Why You Won’t Heal – Part 1

You’re Getting the Wrong Treatment for Your Condition

As a physical therapist, I have the opportunity to work with individuals who suffer with chronic disease, cardiovascular conditions, neurological disorders, and of course, my specialty:  musculoskeletal and orthopaedic conditions.  A person’s rehabilitation process can be highly variable even within those who are recovering from the same type of injury.  While most of my post rehabilitation clients have been able to move forward and live successful lives, there are other clients who took significantly longer to heal.  Unfortunately, there are some who were never able to recover to any significant degree.

The reasons why a person may not recover are vast and complicated.  However, I have identified six categories of common reasons why a person will not fully heal and recover or take an extended time.

6 Categories of Common Reasons Why You Won’t Heal:

  1. You’re getting the wrong treatment for your condition.
  2. The injury or condition isn’t capable of healing.
  3. Physiological and social conditions are affecting your healing.
  4. Poor nutrition.
  5. Poor sleep quality.
  6. The risk factors and causative factors that led to the disease and injury are still present and affecting the current condition.

In Part 1, treatment for the condition is addressed.  In subsequent posts, I will cover the other categories in addition to providing you with methods and strategies for recovery to insure that you will heal and recover and/or effectively be able to manage your injury or medical condition.

You’re Getting the Wrong Treatment for Your Condition:

Sadly in today’s health care environment, it’s not uncommon for individuals to get the wrong treatment for his/her condition and/or inappropriate care which can affect the recovery process.  As a physical therapist, I continue to see countless examples of individuals getting wrong and/or ineffective treatments to manage a particular injury or medical condition.

Sometimes this is deliberate as part of some newest and greatest product scam that is touted as curing this or that condition, but most of the time, it’s done inadvertently.  This problem isn’t just in one medical profession.  It’s throughout the entire healthcare system.

The following three examples illustrate what happened to some of my prior physical therapy clients.  Unfortunately, this list could be very long if I included every example I have witnessed.

Example 1: Total Hip Replacement

The client presents with apparent hip and leg pain.  The client has undergone a total hip replacement in an effort to eliminate the pain only to have it still be present.  Upon further examination, the cause of the hip and leg pain was an undiagnosed lumbar spine injury.  Once the lumbar injury was managed appropriately, the pain in the hip and leg resolved.  Although the client had arthritis and deterioration in the hip to justify the hip replacement, it wasn’t the real cause of the pain.  In this case, the client never needed the hip replacement in the first place.

Example 2: Low Back Pain

The client complains of ongoing low back pain (LBP).  Although there are many reasons why one may experience LBP, the pain is of mechanical origin in the majority of cases.  This means that something in the musculoskeletal system is the pain generator.  The client should be able to establish movement patterns that can help to determine if the pain is improving or worsening.  This directional preference helps me as a physical therapist to guide treatment decisions.

Extending the spine makes the pain improve, but the client’s previous physical therapist has him performing primarily flexion (bending forward) exercises as part of the rehabilitation protocol.  This treatment is not only ineffective, but it significantly slows the healing response as the client continued to aggravate the injury by moving repeatedly in the wrong direction.  Upon stopping the flexion based exercises, the client’s LBP improved and fairly quickly went away.

Example 3: Chronic Headaches

The client sees a neurologist for assistance managing what appears to be a case of chronic migraine headaches.  The client is given prescription medications which are taken on a regular basis in order to help manage the migraines.  Although the medication helps to reduce the length of time of suffering, the client continues to experience migraines on a regular basis.  The treatment may not be wrong, but it certainly isn’t overly effective.  Worse yet, there is the potential for multiple side effects from taking the medication.

In this particular case, the client had a cervical alignment issue which caused mechanical neck pain that would trigger a migraine.  Together, we were able to correct the alignment issue, and more importantly, fix the chronic poor sitting posture that lead to the alignment issue.  This eliminated the headaches completely and the need for the migraine medication.

I tell these stories from past clients to illustrate the point that wrong and/or ineffective treatments can lead to a significantly longer than necessary recovery time.  These clients were fortunate because the true cause for the pain was identified and recovery occurred.

There are a countless number of people who continue to suffer with an incorrect or ineffective treatment therapies.  The key to successfully rehabilitating and recovering from a condition is to direct the right treatment plan for the condition.  This includes how the actual injury or condition is being handled as well as addressing other risk factors or precipitating factors that directly affect the condition.

How to Identify an Incorrect or Ineffective Treatment Therapy:

  • You aren’t experiencing any relief in pain or symptoms from the treatment.
  • Your symptoms continue to worsen.
  • You have been using the same treatment for weeks or months without resolution.  In the case of chronic disease, management of the condition hasn’t been effective.
  • The treatment and why it’s effective cannot be logically explained.
  • You haven’t been given any tools or education on how you to help improve or manage the condition, the rehabilitation or disease process, and its symptoms.
  • You are told that there are no other options.

If you are unsure whether or not the treatment you are receiving for your condition is helping, then it’s up to you to be proactive and seek a second opinion.  Although you should be cautious in researching for medical information online, there are reputable websites that can help to educate you about symptoms and possible causes for your condition.

If you suspect that your treatment course is incorrect, discuss your concerns with your medical provider.  Don’t be afraid to seek a second (or even third opinion) if necessary.  There are many options, and help is available.  Don’t give up!

Have you experienced an incorrect treatment or ineffective medical treatment before?  What did you do in order to resolve it?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Outsmarting Dementia: 5 Techniques for Giving Your Brain a Boost

No matter your age, it’s never too early to begin the fight against dementia. The good news is that it’s easier than you might think. The better news is that there are all kinds of ways to do it, no matter what your interests are! Here are just a few ways you can make the most of your mental workout:

If you’re active (or want to be), combine physical and mental workouts.

Physical exercise is a vital component to total health, and it can even have positive effects on your mental wellness. If you’re already an active person or want to start getting more exercise, combine your efforts! Try going for a walk in the park and issuing yourself mini challenges: how many trees have moss — now what’s the percentage? The ratio of moss to barren trees? If you’re more on the creative side, find objects in nature and find the most accurate color: is that bird in the tree periwinkle, or is it more of a deep sapphire? Maybe it reminds you of the color of the ocean, or of a favorite piece of clothing from long ago. Try thoughtful and engaging challenges.

If you’re bored, play a game.

Some people enjoy having an activity to do every afternoon, evening, or in whatever spare time they find throughout the day. There are lots of card games you can play that can boost memory, require strategic thinking, and many require basic addition and math skills. You can play a game of memory or solitaire on your own or invite some friends over for a group game. Board games are another great option if you have plenty of people to play, but cards tend to be an easier, more portable option.

If you’re a problem-solver, try a puzzle.

Classic jigsaws are a fun, quiet way to work your brain, and like cards they can be done on your own or with loved ones. If dexterity is a problem, there are easier versions you can play online or on a tablet. If sudoku is more of your style, you can find endless options online, and often in local and national newspapers. Try to devote a little time each day, even if it’s just 15 minutes on the puzzle every afternoon.

If you’re on the curious side, learn something new.

For many people, learning is the greatest experience of them all. You probably have a giant list of things you’ve been meaning to research, skills you’ve wanted to acquire, and interests you’ve wanted to pursue. So try one! Maybe you want to learn another language, or take an art class down the street. Even taking a class at a local college could be a great way to get a fresh lesson, and local community centers might offer free or low-cost options.

If you’re adventurous, try a completely foreign experience.

Maybe you’ve always been a thrill-seeker, or after a lifetime of being cautious you’re ready to break out of your comfort zone. Research has shown that you can get maximum mental benefits if you become open to new experiences. Try going to an art show of someone you’re unfamiliar with or sampling a new cuisine. If there’s a cultural fair, grab a friend and go explore as much as you can. If you have the means, traveling is another great way to expand your cognitive horizons and boost your mental health.

Any combination of these techniques can be beneficial, so start with what will be easiest to work into your schedule. From there, you can make adjustments on what activities you enjoy, trips you want to take, or even nightly activity nights you want to hold. Keep challenging yourself, and your brain will thank you for it!

About George Mears

George Mears is a brain fitness expert whose major area of interest is how brain exercises like games, puzzles, and memory activities help people to minimize the brain health deterioration that can lead to Alzheimer’s disease and dementia. Brainwellness.info

Exercise as Medicine

The United States health care system is set up to manage ongoing chronic disease and illness–not to promote health.  It often seems as if there isn’t any incentive to actually cure disease at all, but only to manage and extend the latent period of the disease.

Meanwhile, there is an ironic dichotomy in which the national media loves to cover the lifespan revolution.  Some believe that we are the cusp of significantly advancing the length a person can live.  Sadly, the actual average number of years a person is expected to live remains stable or in many cases, actually decreasing.  This is entirely due to poor nutrition, lack of physical activity, and environmental factors.  The United States continues to not even rank in the top 25 in world health statistics.

Yet, we spend more money on healthcare per capita and per person than any other country in the world!  Health care costs in the United States continue to increase without actual positive change in health status.  It is imperative that we all take a leadership role in our own health care by continuing to be proactive.

American society today is not healthy.  We continue to live in a fast paced, stressed out, and chronically ill environment.  People continue to suffer from preventable diseases such as diabetes, osteoporosis, and heart disease.  Even diseases such as cancer, Parkinson’s, and Alzheimer’s can potentially be prevented with the right health choices.

The promise of a long life is appealing.  But is a long life really what you want if it’s lacking quality?  Increasing the number of years you live is not as important as increasing the way you can live those added years.  Spending an extra 5 or 25 years alive, but ill, is a curse not a blessing.

We all must take an active role in taking charge of our health and wellbeing.  Prevention must be the focus.  I believe that each one of us should develop our own health plan which will allow us to improve health span and lifespan.  There are very simple and scientifically proven techniques that can help you to address and prevent many of the most common chronic illnesses affecting the population in the United States and the Western World.  A new approach to health and medicine must be to understand that exercise is medicine.  When exercise is properly dosed for the individual, both lifespan and health span will improve.

Physical factors that address health span, which is the period of time during one’s life that you are generally healthy and free from disease, include strength, balance, flexibility, and endurance.  These same factors all contribute to your body’s physical resiliency and generally, your mobility.  Maintaining your mobility is critical for all body functions and is fundamental in avoiding chronic illness.

Physical factors that address health span include:

Strength

The importance of strength training cannot be overstated in helping your body prevent chronic disease and illness while maintaining resiliency and mobility.  Properly dosed strength training programs are critical in avoiding chronic illnesses such as diabetes, osteoporosis, and osteopenia.  It provides positive effects to your muscular and cardiovascular system which can reduce the risk of dementia and Alzheimer’s disease.  Strength training also plays a critical role in proper hormone regulation throughout your life which can affect almost every process occurring in the body.

ManDumbbellWeightTraining

The guiding principle for strength training is The Overload Principle.  Resistance or strength training is commonly used to produce an overload of the body’s system.  An example would be any type of pushing or pulling exercise that exerts a force on the muscle, which causes it to work harder than it would normally.

The key to all training is that the system must be properly overloaded to produce the desired effect.  Too little, and you will not receive a positive benefit.  Too much, and you risk injury.  The overload principle must guide all exercise routines if there is to be actual success and benefit from the program.  The overload principle must include a progressive linear model to adding resistance to insure ongoing stimulation of the body’s systems and to avoid injury or plateau of benefits.

Although any properly dosed/prescribed form of resistive exercise would be beneficial, the most effective exercises either activate large muscle groups and/or load the skeletal system.  Examples include squats, lunges, and dead lifts.

Balance

Balance is affected by many of the body’s systems.  Like muscle, balance can be a use it or lose it proposition and therefore, must be part of any health plan program.  Improving your balance is critical to avoiding falling as you age.  Falling continues to be a top cause of injury and debility in the older population.

A quick daily balance routine can greatly reduce your risk of falling.  Please refer to the following resources to get started:  How Do I Improve Balance? (Part I), How Do I Improve Balance? (Part II), and Improving Balance by Using a Water Noodle.

Flexibility

A range-of-motion (ROM) or flexibility program should include many components including gentle mobility exercises as well as static or dynamic stretching to insure proper body mobility.  Stretching is ideally performed 10-15 minutes at a time five days per week.  An excellent time to work on a flexibility program is after a workout.  Static stretching is an excellent method to maintain flexibility, and it’s ideal to perform during a cool down.

Tai Chi is an excellent form of exercise that positively affects your flexibility, strength, and stability while stimulating the somatosensory system.  Yoga, like Tai Chi, also addresses many of these same areas.

Foam rolling is also an excellent method to improve flexibility.  Individuals taking blood thinning medications or with blood clotting disorders should consult his/her physician prior to using a foam roller for mobilization.

For more information on flexibility, please refer to How to Maintain Healthy Joint Motion.

Endurance

The research on the effectiveness of HIT continues to grow.  Even more impressive are the findings that HIT can be safely performed at any age and with almost every medical condition.  It is now even being implemented in many progressive Cardiopulmonary Rehabilitation Programs, where people are recovering from all kinds of cardiac and pulmonary disorders such as COPD, heart attacks, and heart valve replacements.

Perform your cardio activity in short bursts (ranging from 30-60 seconds at a time) followed by a one to two minute recovery.  The 30-60 seconds should be at a high intensity, meaning your rate of perceived exertion (RPE) is high.  You should be breathing heavy.

Accommodations can be made for almost any type of medical condition.  For example, HIT may be performed while using a stationary bicycle, an upper body only bicycle, a rowing machine or in the pool.  You can also walk uphill at a quick pace, then stop and rest.  The point is to get your heart rate up, and then bring it back down for a full recovery prior to repeating.

The exercise as medicine concept needs to be embraced by health care consumers and healthcare practitioners alike.  The only way to truly affect your health span and age well is to take responsibility for your own body.  The key to any longevity or healthy aging program is to remain engaged in all aspects of your life (including your physical, mental, and emotional health).

When implementing your own health plan, which of the four physical factors (strength, balance, flexibility, and endurance) will you take action on in order to improve your health span and life span?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

3 Simple Exercises to Help You Age Well

We are all capable of navigating a successful aging process if we are intentional with our behaviors.  Although successful aging has a different meaning for each of us and outcomes will vary, commonalities exist in most scenarios.  In order to age successfully, you will need to fully embrace what it will take to accomplish the goal of living safely, independently, and comfortably within your community.

Elderly couple walking through the park hand in hand

Mobility is vital to independence.  Independent mobility is different for everyone.  It may be through ambulation or use of an assistive device such as a cane, walker or wheelchair.  You need to maintain the ability to be independently mobile regardless of utilizing a mobility or assistive device.  Aspects of maintaining mobility include adequate balance, strength, and endurance.

The following 3 simple, yet vital exercises will help you to maintain your functional mobility and independence:

Walking

Walking is a wonderful method of exercise.  Out of all the possible movements humans can perform for mobility, we are best at walking!  Since most of us started at a very early age, we are familiar with walking.  It has different purposes and offers many benefits.  We walk to get somewhere, to have fun, to relax, and to exercise.  Compared to other activities, walking is easy on your body and can fit into your busy schedule.  Walking daily can reduce stress, improve circulation and hormone regulation, maintain strength and bone density, reduce pain as well as benefit your overall well-being.  It just makes you feel good!  Walk daily!

Squatting

Squatting in some form or capacity is a normal part of daily life.  The muscles needed to perform a squatting motion or a sit to stand motion are critical for all functional mobility related movements, including walking; getting up from a chair or a toilet; or picking up someone or something.  This motion helps to maintain lower extremity strength and range of motion as well as maintaining bone density and proper hormone regulation.  It can also help improve balance and even aid in digestion.  A simple method to practice this exercise is to move from sitting to standing.  As you improve, find a lower surface to practice from.  Eventually, the goal would be to move into a full squat (as long you don’t have any medical barriers that would prevent that particular motion).

Standing on One Foot

Balance is an important part of mobility.  It is usually overlooked and taken for granted until mobility is significantly affected.  Like all exercise, balance exercise should be fun and convenient.  Balance, just like muscle strength, is a use it or lose it proposition.  A simple, yet effective method to maintain and/or improve balance is stand near your kitchen counter and practice standing on one leg.  You should be able to stand for at least 30 seconds.  To increase the difficulty, practice balancing with your eyes closed.

These three exercises are critical for maintaining mobility and function as we age.  Walking and squatting are some of the first abilities we develop as children, and they need to be the last ones we lose as we age.  Your ability to perform these exercises is fundamental to how you are able to function throughout your life.

Which of these three simple, yet vital exercises can you implement in order to maintain your functional mobility and independence?  Please leave your comments below.

Looking for relevant senior related resources in your community?  The Seniors Blue Book is full of relevant resources for seniors as well as helpful articles on successful aging and elder care.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

(This article first appeared in the Seniors Blue Book, April through September 2016, pages 116 and 117.)

Why Exercise can Reduce Your Risk of Falling

There are many aspects that should be addressed as part of a thorough fall prevention program. None of them should be to limit mobility except in only the most extreme scenarios.  A thorough exercise program is a critical first step in reducing falls.  The American College of Sports Medicine (ACSM)’s Exercise and the Older Adult and The Office of Disease Prevention and Health Promotion’s Physical Activity Guidelines both state the need for all adults (and especially, older adults) to remain active in order to reduce the risk of falling.

Senior couple in the gym

A thorough exercise program should address the following four basic areas of fitness and mobility: balance; strength; cardiovascular (aerobic conditioning); and flexibility. Before starting a new exercise program, it’s best to consult with your physician to resolve any potential medication issues and be certain that you are healthy enough for exercise.

Balance

Visual System

This is the relationship of the head and eyes to your surroundings. Most people are very dependent on their eyesight for balance. Eyesight is easily impaired in dark or dimly lit environments. It tends to decrease with age due to medical conditions, such as glaucoma or macular degeneration.

Vestibular System

Our vestibular system is part of our inner ear. It provides us with information on head acceleration and gravity. It also works closely with our brains to process information on the head’s position in its environment. It helps us produce reflexes which affect our sense of equilibrium and our eyes’ ability to hold a gaze on a desired target.

Somatosensory / Proprioceptive System

The integration of the neurological system (including the brain and nerves throughout the body) with the musculoskeletal system is the somatosensory system. This includes all the touch and movement nerve receptors in the muscles, tendons, and joints. This also includes our ability to distinguish between hot and cold.

Proprioception, which is part of the somatosensory system, is a fancy word describing our brain’s ability to know where we are located in space. For example, if we close our eyes and lift our arms overhead, we know where our arms are located.

A common problem affecting the somatosensory system is neuropathy. One very common form of neuropathy is from diabetes. Neuropathy is when the nerve cells (typically in the extremities like hands and feet) will die. This may be due to poor blood supply, trauma, infection, disease, or even side effects from medication. The death of the nerve is the “neuropathy” which presents initially when a person may feel cramping, shooting or burning pain. Ultimately, it affects the person’s ability to feel sensations which causes numbness. Having numb feet makes it very difficult to balance!

For more information on balance, please refer to Q & A: How Do I Improve Balance? (Part I).

Strength

Strength training is ideally performed two or more days a week and includes a rest day in between sessions. The focus should be on a slow regular progression of weight bearing exercises which are designed to improve posterior chain strength. This includes the back extensors, buttocks, and hamstring muscles. The focus should also be on the calves and quadriceps muscles. Each plan must be designed for you as the individual.

The overload principle states that a greater than normal stress or load on the body is required for training adaptation to take place. The one exercise that should be addressed in some form or another is the squat. This basic movement insures that you can move from a sitting to standing position.

In short, the squat works just about every muscle in the trunk down toward the legs. These muscles are critical for all functional mobility related movements, including walking; getting up from a chair or a toilet; or picking up someone or something. The squat is a critical exercise to maintain mobility and function as we age.

Cardiovascular (Aerobic Conditioning)

Aerobic conditioning is ideally performed for a total of 150 minutes per week. It should be performed in at least ten minute intervals at a moderate intensity.

High Intensity Training (HIT) or High Intensity Interval Training (HIIT) may also be implemented into a cardiovascular training program. The research on the effectiveness of HIT continues to grow. Even more impressive are the findings that HIT can be safely performed at any age and with almost every medical condition.  It’s now even being implemented in many progressive Cardiopulmonary Rehabilitation Programs, where people are recovering from all kinds of cardiac and pulmonary disorders such as COPD, heart attacks, and heart valve replacements.

Perform your cardio activity in short bursts (ranging from 30-60 seconds at a time) followed by a one to two minute recovery. The 30-60 seconds should be at a high intensity, meaning your rate of perceived exertion (RPE) is high. You should be breathing heavy.  Accommodations can be made for almost any type of medical condition.  For example, HIT may be performed while using a stationary bicycle, an upper body only bicycle, a rowing machine or in the pool.  You can also walk uphill at a quick pace, then stop and rest.  The point is to get your heart rate up, and then bring it back down for a full recovery prior to repeating.

Walking should also be implemented into a daily cardiovascular program. Ideally, your walking program will be separate from your specific 150 minutes of cardiovascular exercise per week.

Flexibility

Stretching is ideally performed 10-15 minutes for five days per week. An excellent time to work on a flexibility program is after a workout.  Static stretching is an excellent method to maintain flexibility, and it’s ideal to perform during a cool down.

Tai Chi is an excellent form of exercise that positively affects your flexibility, strength, and stability while stimulating the somatosensory system. Yoga, like Tai Chi, also addresses many of these same areas.

Foam rolling is also an excellent method to improve flexibility. Individuals taking blood thinning medications or with blood clotting disorders should consult his/her physician prior to using a foam roller for mobilization.

For more information on flexibility, please refer to How to Maintain Healthy Joint Motion.

Each exercise program should be tailored to the individual. A physical therapist can help you design and implement an exercise program.  Physical therapists can also help you address the risk factors listed in What You can do to Prevent Falls.

The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Which area of fitness and mobility (balance, strength, cardiovascular, and flexibility) could you specifically improve on in order to reduce your risk of falling? Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

What You can do to Prevent Falls

“Falls don’t just happen, and people don’t fall because they get older. Often there is one underlying cause or risk factor involved with the fall.” –National Institutes of Health (NIH)

Many older adults are concerned about the possibility of falling. In many cases, such apprehension leads to a reduction in activity which only increases the risk of falling and debility over the long term. I recently had the opportunity to speak to a large group of adults regarding the topic of falling. The intent is not to scare people, but to encourage everyone that most falls are preventable!  The goal for healthy aging is the opportunity to live well, be active, and feel empowered to live your life the way you want to.

Son with Elderly Father

The Truth about Falling

  • One-third of adults over 65 fall each year and more than half of adults over 80 fall annually.
  • In older adults, falls are the leading cause of fatal and non-fatal injuries.
  • Adults over 75 are five times more likely to be admitted to a nursing center for over a year from an injury related fall.
  • 20-30% of older adults that fall suffer a moderate to severe injury including lacerations and fractures.
  • Recent information from the Centers for Disease Control and Prevention (CDC) show that each year at least 250,000 older people (those 65 and older) are hospitalized for hip fractures.
      • More than 95% of hip fractures are caused by falling.
      • Women fall more often than men, and experience three-quarters of all hip fractures.
      • Women are more often diagnosed with osteoporosis and osteopenia, a disease that weakens bones and makes them more likely to break.
      • The older you are, the greater the chances of breaking your hip when you fall.
      • Over 20% of people who suffer a hip fracture will die within one year and over 50% that survive will never return to their prior baseline.
      • For excellent patient resources, please refer to Older Adult Fall Prevention.

Fall Risk Factors

Intrinsic (Self Risk Factors):

  • Balance and gait impairments.
  • Visual and motor reaction time problems.
  • Medication side effects and reactions. (Polypharmacy refers to taking more than four medications.)
  • Visual impairments.
  • Cognitive impairments.
  • Cardiovascular issues.
  • Incontinence (loss of bladder or bowel control).
  • Medical complications such as urinary tract infections or dehydration.
  • Vestibular dysfunction.

Extrinsic (External Risk Factors):

  • Poor lighting.
  • Stairs with poor railings.
  • Throw rugs or slick floors.
  • Improperly fitting clothing or footwear.
  • Lack of or improper use of assistive devices such as canes or walkers.
  • Cluttered living areas.
  • Rushed movements such as hurrying to answer the phone or a door.

What You can do to Prevent Falls

Fall Proof your Home:

  • Make sure that you have adequate lighting. This eliminates potential trip issues and helps if you have a visual impairment.
  • Remove loose throw rugs or tack them down.
  • Avoid slick floors.
  • Remove clutter from the floor.
  • Add grab bars and hand rails as needed in the bathroom or near steps and stairs.
  • Re-organize commonly used items to make them easier to reach.
  • Make sure you have clear pathways with extra room to accommodate any assistive devices such as a walker.
  • For an excellent resource for practical strategies to fall proof your home, please refer to http://nihseniorhealth.gov/falls/homesafety/01.html

Fall Proof Yourself:

  • Have your eyes regularly checked and always wear appropriate eyewear. For example, if you wear reading glasses, don’t wear them when you’re walking.
  • Be sure your footwear and clothing fit appropriately. Pants can fall down off your waist and cause you to trip. Pant legs that are too long or improperly fitting shoes are also common trip hazards.
  • Use your assistive devices, such as canes and walkers, appropriately and be sure they fit properly.
  • Be sure you have adequate lower leg and core strength.
  • Be sure you have adequate balance and stability.

Many research studies indicate that exercise can reduce the risk of falling. A thorough exercise program should address aerobic conditioning, strength, balance, and flexibility.  For more information, please refer to Why Exercise can Reduce Your Risk of FallingBefore starting a new exercise program, it’s best to consult with your physician to resolve any potential medication issues and be certain that you are healthy enough for exercise.

Most falls are preventable if you are proactive. A fall can significantly and permanently alter your ability to care for yourself and function independently.  Maintaining your physical function and mobility is a critical component to aging well and gracefully.  For more information, please refer to 8 Easy Strategies to Limit the Risk of Falling.

Have you or a loved one been injured from a fall? Which strategy can you implement to reduce your risk of falling?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

How to Maintain Healthy Joint Motion

Healthy aging could be defined as having the physical, mental, social, emotional, and spiritual capacity to live life on your terms. Maintaining adequate health is a combination of physical strength, cardiovascular endurance, joint motion, and balance in order to perform activities of daily living (ADLs).  This includes any or all desired tasks, such as picking up your grandchildren, to playing golf or running.

The ability to move a joint through its full range of motion (ROM) is critical in maintaining the ability to perform many important functional tasks. Imagine trying to lift a box overhead with a shoulder that only has half its motion.  That makes for a very difficult task.  There are many reasons for loss of joint motion:  muscle or tendon tears; generalized muscle weakness; paralysis; and severe arthritis.

Typically, osteoarthritis (OA) will occur in a joint that has previously been injured or one that doesn’t adequately move. Movement allows the proper nutrients to be circulated through the blood and synovial fluid that coats and lubricates the joint.  There are also genetic factors that may predispose a person to developing OA, which is one of 171 different types of arthritis.

How can you best maintain joint mobility throughout the aging process? What is the minimum effective dose to help insure joint mobility as you age well? The key to maintaining mobility is to take each joint of the body through its full range of motion (ROM) at least once per day.

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A crucial component to joint health and mobility is to insure that the joint surfaces remain coated with the body’s natural lubricant known as synovial fluid. Synovial fluid is best circulated in joints through mobility.  To insure that the entire joint surface is coated, a full arc of motion needs to be performed.

By performing a full arc of motion for each joint, you also insure that the associated ligaments, tendons, and musculature can accommodate for this motion and won’t shorten over time due to lack of use. Moving each joint through a full ROM daily is the key to maintaining motion.  In order to insure optimized healthy aging, it’s best to move that joint frequently.

The latest research indicates that sitting for more than two hours at a time can significantly lessen your life span. The real headline should read, “Even if you are a regular exerciser, sitting for more than two hours a day will still lower your life span.”

Frequent movement throughout the entire day is critical for health.  This includes frequent mobility as it is important for joint health as well as critical for cardiovascular health. Ideally, you should choose movements and exercises that are functional and address multiple joints at the same time.

How to Maintain Healthy Joint Motion:

  • The Squat. The squat activates nearly all of the muscles in the lower leg. It also takes the hips and knees into end range flexion as well as the ankles into near end range dorsiflexion. The squat is particularly effective at activating the muscles in the legs referred to as the posterior chain, which includes the hamstrings, the glutes (or buttock muscles), and the hip adductors (or the groin muscles). It also activates muscles in the hips, the calves, the stabilizing muscles in the ankles, the quadriceps, and as well as the core (the abdominals and lumbar extensor muscles). These muscles are critical for all functional mobility related movements, including walking; getting up from a chair or a toilet; or picking up someone or something. For more information on squatting, please refer to 7 Reasons Why the Squat is Fundamental to Life.
  • Tai Chi and Yoga. Tai Chi, yoga, and Qigong all implement slow simple movements into a full body exercise that can help you to maintain your mobility, balance, strength, and general health as you age.
  • Stretching and Self-Mobilization. There are generally 5 Ways to Improve Range of Motion when utilizing different stretching methods or self-mobilization. Using a foam roller is an excellent method to decrease pain and improve mobility throughout the hip and pelvis. For more information on how to use a foam roller, please refer to Foam Rolling for Rehabilitation.
  • Shoulder Pulley. A simple, yet popular, method to maintain shoulder motion is through a shoulder pulley. Shoulder pulleys are an excellent way to use active assistive motion to regain motion in the shoulder post injury or surgery. I also instruct many of my clients to utilize shoulder pulleys for pain management as well as a prevention strategy for arthritis and loss of shoulder motion and function.

Maintaining adequate joint mobility and range of motion is an important component in healthy aging and can be a critical strategy in order to avoid many orthopaedic or arthritic conditions. Be proactive now, so you can save yourself from experiencing pain and debility in the future. It’s never too early or too late to implement strategies to help you age well!

Which strategy do you use to maintain your joint range of motion and mobility? It could be as simple as using the foam roller or a shoulder pulley.  Please leave your comments below.

Looking for that exercise or book I mentioned in a post?  Forgot the name of a product or supplement that you’re interested in?  It’s all listed in the Resource Guide. Check it out today!

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

7 Strategies to Improve Your Health in 2016

Portrait of a happy fit couple standing over white background

I often hear clients comment, “It’s too late to make a change now. I’m too old!”  Worse yet, so many people actually believe that, but I don’t!  I believe that it is never too late to change.  You are never too old or out of shape to make improvements in your life.  Being healthy and aging well is not a single choice to be made once and then never re-visited.  It is a series of constant choices that add up to a way of living.

Aging well encompasses all of the following aspects of our being: physical, mental, emotional, and spiritual. It also includes the community around us.  This year, choose to make small consistent choices to improve these areas of your life.  This will make all of the difference in aging well.  Each person’s physical journey as he/she ages is different.  Taking consistent and appropriate action now can vastly change future outcomes.

The purpose of The Physical Therapy Advisor web site is to assist you by addressing the physical component in your successful aging journey. My desire is to help you understand how to safely self-treat and manage common musculoskeletal, neurological, and mobility related conditions in a timely manner so you can reach your optimal health.

7 Strategies to Improve Your Health in 2016:

Walk more!

Walking is one of the most fundamental activities we perform as humans. Research is very clear that frequent movements (like walking) are the key to avoiding many chronic conditions.  Walking lowers your risk of Alzheimer’s disease, heart disease, stroke, and diabetes.  It can lower blood sugar levels when performed directly after meals.  Elevated blood sugar levels are a major contributing factor to excessive internal inflammation which is associated with most chronic illnesses.

Walking as exercise and generally walking more during the day should be considered the first line defense in slowing the aging process and maintaining functional independence.  For more information on the benefits of walking, please refer to Why You Should Walk, Not Run and Why Walking is Critical for Your Health.

Embrace fashion.

The first step in adopting a new healthy behavior is to envision and feel what it would be like as if you had already adopted that new behavior. This allows your brain an opportunity to already feel what it would be like to make a change without fully doing so.  This can be very motivating.  Investing in gadgets or new work out attire, including new walking shoes, can be both motivating and fun.  Get in the mindset of adopting the new behavior.  Envision how you will look and feel once you have made the changes.  Then go for it!

Take control.

There is nothing more important than your health. You have control over most of the aspects in your life that affect your health and well-being.  Take charge, and empower yourself. You must be your greatest advocate.  Western medicine is designed to keep you alive, not to help you thrive.  Taking a passive role in your health is not a wise choice in America’s current health care environment.  Only you are responsible for your health.  Decisions now will determine how successful you age in the future.  For more reasons on why you must take control of your health, please refer to 6 Reasons to Self-Treat and Manage Your Health.

Make the decision.

Research on willpower has shown that it is a finite resource. We actually use up our willpower during the day and have to replenish it daily.  This is why you are more likely to “fall off the wagon” later in the day rather than earlier.  Decide on the change and commit to the decision.  Then implement structure to your day that causes the behavior to be more automatic.  Therefore, eliminating the need to rely solely on willpower.

Maintain your strength.

Although all muscle fibers decline some as you age, the fast twitch (Type II) fibers show the most declines. Some loss of strength is anticipated as you age.  Losing strength to the point of complete debility or loss of mobility and independence is not a normal aging process.  For more information, please refer to 3 Strategies to Start Right Now to Improve Health Span.

Strength training is a critical component to maintaining and growing additional Type II muscle fibers. The stronger you are, the more resistant to injury you are.  You are more likely to maintain proper functional mobility.  Also, strengthening of the core area (the abdominals and back extensors) helps to manage low back pain.  When you subscribe to my e-mail newsletter, you will automatically gain access to my FREE resource, 10 Minutes per Day Low Back Pain Prevention Guide. These specific strengthening exercises will help you to not only prevent low back pain, but self-treat it, too.

Perform high intensity training (HIT).

The research on the effectiveness of HIT continues to grow. Even more impressive are the findings that HIT can be safely performed at any age and with almost every medical condition.  It is now even being implemented in many progressive Cardiopulmonary Rehabilitation Programs, where people are recovering from all kinds of cardiac and pulmonary disorders such as COPD, heart attacks, and heart valve replacements.

Perform your cardio activity in short bursts (ranging from 30-60 seconds at a time) followed by a one to two minute recovery. The 30-60 seconds should be at a high intensity, meaning your rate of perceived exertion (RPE) is high. You should be breathing heavy.  Accommodations can be made for almost any type of medical condition.  For example, HIT may be performed while using a stationary bicycle, an upper body only bicycle, a rowing machine or in the pool.  You can also walk uphill at a quick pace, then stop and rest.  The point is to get your heart rate up, and then bring it back down for a full recovery prior to repeating.

If you feel unsure as to how to safely perform this type of training, please seek the help of a competent cardiopulmonary trained physical therapist or exercise physiologist. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Get started!

Make 2016 your year to make the necessary changes that will empower you to age well. Most importantly, just Get Started!

Also, I would encourage you to check out my Resource Guide. The specific exercise section is full of rehabilitation exercises ranging from low back pain to knee pain.  These .pdf files include photos and detailed descriptions to help you get started.  This list of resources also includes books, products, resources, supplements, topical agents, videos, and web sites that I personally use and recommend to my family, friends, clients, and patients (for use in the clinical setting).

For additional strategies to improve your health, please refer to 15 Strategies to make 2015 Your Healthiest Year Ever.

Which strategy can you implement in order to age well in 2016? Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

My Top 5 Most Popular Posts of 2015!

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Many of us struggle with aches, pains, and/or chronic illnesses. Often we search for answers online, but we find nothing more than hype and confusion. If we engage in the traditional western medicine approach, we discover nothing more than symptoms management and a hurried and rushed experience. Such experiences can leave us jaded and disheartened. I created The Physical Therapy Advisor web site to fill in this gap and to help you understand how to safely self-treat and manage common musculoskeletal, neurological, and mobility related conditions in a timely manner so you can reach your optimal health.

My Top 5 Most Popular Posts of 2015:

  1. Q & A: How to Increase Hip Strength and Improve Mobility – Maintaining adequate hip and pelvis mobility and strength is an important strategy in avoiding many lower extremity orthopaedic conditions from knee pain to plantar fasciitis.
  2. How to Prevent Shin Splints – Shin splints are typically caused by inflammation in the lower leg anterior muscles known as the anterior tibialis muscle. This is the primary muscle needed to lift your foot. Shin splints are often considered an over use injury. Unfortunately, shin splints are relatively common in runners and dancers.
  3. Why You Should Walk, Not Run – Although controversial and disappointing for some, running isn’t appropriate for everyone. As a physical therapist and runner, I understand why some people cannot and should not take up running as a form of exercise. An existing injury may make it unsafe to run on a regular basis. If you can’t run, don’t worry about it! Many other forms of exercise without repeated impact can help us to keep fit. Walking is a wonderful method of exercise.  Out of all the possible movements we can perform, we’re best at walking! Walking daily can reduce stress, improve circulation and hormone regulation as well as benefit your overall well-being.
  4. Why Walking is Critical for Your Health – Choose walking as an intentional exercise and add it to your daily activities as part of a healthy lifestyle. You will feel better and likely live longer when you incorporate this critical component to aging gracefully and successfully.
  5. Chronic Pain: Is There Hope? – Jerry Henderson’s post on chronic pain was featured in the Guest Perspective. There are many definitions of chronic pain, but one of the most widely accepted is any pain lasting longer than 12 weeks. Experiencing pain for longer than 12 weeks is simply not normal. Physical therapists need to take the lead on being the providers of choice for these types of problems. No one can do it better.

2015 has been a wonderful year! I have featured reader submitted Q & A’s as well as many exercise and training posts. An important focus has been on longevity and healthy aging. I have also addressed chronic disease management by offering specific advice and rehabilitation strategies.

As many of my posts offer specific strategies and recommendations related to longevity and healthy aging, I was interviewed on the popular podcast, The Longevity and Biohacking Show by Jason Hartman.

In my guest posts for the Seniors Blue Book, I offered advice on healthy senior living (specifically on Exercise is an Effective Treatment for Knee Arthritis Pain and Out of Balance?)

In my guest posts for the Marathon Training Academy, I offered specific rehabilitation strategies to treat common running related injuries. This led to a guest appearance on their top rated running podcast as well. Please refer to Marathon Training Academy Podcast Episode #154, The Marathon That Got Away (How to Rehabilitate Achilles Tendinitis).

I am excited to announce an upcoming guide on injury prevention and recovery for runners that I have collaborated on with Trevor and Angie from The Marathon Training Academy.  Please visit https://marathontrainingacademy.clickfunnels.com/optin8252054 for a FREE digital resource, The Runner’s Toolbox, and to stay informed when the guide is available in early 2016!

Looking toward 2016, I will continue to offer free self-treatment advice to help YOU manage common musculoskeletal, neurological, and mobility related conditions in a timely manner. Together we can all learn to age well and reach our optimal health.

Thank you for supporting The Physical Therapy Advisor! I look forward to serving you in 2016!  If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Don’t forget subscribe to my e-mail newsletter! I will send you weekly posts on how to maximize your health, self-treat those annoying orthopaedic injuries, and gracefully age.  To thank you for subscribing, you will automatically gain access to my FREE resource, 10 Minutes per Day Low Back Pain Prevention Guide.

Why the Squat is Fundamental to Life

Squatting is a fundamental movement. Squatting is one of the first abilities we develop as a child, and it needs to be one of the last ones we lose as we age.  Your ability to perform a squat is fundamental to how you are able to function throughout your life.

Your ability to squat is critical to your ability to function independently. In my experience of working with seniors, there are two main reasons why a person will need additional care and support: 1. The person can no longer safely get from point A to point B (this usually involves walking). 2. The person is no longer able to stand up from a sitting position.  This means he/she cannot get up and down from a chair, a toilet, or even the bed.  If you cannot perform these activities safely and independently, then you will need additional care.

The squat is a critical exercise to maintain mobility and function as we age. For more information, please refer to 7 Reasons Why the Squat is Fundamental to Life.

Do you regularly practice squatting? If not, which modified version of the squat (as demonstrated in the video) can you start implementing?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!