For Your Daughter

Your mother sent you this. You did not ask for it, and you were in the middle of something else.

So here is the point of the page, first, in case you read no further.

There are three measurements further down. They take five minutes, they need nothing but a wall, and they are about your back rather than hers. Take them once this week and write the numbers down. They are worth almost nothing today. They are worth a great deal in twenty years. Nobody can go back and measure you at the age you are now.

All three are on this page, in full, free. You can take them and never hear from me again.

Why this landed in your inbox

Your mother has had a hard year, and has been told to be careful about two hundred times. Sending you this is the one useful thing she can do about it that does not involve her own back.

She is not asking you for anything, and there is nothing here for you to feel bad about.

The one fact that is worth your four minutes

A mother who has broken a bone in her spine raises her daughter's own risk. Raises it. It does not decide it.

I want to be careful with that word, because it gets twisted in both directions.

Raises means the odds moved a little. It does not mean anything is wrong with you, and nothing on this page can tell you whether anything is. It means the question is worth asking early.

Most women are not asked it until sixty-five, if they are asked at all, and usually after something has already happened.

You are being asked now. That is the whole advantage.

The whole method, and then you are done with me

Three measurements. Five minutes. Once every few months, at home.

First, what they do not do. None of this measures bone density. Nothing you can do at home does, and anybody who says otherwise is selling something worse than I am. What these three measure is height and shape: whether your back is getting shorter, and whether it is tipping forward. That is a different question, and a useful one.

One. Your height, taken properly

Almost everybody does this wrong, including plenty of clinics.

Shoes off. Heels, bottom and back flat against a wall. Chin level, not lifted, not tucked. Stand as tall as you can. Breathe all the way out, and mark the wall at the top of your head at the end of that breath.

Then the condition that matters most. Same time of day, every time.

You are taller in the morning than in the evening. The discs in your spine press down under your own weight across the day. By bedtime you can be a little shorter than you were at breakfast.

So a number from a Tuesday morning, next to one from a Sunday evening, tells you nothing except what time it was. Pick a time. Keep it. Change any one of those conditions and the number is noise.

Two. The gap behind your head

Stand the same way, looking straight ahead, as tall as you can manage. Then have somebody measure the distance between the back of your head and the wall.

For most people that distance is nothing at all. The head touches the wall and there is nothing to record. A gap that opens up matters, and a gap that grows matters more. It is one of the more useful signs we have that something has changed in the upper back.

Fifteen seconds, and nobody has ever shown it to you.

Three. The fingers between your ribs and your hips

Put a flat hand on your side, just under your lowest rib, and feel down to the top of your hip bone. Count how many fingers fit in the gap.

When the spine gets shorter, that space closes. Fingers that used to fit stop fitting.

Write all three down, with the date and the time of day, somewhere you will still find them in five years. Not a note on your phone. Paper.

Why now and not at sixty-five

Your first reading is worth almost nothing on its own. It is a starting line.

The third one starts to be interesting. Ten years of them is something else, and it is the one thing your mother cannot buy at any price.

Her line starts the year her back broke. That is the whole trouble with it. There is nothing behind it to compare against, so every conversation with her doctor begins with a guess.

Yours can start on a Tuesday when nothing at all has happened. A line is worth what it is because of how far back it goes. That is the only reason to do this in your forties instead of your sixties.

Where you stand, and where she stands

These are not the same position, and I would rather say so plainly than be delicate about it.

Her spine has already broken once. That shuts some doors, and the programme she is doing is built around the doors that are shut.

A spine that has never broken can usually be loaded, and loading is the stronger answer. Weight in your hands, twice a week, getting heavier over time, under a plan. If that is you, that door is open, and what is behind it is better than anything I can offer her.

Nobody offered it to her in time. That is not her fault and it is not yours. It is only how this information moves, which is late.

Two ways to use this page. I mean both.

The programme I wrote for a woman in your position is called The Threshold Protocol. Twelve weeks, two sessions a week, at home or in a gym, sixteen dollars and ninety-nine cents.

Or take the three measurements above to your own doctor. Tell her your mother has broken a bone in her spine. Ask her what she makes of it. That costs nothing. It is a good answer, and I would rather you did that than nothing.

I am not your clinician, and none of this is advice about your own health. It is the page nobody handed your mother twenty years ago.

She was told late. You are being told now. That difference is worth more than anything I could sell you.

A DPT with twenty-two years in orthopaedic and bone health rehabilitation. A team of physical therapists, in orthopaedic and bone health rehabilitation.