Is it safe to allow normal activity after a compression fracture of 10-20%?

Activity Restrictions After 10-20% Compression Fracture

For neurologically intact patients with a 10-20% compression fracture, normal activity should NOT be allowed immediately; instead, implement a structured 3-month conservative management period with gradual activity progression, reserving unrestricted activity only after demonstrating clinical and radiographic stability. 1, 2

Initial Management Phase (First 4-6 Weeks)

Immediate activity restrictions are mandatory to prevent fracture progression and allow initial healing. 1, 2

• Avoid prolonged bed rest as this leads to deconditioning, accelerated bone loss, and increased mortality risk 1
• Permit slow, regular walking starting with 10-minute periods, gradually increasing duration 3
• Allow range-of-motion exercises and light calisthenics that generate 40-70% of maximum oxygen consumption 3
• Initiate calcitonin 200 IU (nasal or suppository) for 4 weeks to provide clinically important pain reduction 1
• Prescribe analgesics including NSAIDs as needed, while avoiding overuse of narcotics which cause sedation, falls, and decreased physical conditioning 1, 4

Mid-Term Management (4-12 Weeks)

Gradual activity progression is appropriate based on pain tolerance and clinical response. 2

• Reassess at 4-6 weeks to evaluate treatment response and fracture stability 2
• Continue supervised or self-monitored activity progression, though evidence for mandatory supervised physical therapy is inconclusive 2
• Monitor for persistent severe pain, which may indicate need for vertebral augmentation at 3 weeks or beyond 1
• Activities should remain moderate intensity as perceived by the treating physician 3

Return to Normal Activity (After 3 Months)

Unrestricted activity should only be permitted after 3 months if the patient demonstrates:

• Resolution or significant improvement in pain 1, 2
• No progression of vertebral collapse on imaging 1
• Absence of neurological deficits 1, 5
• Adequate functional recovery 2

The natural history is generally favorable, with most patients improving over 2-12 weeks regardless of specific interventions. 2

Critical Red Flags Requiring Immediate Surgical Referral

Any of the following mandate immediate restriction of all activity and urgent surgical consultation:

• Development of any neurological deficits 1, 2, 5
• Frank spinal instability on imaging 1, 2
• Progressive kyphosis or significant spinal deformity 2
• Spinal cord compression 1, 5

Concurrent Osteoporosis Management

Pharmacological treatment must be initiated concurrently to prevent subsequent fractures:

• Start ibandronate or strontium ranelate to prevent additional symptomatic fractures 1
• Ensure adequate calcium intake (1000-1200 mg/day) and vitamin D supplementation (800 IU/day) 3, 4
• Avoid high pulse dosages of vitamin D which increase fall risk 3

Common Pitfalls to Avoid

• Never allow immediate return to normal activity even with "minor" 10-20% compression, as this risks fracture progression 1, 2
• Never prescribe prolonged bed rest beyond initial acute pain management 1
• Never miss unstable fractures by performing inadequate neurological examination 1
• Never delay surgical referral when red flags are present, as delays worsen neurological outcomes 5