Osteoporosis And My Mistake
I came around the corner just as he was sitting this elderly gentleman down.
He looked at me and said: “deal with this I’m going back to the bench”.
Fairly confused, I looked at this elderly gentleman and asked what happened?
He was on the ice taking pictures of the hockey team, as he walked off he slipped and fell on the ice.
Bearing weight on the right side was painful, but there wasn’t a lot of pain while sitting down. I grabbed his leg and passively moved it, no pain.
He called his wife (who was more than a little upset as the game had just started and now she was missing it) because I said he needed to go to the hospital.
We draped his arms over our shoulders and walked him out to their mini-van. She took him to the hospital and I didn’t see them for another year.
The Mistake
For years I have taught first aid courses to other Massage Therapists.
I have viewed the power point slide, I have repeated the information in the slide, I have highlighted the importance of the slide.
The slide I’m talking about says you should all 911 if:
- The injury involves the head, neck, or back.
- The injury makes walking difficult.
- The injury involves the thigh bone or pelvis.
- There is an altered level of consciousness.
However, things didn’t add up.
When it comes to treating injuries and dealing with first aid, one of the things we always harp on is “Mechanism Of Injury” (MOI).
We always use this as a method to quickly determine if there is a spinal, head or neck injury, to see if spinal precautions need to be taken. For those of you who have taken advanced or even basic first aid (and let’s be honest, just as the anatomy pro’s that you are) you understand the importance of stabilizing the neck to reduces possible spinal injuries.
But in this case the mechanism of injury made me second guess myself.
We always worry about further injury when a persons injury is a result of:
- A fall from any height.
- Found unconscious for an unknown reason.
- A diving injury.
- A blow to the head, neck or trunk.
- A car accident.
- Lightning strike or electrocution.
- A persons helmet is damaged.
But this guy didn’t fall from a height, so why would I worry about the injury being that extensive!?
All he did was slip on the ice, there was no fall from a height of any kind.
But like an idiot, I didn’t use the information I had taught so many times.
Walking was difficult and the injury was to the pelvis, it should have been a 911 call.
However since I didn’t think the mechanism was bad enough, I was comfortable to get him to the hospital without using an ambulance.
Photo by: CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=243621
Osteoporosis
For years I taught these courses and never understood why there would be a power point slide about Osteoporosis.
NOW I KNOW!
When I saw this fellow a year or so later, he looked completely different (he had developed some other health issues well beyond his fall that night).
I asked him how things turned out, he said he had broken his hip and had to have a full hip replacement (as a disclaimer, the injury caused the hip problem, not the fact that I didn’t call 911 that day, I just should have handled things a bit better).
Osteoporosis is the leading cause of bone and joint injuries in older adults, the bones don’t have enough calcium, which makes them frail.
According to osteoporosis.ca there are some frightening statistics:
- 70-90% 0f 30,000 annual hip fractures are a result of osteoporosis.
- 1 in 3 women and 1 in 5 men will suffer a fracture due to the disease.
- Without BMD (bone mineral density testing) 80% of fracture patients are not getting proper osteoporosis therapy.
- 80% of all fractures in people over the age of 5o are a result of osteoporosis.
- Fractures from Osteoporosis are more common than heart attack, stroke and breast cancer combined.
Think about what this means for your practice.
How many people do you see on a regular basis that are over the age of 50?
This exact situation could happen at any point in your clinic with an older person coming in for treatment. That gentleman didn’t know he had Osteoporosis, but was diagnosed with it after he fell.
If at anytime one of your patients comes in and suffers a fall on-site that seems harmless enough but there is an injury to the pelvis or thigh and makes it difficult to walk, be sure to call 911 and get them to the hospital in an ambulance. If the person suffered a fall at home and is coming in for treatment, there are some things to look out for. Check for any deformities in the area they are complaining about, along with swelling and point tenderness that could indicate possible injury.(1)
Studies are showing how exercise and strength training are effective ways to manage Osteoporosis once a patient receives the diagnosis, which also plays an important role in building confidence to prevent future falls. As Massage Therapists we want to make sure to use the appropriate pressure when giving treatment, to avoid any injury while the patient is on your table. One study researched a L5 unilateral pedicle fracture on a 66 year old man as a result of an aggressive back massage.(2)
Do yourself, and your patients a favour by not making either of these mistakes when trying to help them out.
References
- Badiyani K, Bottomley J. OSTEOPOROSIS AND ITS MANAGEMENT IN THE ELDERLY. Gerinotes [serial on the Internet]. (2014, Mar), [cited October 24, 2016]; 21(2): 11-18. Available from: CINAHL Complete.
- Guo Z, Chen W, Su Y, Yuan J, Zhang Y. Isolated unilateral vertebral pedicle fracture caused by a back massage in an elderly patient: a case report and literature review. European Journal Of Orthopaedic Surgery & Traumatology [serial on the Internet]. (2013, Nov 2), [cited October 24, 2016]; 23(2): 149-153. Available from: CINAHL Complete.
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Great information! Seriously we need to ve cautious in these conditions on anyone over 50 + . We don’t need lawsuits! Thankyou for the advice :)
Anytime Melissa, glad you enjoyed the post
This makes a lot of sense. My 87 year old mother fell and broke her hip simply getting out of bed. Osteoporosis was diangnosed and she’s recovered now. I didn’t realize the statistics for osteoporosis related fractures were so high. Great insights. Thank you.
Glad she made a full recovery Franco
I had no idea Osteoporosis affected that many! I’m tucking this tid bit in with my basic first-aid skills since I often work large events with people of all ages. Great learning experience for you here which in turn you have used to make others aware!
Thanks Tanya, hopefully you won’t make the same mistake I did!
Wow, I didn’t realize how high the likelihood of osteoporosis was – in both men and women. This is great information for anyone over the age of 50.
I’ve stressed the importance of weight bearing exercise, strength training, and vitamin D with K supplements for clients and family members for just this reason. Not only can that kind of exercise help prevent osteoporosis, but it can help reduce injury when there is a fall. In this case I wouldn’t have thought to call 911 either and it’ll definitely be top of mind next time I witness a fall. Hip fractures increase the risk of mortality within 1 year post fracture apparently also, so even more reason to proceed with caution!
I saw that same statistic Tara, reason for caution for sure.
Personal Trainers, Massage Therapists, and similar professionals can know a lot!! This can put us in difficult positions because we feel like we understand enough to take a variety of actionable steps to fix problems, but bottom line is if its out of scope, it’s out of scope. This article is a good reminder for this.
Thanks Donnie, sometimes scope of practice can be a hazy line for some, but always important to stay within it.
My grandma developed osteoporosis but didn’t find out until she had a major fall. And, similar to the patient whose story opens this article, my grandma’s health suffered a major decline from that point on. Folks who don’t have osteoporosis need to know of it and how to handle it for their older relatives and ultimately, themselves. Thanks for this article!
Thanks Michael, hope grandma is doing better.
Thank you for this summary so that we may all learn from your lesson, and thank you for sharing “your mistake” so openly.
Underlying issues may be difficult to be aware of, (particularly when the subject himself is unaware of his condition), yet, by discussing these occurrences within a community to build a base of knowledge, we can all grow together to become better providers of care.
Thanks Dan, fortunately I make lots of mistakes, so should have more to write about.