Joined: March 21, 2006
Have a patient with an L1 compression fracture from MVA. He is 7 weeks from his initial injury. Recent x-ray shows severe compression fracture with some healing from last x-ray. It also shows a loss of 2/3 of the anterior height. He has intermittent pain and functions relatively normal.
He is an active individual that enjoys weight lifting. I have advised him to refrain from weight lifting until I could find out more about these recent findings. Does anyone have any thought or guidelines specific to lumbar compression fractures?
Joined: February 14, 2003
From: Madison WI USA
I guess I would just say that when he is cleared by his doc to do some regular lifting during household tasks based on radiographic evidence of solid healing, I would then gradually and in a very structured way give him graded lifting tasks to slowly increase axial loading over the course of perhaps 3 months or more to continue the remodeling process. I would want to know what kind of lifts he does with his typical pre-injury routines, and whether he is hoisting huge amounts with squats, dead lifts and the like. This of course would be ill advised for a while. Theoretically, in the absence of neural injury, one could treat this like other fractures. I would also want to know if he is wedged in specific directions with this compression fx, which you mentioned with the loss of 2/3 anterior height, thus meaning he has a relative triangle for a vertebral body now. For this instance, I would make sure he has some gentle extension movements to keep the spine from taking on a forward lean deformity, and caution on the overzealous use of flexion activities without some counteracting in the extension direction. But thats just what I would do, Im sure there are more ideas.
This completely depends upon the age of the patient. If the patient is in his mid 30's, 7 weeks complete rest is necessary after the lumbar compression fracture. You can suggest him for a little mobilization of spine, but don't allow to lift heavy weights. The reason being lumbar fracture is usually associated with major trauma and can cause spinal cord damage that results in neural deficits. So it should be handle with lot of care and sensitivity.
Joined: September 25, 2008
Alice, It is important to understand that it can take 7 weeks to reach a certain degree of healing but there should not be 7 weeks of complete rest. Relative rest, removal of weight lifting, lifting/push-pull/carry restrictions but in the absence of neural signs 7 weeks of complete rest has its significant flaws. Letting a patient know that there should be good initial healing by 7 weeks and until that time pacing/managing his activities and rest are important. It might just be the verbage you use, "complete rest". I've seen too many MVA or back injury patients who are told to rest and avoid lifting and those people typically spend more prolonged time watching tv long sitting in bed, on the couch/recliner or other extremely poor activity choice. I am just about ready to finish with one near 40yr old MVA who because his doctor said rest for a few weeks and take time off work, a time filler for him was to play a few hours of video games-sitting/day. No wonder his lumbopelvic flexion and SLR were tight for awhile.
With a compression fx that is radiographically identified and with an absence of neuro signs, there are enough soft tissues around the spine and areas above and below to help disperse a lot of stress. If we thought of a unilateral pars fracture or bilateral pars fracture, outside of the initial inflammation if it was acute; those are not handled by weeks of rest. The vertebral body is different than the pars but all the factors should be considered
i would definitely avoid excessive loading and impact activities until radiographic proof of healed fracture but since he is ambulatory and weight bearing, i would focus on proper movement patterning and restoration of good gait mechanics.