Can You Walk With a Fractured Back? (+ PT’Tips)

What do the general recommendations say about walking after a vertebral compression fracture?

An Australian research team 🇦🇺 has recently delved into the matter of resuming walking after vertebral compression (Parreira 2017).

By making the following observation: there are arguments IN FAVOR of immediately resuming walking and arguments AGAINST it.

Here they are.

✅ The ARGUMENTS IN FAVOR

Resuming walking immediately after a pelvic fracture would be a good thing because:

• It reduces the risk of complications associated with not walking for several weeks (constipation, phlebitis, muscle loss, etc.).
• Walking can create micro-movements at the fracture site, stimulating bone healing.
• Walking can lead to a quicker functional recovery, a faster return to work and leisure activities.
• Patients often do not comply with non-walking instructions. Nevertheless, there are few complications observed with these earlier-than-recommended walking resumptions.

❌ The ARGUMENTS AGAINST

However, there are theoretical disadvantages to immediately resuming walking after a vertebral compression.

• Walking can exert too much stress on the fractured area and ligaments, increasing the risk of improper consolidation and healing.

What can be concluded?

The Australian team has read and analyzed all the best practice recommendations for the treatment of vertebral fractures with compression. They found four recommendations from three different countries.

Here’s what she found for walking and bed rest after vertebral compression:

Two good practice recommendations advised strict bed rest after vertebral compression. They relied on low-quality evidence to make this recommendation.

Parreira 2017

The recommendations in question were from the American Academy of Orthopedic Surgeons (United States, 2010) and the National Institute for Health and Care Excellence Guidelines (United Kingdom, 2013).

The bed rest duration was approximately 6 weeks, pending a follow-up X-ray.

But the other two recommendations included in the study (from American and Canadian radiologist associations) did NOT recommend bed rest! They advised to resume walking immediately.

How to know if you can walk in YOUR case and when?

Normally, the healthcare professional who diagnosed your vertebral compression (doctor or surgeon) should have given you clear information on this.

Both verbally and in writing, such as in your medical records, hospitalization report, emergency room visit, or surgical notes.

As a physical therapist, we typically encounter two types of patients:

Patients who are prohibited from walking for several weeks. These are, in the vast majority of cases, younger patients.

These patients often go to a rehabilitation center, especially if they live alone. They are often not allowed to sit and may be semi-upright at about 30 to 60 degrees of trunk inclination at most. Walking is usually permitted after a follow-up X-ray several weeks after the initial one.

Even if you are bedridden, there are several things you can do to maintain your muscle strength, joint mobility, and cardiovascular health, such as adapted muscle strengthening exercises and arm cycling.

Patients who are allowed to walk immediately, and this group is more common.

These patients often have less severe fractures, simpler, less displaced, as the trauma was less significant. They are typically older individuals for whom staying immobile would pose too many risks of complications.

Data from clinical studies increasingly suggest that some healthcare recommendations are overly conservative, pushing too much for caution and avoiding the risks associated with walking. There are risks associated with bed rest as well!

You may have encountered contradictory information about resuming walking after your vertebral compression.

If the instructions given to you seem overly restrictive, discuss this with your physical therapist, doctor, or surgeon. Ask them for their reasons to apply such restrictive guidelines in your case and what the risks might be if you were to deviate slightly from them or be more flexible.

How to walk with a compressed vertebra in your back if walking is permitted?

If you are allowed to walk, there are no specific precautions you need to take.

You can walk as you normally would, as long as the pain is manageable.

Often, you’ll require a walking frame, crutches, or a walker to alleviate back pain.

There is no maximum walking distance to adhere to. It’s a good idea to gradually increase your walking distance each day, based on how you feel.

Physical therapists in rehabilitation centers, at home, or in private practices are available to help you gradually regain your normal walking ability.

How to resume walking after a period of bed rest?

If you have been bedridden or without weight-bearing for several weeks or even months after a vertebral compression diagnosis, here are some tips for resuming walking, although generally, you should be supervised by a physical therapist for at least a few sessions.

Getting back on your feet for the first time

If you have been lying down for an extended period, the idea is to gently reacclimate your body to two things:

• To be upright
• To move.

For your first time standing after an extended period of bed rest, follow these steps:

1. Sit for a few minutes (if you have been strictly lying down for several weeks).
2. Then, stand up with a sturdy support, and have someone nearby in case you experience any dizziness from being upright for the first time.

Resuming walking with support

When resuming walking with support, it should be done gradually based on your feelings and any pain you may experience. You will likely need a walker or crutches for at least a few days.

You can increase the distances you walk over the days, starting on flat surfaces and then including uphill and downhill walks. You can also tackle stairs, as this engages your muscles and cardiovascular system differently.

If you experience pain during the night or the day after, adjust your activity levels. Reduce your activity slightly the next day, and then gradually increase the frequency or intensity in the following days.

How long does it take to walk normally after a vertebral compression fracture?

Most often, my patients who have experienced a vertebral compression fracture regain a “normal” walking pattern more quickly than those who have had a lower limb fracture.

Some people are able to walk comfortably within 2 to 3 weeks.

Others may require 1 to 2 months to return to a normal walking pattern, but rarely more.

In cases of multiple vertebral compression fractures partly due to osteoporosis, long-term changes in walking may occur.

Here are some additional insights from studies that track the recovery of individuals who have experienced vertebral compression fractures.

People who have had one or more osteoporotic vertebral compression fractures often experience altered walking patterns for over 6 months compared to people of the same age without fractures: their steps are shorter, quicker, and more spread out. However, improvement is possible, and a return to a normal walking pattern can be achieved (Jacobs 2020).

Another study observes that walking is slowed down in women with at least two vertebral compression fractures compared to those without fractures, but not in those with only one (Arima 2017).