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I went to see a chiropractor for some low back pain I've been having. The X-rays didn't show anything funny in the lumbar area but I have two old compression fractures in the mid-back area I didn't even know about. Should I do anything for these? Is there any evidence that a back brace might help? What about exercise?

Many older adults have spinal compression fractures that are painless. Like you, they usually don't even know they have a fractured vertebra. The diagnosis is made when an X-ray is taken for something else and the damaged bone is seen for the first time. There's plenty of evidence that pain doesn't necessarily come from these fractures. Many people with confirmed compression fractures (as seen on X-rays) don't have any pain at all. It's not clear that the bone fracture is the true cause of pain for anyone with this condition who does have pain. The question of what to do about "old" or "chronic" (healed) fractures is a good one. Unfortunately, there isn't a lot of evidence one way or the other from high-quality studies to answer the question. It seems there are just too many factors and variable impacting results to make good comparisons. For example, with the use of bracing for spinal compression fractures, patient age, type of fracture, spinal level of fracture, type of brace, and amount of time brace is worn are all things to consider. A change in even one of these factors could alter the results. Likewise, when it comes to exercise, every study agrees that exercise benefits the body in many more ways than we know how to measure. But what type of exercise (stretching, calisthenics, core training, aerobics, dancing, gardening and so on) is best? Is it the same for each person with the exact same type of spinal fracture? These are things we just don't know yet. Good, quality research is clearly needed in this area. With so little evidence to support so many different approaches to the problem, there's room for many future studies.

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