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Kathleen Boone instructs Carolyn Marie of Biloxi in appropriate exercises for people with osteoporosis. Instruction also includes what not to do — exercises like abdominal crunches and sit ups, which could cause injury in osteoporsis patients.

When physical therapist Miriam Deemer began the gentle work of unfurling elderly women's curved-over spines, she was met with a measure of hesitation among the doctors overseeing their care.

"They thought these patients were too fragile or beyond help," said Deemer, director of rehabilitation services, wound care and hyperbarics at Biloxi Regional Therapy Center.

"For a lot of physicians, when they saw these patients with extreme curving of the spine, they assumed the disease had progressed to the point that there was nothing physical therapy could do," she said.

That would have been the case, Deemer said, before she and physical therapy assistant Kathleen Boone sought training in 2004 in the methods of Sara Meeks. The Gainesville, Fla., based physical therapist offers seminars in the method she developed to stop and even reverse patterns of postural change, which come about with age and particularly through osteoporosis.

"We have come back and trained our staff in this method," Deemer said. "Sara Meeks teaches a wonderful program, but once you have the knowledge, you can share it with others."

The method begins with an assessment of each patient to understand the level of postural dysfunction they're already experiencing.

"Some come to us and may not be showing postural deformity yet, but are having pain and have the diagnosis of osteoporosis," Deemer said. "Another may come in and have had osteoporosis for 15 years and have already had compression fractures in the spine and developed a pretty major curve. For those, we start out very gently."

In either case, the exercises begin from the safe posture of supine, working first on the back extensor muscles.

"We focus on strengthening those muscles and getting that patient to learn, what is normal posture?" Deemer said. "If they have been in incorrect posture for a long time, what is 'standing up straight' to them is not truly straight."

For patients like those, it often takes pillow props to support the curve in their spine until they progress to the point where they are able to lay flat on a mat. Those with more advanced problems may need 12 to 20 sessions with a therapist in order to see real postural improvement, while those proactive osteoporosis patients who come in for treatment as chiefly a preventive measure see progress in as few as six sessions.

Treating — or better yet avoiding — the slow onset of a hunched back is far more than an aesthetic concern for an aging population. Since a forward bend compresses the internal side of the spine, it contributes to compression fractures — which in turn worsens postural dysfunction in a vicious cycle.

Hunching over also begins to alter a patient's breathing and digestive system, in addition to changing balance and increasing the risk of falls, Deemer said.

Among osteoporosis patients who've seen benefit to the treatment her team is now offering, even those in wheelchairs have been helped, she said.

"The difference may not be the same as for a person who came in at a higher level," she said. "But we may be able to reduce their pain, teach them how to safely move and show their family how to position them in a way that gives them more comfort and doesn't add to the deformity."

The only group that has not benefited from the approach are those with cognitive impairments, she said.

"There has to be a certain level of understanding for the program we teach," she said. "What we do in clinic is a big part, but they also have to be able to go home and apply it."

Treatment of osteoporosis patients with a focus on postural correction makes up about 5 percent of the clients Deemer and her team see at the outpatient rehabilitation clinic.

The growth in physical therapy treatment for osteoporosis comes about both as America's population ages — but also as women become more proactive about their own health.

"If they feel like there's a service they need, they're really vocal with their physicians," said physical therapist Susan Geiger, manager of growth and development for outpatient services with Methodist Rehabilitation Center in the Jackson area.

At MRC clinic locations, the growing focus on working with aging women came as Geiger began receiving referrals of early-diagnosis osteoporosis patients from Kathy Gregg MD, a specialist in geriatrics at the University of Mississippi Medical Center.

"She wanted to get them actively involved in an exercise program with weight-bearing activities," Geiger said. "Walking itself is an excellent one. All you need is a really good pair of tennis shoes and maybe a walking partner, and there you go."

At the same time, though, assessing patients for fall risks has also become a key part of therapists' work with osteoporosis patients.

Geiger, who has undergone special training in the area of balance issues, spends time with patients to gauge any problems that may make the patient more likely to suffer a fall. Her assessment and subsequent therapy techniques focus on inner ear issues, on the level of sensation in the feet and legs, and whether vision defects like glaucoma or cataracts may be setting a patient up for a fall.

"We also do education in the home, looking at the layout of the home and whether they have things like grab bars and skid mats in the bathtub or shower," she said. "We also want to make sure they have appropriate footwear — especially for ladies who still want to wear high heels."

As physical therapy for osteoporosis becomes an increasingly important part of treatment strategies, MRC clinics today are seeing a couple of patients each month for specialized help in this area.

"We're finding more physicians who realize we're working with patients like that," Geiger said, adding that the MRC clinic location at Fitness Lady health club in Ridgeland has been a source of interest in the program.

"If they're members of Fitness Lady, the ladies do talk," Geiger said. "They realize, 'Hey, you're getting some therapy for that?'"

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