Open AccessVertebral fracture during one repetition maximum testing in a breast cancer survivor
Author(s) -
Friederike Rosenberger,
Justine Schneider,
K Schlueter,
Jean-Luc Paratte,
Joachim Wiskemann
Publication year - 2021
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000025705
Subject(s) - medicine , osteoporosis , breast cancer , physical therapy , spinal fracture , surgery , radiology , cancer
Rationale: One repetition maximum (1-RM) testing is a standard strength assessment procedure in clinical exercise intervention trials. Because no adverse events (AEs) are published, expert panels usually consider it safe for patient populations. However, we here report a vertebral fracture during 1-RM testing. Patient concerns: A 69-year-old breast cancer survivor (body-mass-index 31.6 kg/m 2 ), 3 months after primary therapy, underwent 1-RM testing within an exercise intervention trial. At the leg press, she experienced pain accompanied by a soft crackling. Diagnosis: Imaging revealed a partially unstable cover plate compression fracture of the fourth lumbar vertebra (L4) with a vertical fracture line to the base plate, an extended bone marrow edema and a relative stenosis of the spinal canal. Interventions: It was treated with an orthosis and vitamin D supplementation. Another imaging to exclude bone metastases revealed previously unknown osteoporosis. Outcomes: The patient was symptom-free 6.5 weeks after the event but did not return to exercise. Conclusion: This case challenges safety of 1-RM testing in elderly clinical populations. Lessons: Pre-exercise osteoporosis risk assessment might help reducing fracture risk. However, changing the standard procedure from 1-RM to multiple repetition maximum (x-RM) testing in studies with elderly or clinical populations would be the safest solution.