“Don’t Bend or Twist”: Is That the Right Advice After a Spine Fracture?

A woman emailed me recently. She had spine fractures a few months earlier and wanted to know what exercises she could do. Her physiotherapist had told her not to bend or twist.

It’s easy to see why someone would say that. But is it the right message? And what would happen if she followed it for the rest of her life?

Why discouraging movement can be dangerous.

A group of us asked a version of this question years ago. We brought together researchers, clinicians and patient groups to agree on exercise recommendations for people with osteoporosis, with or without spine fractures. This is called a Delphi consensus: a structured process in which experts answer surveys in rounds until they converge on shared recommendations (Giangregorio et al., 2015). It sits alongside our earlier Too Fit to Fracture exercise recommendations, which an expert panel developed by weighing the evidence, the benefits and risks of exercise, and what patients value.

Here is what the consensus said, in plain language:

• People should be encouraged to be active, not limited by generic rules. The experts specifically rejected blanket restrictions like “lift nothing heavy, no twisting.”
• Guidance should fit the person. It should account for your fracture history, pain, activity history and preferences.
• Teach spine-sparing movement. A good example is the hip hinge, which lets you bend by folding at the hips rather than rounding your spine. Other examples are slow and controlled movement, holding loads close to the body.
• Strength, balance and posture matter. Everyone, with or without a spine fracture, should work on balance every day and on the endurance of their back muscles. Wait until the fracture heals and you have the go-ahead from your doctor or physical therapist.
• If you’ve had a spine fracture, avoid heavy lifting or vigorous activities for the first 3 months or so, while the fracture heals. If you have pain, multiple fractures or a very curved upper back, see a physical therapist to get advice on an exercise program that is right for you, because some activities may carry more risk than benefit.

So the answer to my email was not “never bend or twist.” It was to learn how to bend and twist safely, when to return to physical activity. You can find resources related to recovery after spine fracture here: click here for spine fracture rehabilitation resources

Why balance training is part of the plan

In our recent analysis of the Canadian Multicentre Osteoporosis Study, we looked at how various fracture types actually happen, and falls were behind most of them (McLaughlin et al., 2025). Even many spine fractures happen due to falls. That’s why a good program includes balance training, not just strength. You can read more in our related post on how fractures happen: click here to read the blog!

Words matter and can create fear

When we tell people they have “brittle bones” or need to “be careful,” we may make them afraid to move. Fear of falling is itself a risk factor for falls. If fear keeps you from being active, you can become weaker and less steady, which raises your risk further. That’s why I’d like us all to stop using fear-based messages.

What this can look like

Everyone is different, so check with a healthcare professional first. These are examples, not a prescription:

• Learn the hip hinge. Building the muscles that support your spine can help you feel safer when you bend.
• Move slowly and with control. Hold loads close to your body.
• Be careful with heavy loads while bending or twisting if you’ve been told you’re at high risk of fracture.
• Build back muscle endurance. A bird dog exercise, starting with your hands on a counter, is one option.
• Practice balance regularly, like toe taps on a step or reaching and shifting your weight.

Click here to see a modified bird dog exercise with a chair

Know when to stop

Stop exercising and see a physician if you have sudden new back pain, or pain that spreads down a leg. The same goes for existing back pain that suddenly gets worse, pain that makes it harder to move, a sudden worsening of stooped posture, loss of height, or shortness of breath.

The bigger picture

Having had a spine fracture means you’re at high risk of future fractures (Morin et al., 2023). Exercise is one part of managing osteoporosis, not the whole plan. If that’s you, talk to a doctor about treatment, and ask a qualified professional (e.g., BoneFit trained physical therapist or exercise physiologist or kinesiologist) to help you adapt exercise to your situation.

You are not fragile. With the right guidance, you can keep moving.

References

1. Giangregorio LM, McGill S, Wark JD, et al. Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures. Osteoporos Int. 2015;26:891–910. doi:10.1007/s00198-014-2881-4
2. Giangregorio LM, Papaioannou A, MacIntyre NJ, et al. Too Fit to Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporos Int. 2014. doi:10.1007/s00198-013-2523-2
3. McLaughlin EC, Giangregorio LM, Adachi JD, et al. Characterizing types and circumstances of fractures in the Canadian Multicentre Osteoporosis Study. Osteoporos Int. 2025. doi:10.1007/s00198-025-07435-y
4. Morin SN, Feldman S, Funnell L, et al. Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update. CMAJ. 2023;195(39):E1333-E1348. doi:10.1503/cmaj.221647