Twenty-four bones, called vertebrae, make up the entire spine. There are seven cervical (neck) vertebrae, 12 thoracic (upper and middle back) vertebrae, and five lumbar (lower back) vertebrae.

A simple activity like bending to lift an object or twisting can cause a compression fracture. Even coughing, laughing, or sneezing can cause a compression fracture in someone with weakened bones. These small compression fractures can cause the spine to lose height and stability over time. Fractures can weaken the entire spine.

Compression fractures often cause the bone in the front of a vertebra to break down. The back portion of the vertebra remains solid. This frontal breakdown causes the upper spine to round forward. This rounded posture is a condition known as thoracic hyperkyphosis, or “dowager’s hump.”

A spinal compression fracture also may be caused by trauma to the spine. Events that may cause trauma to the spine can include:

• A car accident.
• A hard fall or a fall from a height of more than 15 feet, landing on the feet.
• A blow to the head.

Any fall from a standing height that results in a spinal compression fracture or any other fracture most likely indicates weak bones due to osteoporosis.

Physical therapy begins as soon as possible after the compression fracture is stable (as determined by a physician). Physical therapists help people with spinal compression fractures:

• Reduce their back pain.
• Improve their flexibility and strength.
• Improve their posture.
• Increase their overall function.
• Reduce their risk of falling to help lessen the chance of future fractures.

The symptoms of a spinal compression fracture are often overlooked. They can be dismissed as common back pain that occurs with a muscle strain or with aging. About two-thirds of nontraumatic compression fractures of the spine go untreated. If you have a spinal compression fracture, you may experience:

• Back pain that occurs suddenly or worsens over time.
• Pain or numbness in the legs.
• Back pain that gets worse with standing and walking.
• Pain felt with coughing, sneezing, laughing, or breathing deeply.
• Back pain that improves with lying down.
• Pain and difficulty with bending or twisting.
• Tenderness over a specific area of the spine.
• A stooped-over posture.
• Loss of overall height.

In severe cases people with spinal compression fractures may have:

• Difficulty walking.
• Loss of bowel and/or bladder control.
• Inability to move the legs (paralysis).

A physician may order one or more tests to determine if a spinal compression fracture has occurred. They may include:

• Spinal X-rays.
• A special side-view X-ray (Vertebral Fracture Assessment).
• Bone density testing to measure the thickness of the bone.
• CT scan or MRI imagery (in severe traumatic cases).

Your physical therapist will perform a complete evaluation. They will gather information about your past medical history, medications you may be taking, and your current symptoms. Your regular daily activities and exercise regimen will be discussed. Your physical therapist will use this information to design a treatment plan specific to your personal needs and goals.

When you experience a spinal compression fracture, it is very important to start physical therapy immediately. If you are in too much pain to travel to an outpatient clinic, you can receive home care or start physical therapy in the hospital. Your physical therapist will immediately teach you safety measures to protect your spine. This information can help prevent more fractures of nearby bones. If needed, they will also fit you for a brace for additional support.

Your physical therapist also will perform a physical examination of your spine. They may touch places along your spine to locate any areas of pain or tenderness, and check your spinal movements. They will test the strength in your spine, legs, and shoulders, and check your balance.

A compression fracture rarely requires surgery. In more severe cases, a surgeon may perform a procedure (vertebroplasty or kyphoplasty) injecting medical cement into the collapsed vertebra to give it support.

It may take weeks or months for a spinal compression fracture to heal. During the healing process, your doctor may recommend that you:

• Wear a back brace.
• Take bone-healing medications.
• Reduce your overall activity level for a short time.
• Avoid intense activities, depending on the severity of the fracture

While you heal and your activity is limited, muscles in the core, hips, and back can become weak. This weakness can make it difficult to resume your regular activities. It may also increase your risk for falls. It is important to help the muscles of the trunk and legs stay strong as you heal. Your physical therapist can help.

Your physical therapy treatment may include:

Pain reduction. Your physical therapist may use different treatments, technologies, and manual (hands-on) therapy to control and reduce your pain. These treatments can help you avoid the need for pain medications, including opioids.

Movement guidance. Your physical therapist will teach you what movements and exercises to gently perform, and not to perform. Avoiding certain movements will promote healing and help prevent future fractures or collapse of the vertebrae.

Flexibility exercises. Your physical therapist may teach you gentle spinal range-of-motion exercises for the neck, middle, and low back, and the hip and shoulder areas.

Strengthening exercises. Your physical therapist will prescribe gentle exercises to help stimulate your bone strength and straighten the curve of your middle back. These may include upper- and lower-body, stomach, and back muscle-strengthening activities.

Posture and spine sparing. Your physical therapist will teach you how to maintain safe posture and spinal positions. This will protect the vertebrae from undue stress when you sit, stand, walk – and even while you sleep. You also will learn proper ways to perform tasks at home, such as bending and lifting.

Fall prevention. Your physical therapist will teach you exercises to improve your balance and steady your walking to prevent falls. You may be instructed in the use of a walker or cane for temporary support as you recover. You may learn how to do gentle exercises on a variety of surfaces. You also will learn ways to make changes to your home to make it safer and reduce the risk of a fall.

Home-exercise program. Your physical therapist will design a personalized home-exercise program just for you. Continuing the program at home after you have completed your formal physical therapy sessions will help you stay strong and avoid further injury.

There are several ways to prevent spinal compression fractures. Physical therapists recommend that you:

• Maintain proper posture and body mechanics when performing activities of daily living.
• Avoid forward bending and deep or rapid twisting of the spine in daily activities and exercises. Your physical therapist will teach you the right movements and exercises to perform to help keep you safe.
• Reduce your risk of falls. Your physical therapist may recommend home modifications and balance exercises.
• Exercise regularly. Include weight-bearing activities, such as walking and using light weights.
• Stop smoking. It slows down the healing process.
• Keep alcohol consumption moderate, as it impairs balance.
• Eat a well-balanced diet to promote bone health.
• Take calcium and vitamin D supplements as recommended by your doctor or dietitian.

All physical therapists are prepared through education and experience to treat a variety of spinal conditions and injuries. However, you may want to consider:

• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic or geriatric physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
• A physical therapist who is experienced in treating people with spinal conditions and trauma. Some physical therapists have a practice with an orthopedic or geriatric focus.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family, friends, or other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have spinal conditions and injuries.
• During your first visit with the physical therapist, you will be asked to describe your symptoms in as much detail as possible, and say what makes your symptoms worse. Here are some tips to prepare for your visit.