Wrist fractures are “sentinels” of bone fracture risk; in fact, having a low-trauma wrist fracture may be more important than a diagnosis of osteoporosis in determining risk for subsequent hip fracture.
It makes perfect sense — when we fall, the reflex to throw out our hands and take the impact on the wrists protects our hips from being injured far more seriously. As we get older, that reflex isn’t as quick, and thus we have greater frequency of hip rather than wrist fractures.
So how do you know if your wrists are strong enough to stop your fall? And if they’re not — what do you do about it?
Get a grip on your grip strength
To start, figure out how strong your grip is. Grip strength is a marker of overall muscle strength. As studies have shown, muscle weakness as measured by grip strength is a predictor of unhealthy outcomes including cardiovascular and metabolic diseases, disability and even early mortality (Correia Martins et al., 2018).
One sign that your grip may be getting weaker is if you notice that opening jars is getting a bit harder. My favorite tool for measuring grip strength is a simple hand held-dynamometer. Simply squeeze the handle of this device as strongly as you can to measure your grip strength. Grip strength norms by age have been well established, so it is easy to see how yours compare (Massey-Westropp et al., 2011).
Exercise to strengthen your wrists
If your wrists aren’t as strong as you’d like, there’s certainly much you can do to change that. But first, understand that dominance has a profound effect on strength of the wrist and the bone mineral density of the wrist and forearm.
You might want to jot down the grip strength difference between your dominant and non-dominant arm and then exercise and non-dominant arm specifically to bring it up to the same strength level as a dominant arm. After all, we might have to stop a fall with either wrist, so we want to have both wrists as strong as possible.
Here are some basic exercise principles to strengthen your wrists:
- The impact of exercise is “site-specific” — that is, if you strengthen the muscles around the wrist, you will strengthen the wrist. That means that you need to load, and thus strengthen, all the muscles around the wrist and arm.
- Simply doing one type of exercise, such as a wrist curl, isn’t going to cut it. It only exercises one set of muscles, so you need to include wrist exercises that involve a full range of motion of the hand and wrist. See our exercise graphic below for ideas!
- As with all exercises, start slow and build up. You do not want to overdo it.
Maintain a healthy skeleton
Of course, your wrists don’t exist by themselves, floating in midair — and anything you do to support your overall bone and body health will certainly help your wrists too. So in addition to wrist-strengthening exercises, you can also do full-body workouts to strengthen your muscles and bones as well as focus on getting the full suite of bone-building nutrients and alkaline diet that support better bones and a better body.
Your wrists are the first line of defense against a fall, so why not give them a helping hand?
Correia Martins A, Moreira J, Silva C, et al. Multifactorial Screening Tool for Determining Fall Risk in Community-Dwelling Adults Aged 50 Years or Over (FallSensing): Protocol for a Prospective Study. JMIR Res Protoc. 2018 Aug; 7(8): e10304. Published online 2018 Aug 2. doi: 10.2196/10304
Massy-Westropp NM, Gill TK, Taylor AW, Bohannon RW, Hill CL. Hand Grip Strength: age and gender stratified normative data in a population-based study. BMC Res Notes. 2011; 4: 127. Published online 2011 Apr 14. doi: 10.1186/1756-0500-4-127
Bone responds to certain levels of physical strain in a really interesting way — it gets stronger.
Any type of strain on bone that applies enough impact or compressive pressure to stimulate new bone growth is called “osteogenic loading.” Our wise body constantly monitors strain, and in the brief moment of impact, when strain is enough to slightly stretch, bend or compress the bone matrix, this impact sends a warning message: high loads are coming, and the bones should grow stronger to carry them. This signal tells the bone-building osteoblast cells to increase their minerals uptake and build bone —which is why we emphasize the importance of having those minerals in your diet or using a well-constructed multivitamin like our Better Bones Builder.
Osteogenic loading basics
Even when just standing upright, the simple act of resisting gravity puts a load on bone, but this is a one that our body is well adapted to. To build stronger bones, a much higher load — that is, greater compression and bending — is needed to encourage our bodies to spend the necessary energy and resources.
The load put on bone can be measured in terms of multiples of body weight. The higher the load, the better able the activity is to stimulate bone growth. Calculations of multiples of body weight look like this for common physical activities:
Swimming: 0 (Your load is actually lessened in water.)
Brisk walking : 1–2
Power jumping: 4+
Resistance, strength training: 4 to 10 (Depending on impact.)
Safe impact training programs for osteogenic loading
Most physical activity loads bone to a degree, but for strong osteogenic stimulation, the load needs to reach around 4 times body weight.
At these higher multiples of body weight, however, safety becomes an issue. Any bone will succumb to fracture under loads that exceed its capacity. When training with high multiples of body weight, professional guidance is mandatory.
Simple ways to enhance your osteogenic loading
- If you have a desk job, stand frequently and walk, or stomp/skip around every hour.
- Walk more, walk faster, jog if you can.
- Practice stepping down stairs with a thud, or walk downhill.
- Do 100 heel drops.
- Turn up the music and kick up your heels in dance.
- Practice jump rope or 1- or 2-legged hopping or jumping, if your knees permit.
- Begin a strength training program, even in a moderate one. Many studies report a gain of both bone and muscle mass with regular resistance training done just twice a week.
I have seen uncounted clients gain significant bone density doing our full Better Bones, Better Program while amplifying our exercise component with serious strength training. We are now documenting a variety of successful exercise programs and will be detailing them to you in this weekly blog and on our new Exercise Evolution Channel. Not everyone is suited to lifting heavy weights, but everyone can and should work to increase muscle mass and bone strength.
Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, 2004.
Jaquish J, Singh R, Hynote E, Conviser J. Osteogenic Loading: A New Modality to Facilitate Bone density Development. A: Jaquish Industrial Research, LLC, 2017.
Westcott W. Resistance training is medicine: effects of strength training on health. Current Sports Medicine Reports July/August 2012;11:4P209216.
We know our time-tested Better Bones, Better Body® Program works!
It works because we provide the body with everything it needs to build and maintain bone strength.
- pH Balance through The Alkaline for Life Diet®
- Targeted Nutritional Supplementation
- Endocrine Balancing and Stress Reduction
- Digestion Enhancement
All these components are important building blocks of our successful program . . . but no part of our program is more important than:
The health and strength of our skeleton is directly related to our level and type of physical activity. Bone grows stronger or weaker depending on the load put upon it. Even low-intensity regular physical activity promotes bone strength and reduces fracture risk. At the other end of the scale, intense strength training builds bone density more than any drug therapy ever did.
Everyone can enjoy the bone building benefits of exercise and everyone can develop a personal bone building exercise program suited to their body type, personal needs and desires.
Exercise indeed builds Better Bones and a Better Body and there is no better time than right now to take charge of your own personal life-supporting exercise.
Introducing the Better Bones Exercise Evolution — Exercises for Osteoporosis
Development of a well-rounded and effective bone health program has been my goal from day one. Over the decades the Better Bones, Better Body Program has come a long way empowering women to take charge of their bone health. Today I’m very excited to introduce to you my longtime assistant and fitness expert Gina Galli RYT . Each week Gina will be leading you through safe bone-building exercises. Over time we will present a variety of exercise programs and each of you will have the opportunity to develop your own personal program to build bone and stay stronger longer.
Stay strong and have fun.
Love to all of you, Dr. Susan Brown
Better Bones Exercise Evolution is safe bone building exercises sharing the latest research on how to build strong bones community sharing, motivating and supporting one another a key part of the Better Bones, Better Body program
I’m so excited to be part of the Better Bones Exercise Evolution. We were inspired by many women like you who shared their stories of their fear of doing yoga or other exercises because they were afraid of injuring themselves further. This program was developed out of the need to create safe guidance and information on how to exercise and move your body without fear. Yoga and other exercise modalities have been proven to be very beneficial to build and strengthen bones.
The instructions you will receive from the Better Bones Exercise Evolution will guide you on alignment and understanding the muscle groups used in each sequence. We will give modification and suggestions of how to build on each pose to further your success. Through this program you will gain a better understanding of how your body moves, creating total body awareness. Our goal is to give you the tools to build a stronger, healthier version of yourself and to create a better quality of life to do the things you love.
Peace and Gratitude,
Gina Galli, E-RYT 200
Build Better Bones and a Better Body for Only $12.99 a Month
Always Fresh Videos — Stay Motivated and Never get Bored — New Bone Building routines will be presented once a week, on Monday. This will be in addition to the rich library of exercise videos already present!
Learn and Grow with Other Women Like You — Become part of a growing community of women focused on building bone NATURALLY! Interact with your peers, share ideas, and get motivated on our community page.
Exclusive Content — Get the latest research on bone building exercises exclusively for Exercise Evolution members (not available on my blog).
Access to Our Client Only Diet and pH Tracking Portal. — We know that exercise alone is not enough so we want to arm you with all the tools I give my clients. Using our portal, you can track your diet, exercise, and pH from the convenience of your computer or phone.
Unparalleled Support — Not sure if you are doing something correctly? Send us a message quickly using the portal and get an equally quick response!
With our new Better Bones Exercise Evolution we have set out to bring you safe bone building exercises that are accessible, fun, motivating and best of all . . . able to be done right from the luxury of your own home.
One thing we know about bone is that it responds to increased weight load by getting stronger. So the recent findings of an Australian bone clinic that studied women doing high-intensity weight lifting really shouldn’t surprise us. But just look at these results!
What happens when older women weight lift?
The clinic studied 101 postmenopausal women with a T score below –1; 44 were classified as having osteoporosis and the remaining 57 were considered to have osteopenia. A bit more than one-fourth of them had already had a fracture.
The women were divided into two groups, experimental and control; they exercised twice a week for at least 8 and up to 12 months, but the kinds of exercise they did were different. For the control group, a low-intensity, home-based exercise regimen that emphasized balance and mobility, but not heavy weight loading, was used. They did lunges, calf raises, and stretches with no more than 3-kg weights in their hands — common types of exercises recommended for older women seeking to maintain fitness and bone strength.
The experimental group, on the other hand, underwent supervised, 30-minute sessions of high-intensity resistance training at 80–85% of the “1 rep max” weight — that being the weight they could only lift only once with maximum effort. The exercises included deadlift, overhead press, and back squat along with jumping chin-ups with drop landings. These types of exercises are not usually recommended for older women, and prior studies of weight-bearing exercise for bone mass improvement used moderate loads rather than high loads, as in this study.
The bigger the load, the stronger the bone
The study’s results were striking:
• The high-intensity group gained an average of 2.9% BMD in the lumbar spine, while the control group lost an average of 1.2%.
• The high-intensity group gained on average 0.3% BMD in the femoral neck, while the control group lost on average 1.9%.
• The high-intensity group gained 13.6% femoral neck cortical thickness, while the control group lost 6.3%.
Some of the individual outcomes were truly amazing. One 59-year-old-woman who trained for a total of 12 months saw an increase of 10.5% in the hip and 8.8% in the lumbar spine!
I just heard about even more record-breaking gains from “C.F.” — one of our clients. Motivated to find a way to reverse her ongoing bone loss, C.F. — a 67-year-old woman — combined our Better Bones, Better Body Program with supervised high-intensity strength training. In just 1.5 years she gained a whopping 21.5% in the neck of the hip, 10% the total hip and 5.6% in spine — moving her totally out of the osteoporosis category! Her doctor was so astonished she called me to ask what we were doing. This is a bone density gain that is unprecedented and we will soon be make available to you the details of our client’s full program.
The benefits of high-load weight lifting for older women
Given that we’ve known for years that bone responds to the load placed on it, why hasn’t high-load weight lifting ever been looked at before in women?
As the authors of this study point out, it’s a common misconception that women with low bone mass risk developing spinal fractures if they use heavy weights or free-weight exercises — but this study shows that isn’t true. Only one woman in the study had any sort of injury — a mild muscle strain in her lower back that probably occurred from an error in technique (which is very important in free-weight lifting) rather than the amount of weight she used. Keep in mind, these women were carefully taught the proper form for lifting and highly supervised. Should you try a high-intensity resistance program yourself, be sure to work with a qualified training.
What all this tells us is that even in women who are actively losing bone, high-intensity weight-bearing exercise offers more benefits in reversing the trend than low- or moderate-load weight-bearing exercise.
At the Center for Better Bones, we view exercise as an important part of a natural approach to building and strengthening bone. Learn about our Better Bones, Better Body Program to find out how you can start building serious bone naturally.
Watson SL, Weeks BK, Weis LJ, et al. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: The LIFTMOR Randomized Controlled Trial. Journal of Bone and Mineral Research 2018; 33(2): 211–220. DOI: 10.1002/jbmr.3284
“The foot feels the foot when it feels the ground.” – The Buddha
Now that winter is finally over — after what seems like forever — more and more of us are getting outside and being active. It’s a time that I like to go for walks to watch the world wake up from its long sleep.
Walking is one of the most useful exercises we have because it offers us so many key health benefits, as enumerated by many, many studies:
- Even one hour a week walking at the average pace reduce hip fracture risk by 6% in postmenopausal women, while walking for at least four hours a week was associated with a 41% lower risk of fracture (Feskanich et al., 2002)
- Walking reduces the tendency to high blood pressure, the risk of blood clots and stroke, and multiple cardiovascular risk factors (Murtagh et al., 2015).
- In older adults, walking more correlates to lower risk of depression and greater quality of life (Arrieta et al., 2018).
- Brisk walking improves oxygen uptake and cardiovascular fitness as well as muscle tone—while alkalizing the body.
But I would argue that simply hopping on a treadmill for 10–15 minutes every other day, while it gathers all those benefits and more, somewhat misses the point. Walking outdoors gives us a chance to reconnect with the world around us — ideally in a soothing natural environment like a park or trail, or at the very least a tree-lined sidewalk. (Interestingly — and something that resonates with the Earth Day anniversary coming up — research shows that people who walk in parks tend to get more benefits due to less interruptions in walking from traffic or other hazards they must negotiate [Sellers et al., 2012]).
When we walk outside, we can enjoy the breeze, the rain, the sun, the leaves — all that the world has to offer. And it reconnects us to ourselves in a very useful way: Walking upright on two legs is the trait that defines the human lineage. Even though we’ve become used to sitting more than standing nowadays, regular walking on two legs is considered a uniquely human trait. Taking the time to walk — to put our feet on the ground and feel them, as the Buddhist saying goes — can offer us a type of internal realignment that very few other exercise methods provide.
As we approach Earth Day, we have the opportunity to celebrate all the positives that walking offers us. If you can, take that opportunity in a park or garden path; let your feet touch the ground, mindful of all the good things walking in the open air can bring you.
But if you can’t, no worries! No matter how you like to do it—in groups, by yourself, fast or slow, listening to music or meditating—just walk. Do it on a regular basis. Do it 30 minutes a day, and your bones and entire body will thrive.
Arrieta H, Rezola-Pardo C, Echevarria I, et al. Physical activity and fitness are associated with verbal memory, quality of life and depression among nursing home residents: preliminary data of a randomized controlled trial. BMC Geriatr. 2018 Mar 27;18(1):80. doi: 10.1186/s12877-018-0770-y.
Feskanich D1, Willett W, Colditz G. Walking and leisure-time activity and risk of hip fracture in postmenopausal women. JAMA. 2002 Nov 13;288(18):2300-2306.
Murtagh EM, Nichols L, Mohammed MA, et al. The effect of walking on risk factors for cardiovascular disease: an updated systematic review and meta-analysis of randomised control trials. Prev Med. 2015 Mar;72:34-43.
Sellers CE, Grant PM, Ryan CG, et al. Take a walk in the park? A cross-over pilot trial comparing brisk walking in two different environments: park and urban. Prev Med. 2012 Nov;55(5):438-43.
A few months ago, I spoke with Rick Berman, a certified personal trainer and owner of Studio 2020 Fitness. Rick uses a weight training technique that was originally researched for building bone — a slow-motion, high-intensity training program. While this strength training program might not suit everyone, I like it because you can see benefits working out only once or twice a week for 15 to 20 minutes!
If that sounds too good to be true, for once, it’s not — because this workout is not light duty. The whole point, Rick tells me, is that you have to work the muscles to great intensity in order to stimulate the muscle cells to build more muscle (which, as you know if you’ve read my blog, goes hand-in-hand with building bone. That means working the muscles to the point of complete fatigue — that “just can’t do even one more rep” point. This is accomplished by slowing the workout down considerably so that you aren’t using momentum to provide energy for the next rep; it forces your muscles to provide all the force needed to raise the weight. Getting to complete fatigue doesn’t actually take long, when you’re doing that much more work with slow movements (and that’s why the workouts are fairly short).
This program takes advantage of the body’s ability to adapt to the stresses we place on it — the more work we do, the more the muscles and cardiovascular system adjust to meet those strains. And it doesn’t matter how young or old you are: Rick says that “a number of my clients are 60, 70 years old — I have some in their 80s — and I see people that come in the door that can barely lift, sometimes, 20, or 30, or 40 pounds. I’ve had clients that have started at 20 pounds, and within … maybe 8 weeks, they’re doing 40 or 60 pounds. We see very rapid increases in muscular strength.”
It should be no surprise that this method is good for developing bone as well as muscle. As Rick pointed out, the original exercise protocol was developed for an osteoporosis study some 33 years ago at the University of Florida Hospital. The slow speed was initially used because of fears that the research subjects — women 60 and older with osteoporosis — might injure themselves, but the serendipitous finding was that this slower training safely created more muscle mass, even with less-frequent workouts!
For more, watch my full discussion with Rick Berman. You will learn a lot!
Important PS: Always check with your doctor before starting any new form of exercise. There is no “one size fits” all strength training program and this intense slow-motion workout is not for everyone. If you’re new to weight training, I encourage you to work with a professional trainer who can teach you correct technique to avoid injuries and help you get the most out of your workouts. Best would be to find a trainer like Rick who specializes on slow-motion, high intensity training if you chose to give this system a try.
Recently, I had the opportunity to spend some time with Miranda Esmonde-White, founder of the world renowned Classical Stretch Exercise Program.
It is always a delight to be in the company of someone who radiates so much warmth and energy — but I was also eager to ask her a question: I had been told by my physical therapist that the muscles in my right hip were weaker than my left, and I was using one of Miranda’s exercises to strengthen my right hip. The movement involved a series of leg lifts, so I showed her what I was doing and asked her if I was performing them correctly.
Her reply was a gentle but firm rebuke: the most effective approach to building any single muscle group is a whole-body approach.
All our muscles are interwoven in a series of elegant chains, all interconnected. Thus, she explained, the strengthening of any particular muscle group should begin with lengthening and strengthening the total body muscular system. In fact, this is what Miranda teaches us to do in each of her 20-minute exercise DVD segments — strengthen and lengthen all the muscle groups.
Only after this whole-body work-out should I go on to focus on my right hip muscle group, if needed.
My response to her pointing out the error of my ways initially was embarrassment — because I immediately recognized my flawed thinking as something I’ve railed against when it comes to bone health!
I’ve always argued that the health of the skeletal system is dependent on the health of the entire body and vice versa. You cannot successfully nourish and promote the health of one single bone, nor can you expect excellent results if you deal with just one factor that is causing bone loss and don’t address the others.
I’m a big believer that any step you take to improve your health, no matter how minor it may seem, can have profound effects on all the body’s interconnected systems.
Case in point: a recent study on interval training found that exercising a few times week for 10 minutes — with just 60 seconds of maximal effort per session — was enough to boost insulin sensitivity, cardiorespiratory fitness, and skeletal muscle strength.
In the study, the researchers took an interval training regimen developed some years ago that used 20 to 30 minutes of cycling per session and pared it down to a 10-minute program to see if the benefits could be obtained with even less time commitment. Over the course of 12 weeks, previously sedentary men engaged in interval training 3 times per week for 10 minutes per session. Their workouts consisted of:
- 2 minutes of low-intensity cycling followed by a maximum-effort burst lasting 20 seconds (performed 3 times)
- A 3-minute cool-down to end the session.
Meanwhile, a continuous training group did a 2-minute warm up, followed by 45 minutes of cycling at 70% max heart rate, then a 3-minute cool down.
Just 60 seconds is all it takes
The astonishing conclusion was that the sprint interval training regimen — a total time commitment of 30 minutes per week, with just 60 seconds of maximal effort per session — was as effective as 150 minutes per week of moderate-intensity continuous training. And more amazing is that benefits were seen across the board — increasing insulin sensitivity, cardiorespiratory fitness, and skeletal muscle mitochondrial content. (I should note here that although this particular study was done with men, other research suggests interval training has a similar effect among women.)
This is an absolutely incredible finding! It reinforces the idea that even a small commitment of time and effort and can have big benefits. So go all out for a minute to improve your bone health — and total health — this year!
Gillen JB, Martin BJ, MacInnes MJ, et al. Twelve weeks of sprint interval training improves indices of cardiometabolic health similar to traditional endurance training despite a five-fold lower exercise volume and time commitment. PLoS One. 2016 Apr 26;11(4):e0154075. doi: 10.1371/journal.pone.0154075.
When I talk to some of my clients about exercise, I know a lot of them aren’t enthusiastic, thinking I’m going to tell them they need to spend hours lifting heavy weights and sweating in a gym. After all, everyone knows it’s weight-bearing exercise — and lots of it — that builds bone and lowers the risk of fractures, right?
Surprise! Not necessarily. Two new studies show that even small amounts of low-impact exercise have a positive effect on fracture risk.
Twenty minutes of walking does the trick
The first study (Stattin et al., 2017) followed over 65,000 Swedish men and women for 17 years and found that participants who walked or bicycled daily for even short periods of time had a lower fracture rate compared with those who did not. Regardless of sex or age, even relatively sedentary people could lower their fracture risk by exercising just a little bit every day. As long as they got at least an hour of exercise per week, these otherwise inactive people had a 13% lower rate of hip fractures and a 6% lower rate of any fracture compared to people who did none at all.
It’s worth emphasizing that the findings held true whether you looked at any fracture (including common, relatively mild fractures like vertebral or wrist fractures) or the more serious and life-changing hip fractures that everyone fears.
Of course, the more exercise they got, the better the results: those with 20 minutes of walking or cycling every day, which translates to about 2 hours per week — had a 23% lower rate of hip fracture and a 13% lower rate of any fracture. That’s a pretty good return for not a lot of effort — just imagine what you get when you do even more!
Light loads do more than you think
The second study (Hamaguchi et al., 2017) had a small group of 7 postmenopausal women undergo six weeks of training wearing a weighted vest with 380-760 g (roughly from 1.75 pounds) of added weight. With just two workout sessions per week, the participants saw improvements in pelvis BMD (1.6%) and knee extensor strength (15.5%) — which is helpful in maintaining balance and preventing falls. Workouts consisted of squats, front lunges, side lunges, calf raises and toe raises (eight sets of three repetitions with a 15-second rest between each set).
A little bit goes a long way
I know that it can be hard to start exercising if you’re not accustomed to it, and especially if you’re recovering from a muscle strain or a fracture, the get-up-and-go impulse just isn’t there. But you don’t have to do a lot to get benefit from it! Both of these studies show that a little goes a long way.
Hamaguchi K, Kurihara T, Fujimoto M, et al. The effects of low-repetition and light-load power training on bone mineral density in postmenopausal women with sarcopenia: a pilot study. BMC Geriatrics 2017;17:102. doi:10.1186/s12877-017-0490-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414134/
Stattin K., Michaëlsson K., Larsson S.C., Wolk A., & Byberg L. Leisure-Time Physical Activity and Risk of Fracture: A Cohort Study of 66,940 Men and Women. Journal of Bone and Mineral Research 2017;32(8):1599-1606. doi: 10.1002/jbmr.3161.
The Center for Better Bones and the Better Bones Foundation
Dr. Susan E. Brown, PhD
605 Franklin Park Drive
East Syracuse, NY 13057
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- Mediterranean diet a special help for those with osteoporosis December 3, 2018
- Lessons from our latest retreat — why rest and rejeuvenation matter November 27, 2018
- Muscle loss with aging — are you at risk for sarcopenia? November 17, 2018
- Sweet potatoes’ alkalizing benefits are all in how you prepare them November 7, 2018
- Don’t be fooled: Vitamin D does prevent fracture November 1, 2018
- New bone drug Tymlos — is it safe? October 19, 2018
- Why you should strengthen your wrists October 8, 2018
- Osteogenic loading — a key to reversing osteoporosis September 20, 2018
- Osteopenia Treatments — What Works? September 10, 2018
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