Compression Fracture Rehab | Case Study | Chesterfield | St. Louis
This is a little snapshot of our vertebral compression fracture rehab process. This case study highlights what we did during "phase 3" of the rehab process. It surprisingly does not look much different from typical rehab and strength training.
What is a Vertebral Compression Fracture?
A vertebral compression fracture is an injury to that spine that involves a "buckling" or compression of the vertebrae(s). These injuries usually are caused when someone lands on their butt in a forceful manner (the mechanism of injury in the case study below). They can also occur when falling flat on the back.
Rarely, they are caused from a much less traumatic cause. These may be considered "pathologic" because there is an underlying issue (i.e. severe osteoporosis, cancer, etc) which caused the spine to be more fragile in the first place.
Compression Fracture Rehab
This patient presented around 7 weeks post T11 compression fracture. She is about 12 weeks post fracture when these videos were taken. We’ve been able to gradually step up her rehab plan with just a handful of visits that were spaced out quite a bit. We typically would see the patient more consistently at first, but geography was limiting us, so we had to make do.
Summary of Phase 1 and 2 Compression Fracture Rehab
Initially, we worked on diaphragmatic breathing in various positions to help with pain control and gentle rib cage expansion. In addition, we worked to shed the brace that was prescribed. This was our “phase 1”.
For phase 2, we started to work on core stability in the supine and quadruped positions. We worked on this during the second visit (3 weeks after the initial visit). A lot of times the patient will be a little nervous with this due to the nature of their injury. Reassurance is key!
Below are some simple breathing drills to try out.
When ready, we then transition into simple core based exercises on the back. Below is a common example called a "dead bug".
Phase 3 - Building Strength AND Confidence
During phase 3 (highlighted in these videos), we started to work on weight bearing based exercises while progressing some of the things from phase 2. My goal is to return one’s function ASAP (hence “functional rehab”). Reassurance is still very important. In this instance, I picked things to work on anti-extension and anti-rotation core function as well as the classic deadlift (because I felt like it).
- Supine Bridge with Overhead Weight
- Pallof Press
- KB Deadlift
Disregard the Bruce Lee discussion!
What About Phase 4?
Is there a phase 4? There sure can be! This would be further down the road and would start to involve actual range of motion through the site of injury. Honestly, you can likely begin this much earlier in the process. I just find that people “break their backs” don’t feel comfortable with that right away which is understandable. However, we eventually want to improve the active range of motion (unloaded and then loaded) so that we aren’t left with long term mobility issues.
Conclusion - KISS for Compression Fractures!
The thing with traumatic compression fractures is that they aren’t as severe and unstable that many people think. Just keep it simple. Work on simple ways to control pain (breath work). Gradually build confidence with low load and core stability and then hammer it home into weight bearing activities. Modify and adjust the program depending on how the patient feels. BOOM.
Posted on 2/24/2022