# 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 [complete guide to back pain](/complete-guide/back-pain-complete-guide). ## What is a spinal 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 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 receives a lot of mechanical stress during daily activities.^5^ The middle of the thoracic spine (T6-T8) also shows a high risk in people with lumbar osteoarthritis and osteoporosis. Multiple fractures can create excessive forward curvature called kyphosis (hunchback) and progressive loss of height. ## What causes vertebral 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. 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 trauma**: Falls from heights, car accidents, and sports injuries create forces sufficient to fracture even healthy vertebrae in young adults.^10^ **Pathological conditions**: Cancer 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 some athletes who practice gymnastics, rowing, or weight training.

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 spinal fracture? Spinal fractures cause sudden, intense back pain (7-10/10) at the fracture site, which is aggravated by movement and relieved by lying down. Chronic symptoms include progressive loss of height and a hunched posture. **Acute symptoms**: Pain peaks within a few hours after the fracture. Patients describe sharp, stabbing, or crushing pain. They can often identify the exact moment of injury. **Worsening pain**: Leaning forward, getting up from a chair, and rolling in bed increase pain. Lying on the back with proper support provides partial relief. **Chronic symptoms**: Each fracture can reduce total height by 1-2 centimeters.^17^ Multiple fractures create cumulative height loss 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 fractures**: Approximately one-third of vertebral fractures remain clinically silent, discovered incidentally during imaging for other reasons. Rest assured: even if the pain is intense at first, it usually decreases significantly in the first few weeks. It is normal to feel limited at first. With time and the right exercises, you will regain your mobility. ## How are vertebral fractures diagnosed? The diagnosis combines X-rays showing loss of vertebral height, an MRI distinguishing acute from chronic fractures, and a DEXA test assessing underlying osteoporosis. The TLICS classification guides decisions about 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 classification**: Grade 1 (mild): 20-25% height loss. Grade 2 (moderate): 25-40%. Grade 3 (severe): more than 40%.^24^ **MRI (Magnetic Resonance Imaging)**: MRI definitively identifies acute fractures through bone marrow edema patterns visible for 6-12 weeks post-injury.^25^ It also differentiates between benign osteoporotic fractures and pathological fractures caused by cancer.^26^ **DEXA (bone density) test**: 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. ### Which imaging technique best shows vertebral fractures? MRI is superior for detecting acute fractures, determining the age of the fracture, and identifying pathological fractures by visualizing soft tissue, which is not possible with X-rays or CT scans.^29^ ### How are fractures classified for treatment? The Thoracolumbar Injury Classification and Severity (TLICS) 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 aid 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

**Acute phase (0-4 weeks):** Physical therapists teach proper positioning with pillows under the knees while lying down to reduce stress on the spine.^32^ Block rolling techniques for mobility in bed and using armrests to get up from chairs protect the healing vertebrae.^33^ **Subacute phase (4-8 weeks)**: Walking is the fundamental exercise. It promotes bone loading to stimulate healing while maintaining cardiovascular fitness.^35^ Range of motion exercises begin at pain-free ranges. **Consolidation phase (8-16 weeks)**: Resistance exercises target the paraspinal muscles (spinal erectors, multifidus), trunk stabilizers (transverse abdominis), and hip extensors (gluteus maximus).^36^ Fall prevention programs reduce fall rates by approximately 25% in older adults.^38^ You are not alone in this challenge. Our physical therapists will support you every step of the way, adjusting the exercises to your comfort level. ## How long does it take for spinal fractures to heal? Spinal fractures typically heal in 12-16 weeks. Acute pain decreases significantly after 4-6 weeks. Bone healing goes through inflammatory, reparative, and remodeling phases over 3-12 months.^39,40^ **Inflammatory phase (0-2 weeks)**: Hematoma formation at the fracture site and infiltration of inflammatory cells. This is the period of most intense pain. **Repair phase (2-12 weeks)**: Formation of soft callus transitioning to hard callus as osteoblasts deposit new bone. The vertebra gradually stabilizes. **Remodeling phase (3-12 months)**: Gradual remodeling of the bone to optimize architecture and restore structural integrity.^40^ **Pain trajectory**: Severe 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 fractures:** Patients with a vertebral fracture face an approximately 5 times higher risk of additional vertebral fractures and a 2 times higher risk of hip fractures. Each person 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. Forward bending and twisting under load should be avoided initially. **Walking**: 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 at 6-8 weeks. **Isometric exercises**: Muscle contraction without joint movement, safe during acute phases. Abdominal bracing (gentle contraction of the transverse abdominis) and gluteal squeezes are particularly recommended.^47^ Hold for 5-10 seconds, repeat 10 times. **Extension exercises**: Lying prone (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**: Begin approximately 8-12 weeks after fracture.^49^ Progress from body weight to elastic bands to light free weights. **Balance training**: Single-leg stance, heel-toe walking, weight transfer exercises, and gentle tai chi movements.^51^ Start with stable support (hold onto the counter), then progress to challenges without support. **Initially avoid**: Forward bending under load, twisting under load, high-impact activities. ## How can future vertebral fractures be prevented? Prevention combines osteoporosis treatment (bisphosphonates reduce risk by 50-70%), calcium supplementation (1200mg) and vitamin D (800-1000 IU), regular weight-bearing exercise, and fall prevention strategies.^53^

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

**Médicaments pour l'ostéoporose**: Les bisphosphonates (alendronate, risédronate) réduisent le risque de fracture vertébrale de 50-70%.^53^ Les agents anaboliques (tériparatide, romosozumab) démontrent une réduction encore plus grande de 65-85% dans les cas sévères.^54^ **Exercice pour la santé osseuse**: Les activités avec mise en charge (marche, montée d'escaliers, danse) stimulent la formation osseuse.^57^ L'entraînement en résistance 2-3 fois par semaine avec intensité modérée à élevée améliore la densité osseuse.^58^ **Prévention des chutes**: Les évaluations de sécurité à domicile éliminent les dangers (tapis lousses, mauvais éclairage). La correction de la vision et la révision des médicaments réduisent aussi le risque de chutes.^59^ ## Quand considère-t-on des procédures comme la vertébroplastie? La vertébroplastie est considérée pour les fractures douloureuses ne répondant pas à 4-6 semaines de traitement conservateur. Cette injection de ciment osseux offre un soulagement potentiel, mais les études contrôlées montrent des résultats mitigés.^65^ **Vertébroplastie**: Injection percutanée de ciment osseux (PMMA) dans le corps vertébral fracturé sous guidage fluoroscopique pour stabiliser la fracture.^63^ **Cyphoplastie**: Ajoute une étape initiale de gonflage d'un ballon à l'intérieur du corps vertébral pour tenter de restaurer la hauteur avant l'injection de ciment.^64^ **Efficacité**: Les études initiales suggéraient un soulagement dramatique chez 75-90% des patients.^67^ Cependant, deux essais contrôlés par placebo publiés en 2009 ne montraient aucun bénéfice significatif par rapport à une procédure simulée.^68^ Les études subséquentes suggèrent des bénéfices modestes chez les patients soigneusement sélectionnés.^69^ La décision nécessite une évaluation individualisée pesant les bénéfices potentiels contre les risques, en considérant la sévérité de la douleur, les caractéristiques de la fracture et la réponse au traitement conservateur. ## Quels sont les effets à long terme des fractures vertébrales? Les effets à long terme incluent la douleur chronique (30% des patients au-delà d'un an), la déformation progressive avec cyphose et perte de hauteur, la fonction pulmonaire réduite et un risque 5 fois plus élevé de fractures vertébrales futures.^72,77^ **Douleur chronique**: Persiste au-delà des délais de guérison attendus chez environ 30% des patients. Les approches de gestion incluent l'exercice continu, l'entraînement postural et la thérapie manuelle.^72^ **Déformation de la colonne**: La cyphose thoracique progressive déplace le centre de gravité vers l'avant, nécessitant des ajustements posturaux compensatoires et un effort musculaire augmenté.^73^ **Capacité pulmonaire réduite**: Approximativement 9% de réduction de la capacité vitale pour chaque fracture vertébrale thoracique.^75^ **Cascade de fractures**: Les patients font face à un risque environ 5 fois plus élevé de fractures vertébrales subséquentes et 2 fois plus élevé de fracture de hanche. La période de risque la plus élevée se produit dans la première année suivant la fracture initiale, soulignant l'importance du traitement agressif immédiat de l'ostéoporose.^77,78^ Les patients recevant des soins multidisciplinaires coordonnés (traitement médical, physiothérapie, optimisation nutritionnelle) démontrent des résultats supérieurs.^81^ ## Prêt à récupérer de votre fracture vertébrale? Nos physiothérapeutes chez Physioactif fournissent une réadaptation spécialisée des fractures vertébrales. Nous combinons des exercices progressifs sécuritaires adaptés à chaque phase de guérison, des stratégies de gestion de la douleur et une éducation sur la prévention des fractures. Notre équipe vous aide à récupérer votre fonction, prévenir les fractures futures grâce à l'entraînement basé sur les données probantes pour la santé osseuse et l'équilibre, et maintenir votre indépendance à travers des protocoles de traitement individualisés. Le processus de réadaptation nécessite de la patience à mesure que la guérison osseuse progresse sur plusieurs mois. La participation constante dans des programmes d'exercice conçus appropriément produit des bénéfices significatifs dans la réduction de la douleur, la restauration fonctionnelle et la prévention de fractures futures. Contactez Physioactif aujourd'hui pour planifier votre évaluation et commencer votre programme de réadaptation structurée. ## Références 1. Ballane G, et al. Worldwide prevalence and incidence of osteoporotic vertebral fractures. Osteoporos Int. 2017;28(5):1531-1542. 2. Hulme PA, et al. Vertebroplasty and kyphoplasty: a systematic review. Spine. 2006;31(17):1983-2001. 5. Wood KB, et al. Management of thoracolumbar spine fractures. Spine J. 2014;14(1):145-164. 7. Johnell O, Kanis JA. Worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726-1733. 8. Cosman F, et al. 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