master Instructor Trainer Kim Kraushar, who studied education, fine arts and holds a bachelor’s of science degree in kinesiology, has researched osteoporosis extensively as part of her work creating mindful movement programming for Merrithew.

Here she tells us all about how instructors should program, teach and approach their sessions with osteoporosis clients to provide them with a safe, effective and satisfying workout, while also giving them the confidence to move well outside of class.

Q: For clients with osteoporosis, which movements should be avoided and which should be encouraged?

A: First you must determine the fracture risk for each participant. Merrithew has compiled a health history intake checklist as well as postural/movement and balance assessments to determine risk levels and appropriate exercise selection. We have set detailed exercise guidelines on a continuum for low/moderate and high-risk participants.

In general, movements that increase spinal compression can increase fracture risk and should be avoided. Some examples are:

  • Rapid, weighted, repetitive and/or end-range twisting and side bending
  • Full forward flexion in supine, standing or seated positions

Here are some movements to encourage your osteoporosis clients to try:

  • Functional weight-bearing exercises like hip hinges, squats, lunges, and push/pull patterns performed in a neutral spine
  • Standing, kneeling, supine, prone, side-lying exercises performed in a neutral spinal alignment
  • Strengthening of postural muscles (mid-back and hip extensors)
  • All exercises performed with good form, control and optimal postural alignment. Quality over quantity!

Q: Do you have any tips on how instructors should modify their programming for osteoporosis clients?

A: Osteoporosis guidelines essentially limit spinal motion to very moderate ranges. Typically, in Pilates programming, we are encouraging full spinal motion in all ranges, so instructors initially can feel both nervous and limited in programming options.

In our bone health and osteoporosis workshops, we review STOTT PILATES® Mat and Reformer repertoire and note which exercises are appropriate, contraindicated or require slight modification. We also introduce a vast library of standing weight-bearing exercises and exercises using small props. Once you become comfortable with the guidelines, you will quickly realize that there are endless programming options available.

Instructing an older client in Osteoporosis workshop

Q: What are some effective props or tools to use to support osteoporosis clients?

A: Use supportive props such as Foam Cushions in supine positions, especially for clients with kyphosis; and a pillow or deflated Stability Cushion under the ribs in prone positions. Some additional props that are very popular when programming for clients with low bone density are Merrithew’s Mini Stability Ball, Toning Ball, Flex-Band® and Foam Roller Soft Density.

Q: What are some key things to think about when working with osteoporosis clients?

A: Know your participants! You will see a wide range of health profiles and fitness levels presenting with low bone density, so a thorough risk assessment will enable you to personalize your programs to respect their body as well as achieve their goals.

Some clients will be nervous and require assurances that you are fully educated, qualified and capable of accommodating their needs. Other clients will be very fit and strong and expect you to respect the guidelines while providing an intense, challenging workout.

As mindful movement professionals, we are not only providing a safe, effective movement experience for our clients, we are also educating them to confidently move well in their bodies outside of the studio environment.

Find out more about Merrithew Instructor Training >

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