Osteoporosis Awareness Month: Mat Pilates for Osteoporosis /Osteopenia

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“Change happens through movement and movement heals.”

– Joseph Pilates 

Movement is Medicine 

Safe daily movement is fundamental to staying healthy, mentally alert, building strong bones, maintaining your balance and independence.   Keep in mind these foundational movement principles throughout your daily routine.  Ask yourself if your daily movement routine incorporates (1) hip extension, (2) thoracic spinal extension plus (3) strengthening movements for your hips and ankles?  If your answer is no at the moment, today is the day you start to incorporate them into your daily movement plan.  We are here to help you stay on track and become more aware of how to move better in your bones.  Contact us with any questions to start moving better.

Foundational Movement Principles 

  • Find a neutral spine (upright, sidelying, prone or supine) 
  • Transition from the floor to standing using a neutral spine using quadruped positions 
  • Hip hinge vs. rounding / flexing the spine 
  • Always avoid movements that load the spine in a flexed, sidebending or rotational position 
  • Improving core strength
  • Strengthening posture 
  • Stretching and strengthening your spine

What is Pilates?

Pilates was created in the early 1900s by Joseph H. Pilates, with the notion that the mind and body should both be exercised during a workout. Pilates exercises focus on the core (transverses abdominis, pelvic floor, multifidi, diaphragm).  During this core workout, the mind is engaged. Balance, coordination, strength and flexibility are key components to every movement.

How is pilates different from other exercise?

Pilates exercises use whole-body integration versus isometric isolation of muscle groups. It incorporates upper- and lower-body extremities to foster balanced muscle development with less stress or strain.

Why should I try pilates?

Pilates teaches you how to isolate and precisely control your core muscles to help you gain functional strength. All levels of fitness are welcome and modifications and/or variations of exercises are taught when appropriate.

  • Learn how breathing can facilitate our movement(s) and also challenge our movement(s)
  • Increase coordination, strength and mobility with efficient and flowing movements
  • Find mental and spiritual rejuvenation
  • Improve self-awareness and self-confidence
  • Integration of mind, body and spirit
  • Enhance your quality of life and well-being

Pilates Principles

  1. Whole Body Movement
  2. Breathing
  3. Balanced Muscle Development
  4. Concentration
  5. Control
  6. Centering
  7. Precision
  8. Rhythm

General Contraindicated Movements

If something is questionable in your mind best to ask a qualified and educated healthcare movement practitioner who specializes in Osteoporosis / Osteopenia before doing any movement and risking a possible fracture.  

  • All rollups, rollerovers, short spine, plough (forward flexion of the spine)
  • All forms of crunches (forward flexion of the spine)
  • Abdominal work with oblique rotation (loading of lumbar spine and disc)
  • Increased pressure on the ribcage (adding extra load and stress on possibly brittle cartilage)
  • Forced external rotation of the hip in standing or in floor exercises (added stress placed on femoral neck of hip socket) 

Contraindicated Mat Pilates Movements

The reason these mat pilates movements are contraindicated is they place added stress on the spine.  Have no worries you can still take mat pilates classes or practice at home keeping in mind the pilates principles.  If you’re taking a mat pilates class at the gym or club I would recommend talking with the instructor before class starts and mentioning you have osteoporosis or osteopenia.  If the class does forward flexion, spinal rotation or sidebending movements you can do an extra set of your single leg balance movements to keep moving.  

  • Roll up 
  • Rollover (both ways) 
  • Rolling like a ball 
  • Spine stretch 
  • Open leg rocker
  • Cork-screw
  • Saw
  • Neck pull
  • Scissors
  • Bicycle 
  • Spine Twist
  • Jack-knife
  • Teaser
  • Boomerang
  • Seal
  • Crab
  • Rocking
  • Control balance 

Safe Mat Pilates Movements 

Most of the population spends too much time seated and slouching with rounded shoulders be it on their computers or smartphones for work or school.  To help counter balance those poor postural positions these movements focus on improving hip extension, increasing thoracic spinal extension, lengthening your stride when you walk, enhancing your overall leg strength specifically at your ankles and hips to improve your balance and stabilization.   

  • Hundred with head down on mat
  • Single leg circles 
  • Single leg stretch with head down on mat 
  • Double leg stretch with head down on mat 
  • Single leg stretch with straight legs and head down 
  • Double leg stretch with straight legs and with head down on mat 
  • Criss-cross with head down on mat 
  • Swan-dive (only one)
  • Single leg kick 
  • Double leg kick 
  • Shoulder bridge (not too high)
  • Side kick 
  • Hip circles/hip twist with arms stretched out to sides to help maintain neutral spine 
  • Swimming 
  • Leg-pull front 
  • Leg-pull 
  • Side kick kneeling with neutral spine 
  • Side support with neutral spine 
  • Push ups 

Helpful Resources & Tools 

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The Osteoporosis Exercise Book, 2nd Edition by Sherri R. Betz, PT, GCS, CEEAA, was written to help you incorporate safe mat, chair and standing exercises into your bone-building program. The exercises will help you build bone density of the spine and hip, improve posture and balance, and increase flexibility and mobility. You will also learn how to avoid movements that increase the risk of fracture. Includes photos, nutritional recommendations, and some of the latest research findings on Osteoporosis. Large print, special “stay open” binding and over 100 photos!  Click here to purchase.

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Pilates Exercises for Osteoporosis Video was designed by physical therapist, Sherri Betz to help you incorporate safe Pilates exercises into your bone building program. Many Pilates exercises can be unsafe and contraindicated for those with low bone density. By modifying the wonderful exercises of Joseph Pilates and incorporating sound physical therapy principles, you will learn the best exercises to build the bones of the most vulnerable areas of the hip and spinal vertebrae.  Click here to purchase.

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Based on the latest research and specifically designed for Osteoporosis or Osteopenia. Incorporate safe and effective Pilates-based Mat exercises to target bone and muscle strength!
Learn a great Mat Program designed especially for osteopenia or osteoporosis. Safe and challenging exercises target the bones of the spine, hips and wrists.  Click here to purchase.
  • Standing Posture & Balance Exercises
  • Leg Strengthening Lunges
  • Fletcher Towelwork®
  • Foam Roller & 8” Massage Ball Exercises
  • Abdominal Strengthening without Flexion

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Did you think Pilates was just for the young and fit? Pilates principles and Pilates-based exercises are perfect for the Frail Older Adult! However, 70% (24/34) of the Mat Exercises from Joseph Pilates’ book Return to Life are contraindicated for those with osteoporosis. Follow along with this “real-time” Pilates-Based Class taught to two older adults with osteoporosis using Chairs, Dowels, Therabands and Balls! We will focus on balance, leg strengthening, hip extension, and thoracic extension for improved posture and reduction of thoracic kyphosis. You might be surprised at the challenge! Click here to watch more!

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Everyone knows the effect of gravity and time on your body and posture, rounded shoulders, slouched back, and weaker bones. But you can fight these changes and we can help. Stand Tall is a physical therapist created program designed to specifically address these issues.

The specialized exercise and postural training that make up this class will strengthen core and back muscles, improve posture and bone health with targeted strength training and weight bearing exercise. This social, specialized exercise class will improve your current and future functioning while offering a great peer support network.

Stand Tall was created by Wendy Katzman, PT, DPTSc, OCS. A board certified orthopedic clinical specialist since 1995, she is the principal investigator in 2 clinical trials to determine the effects of these exercises on posture, physical function, and quality of life. Learn more here!

We believe in treating the whole person with a holistic approach and blend our knowledge and training of movement, nutrition, massage therapy and traditional chinese medicine. 

We love teaching mindful movement and even during this time, we are here to support you in your journey to wellness by offering online remote training from anywhere in the world. Contact us today to get started and learn to move with less pain and greater ease. We look forward to answering your movement questions and/or concerns.

Feel free to check out our blog posts specific to pilates, pre/post natal, bone building for osteoporosis/osteopenia, mindful meditation, restorative yoga therapy, partner and endurance training.

Assumption of the Risk: By attempting any of the exercises, you do so at your own risk.  We make no representations, guarantees or warranties that the information or exercises on this blog are appropriate for you or will result in improvements of your medical condition or function.  

Not medical advice or physical therapy.  This content is intended to provide information and instructions on general exercises that may help increase strength, mobility, and function for specific areas of the body.  It is not intended to be a substitute for obtaining a medical diagnosis or medical or physical therapy advice from a qualified licensed provider.  You should seek medical advice from a qualified physician or physical therapist before trying any of the exercises or self-treatment suggestions on this blog, particularly if your pain is from a traumatic injury or event. 


BETZ, S., 2010. TheraPilates for Osteoporosis.