A fracture in the spine seems scary, and of course, it certainly can be! At the same time a very common type of spinal fracture is a compression fracture, and although these can be very painful, they can often be subtle and not threatening to the neurological status of the patient. In other words, you don’t need to worry about being paralyzed despite the fact that you’ve technically “broken your back”, although it can sometimes be serious and can be painful, most don’t affect a patient’s health in the long term.
Vertebral compression fractures are surprisingly common. Once present for a period of time they appear on a lateral x-ray as a loss of vertebral height. In simple terms, think of the vertebrae like a cardboard box that has been squished down a little. For some people, if they have several compressed vertebrae they might get a “bump” or “hump” in the spine. Keep in mind when we’re talking about this type of compression injury we are not referring to the intervertebral discs. We’re referring to compression injury (fracture) of the bone. Many people talk about compressed discs; that’s a different injury altogether.
Compression fractures are most common in the middle of the spine and the lower back. Perhaps the most common contributing factor to a compression fracture is the pre-existing quality of the bone. That is, people who have osteopenia or osteoporosis are more prone to these fractures. These fractures are common in the elderly, especially women. There is often a force that goes “through” the spine axially. This means a force that goes through the spine from top to bottom. Falls, stepping awkwardly off a curb or even a cough can cause compression fractures. Certain medications, inactivity or being excessively underweight can all contribute to a reduced bone mineral density that can therein lead to compression fractures.
Compression fractures are visible on x-rays. Many patients are surprised when we spot an old compression fracture on their x-rays. This is because most compression fractures are not painful! Many patients cannot recall an incident of injury. For others, a spinal compression fracture can be very painful and the person recalls that final event that created the injury. Usually, a compression fracture does not require further imaging beyond x-rays. This depends on that specific patient, however. If there is suspicion as to why the patient has a reduce bone density or if there are neurological symptoms, an MRI might be helpful in determining any other considerations or factors associated with the injury. Usually, a thorough clinical examination is enough to ensure that the patient is safe and to determine the most appropriate course of treatment for that patient.
For most patients with this type of spinal injury, the treatment is to reduce pain, restore normal spinal function as well as address any contributing factors. Usually, patients are encouraged to stay mobile so consulting with a physiotherapist, chiropractor or athletic therapist can be important. Since many patients experience compression fractures because of a reduced bone density, resistance exercises under safe conditions are often suggested. Usually this is done under the supervision or guidance of a professional, like a physiotherapist or an athletic therapist and we have some excellent ones at our Burlington Sports Therapy clinic that can help you out. Unsure what is the cause of your back pain? Need help? Give us a call!
Since 2005, Burlington Sports Therapy has been treating people in Burlington, Oakville, and the surrounding area for their back and neck pain.
McCarthy J & Davis A. Diagnosis and management of vertebral compression fractures. American Family Physician 2016; 94(1): 44–50.