These fractures are difficult little devils to deal with, but I've found that it is most beneficial to follow the following regimen:

- Stage I: In the initial stages the patient is going to have lots of pain, and concommitant muscle spasm. This is the area you really want to work on first. I usually work on decreasing muscle tone in the upper thoracic and lower lumbar regions (leaving the thoraco-lumbar junction alone) until about 6weeks post injury. I also strongly recommend getting your patient a thoraco-lumbar back brace to help support the spine and core muscles. Start very gentle isometric core exercises (TA/Mult) and add some gentle weight-bearing exercise. Hydro pool gentle walking to begin with, then overground.

- Stage II: At about week 6-10 more emphasis on core strengthening, gentle mobilisations of the joints around the compression fracture (but avoiding levels immediately above or below) and soft tissue work on the affected levels. Try weaning off the brace for lighter tasks.

- Stage III: 10-20 weeks. Repeat X-ray, document healing rates. If union has occurred then mobilisation of the affected area can begin, and pilates in a neutral/flexion bias position can begin. Slowly progress to gentle extension bias. Wean off brace.