Living with fractures
As explained in about osteoporosis, pain and other problems associated with osteoporosis are caused by the fractures it causes, and these experiences can vary from person to person.
Osteoporosis does not affect the healing process. So if you have a fracture it will usually heal in about six to twelve weeks although, like any broken bone, sometimes it can take longer. If you are having problems coping at home after your fracture, there are services such as physiotherapy and occupational therapy that can help you to regain your independence.
As with any broken bone, it is really important that you are eating healthily to help with your recovery and the healing process; see here for more information about a well-balanced diet. It is especially important that you have enough protein to help the healing process, especially if you are older and frailer.
If you smoke, a fracture may take significantly longer to heal as smoking alters the blood supply to the bones. Ask your doctor or practice nurse for help with giving up smoking to give your bones the best chance of healing well.
Some broken bones require an operation to aid healing; others get better on their own. Sometimes a fracture needs to be immobilised (or kept still) for a period of time, but with other fractures this isn’t necessary. Here are three common fractures that can be caused by osteoporosis, how they are treated and how healing is promoted.
A plaster cast will usually be applied in hospital to stabilise the break and aid healing. A hospital stay will not usually be necessary. The plaster cast will stay on until the bone has healed, usually for about six weeks. You will be advised about appropriate exercises to help strengthen your muscles and get back to normal activities.
Occasionally an operation may be needed to re-align and stabilise the bones. Sometimes wires are used to hold the bones in position and a partial cast is applied in the operating theatre. After a few days, when the swelling has gone down, a full cast is applied.
A small proportion of people with wrist fractures may go on to develop longer-term problems, such as osteoarthritis of the wrist. A rare but painful complication of wrist fracture is a condition known as complex regional pain syndrome (CRPS). To reduce your chance of developing CRPS it is important to do the recommended exercises before and after the cast is removed. For more information see our factsheet Complex regional pain syndrome and osteoporosis.
Broken hips most commonly occur in people over 75 years of age who fall directly onto their hip. An operation is normally required to fix or replace the upper end of the thigh bone that has broken (see photos opposite). Your surgeon will want to repair the break as soon as possible, but this may be delayed if you have a urine or chest infection, low levels of red blood cells (anaemia) or heart problems. You will either have a general anaesthetic or an injection into your spine to completely numb the lower half of your body.
The quicker you get up after surgery, the more successful your recovery is likely to be as this reduces your risk of problems such as a chest infection and clotting issues. You will usually be up and out of bed the next day with the help of a physiotherapist and a walking frame, and gradually become more mobile as the days progress. After the operation you will have regular, strong pain-relieving injections or a patient-controlled analgesia pump, which provides a pain-relieving drug straight into a vein. This allows you to control your pain by giving yourself safe amounts of medicine.
If you were already quite frail before breaking your hip, you may need a period of rehabilitation after your operation so that you can go home safely. The length of stay in hospital can be between five days and three weeks. A physiotherapist should give you specific advice about appropriate exercises to help with your recovery.
Operation to mend a hip fracture
There are other fractures that may occur with osteoporosis such as fractures of a rib, an upper arm or the pelvis. If you experience one of these, talk to your doctor or ask to see a physiotherapist for advice about what you can expect and also about appropriate exercises (or limits to your activities) to aid your recovery.
Spinal compression fracture
The experience of compression fractures is varied. For some people these fractures occur suddenly with severe and disabling pain, but for many the compression of the bone is ‘silent’, causing little or no pain.
These are usually stable fractures so you do not need an operation and you do not need to wear a special spinal brace to keep your back immobile. In fact it is important that you keep as mobile as you can to help to prevent problems such as chest infections, constipation and even blood clots. Keeping mobile will also help to maintain your muscle strength and reduce further pain problems. Taking a pain-relieving medication can help with the pain and will also help you to stay as active as you can. However, if pain is severe in the early stages, you may need to reduce your mobility for a while, although this isn’t necessary to aid healing.
In the longer term, whether or not your spinal fractures are painful, you may notice you have lost some height or are beginning to get an outward curve at the top of your spine (see What is Osteopororsis for more information on how these changes in your spine occur).
Many people recover well from painful compression fractures but some will go on to experience chronic (persistent) back pain due to the effects of the changes in spinal shape. Sometimes these fractures can lead to being less active, having sleep problems, feeling emotionally low and reduced general health. Height loss and postural changes can cause shortness of breath and your stomach may feel squashed and bloated. This can make day-to-day living more difficult.
For hints and tips on how to overcome various problems associated with broken bones caused by osteoporosis see our Living with osteoporosis factsheets Daily living after fractures and Out and about after fractures
A compression fracture seems different from a normal broken bone so why is it painful and what can I expect?
It is still a broken bone in the sense that there is a break in the outermost layer. Nerves are therefore stimulated, sending signals to the spinal cord and up to your brain.
Often, during a fracture, blood vessels in the bone are torn and bleed, and back muscles can go into spasm as they try to hold the broken bone together. These changes create further pressure on nerve endings. This immediate pain is often described as ‘acute pain’. You may experience it immediately when a bone breaks and it will usually lessen over the following six to twelve weeks, as the injured tissue and bone heal.
Why am I still getting pain after my spinal fracture has healed?
Even though a fracture has healed, sometimes pain improves but doesn’t go away completely, with pain coming and going or occasionally becoming constant. Pain that lasts beyond the expected healing time, sometimes defined as longer than three months, is called persistent pain or ‘chronic pain’. If the fracture has healed, there will be other causes of the pain:
- Nerves leave the spinal cord and travel between the individual spinal bones to all areas of the body. It is possible for a spinal fracture to pinch or irritate one or more of these nerves, causing pain. Sometimes this pinching or irritation of the nerve carries on after healing because the bone has healed into a flattened or wedge shape. Occasionally, pain persists when nerves carrying pain signals have become overly sensitive and continue to ‘fire off’ pain signals even though the fracture has healed.
- Joints and ligaments, where spinal bones join together, are put under strain as they try to adapt to the new shape of the spine. Sometimes arthritis in your back may be aggravated by the change in the natural curve of the spine caused by osteoporosis. For more information see our Factsheet on Osteoarthritis and osteopororsis
- Painful muscle spasms can happen with a new spinal fracture due to inflammation around the fracture and the altered stresses and strains on the back muscles caused by the new shape of the spine. However, when a spinal fracture has healed, unfortunately these spasms may still occur because of ongoing muscle strain. Height loss and changes in the natural curves of the spine can over-stretch or shorten some back and torso (chest and abdominal) muscles. These may become easily tired when pulled and strained in ways they are not used to and may be prone to going into spasm. Typically, a spasm can happen when lifting an object, or when pushing, pulling, bending or twisting, such as when using a vacuum cleaner. Occasionally even a small movement can set off a muscle spasm. See below for ways to help with pain.
Pain and pain relief
Acute pain and chronic pain can respond well to pain-relieving medications that are purchased from a chemist or supermarket such as paracetamol, anti-inflammatory medications (such as ibuprofen) and codeine. Sometimes pain is more severe and your doctor will need to prescribe stronger pain-relieving drugs. For more information see our factsheet Living with osteoporosis: Pain relieving drugs after fractures
Learning and using ‘self-help’ strategies can also play a valuable part in helping to lessen the impact of chronic pain that cannot be relieved completely. For more information see our factsheet Living with osteoporosis: Managing persistent pain after fractures
Everyone responds to pain differently so pain relief that works for one person may not be effective for another. Experiencing pain can lead to difficulties with sleeping, low mood and tension, but in turn feeling tired, emotionally low and stressed can make pain more difficult to manage. You may feel everything is improving and then have a set-back. This is common and can be very frustrating. Many tissues around the fracture have been affected so it can take a long time to get back to normal but, in time, most people make a good recovery.
What can I do myself to help relieve chronic back pain caused by a spinal fracture?
There are a number of steps you can take that may help to avoid or relieve chronic pain and back-muscle spasm caused by spinal fractures. Exercises that help with posture and that build muscle strength may also help to reduce pain and increase your sense of wellbeing.
Ways to avoid pain and muscle spasm:
- When planning to lift anything heavy or bulky, allow someone to help you if you can. If you have no option but to lift it yourself, do so by bending your knees and not by bending your back forwards, and hold the object close to your body and not at arm’s length.
- Housework and shopping can be strenuous! Avoid over-stretching when reaching to a high shelf and when pushing or pulling a vacuum cleaner. When hanging out the washing, put the washing basket on a chair or table to avoid repeatedly bending down. Avoid carrying one heavy shopping bag; divide the shopping into two lighter bags held in each hand. If lifting bags from a shopping trolley into your car boot, don’t twist your spine while holding a heavy bag. Instead, hold the bag close to your body rather than at arm’s length and step round to face the boot of the car.
- When sitting, use a rolled-up towel or ‘lumbar roll’ to support your lower back, and keep your knees below the level of your hips.
- If you notice that you are prone to muscle spasm with certain types of moves or activities, try doing some gentle warm-up stretching exercises beforehand (some examples are coming up next). These can help by strengthening over-stretched muscles, improving the blood supply to the area and gradually increasing the length and ‘stretchiness’ of shortened muscles.
- When sitting at a table, try gently sliding your arms from side to side on the table in an arc, keeping your body upright. If lying on your bed, bend your knees with your feet flat on the bed, then gently roll your knees to one side and then the other as far as you can comfortably go – don’t force them to go further. If lying on your front, gently raise your head and shoulders by pushing up with your arms; this can help to build up the back muscles and may ease back pain. These gentle exercises work even better if done after some warmth to help muscles relax, such as a hot water bottle, shower or bath.
For more information on safe lifting techniques and exercises see our booklet Exercise and osteoporosis
When your back is hurting or you are having a muscle spasm:
- Alter your posture or rest for a while using a lumbar support (such as a rolled-up towel) in your lower back. Resist the temptation to curl up and instead gently arch your upper body backwards or try some of the gentle exercises above.
- Apply warmth to the painful area for up to 20 minutes. Use a covered hot water bottle or a microwave-heated wheat bag (making sure you don’t burn yourself), or have a warm bath or shower. Special heat patches and gel packs can be purchased from chemists and supermarkets. Heat therapy has a number of possible benefits. It helps to block some of the pain signals going to the brain and relaxes tight and painful muscles. Heat can also improve the blood supply to the muscles, which may help inflamed or sore muscles and tissues to heal.
- Alternatively, try an ice or cold pack. Use a bag of frozen peas wrapped in a tea towel (to avoid an ice burn) or special reusable ice gel packs, which can be bought from supermarkets or chemists and re-chilled in the freezer. You could even try ice-cold water in a hot water bottle. Another method is to place a damp, folded towel in a plastic bag in the freezer for 10 to 20 minutes. Remove the plastic bag and apply the towel to the painful area. It’s important that ice or cold packs are applied for no longer than 15 minutes at a time to avoid damage to the skin from prolonged exposure, but they can be re-applied every few hours.
- Try a relaxation technique or watch a favourite TV programme. This helps to slow down your breathing, lessen muscle tightness and relax neck and shoulder muscles that have ‘tensed up’ because of pain.
- Try ‘pacing’ your daily activities. This means ‘doing a bit, resting a bit and then doing a bit more’. This allows muscles to have rest periods before they become over-tired and can help reduce the frequency of spasms.
There is no easy solution that will stop all pain, but a good working partnership between you, your family and your GP is a helpful starting point.
Other ways to help relieve pain
It can help to use other therapies or treatments to ease pain either alongside or instead of taking a pain-relieving medication. You may find some of the following useful to try.
Transcutaneous electrical nerve stimulation (TENS) machines
A TENS machine works on the same principle as rubbing an area after it has been hurt. When rubbing sensations are relayed along nerves, the number of pain signals reaching the brain is reduced and this lessens or blocks the feeling of pain. In a similar way, TENS relays tiny electrical signals that block some of the pain signals. It also encourages the body to produce endorphins, a group of chemicals that are the body’s natural pain relievers.
TENS machines are quite small and portable. Some can be clipped to the waistband of a skirt or trousers so movement is not restricted. The machines themselves have wires with small adhesive pads attached that are placed just above and on either side of the painful area, such as the spine, or following a painful nerve pathway such as around the ribs. You will feel a tingling sensation but this should not be painful or unpleasant. The depth and frequency of the tingling pulse can be easily adjusted to suit your own preference and needs. You can often borrow a TENS machine on a trial basis for around four weeks from a physiotherapist or doctor’s surgery. They are also sold in most high street pharmacist shops, and cost around £15 to £20.
If you are having problems getting up and about again following a broken bone, ask your doctor if you can be referred to a physiotherapist. The physiotherapist will assess you to work out what would best help you and show you exercises matched to your abilities and needs.
The purpose of physiotherapy includes:
- improving mobility and independence and generally getting back to normal
- improving balance and muscle strength to reduce the risk of a fall
- improving flexibility, breathing and posture; even if you suffer from severe curvature of the spine, it is possible that appropriate exercises and some activity may bring relief and improvement
- increasing confidence and wellbeing
- helping with pain; physiotherapists can offer a combination of pain-relieving techniques such as TENS machines, acupuncture, hydrotherapy and exercises tailored to your needs.
For more information on safe and helpful exercises, see our Exercise and osteoporosis booklet
Hydrotherapy may be helpful if you have back pain or other difficulties that affect walking and movement. Hydrotherapy is exercise therapy in a warm-water pool, usually within a hospital’s physiotherapy department, with specially trained staff or a physiotherapist supervising the exercises. Usually other people undergoing treatment will share the pool with you.
Hydrotherapy involves slow, controlled movements that help to improve your range of movement and can be particularly helpful in relieving pain. By pushing your arms and legs against the water’s resistance, you can increase muscle strength and balance and improve mobility, and the support of the warm water encourages relaxation of tight muscles and joints.
Your GP or hospital doctor may be able to refer you to your local NHS hydrotherapy department, usually for a course of five or six half-hour sessions. Before you start, you will be seen by the physiotherapist, who will assess your individual needs. You do not need to be able to swim to participate in hydrotherapy. The pool is usually fairly shallow and most have a range of depths so that you can exercise at a depth that suits you. There will be a good supply of floats and a rail around the edge, and you are never left alone as there is always at least one staff member in the pool with you. Even those who feel nervous in swimming pools find hydrotherapy safe, soothing and beneficial. If you have difficulty using the steps into the pool, a mechanical hoist will be available to gently lower you into or out of the water.
Once the course has finished, your physiotherapist may suggest continuing with aqua aerobics in your local swimming pool. This is usually a more strenuous form of exercise and the water will be cooler. Sometimes, it is possible to pay for extra sessions in the hydrotherapy pool, although this may be without the close supervision of a member of staff that you had during the course.
Most complementary therapies have not undergone the rigorous testing and clinical trials expected of conventional medicine so you are unlikely to find proof that they work to reduce pain. However, having gathered sufficient information, you may wish to try complementary therapies as part of your pain-management plan.
Some of the most commonly used therapies are acupuncture, osteopathy, chiropractic therapy, the Alexander Technique, aromatherapy, reflexology, herbal medicine and homeopathy. It is important to let the therapist know if you have had spinal or other fractures or are at high risk of fractures because of osteoporosis. For more information see our Complementary therapies after fractures factsheet.
Courses for self-management of long-term health conditions
As someone with a long-term health condition it’s likely that you spend just a few hours a year with your doctor, and possibly much less than that. The rest of the time you probably manage the effects of fractures by yourself.
A self-management course aims to give you the skills and knowledge to help manage pain, and the symptoms, fatigue and emotional changes linked to pain and living with a longterm health condition. It also aims to empower you to communicate better with your doctor, make decisions about your health, set personal goals, and increase your self-confidence and selfesteem. Ask your doctor whether there is a selfmanagement course in your area, or contact Self Management UK.
If you live with long-term pain from spinal or other fractures, you may have found pain-relieving medications and other ways of managing pain that work for you. If, however, you are having significant problems managing and living with your pain, a referral by your doctor to a pain-management clinic may be helpful.
Pain clinics vary but they usually offer a variety of treatments aimed at relieving long-term pain. These may include pain-relieving medications, injections, hypnotherapy, acupuncture and psychological strategies, although some may focus solely on the control of pain by various types of drug treatments. Each clinic team will be different but may include doctors, nurses, psychologists, physiotherapists and occupational therapists who work together to help people with pain.
Some hospitals run a Pain Management Programme, which is a series of sessions for a small group of people aimed at showing you how to live with your pain and enjoy a better quality of life. Many who attend also enjoy meeting others who are experiencing similar problems.
It’s possible that you may need to wait quite a long time to be seen in one of these clinics or attend one of these programmes. Your GP may be able to tell you how long the waiting list is in your area. For more information see our Managing persistent pain after fractures factsheet.
Surgery to help with pain
There are surgical techniques called percutaneous vertebroplasty and balloon kyphoplasty that may help with the pain of spinal fractures in a few specific situations. However, surgery is not suitable for the majority of people with spinal fractures. For more information see our Percutaneous vertebroplasty and balloon kyphoplasty and osteoporosis.