Lumbar vertebral fracture

A vertebral fracture is a break or collapse of a bone in the spine. It mainly affects people with bones weakened by osteoporosis or who have suffered significant trauma. This injury causes acute back pain, changes in posture, and functional limitations. It requires a complete medical evaluation and structured rehabilitation, including physical therapy to manage pain, restore mobility through safe, progressive exercises, strengthen supporting muscles, and implement fall prevention strategies. To understand how spinal fractures differ from other back problems, see our comprehensive guide to back pain.

What is a vertebral compression fracture?

A vertebral compression fracture occurs when a bone in the spine collapses or caves in, losing more than 15-20% of its normal height. This type of fracture mainly affects the thoracolumbar junction (T11-L2) in people with bones weakened by osteoporosis^.

The spine is made up of bones called vertebrae. Each vertebra has a hard outer shell (cortical bone) and a spongy interior (trabecular bone). The spongy bone gives the vertebra strength while keeping it light. When too much pressure is applied, this interior collapses. This mechanism occurs mainly in the front part of the vertebra during flexion movements^.

The thoracolumbar junction (T11-L2) suffers the most fractures because it represents a transition zone between the rigid thoracic spine and the mobile lumbar spine. This region is subject to a great deal of mechanical stress during daily activities.⁵ The middle thoracic spine (T6-T8) also shows a high risk in people with lumbar osteoarthritis and osteoporosis. Multiple fractures can cause excessive forward curvature called kyphosis (hunchback) and progressive loss of height.

What causes spinal fractures?

Osteoporosis causes the majority of vertebral fractures, accounting for approximately 700,000 fractures per year in the United States. Postmenopausal women are 2 to 3 times more at risk than men, and the risk increases significantly after age 60.^7,8

The main causes include:

Osteoporosis (fragility fractures)A healthy young adult has bones that can withstand 6,000-8,000 Newtons of force. Advanced osteoporosis reduces this resistance to less than 2,000 Newtons.⁹ Fractures can occur during everyday activities such as coughing, sneezing, or bending forward. High-energy traumaFalls from height, car accidents, and sports injuries generate sufficient force to fracture even healthy vertebrae in young adults.¹⁰ Pathological conditionsCancer can spread to the spine (metastasis), creating areas of bone destruction that are vulnerable to fractures. Breast, lung, prostate, and kidney cancers frequently spread to the spine.¹¹ Repetitive loading: Stress fractures affect certain athletes who practice gymnastics, rowing, or weight training.¹⁴

Category	Risk factors
Age and gender	Advanced age (especially after age 60), female gender (2-3 times higher risk)
History	Anterior vertebral fracture (5 times higher risk), family history of osteoporosis
Medications	Prolonged use of corticosteroids (prednisone, cortisone)
Lifestyle	Smoking, excessive alcohol consumption, sedentary lifestyle, low body weight
Nutrition	Vitamin D deficiency, insufficient calcium intake

The good news? Most spinal fractures heal well with proper care. Your body has a remarkable ability to repair bone.

What are the symptoms of a vertebral fracture?

Vertebral fractures cause sudden and intense back pain (7-10/10) at the fracture site, aggravated by movement and relieved by resting in a lying position. Chronic symptoms include progressive loss of height and stooped posture^.

Acute symptomsThe pain peaks within a few hours after the fracture. Patients describe sharp, stabbing, or crushing pain. They can often pinpoint the exact moment of injury. Worsening of painLeaning forward, getting up from a chair, and rolling over in bed increase the pain. Lying on your back with proper support provides partial relief. Chronic symptomsEach fracture can reduce the total height by 1-2 centimeters.¹⁷ Multiple fractures cause cumulative loss of height and progressive thoracic kyphosis (appearance of a "hunchback").¹⁸ Severe kyphosis reduces the volume of the rib cage, potentially causing shortness of breath during exertion, with a reduction of approximately 9% in lung volume for each thoracic fracture.²⁰ Silent fracturesApproximately one-third of vertebral fractures remain clinically silent, discovered incidentally during imaging for other reasons.²²

Rest assured: even if the pain is intense at first, it usually decreases significantly within the first few weeks. It's normal to feel limited at first. With time and the right exercises, you will regain your mobility.

How are spinal fractures diagnosed?

The diagnosis combines X-rays showing loss of vertebral height, an MRI distinguishing acute from chronic fractures, and a DEXA scan assessing underlying osteoporosis. The TLICS classification guides decisions on conservative or surgical treatment^.

X-rays: Lateral views show loss of vertebral body height and fracture lines. A loss of height exceeding 15-20% indicates a fracture. Genant classificationGrade 1 (mild): 20-25% loss of height. Grade 2 (moderate): 25-40%. Grade 3 (severe): more than 40%.²⁴ MRI (Magnetic Resonance Imaging)MRI definitively identifies acute fractures based on bone marrow edema patterns visible for 6-12 weeks after injury.²⁵ It also differentiates between benign osteoporotic fractures and pathological fractures caused by cancer.²⁶ DEXA test (bone density)T scores between -1.0 and -2.5 indicate osteopenia (low bone mass). T scores below -2.5 define osteoporosis. Each one-standard deviation decrease in bone density approximately doubles the risk of fracture.^27,28

Which imaging technique best shows spinal fractures?

MRI demonstrates superiority in detecting acute fractures, determining fracture age, and identifying pathological fractures through visualization of soft tissue that is not possible with X-rays or CT scans.²⁹

How are fractures classified for treatment?

The TLICS (Thoracolumbar Injury Classification and Severity) classification system assesses fracture morphology, ligament integrity, and neurological status. Scores below 4 typically warrant conservative management, while scores above 4 indicate a potential benefit from surgery.³⁰

How does physical therapy help with recovery from spinal fractures?

Physical therapy guides recovery through three distinct phases: acute pain management (0-4 weeks), progressive mobilization (4-8 weeks), and strengthening (8-16 weeks). It includes safe exercises, education on body mechanics, and fall prevention strategies.

To learn more about how physical therapy effectively treats back pain, visit our page on services for the back region.

Phase	Deadline	Objectives and interventions
Acute	0-4 weeks	Pain management, positioning (pillows under knees), body mechanics, transfer techniques
Subacute	4-8 weeks	Gradual walking, gentle range-of-motion exercises, beginning extension exercises
Consolidation	8-16 weeks	Progressive strengthening, resistance, balance training, fall prevention

Fall prevention ^programs reduce fall rates by approximately 25% in older adults.

You are not alone in this challenge. Our physical therapists will support you every step of the way, adjusting the exercises to suit your comfort level.

How long does it take for spinal fractures to heal?

Vertebral fractures typically heal within 12-16 weeks. Acute pain decreases significantly after 4-6 weeks. Bone healing goes through inflammatory, reparative^, and remodeling phases over 3-12 months.

Pain trajectorySevere acute pain dominates the first 2-4 weeks, then gradually decreases. Most patients experience a substantial reduction at 6-8 weeks.⁴¹ Approximately 30% of patients report persistent pain beyond 12 months.⁴² Risk of cascade fracturesPatients with a vertebral fracture face a risk approximately 5 times higher of additional vertebral fractures and a risk 2 times higher of hip fractures.⁴⁵

Everyone heals at their own pace. If your recovery takes longer than expected, don't be discouraged. Your physical therapist will adjust your program according to your individual progress.

What exercises are safe after a spinal fracture?

Safe exercises include walking with good posture, isometric core strengthening, spinal extension exercises, and balance training. Initially, bending forward and twisting while carrying weight should be avoided.

Walk: The safest and most beneficial exercise early on. Maintain an upright posture and avoid leaning forward.⁴⁶ Start with 5-10 minutes, then gradually increase to 30 minutes daily over 6-8 weeks. Isometric exercises: Muscle contraction without joint movement, safe during acute phases. Abdominal bracing (gentle contraction of the transverse abdominis muscle) and gluteal squeezes are particularly recommended.⁴⁷ Hold for 5-10 seconds, repeat 10 times. Extension exercises: Positioning in the prone position (face down) for 10-15 minutes daily provides gentle passive extension.⁴⁸ Active exercises include prone lifts (cobra pose), wall angels, and chin tucks. Progressive resistance training: Begins approximately 8-12 weeks after the fracture.⁴⁹ Progression of body weight to elastic bands to light free weights. Balance training: Single-leg stance (on one leg), tandem walking (heel-toe), weight transfer exercises, and gentle tai chi movements.⁵¹ Start with stable support (hold onto the counter), then progress to challenges without support. To be avoided initiallyForward bending under load, twisting under load, high-impact activities.

How can future spinal fractures be prevented?

Pre^vention combines treatment for osteoporosis (bisphosphonates reduce the risk by 50-70%), calcium supplementation (1200 mg) and vitamin D (800-1000 IU), regular weight-bearing exercise, and fall prevention strategies.

Strategy	Recommendations
Medications	Bisphosphonates (alendronate, risedronate), denosumab, anabolic agents (teriparatide)
Supplements	Calcium 1200mg/day, vitamin D 800-1000 IU/day, magnesium
Exercise	Daily exercise (walking, stairs), weight training 2-3 times a week
Fall prevention	Home safety, vision correction, medication review, balance exercises
Lifestyle	Quit smoking, limit alcohol, maintain a healthy weight, adequate protein intake

Medications for osteoporosisBisphosphonates (alendronate, risedronate) reduce the risk of vertebral fracture by 50-70%.⁵³ Anabolic agents (teriparatide, romosozumab) demonstrate an even greater reduction of 65-85% in severe cases.⁵⁴ Exercise for bone health: Weight-bearing activities (walking, climbing stairs, dancing) stimulate bone formation.⁵⁷ Resistance training 2-3 times per week at moderate to high intensity improves bone density.⁵⁸ Fall preventionHome safety assessments eliminate hazards (loose rugs, poor lighting). Vision correction and medication reviews also reduce the risk of falls.⁵⁹

When are procedures such as vertebroplasty considered?

Vertebroplasty is considered for painful fractures that do not respond to 4-6 weeks of conservative treatment. This bone cement injection offers potential relief, but controlled studies show mixed results^.

Vertebroplasty: Percutaneous injection of bone cement (PMMA) into the fractured vertebral body under fluoroscopic guidance to stabilize the fracture.⁶³ Kyphoplasty: Adds an initial step of inflating a balloon inside the vertebral body to attempt to restore height before cement injection.⁶⁴ EffectivenessInitial studies suggested dramatic relief in 75-90% of patients.⁶⁷ However, two placebo-controlled trials published in 2009 showed no significant benefit compared to a sham procedure.⁶⁸ Subsequent studies suggest modest benefits in carefully selected patients.⁶⁹

The decision requires an individualized assessment weighing the potential benefits against the risks, considering the severity of the pain, the characteristics of the fracture, and the response to conservative treatment.

What are the long-term effects of spinal fractures?

Long-term effects include chronic pain (30% of patients beyond one year), progressive deformity with kyphosis and loss of height, reduced lung function, and a fivefold increase in the risk of future vertebral fractures.^72,77

Chronic painPersists beyond the expected recovery time in approximately 30% of patients. Management approaches include ongoing exercise, postural training, and manual therapy.⁷² Spinal deformityProgressive thoracic kyphosis shifts the center of gravity forward, requiring compensatory postural adjustments and increased muscular effort.⁷³ Reduced lung capacityApproximately 9% reduction in vital capacity for each thoracic vertebral fracture.⁷⁵ Fracture cascadePatients face an approximately 5 times higher risk of subsequent vertebral fractures and a 2 times higher risk of hip fractures. The period of highest risk occurs in the first year following the initial fracture, highlighting the importance of immediate aggressive treatment of osteoporosis.^77,78

^Patients receiving coordinated multidisciplinary care (medical treatment, physical therapy, nutritional optimization) demonstrate superior outcomes.

Ready to recover from your spinal fracture?

Our physical therapists at Physioactif provide specialized rehabilitation for spinal fractures. We combine safe, progressive exercises tailored to each phase of healing, pain management strategies, and education on fracture prevention.

Our team helps you regain function, prevent future fractures through evidence-based training for bone health and balance, and maintain your independence through individualized treatment protocols.

The rehabilitation process requires patience as bone healing progresses over several months. Consistent participation in appropriately designed exercise programs yields significant benefits in pain reduction, functional restoration, and prevention of future fractures.

Contact Physioactif today to schedule your assessment and begin your structured rehabilitation program.

References

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