How do fractures affect me?

Although bones heal over the next six to eight weeks, multiple compression fractures in the spine can cause problems that don’t improve with healing. Height loss and changes in the curvature of the back can make standing and moving more of an effort.

A hip fracture may occur following a fall. You will probably need an operation, and although a full recovery is always possible, this will often depend on how well you were before the fracture happened. Hip fractures can have a big impact on your usual ability to stay as active as you were.

The following suggestions can also go some way to help lessen problems or restrictions caused by fractures.

Leisure time

Are there any hints and tips to allow me to continue with activities I enjoy?

If you have had fractures you may be worried about continuing with some activities you used to enjoy. This may be because you are frightened of having a fall or doing something to cause another fracture, or it may
be because the fractures you have had now make that activity difficult. There are many ways around these problems and many organisations who can offer adapted equipment and good advice.

The Disabled Living Foundation (DLF – see ‘Useful contacts’ section at the end of this factsheet) produces a very good factsheet called ‘Choosing Equipment for Leisure Activities’ which covers activities from cycling to sewing, and rambling to painting and photography and gives links to useful products and organisations.

Can I continue to garden with spinal fractures?

Gardening is a pleasurable activity that many people with osteoporosis enjoy, but, once they are affected by compression fractures in the spine, they often wonder whether to give it up. There is no reason why,
with forward planning and useful aids, you cannot continue to enjoy your garden. Gardening can act as a diversionary therapy, taking your mind away from your pain and generating a feeling of achievement and
well-being. So, when planning changes in the garden, decide what is right for you and avoid difficult or painful tasks. You may need to recruit some willing family members to make some of these changes or hire a gardener if you have sufficient funds. Most advertise in local newspapers. Some ideas that may be helpful are listed below:

  • Replace lawns with paving or longer meadow grasses.
  • Create narrow borders or beds so that you do not have to stretch to reach the back.
  • Raise beds to cut out the need to bend forward, particularly if beds are narrow.
  • Use ground cover or low-maintenance herbaceous borders with plants that do not need pruning.
  • Avoid fast-growing bushes or hedges that need regular pruning.
  • Do a little bit of gardening often rather than overdoing it. This can help to reduce muscle fatigue and increased pain.
  • Stop and stretch in between jobs and try to avoid repetitious tasks.
  • Stretch by squeezing your shoulder blades together every 10 to 15 minutes.
  • Set yourself small attainable goals and enjoy regular breaks to admire your work!
  • Look for different tools at your local gardening centre, Disabled Living Centre or DIY superstore. Tools that have interchangeable heads and extended handles can be helpful.
  • When kneeling, a low padded stool with side handles can help you to push up again and also balance you.
  • Always lift correctly with bent knees and a straight back and use wheelbarrows and trolleys to avoid unnecessary lifting.
  • Use a hosepipe for watering rather than a heavy watering can.
  • Make sure there is clear access to all parts of the garden.
  • Try dwarf varieties of fruit trees to avoid climbing ladders when pruning.
  • Use a perching stool in the greenhouse or potting shed.
  • Attach a basket to your walking frame to leave your hands free.
  • Wooden rails can help if garden levels are changeable and slopes or ramps are better than steps.

Your local council may also have information about authorised garden share schemes in your area. This is where someone uses all or part of your garden themselves which benefits you by ensuring your garden is well tended. Make sure you only permit those people who have been authorised by the local council via the scheme to use your garden.

Moving around

I have difficulty looking up ahead of me when I am walking because of my spinal curvature. What can I do about this?

Use a walking stick or frame to help with balance if necessary, ensuring it is the right height for you. Rica (an organisation who provide consumer research for older and disabled people - see contact details at the end of this factsheet) produce a very useful booklet called ‘Stepping out: A guide to wheeled walking frames’. This covers all types of walking aids from sticks to trolleys and frames, and will help you decide which one is right for you.

Avoid very crowded areas where you may be easily jostled or pushed, and try to avoid going out in very bad weather such and snow and ice if possible. If you can’t avoid these things see if there is someone else who can go with you.

If you have difficulty in walking, you may qualify for a disabled badge that will allow you to park closer to places you wish to go. Apply to your local council for more information.

Always use a trolley in a supermarket rather than a basket. Some shops now have trolleys specifically designed for disabled shoppers and you can always ask for help with packing and the carry-out service.

Use a shopping basket on wheels that can be pushed or pulled along, or a bag or basket that fixes to a walking frame, instead of carrying your shopping in bags.

It may be useful to ask your surgery for a mobility assessment. This type of assessment is usually done by a physiotherapist who can advise on any walking aids (such as walking sticks or frames) that might be appropriate for you, or any other techniques or services that may be of use or interest to you.

How can I drive my car safely and comfortably?

For many of us driving is an integral part of our daily life, therefore it’s not surprising that getting back on the road again and regaining that feeling of independence following a fracture is a very important goal. The downside of driving is that it may require sitting in a fixed position in a confined space for a long time, coupled with bumpy roads and vibrations. Although some factors can’t be changed, such as the state of the roads or having to negotiate speed bumps, there are ways to improve your comfort and safety when you are out driving. The following tips may help to make driving a little easier:

  • If you haven’t driven for some time, always have a trial run around the block or on a quiet road – take someone with you so that they can take over the driving if needed.
  • Be careful if you are taking medications for your pain. Many pain relievers (particularly the stronger ones) can make you feel drowsy and slow down your reaction time. Whilst it is legal to drive if you are taking one of these pain medications, you should not drive if you suffer these side effects or feel at all unsafe. You should inform the DVLA if you are taking an opiate pain medication.
  • Plan your journey and allow plenty of time so that you can take regular breaks. This will allow you to get out and move around. Avoid the rush hour and bad weather wherever possible.
  • Avoid twisting to reach things on the back seat.
  • If you’ve lost height, adjust the driver’s seat by moving it forward and upward, the seat should be adjusted so that the hips and legs are comfortably flexed.
  • A wedge cushion can help to raise your height in the car seat without raising the knees - choose one which is designed for a car so that it will fit on the car seat properly.
  • If your seat doesn’t support your back, try a lumbar support cushion or lumbar roll or back support such as BackFriend. A fleece or sheep skin seat cover can also add softness and reduce pressure points. Some people find a beaded seat cover comfortable.
  • Head restraints in the car which minimise the risk of whip lash injury should be positioned approximately three inches behind your head and not in the nape of the neck. If a spinal curvature greatly increases the gap, your head restraint may need a bigger cushion.
  • Try not to hunch over the wheel or hold the steering wheel too tightly; this will cause tension in your neck and shoulders. Adjust the backrest so that your arms are soft and comfortable on the steering wheel – ensuring that you are not too reclined and that you can still use your mirrors and have a clear view through the windscreen.
  • Heat pads can help to ease back pain – single use heat pads (often called heat wraps or patches) can be good for travelling with the ‘wrap around’ ones being thin enough to be comfortable to use when driving. If you’re lucky enough to have heated car seats these can help to alleviate back pain during a journey.
  • Before you get in the car remove things like your wallet or mobile phone from your back pocket – they can affect your posture causing you to sit at an angle rather than squarely in your car seat.
  • If getting in and out of your car is difficult there are various aids available to assist you, such as the Ross ‘Auto Slide’ - a two part cushion which allows you to turn and move sideways in the car or a ‘Handybar’ a portable grab rail which fits into the car latch giving you something secure to hold on to as you get in and out of the car.

If you intend to keep driving but are worried that your health or eyesight may affect your ability to safely do so, speak to your GP or contact the DVLA directly.

It may be that you are unable to continue driving your car without considering having some adaptations done. Specialist mobility centres can carry out driving assessments and provide advice about making adaptations to your car. Charges for this will vary and in some situations it may be free of charge. Mobility centres can also provide advice for passengers with disabilities. Car modifications can range from fairly simple modifications such as lightening the power steering or adding extra panoramic mirrors, to replacing the driving controls for hand operated ones or having a hoist fitted for wheelchair users.

You may be considering buying a new car. Whilst there is no ideal model for everyone, there are some features worth considering.

  • Automatic transmission - consider changing to an ‘automatic’ as they tend to be easier to drive.
  • Power assisted steering –most modern cars have this however if your car is quite old it might not.
  • Accessibility - 2 or 3 door cars usually have larger, wider door openings which are easier to get into and out of. This also applies to cars with seats which are higher off the ground (but not too high that you need to step up). Consider a car with a good amount of headroom and low sills – for easier access to the boot.
  • Visibility - avoid cars with thick window pillars as these can create big blind spots and extra movement in your neck will be needed to get a clear view when changing lanes or approaching junctions.
  • Check that the heating, lights and indicators are positioned where you can easily reach them.
  • Reversing and parking sensors – to help you to park easier (these can also be added to your existing car).
  • Avoid ‘sporty’ versions of cars, for example those with low profile tyres (bigger wheels), as there tends to be less shock absorption by the tyres (and suspension) resulting in a bumpier ride.

Rica have a useful section on their website (www.rica. org.uk) to help you choose models of car that may be suitable for you depending on the features you want.

You may qualify for the government’s Motability Scheme to help lease a new car. The scheme is open to anyone who receives the following allowances:

  • Higher Rate Mobility Component of the Disabled Living Allowance
  • Enhanced Rate of the Mobility Component of the new Personal Independence Payment
  • War Pensions Mobility Supplement
  • The Armed Forces Independence Payment

Although it is often a very hard decision to make, there will come a point when it would be sensible to stop driving both for your own safety and that of your passengers and other road users. Your doctor and family members will be able to help you with this difficult decision.

Are there any tips on using public transport?

If you need assistance getting on or off public trains or buses or you need help with your luggage, contact the transport company at least 24 hours in advance as they will usually be able to ensure someone is there to help you. An easy access bus may be made available with enough notice. You can also contact the appropriate transport company to find out information about which facilities are available, such as disabled access toilets, disabled parking, stairs and lifts or accessible platforms. For trains, contact National Rail Enquiries for information on all journeys.

If you are travelling by air you can arrange to have assistance in the airport (such as getting to the correct part of the airport and on and off the plane), and on the plane (such as help getting to, but not using, the toilet facilities). You can also arrange for the airline to help you with storing medication that needs to be kept in the fridge. Again it is important that you book this well in advance, at least 48 hours before, and then confirm again as you arrive to check in.

If you are travelling by taxi, most companies will offer facilities to carry disabled passengers. Black cabs (that you hail from the roadside and are often available in bigger cities) usually have plenty of room to get in and out, and they are usually built with wheelchair access in mind. Check with the driver if you need assistance as most will be able to help. Private hire taxis (that you book in advance) will often send a specific vehicle if you need easy or wheelchair access, but make your requirements clear when booking.

Rica produce a very useful free booklet called ‘Public transport: A guide for older and disabled people’ which covers all travel related issues.

If you are going on a long trip, or an unfamiliar one, plan your journey! There are a number of organisations such as Transport Direct (see useful contacts below for details) that can help you work out which buses, trains or other forms of transport to use for a particular journey to see you from door to door.

All aids mentioned throughout this fact sheet are available via the internet, mail order or from local daily living equipment shops. More information on equipment can be obtained from Disabled Living centres (see Assist details below to find your nearest branch).

Useful contacts

Assist UK
Assist UK leads a UK wide network of locally-situated
Disabled Living Centres. Most centres include a
permanent exhibition of products and equipment
that provide people with opportunities to see and try
products and equipment and get information and
advice from professional staff about what might suit
them best.
Helpline: 0161 850 9757 (Mon-Fri 8.30-4.30)
www.assist-uk.org

Blue Badge Scheme (for parking concessions if you
are disabled)
www.gov.uk/apply-blue-badge

Disability Onboard
Disability Onboard aims to encourage disabled people
to travel by train by providing accurate advice and
guidance.
www.disability-onboard.co.uk

Disabled Living Foundation
DLF is a national charity providing impartial advice and
information on independent living. They also provide
details of suppliers of daily living equipment.
Disabled Living Foundation,
Ground Floor, Landmark House,
Hammersmith Bridge Road,
London, W6 9EJ
Tel: 0300 999 0004
www.dlf.org.uk

DLF also includes ‘AskSARA’ which is an easy-to-use,
award-winning online self-help guide that is particularly
useful if you are not sure what items might help you.
www.asksara.dlf.org.uk

Driver & Vehicle Licensing Agency (DVLA)
Drivers’ Medical Enquiries
Tel: 0300 790 6806
www.gov.uk

Driving Mobility
Tel: 0800 559 3636                              www.drivingmobility.org.uk

Gardening For Disabled Trust
A voluntary organisation that gives grants to people
all over the United Kingdom in order that they may
continue to garden, despite disability or advancing
illness.
The Secretary, Gardening for Disabled Trust
PO Box 285
Tunbridge Wells
Kent. TN2 9JD
www.gardeningfordisabledtrust.org.uk

Motability
The Motability Scheme provides a simple way to lease
a new car, scooter or powered wheelchair without the
worry of owning and running one.
Tel: 0300 456 4566
www.motability.co.uk

National Rail Enquiries
For all information about rail travel including passenger
assistance.
Tel: 03457 48 49 50 (open 24 hours a day)
www.nationalrail.co.uk

Rica
Provides consumer research for older and disabled
people.
Rica, Unit G03
The Wenlock, 50-52 Wharf Road
London N1 7EU
Tel: 020 7427 2460
www.rica.org.uk

Translink
Translink (Northern Ireland) has an online journey
planner for train, bus and metro services.
Tel: 028 9066 6630 (Monday-Friday, 7am-8pm;
Saturday & Sunday 8am-6pm)
www.translink.co.uk/journey-planner

Traveline
Traveline (England, Scotland and Wales) provides
timetables for local and national journeys on buses,
coaches and trains, and has details on access.
Tel: 0871 200 2233 (8am-8pm, calls are charged at
national rates)
www.traveline.org.uk

Thrive
Thrive is a national charity that helps people with a
disability to start or continue gardening. They have
practical information to make garden jobs easier,
advice on taking care, useful hints and tips and details
of the equipment and tools which will be particularly
helpful.
The Geoffrey Udall Centre,
Beech Hill,
Reading, RG7 2AT
Tel: 0118 988 5688
www.thrive.org.uk (about the organisation)

www.carryongardening.org.uk (practical
information and products)