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Biofeedback load technique in the rehabilitation of osteoporotic patients (Biomechanical analysis)

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Based on a simple biomechanical analysis, available to physicians, the article recommends carrying a backpack regularly as a part of the complex rehabilitation of osteoporotic patients. Carrying a backpack in front or on the back is recommended for patients with uncomplicated osteoporosis, carrying a backpack only on the back is recommended for patients with osteporotic vertebrae fractures. The importance of carrying a backpack is based upon remove the muscular dysbalance of the trunk muscles and upon increasing the bone strength by compressive force acting upon the vertebrae and proximal femur and activating osteoblasts to osteoformation. The backpack load magnitude is differentiated--patients with vertebrae fractures put a weight up to 1 kg into the backpack, patients without vertebrae fractures up to 2 kg.
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Didactics and method of therapeutic exercise in patients with osteoporosis
  • J Wendlová
  • J Wendl
Wendlová J, Wendl J. Didactics and method of therapeutic exercise in patients with osteoporosis. Osteological bulletin 1997; 2: 49-51.
Osteoporosis -Kinesither apy. Bratislava: Sanoma Magazines Slova kia
  • J Wendlová
Wendlová J. Osteoporosis -Kinesither apy. Bratislava: Sanoma Magazines Slova kia 2008: 24-36.
Theoretical mechanics. Bratislava: Pub lishing House of technical and economic literature ALFA 1990
  • V Obetková
  • A Mamrilová
  • A Košinárová
Obetková V, Mamrilová A, Košinárová A. Theoretical mechanics. Bratislava: Pub lishing House of technical and economic literature ALFA 1990: 30-94.