Posted on Wednesday, June 10, 2015

Why Walking is Critical for Your Health

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 as well as benefit your overall well-being. It just makes you feel good!

As we consider what it means to age successfully, we must look at our ability to live safely, independently, and comfortably regardless of age. In order to age successfully, we must be intentional about the process. A walking routine can help you to manage each of these critical components to successful aging including: physical health, mental health, emotional health, community, and finances (particularly if leading a healthy lifestyle helps you to avoid the ever growing costs of health care).

Almost anyone can walk, even those who may have a temporary or permanent medical condition which doesn’t allow for other forms of exercise. Walking can still be appropriate for those with the following conditions:

Certain Forms of Arthritis – There are 171 different kinds of arthritis. Although causes and presentations vary, the most common form is osteoarthritis (OA). Regular exercise and a range of motion (ROM) program is a critical component to proper management of arthritis. For more information specifically on Rheumatoid Arthritis, please refer to Q & A: Exercises Beneficial in Managing Rheumatoid Arthritis.
Joint Replacement – As America’s population continues to age, total joint replacement has become an increasingly more popular method to treat pain and arthritis in joints.
Morbid Obesity – Morbid obesity is defined as a Body Mass Index (BMI) greater than 40 or having more than 100 lbs. of body weight.
Recent Medical Procedures or Injury – Often after a medical procedure, physicians will advise not to run or participate in overly strenuous exercise during recovery. Walking is nearly always indicated as part of a recovery process (particularly after spinal surgery). Many lower leg surgeries may indicate a reduced or non weight bearing time period when walking isn’t recommended. Always refer to your physician and physical therapist regarding when to avoid activity. Once you have sufficiently healed, you can taper back into your prior level of activity and walking program. Your physician or physical therapist can offer advice on how to safely resume your activities.
Chronic Injury or Illness – Past injuries or illness can cause permanent injury and debility. Sometimes it may cause someone to have to permanently alter his/her ability to participate in more high impact activities. Other forms of chronic disease, such as fibromyalgia, may make intense exercise unreasonable. In almost all of these cases, a walking program may be indicated.
Severe Osteoporosis – Osteoporosis is the weakening of the bones. Besides dietary modification, the best course of treatment is weight bearing activities such as weight training and walking.

Walking is a wonderful form of exercise. Regardless of your age and fitness level, I believe walking should be part of a healthy lifestyle. Many of the benefits of walking overlap. Improving your circulation and hormone function will have a positive effect on other areas of your health.

What are the benefits of walking?

Lowers the risk of heart disease, stroke, and diabetes.
Lowers your risk of cancer, including breast cancer.
Improves circulation and blood flow to the entire body.
Releases stress reducing hormones.
Releases hormones that can control blood sugar levels for up to 24 hours. This helps to reduce your risk of diabetes while keeping your energy levels stable throughout the day.
Keeps your mind sharp and reduces your risk of Alzheimer’s disease and dementia.
Boosts your immune system.
Improves sleep quality.
Reduces pain levels.
Helps to manage arthritis symptoms. Please refer to Exercise is an Effective Treatment for Knee Arthritis Pain.
Helps to maintain your eyesight and avoid cataracts through improved circulation.
Reduces the risks of periodontal disease.
Burns calories.
Helps to prevent constipation.
Walking in a fasted state can help your body to learn how to utilize fat more efficiently as an energy source.
We are naturally good at walking. Do it daily!
It is a weight bearing activity that can be beneficial in reducing osteoporosis.
Keeps the spine healthy. The walking motion is vital to nutrient exchange in the spinal discs.

Typical guidelines suggest walking for 30 minutes per day, five or more times per week. The recommended 30 minutes per day doesn’t need to be performed all at once. I highly encourage you to walk more than 30 minutes–just in shorter sessions throughout the day. When formulating a walking plan, look for ways to add a short distance here and there.

As part of a regular exercise plan, walking in the morning can be an excellent method to help energize your day by starting out on the right path mentally and emotionally. If performed prior to breakfast, walking also has the additional benefit of helping to regulate your appetite. When performing low intensity exercise in a fasted state, your fat burning capability increases while your hormone levels stabilize. Walking after dinner has a similar effect on hormone levels (particularly with stabilizing insulin levels).

If you want to increase the amount of calories burned during a walk, you may need to make a few changes to your morning or evening stroll. Don’t walk at your preferred speed. The trick is to make your body inefficient by walking slower, faster, uphill, downhill, or at varying speeds. Perform a high intensity workout by walking uphill briskly or using the Fartlek method.

Nordic walking, which utilizes walking poles that can help to stabilize you if your balance is poor, is also very popular. The use of walking poles can reduce stress from your back and lower extremity joints, increase your body strength, and burn more calories than traditional walking!

The most important component of a walking program is actually doing it! If you are unable to ambulate safely or need an assistive device to ambulate safely, walk with a friend or group. You may consider walking in safe location, such as a shopping center or mall, to avoid environmental hazards. With a little thought and preparation, walking can be possible for nearly everyone. If you are experiencing issues with balance, safety or other orthopaedic concerns, please consult a physical therapist. 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).

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.

Which benefits have you experienced from your walking program? 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!

Posted on Wednesday, May 27, 2015

Exercise is an Effective Treatment for Knee Arthritis Pain

Knee osteoarthritis (OA) causes chronic pain, reduces physical function, and diminishes quality of life. Obesity, prior injury, and increasing age are among the risk factors for knee OA, which is more common in women. Typical treatments for knee OA include total joint replacement and exercise. Medication management may include oral anti-inflammatory use, cortisone injection, and supplementation with glucosamine and chondroitin.

A recent meta-analysis of 54 randomized control studies, published in Cochrane Database (January 2015), concluded that therapeutic exercise provides a 2-6 month benefit even after cessation of the exercise program. This benefit is comparable to the use of non-steroidal anti-inflammatory drugs without the side effect risk from drugs. The study concluded that exercise is just as effective in treating knee OA pain as anti-inflammatory medication.

This most recent study looked at 2-6 month benefit when performing exercise. It is reasonable to conclude that long term therapeutic exercise continues to have a positive effect in pain management and functional loss well beyond the 2-6 month time frame. Performing therapeutic exercises improves physical function and alleviates pain levels with little risk. When properly performed, exercise doesn’t significantly increase the risk of further damage or deterioration in OA (or in most other forms of arthritis).

The study also indicated that individually tailored exercise programs tend to result in a greater reduction in pain as well as improvement in physical function. If you suffer from knee OA, initiating a therapeutic exercise program could be the best long term solution in managing the condition while maintaining function and quality of life. A thorough therapeutic exercise program should include cardiovascular exercise, flexibility training, balance activities, and strength training. Seek guidance from a physical therapist, who can design an individually tailored exercise program to meet your specific needs.

Possible options for cardiovascular exercise include bicycling, rowing, and the elliptical machine. Less impact options include swimming and pool-based exercise programs. Exercise studies indicate the effectiveness of aquatic-based programs in reducing knee pain while improving general functional mobility. Performing a long term aquatic exercise program can be highly effective for managing knee OA symptoms. To insure maximal strength gains and carry over in functional mobility tasks (such as going up and down stairs, up and down curbs, and navigating uneven terrain), also incorporate a land-based program.Flexibility is an important component in managing knee OA pain. The goal should be to maintain full knee range of motion (ROM) with both extension (straightening) and flexion (bending). A joint should be moved through its full available ROM daily to remain healthy. Activities such as aquatic exercise, cycling, yoga, and flexibility classes are ideal for maintaining ROM.

Balance is an important component to maintaining functional mobility and limiting pain in the knee. Performing therapeutic exercises and weight training will help you to maintain your balance. Additional balancing activities should be performed to insure safe mobility and to reduce the risk of falling. Activities, such as yoga and Tai Chi, have excellent research demonstrating their effectiveness. Practice standing on one foot (near a counter top for support, if needed). It is an easy and effective method to maintain single leg balance which is critical for going up or down stairs and sidewalk curbs.

Strength training programs should include closed chain exercises. Closed chain exercises are closely related to functional movements and tend to cause less strain on your body tissues and joint surfaces. Squats, lunges, and bridging are examples of closed chain exercises. The bridge exercise involves lying flat on your back and raising your pelvis up into the air.

There are many variations of the squat. Perform sit to stands from a chair. If this is difficult, start with using your hands, but eventually you shouldn’t need to use them. Use a standard height chair and see how many sit to stands you can perform in 30 seconds.

For another squat variation, perform wall squats. Stand with your pelvis, back, and head touching a wall. Your feet will be approximately hip width apart and far enough out from the wall. When you slide down, your knees will make a 90 degree angle. From your starting position, slowly lower your body down and hold for time. As you improve, lengthen the amount of time you hold the wall squat. (Another variation is to place an exercise band around your thighs above your knees. It will help to increase the activation of the hip muscles.)

To maintain physical function and quality of life, a therapeutic exercise program (including cardiovascular, flexibility, balance, and strength training) may be the best long term solution for managing knee OA pain. Be certain to perform a thorough warm up and cool down before and after each exercise session. Focus on maintaining your ROM. If it hurts, modify or discontinue the activity, and refer to your physical therapist.

How do you incorporate cardiovascular exercise, flexibility training, balance activities, and strength training into your therapeutic exercise program? Please leave your comments below.

(This article first appeared in the Seniors Blue Book, April-September 2015, pages 106 and 107).

Posted on Wednesday, May 13, 2015

8 Easy Strategies to Limit the Risk of Falling

Falling is one of the most debilitating problems an elder adult can face. Presently nearly 90% of hip fractures in the elderly population are due to falling. Sadly, nearly 1 in every 5 elder adults who fracture a hip will die within one year due to complications from the injury. Implementing strategies to avoid falling and injury is one of the most important things you can do for yourself and your loved ones. As part of aging successfully and gracefully, strive to maintain your independence and functional mobility as long as possible.

Falling and the fear of falling cause a downward spiral of mobility and independence among the elderly. This affects a person’s quality of life and significantly increases end of life health care costs. A lack of mobility is a major contributor to poor health status. More health care dollars are spent as the person continues to become sicker with chronic diseases such as diabetes, heart disease, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and cancer. These conditions should be (in part) managed through exercise as medicine along with a healthy diet.

8 Easy Strategies to Limit the Risk of Falling:

Keep walkways clear and free from clutter. Many falls are avoidable simply by cleaning up the areas we frequently walk through.
Remove throw rugs or at the very least, tack them down so they are less of a trip hazard.
Add adequate lighting that is easy and convenient to turn on/off from your destination location (such as your bed or recliner). Put the light source on a remote control or clap on/off switches so that you don’t have to walk in the dark from the light switch to your destination.
Drink more water. Many falls are due to dizziness caused by dehydration. The older you are, the easier it is to become dehydrated. Drinking more water not only prevents dehydration, but it also aids in preventing urinary tract infections (UTI). A UTI can cause weakness, dizziness, and confusion in the elder adult; thus, increasing the risk of falling.
Use assistive devices correctly. Many people don’t use their canes or walkers appropriately. This can make the device a trip hazard and also increases the risk of falling. If you are unsure how to correctly use an assistive device, please ask a physical therapist for instruction.
Stay active. Many older adults become less active over time. This occurs for a variety of reasons, but muscle weakness and debility can develop very quickly. A daily walking program or participating in a Tai Chi class can be excellent methods in maintaining balance and mobility while decreasing the risk of falling. I also highly encourage weight training in older adults as muscle atrophy is a major cause of debility and frailty. You are never too old to strength train. The benefits of strength training are noticeable regardless of age.
Work on your balance. Like muscle, balance can be a use it or lose it proposition. Balance is affected by many of the body’s systems. 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.
Seek help from a physical therapist. Many physical therapists specialize in geriatric care and balance disorders. Treatment options are available in a clinic setting or in the home. Physical therapists can provide care directly in a client’s home. Most health insurance will cover the service if ordered by a medical physician. Physical therapy can provide a great benefit in addressing risk factors for falling. This may include a home evaluation, a physical assessment, and treatment recommendations. In most cases, a treatment plan should include a balance and strengthening component. Thankfully, you can benefit from physical therapy no matter your age. My oldest client was 102 years old. She progressed from being bed bound to being transferred (while using a lift) to walking over 100 feet with assistance!

Most falls are preventable if you are proactive. Implementing these 8 easy strategies will significantly reduce your risk of falling. A fall can significantly and permanently alter your ability to care for yourself and function independently. Broken Hips: Preventing A Fall Can Save Your Life is an excellent NPR article, including an audio clip, that really drives home the importance of this issue. Make changes today for a better tomorrow!

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.

Posted on Wednesday, April 29, 2015

14 Tips and Strategies to Self-Treat Muscle Pain

Muscle pain is common and often occurs after exercise or activity. Although the pain is uncomfortable, most types of muscle pain are benign and quickly pass. Muscle aches and pains can affect your ability to compete or train at a high level. It also can affect your sleep and mood. Discover the possible causes of muscle pain as well as prevention and treatment strategies.

Possible Causes of Muscle Pain include:

Delayed Onset Muscle Soreness (DOMS). This soreness typically occurs 24-48 hours after an exercise session due to micro trauma within the muscle tissue. It tends to be worse after eccentric biased exercise where the muscle is lengthened.
Muscle Strain. If you strain your muscle either by over lengthening or over exerting the muscle capacity, muscle tearing may occur. Depending on the size and location of the tear, it may range from minor to severe (potentially needing surgical intervention).
Myofascial Issues. Layers of the myofascia (the dense, tough tissue which surrounds and covers all of your muscles and bones) may become bunched or knotted up and result in pain. This is typically due to poor posture, repetitive motion injuries or over exertion.
Neurological Issues. Many neurological disorders, including pinched nerves, can cause pain. Other medical conditions, such as muscular dystrophy, cause muscle dystonia.
Illness. Muscle pain can occur as a symptom in colds, flu, Rocky Mountain Spotted Fever, and other viral or bacterial infections.
Disease. Many diseases, such as Polio, Lupus, and Lyme’s Disease, cause muscle pain.
Medications. Certain medications, such as statin drugs for cholesterol, have been strongly associated with muscle pain.
Fibromyalgia. This condition causes muscle pain, joint pain, and extreme fatigue.
Rhabdomyolysis. A serious condition, due to either direct or indirect muscle trauma, which causes pain. It can be life threating due to the potential for kidney failure. Common causes include extreme exercise, statin medication, severe injury or illicit drug use.
Compartment Syndrome. A serious condition in which excessive swelling and pressure build up in a confined space. It leads to extreme muscle pain and eventually, numbness and tissue death.

This list highlights some of the many potential causes of muscle pain. Many are benign while others are true medical emergencies. The most common reasons include: delayed onset muscle soreness (DOMS); muscle strains; myofascial related issues due to posture and/or repetitive motion injuries; and fibromyalgia.

In order to properly treat muscle pain, first identify the cause of your muscle pain. Can you correlate the symptoms with a certain activity or exercise? Are you suffering from a cold or flu like symptoms? If you are unable to correlate a reason for the pain, then you may consider consulting with your medical physician to rule out other possible causes for muscle pain.

The following tips and strategies to treat muscle soreness specifically address mechanical causes related to DOMS, minor muscle strains, and myofascial issues. Many of these strategies are also appropriate in helping to manage fibromyalgia symptoms.

14 Tips and Strategies to Self-Treat Muscle Pain:

Fix Your Posture. Poor posture is one of the most common causes of muscle spasming and pain. This is particularly true if you spend a good portion of your day sitting. Sign up to receive my weekly blog posts via e-mail, and I will share with you My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain. These simple exercises, with complete instructions and photos, will help you to improve poor posture and can be performed at home.
Massage. Contact a masseuse, physical therapist, athletic trainer or friend who is skillful in body work and massage to relieve the area in spasm. The specific massage technique to use will vary according to your preference. Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.
Foam Roller. The foam roller allows you to perform self-massage and tissue mobilization. The foam roller is a wonderful tool to prevent muscle cramping and spasms. Please refer to the following posts for more information: Foam Rolling For Rehabilitation and 5 Ways to Improve Range-Of-Motion. I highly recommend a High Density Foam Roller to help aid in your recovery.
Other Self-Mobilization Tools. Many times, a friend or masseuse isn’t available to assist when you need the help the most. A foam roller cannot effective reach places in the upper back or arms, so other self-mobilization tools may be necessary. You can get creative and use a tennis ball or golf ball, but I like a specific tool called a Thera Cane Massager. This tool allows you to apply direct pressure to a spasming muscle. When held for a long enough period of time, the Thera Cane Massager will usually cause the muscle spasms to release and provide much needed pain relief! I am also a big fan of the Thera-Band Standard Roller Massager. I particularly like that its firmness allows for a deep amount of pressure. If you prefer something similar, but more flexible for the boney regions of the thigh or lower leg, I recommend The Stick Self Roller Massager.
Topical Agents. Many topical agents can help to decrease and eliminate muscle spasms. The method of action varies greatly according to the product used. You may find that one product works better than another. Some of my favorite products in my medicine cabinet include: Biofreeze Pain Relieving Gel; Arnica Rub (Arnica Montana, an herbal rub); and topical magnesium.
Magnesium Bath. The combination of warm water with magnesium is very soothing and relaxing. Magnesium is known to help decrease muscle pain and soreness. Options include: Epsoak Epson Salt or Ancient Minerals Magnesium Bath Flakes. I find that the magnesium flakes work better, but they are significantly more expensive than Epson salt.
Oral Magnesium. You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates. Taking additional magnesium (particularly at night) can help to reduce muscle cramps and spasming. It is also very helpful in reducing overall muscle soreness and aiding in a better night’s rest. Most people are deficient in the amount of magnesium they consume on a regular basis. I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose as needed. I would caution you that taking too much magnesium can lead to diarrhea. Mag Glycinate in its oral form is the most highly absorbable. Although not as absorbable, Thorne Research Magnesium Citrate and magnesium oxide can also be beneficial.
Stay Hydrated. The human body is primarily made of water, which is critical for all body functions. Your muscles are approximately 80% water. Dehydrated tissues are prone to injury and pain as they struggle to gain needed nutrients to heal and repair. Dehydrated tissues are less flexible and tend to accumulate waste products. Stay hydrated by drinking water. Try to avoid beverages that contain artificial sweeteners or chemicals with names you can’t spell or pronounce.
Eat Healthy. A healthy diet is critical to avoid injury, illness, and pain. Your body tissue needs nutrients to be able to perform at a high level. Avoid processed food as much as possible. Limit sugary food and add more protein and healthy fat in your diet. Maintaining a diet with adequate healthy fats is essential in providing the nutrients to support all hormone function in the body as well as support the brain and nervous system. Adequate protein intake is necessary to support muscle health and development. Give your body the needed nutrients to combat illness and function at a high level.
Move More! Not only has research proven that sitting for more than two hours at a time decreases your expected life span, but extended sitting also leads to increased muscle tension, cramping, and pain. If you sit most of the day, get up and walk. If you stand most of the day, frequently change your standing posture. To optimize health and joint function, you should take each joint in your body through a least one full range of motion (ROM) every day. If you are experiencing pain, I recommend performing more frequent ROM (every 1-2 hours).
Stretch. Stretching is a wonderful way to help eliminate a muscle spasm. We instinctively stretch when we feel a spasm begin. Try gently stretching (lengthening) the muscle affected by the spasm. I recommend beginning with a short 30-60 seconds stretch, then repeating as needed. If the spasm or cramp is severe, you will likely need to continue stretching several times in a row, multiple times throughout the day. Stretching should always be part of a general fitness and lifestyle program. As we age, muscle and tendons tend to lose elasticity so stretching becomes even more important. I highly recommend a daily stretching routine or participation in a group class, such as yoga, which incorporates full body stretching.
Acupuncture. I am personally a big fan of acupuncture. It is very useful in treating all kinds of medical conditions. It can be particularly effective in treating muscle cramps, spasms, and pain as it addresses the issues on multiple layers. Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
Sleep and Rest More. Most people are not sleeping long enough or often enough to optimize health. Take a nap or go to bed earlier. Your body requires time to repair and heal as you sleep. Your body must rest in order to grow and develop. Training every day is not the best way to improve. It can lead to injury and burn out. Take a rest day and have fun. Participate in a Tai Chi or yoga class, take a leisurely bike ride or take a walk in the park.
Speak with your Physical Therapist (PT) or Physician (MD). If your muscle pain cannot be correlated to a specific mechanical cause, please speak to your medical provider to determine if other causes are contributing to the problem. 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).

Most muscle pain and soreness can be self-managed and self-treated if you are proactive. These tips and strategies are highly effective in managing muscle pain. A healthy lifestyle is a lifelong pursuit. If you are injured or not enjoying an activity, you will not stay engaged or motivated in the long term. Seeking advice specifically from a running coach, physical therapist or physician can be beneficial.

How do you manage your aches and pains? Which tip or strategy will you incorporate into your treatment? Please leave your comments below.

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.

Posted on Wednesday, April 8, 2015

Q & A: How to Increase Hip Strength and Improve Mobility

Q. Hi. I have been noticing that even with my current strength training I’m pretty weak in my hip area. I’d like to work on strengthening this area, so I don’t have problems when I’m older. Can you recommend a few exercises that I can add to my routine? Thanks, I love your posts and utilize the information as often as I can. -Amy

A. Thanks, Amy, for this fantastic question! It’s wonderful that you are aware of this particular weakness and you’re being proactive now versus experiencing potential issues later. Maintaining adequate hip and pelvic strength is important for many reasons. The hip muscles control or influence most of the lower leg mechanics, including the hip, knee, and foot. They also play a role in lumbar stability and mobility. Both hip strength and mobility is vital to insure proper lower extremity movement.

Weakness and/or poor mobility in the hips can lead to potential problems including:

Hip pain
Knee pain
Lumbar pain
Abnormal gait patterns
Increased fall risk
Early development of osteoarthritis in the hips and knees
Iliotibial band syndrome
Hip bursitis
Shin splints
Plantar fasciitis

Many other conditions and pain can also be attributed to poor hip strength and mobility. This is by no means an all-inclusive list. I have written specific blog posts regarding many of these conditions. In each case, one of my recommended tips is to improve both hip strength and mobility. Many of the hip muscles are located deep in the pelvis and buttock area. They are not necessary large, but they are critical. These hip muscles can also be responsible for pain, particularly when spasming. Piriformis Syndrome occurs when the piriformis muscle (a deep hip rotator muscle) spasms. The spasm can cause buttock pain. Due to its proximity to the sciatic nerve, it can also cause radiating pain down into the leg known as sciatica.

How to Increase Hip Strength and Improve Mobility:

Squat. The squat activates nearly all of the muscles in the lower leg. It 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, 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.
Target the hip muscles. Many of the muscles of the hip require specific exercises to insure that the correct muscle is activated. Please refer to Hip Strengthening Exercises for detailed descriptions and photos of my recommended exercises.

Improve your mobility. Tightness and restrictions in the hip and pelvic musculature are often associated with pain in the legs and low back. Please refer to Hip Stretches and Mobilizations for detailed descriptions and photos of specific stretches for the hip and pelvis and how to self-mobilize by using a foam roller and lacrosse ball. Tightness and restrictions increase your risk of injury due to improper mobility. For example, tightness in the hip internal rotator muscles causes the hip and lower leg to roll in, which is associated with Patellar Femoral Pain Syndrome (also known as runner’s knee). For more information on this condition, please refer to How to Self-Treat Patellar Femoral Pain Syndrome.
Self-mobilize. 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.
Walk more frequently. Walking is a critical component to healthy aging. Walking on various surfaces and terrain is an excellent way to improve your health, fitness, and hip strength. To discover other benefits walking, please refer to Why You Should Walk, Not Run.

Maintaining adequate hip and pelvis mobility and strength is an important strategy in avoiding many lower extremity orthopaedic conditions. Being aware of a particular area of weakness and being proactive now could save you from experiencing pain in the future. Thanks, Amy, for your question!

Which strategy will you use to increase your hip strength and improve mobility? It could be as simple as using the foam roller or walking. Most importantly, just get started! 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!

Posted on Wednesday, March 11, 2015

6 Reasons to Self-Treat and Manage Your Health

The United States spends more money by a wide margin than any other country on health care. Our health care system is set up to keep us from dying, not thriving. Our average life span barely makes it in the top 30 when compared to other nations. As it stands now, the American health care system is poorly equipped to help us maximize our health span. Health span is defined as a period of time in which a person is generally healthy and free from serious disease.

Health care costs in America continue to increase without actual positive change in our health status as consumers. It is imperative that we take a leadership role in our own health care by continuing to be proactive. Part of being proactive is learning how to care for and manage common non-life threatening injuries and illnesses. The medical system is not designed to help you to maximize your health and well-being. It is designed to prevent you from dying and to maximize profits for the corporatocracy that controls our health care system. It is imperative that we manage our health by learning how to self-treat non-life threatening and non-emergent injuries and illnesses.

6 Reasons Why You Should Self-Treat and Manage Your Health:

Money – Health care is expensive. Many of the most common treatments and fancy diagnostic methods are not necessary. Costs are only going to rise more in the future. As this occurs, it will be even more important to be able to take care of the simple common place injuries and illnesses. It will save you a lot of time and money!
Empowerment – There is nothing more important than your health. You have control of most of the aspects in your life that affect your health status. Taking care of yourself and your health needs leads to a sense of empowerment.
Improved Care – If you understand how to be healthy and take care of yourself, you will be able to assist your medical practitioner in making the best decision on how to manage your care. Remember, it is your body and your health. Being your own advocate will insure that you receive quality care.
Quicker Recovery Time – Often by taking out the middle man, you can help to increase the speed of recovery. You can address the condition and help your body to initiate the healing response to insure a faster recovery.
Emergency Situations – You never know when an emergency, such as a motor vehicle accident or inclement weather, may occur. You may experience an injury or illness during a camping trip when resources are a far distance away. In the event of an emergency situation, you will be knowledgeable and equipped to take care of yourself and your loved ones. (If necessary, please seek appropriate medical assistance as soon as possible.)
Healthy Living – Take the time to focus on your health. Often, small changes in your diet, activity level, and relationships can make a big difference. You can take control of your health and your life! For more healthy living tips, please refer to My Top 10 Anti- Aging Tips and How to Age Successfully.

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. My goal is to have a positive impact on the lives of others and on the health care system in general. I desire to accomplish this by providing useful and practical types of “how to” information. With the cost of healthcare on the rise, I desire to help proactive adults of all ages to understand how to safely self-treat and manage common physical therapy related conditions in a timely manner so they can reach their optimal health.

To accomplish this goal, I need to hear from YOU! What are your pains? What injuries are you suffering from? Please submit your questions to contact@thePhysicalTherapyAdvisor.com. I look forward to answering your health related questions! You CAN achieve optimal health!

Get started now by checking out the 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).

Also, be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on Wednesday, March 4, 2015

Q & A: Why Am I Dizzy Upon Standing?

Q. Almost every time I stand up, I feel dizzy. It seems to be worse if I am lying down before standing up. Should I be concerned? –Jill

A. Great question, Jill! We have all likely experienced the sensation of dizziness upon standing at one time or another. You are likely experiencing a sensation known as orthostatic hypotension (also known as postural hypotension). Orthostatic hypotension (OH) is defined by a drop in blood pressure that is greater than 20 mm of mercury during contraction of the heart muscles (systole, the top blood pressure number) and more than 10 mm of mercury during the expansion of the heart muscles (diastole, the bottom blood pressure number).

Suddenly standing up can cause blood to pool in the blood vessels of the body and legs. For a short period of time, a decreased supply of blood is carried back to the heart to be pumped to the brain. This results in a sudden drop in blood pressure which causes a feeling of dizziness.

Unless you’re experiencing severe symptoms or losing consciousness (blacking out), OH is typically not a concern and can happen to anyone. In my clinical experience, I have treated highly active adults and athletes as well as the elderly for OH. The concern is greater for the elderly as it may be a sign of additional cardiac related illness such as congestive heart failure (CHF). OH can increase the risk of falling which is already an issue for many elder adults.

The following conditions may increase the likelihood of developing OH:

A low blood volume from dehydration can cause OH, fatigue, and weakness. Be sure to adequately re-hydrate after activity. Soda and other processed drinks do not optimally hydrate your body. Water is best. Other options include coconut water, caffeine-free tea, and consuming fruits and vegetables.
Postprandial hypotension is a sudden drop in blood pressure after eating. The body shunts blood to the stomach and digestive system to aid in the digestion and transport of nutrients out of the gut. This can lead to low blood volume in other parts of the body and could cause OH. Eating small, low-carbohydrate meals may help to reduce symptoms.
When I am in a high volume cardiovascular training cycle, I tend to experience low blood pressure. Average blood pressure (BP) should be around 110/70 mm mercury. My blood pressure will be close to 100/60 mm mercury when I struggle with OH. To eliminate this problem, I increase my salt intake. Sherpa Pink Gourmet Himalayan Salt is my preferred type of salt to use. The extra sodium retains more fluid in my system which keeps my blood pressure up while providing important trace vitamins and minerals.
Bradycardia (slow heart rate) can increase your risk of OH. A slow heart rate is generally considered a healthy side effect of being cardiovascularly fit. A heart rate less than 60 beats per minute (bpm) is considered low. This is a common finding in well trained athletes as they range between 40-60 bpm. Other more serious heart conditions, such as heart valve related issues and CHF, can be associated with bradycardia. OH is also common post cardiac surgery or heart attack. If your heart rate is low or you’re experiencing cardiac issues, please consult with your physician.
Diabetes, thyroid dysfunction, and adrenal insufficiency as well as other hormone (endocrine) related issues can cause OH.
Many illnesses affecting the nervous system (spinal paralysis, Parkinson’s disease, and some forms of dementia) can cause OH related symptoms.
Many medications have side effects that can result in OH symptoms. If you develop symptoms of OH, address your medications with your medical physician or pharmacist.

Treatment options for OH include:

Compression. Lower extremity compression serves to help prevent blood from pooling in the lower extremities and can aid the venous return system. With compression, the heart doesn’t work as hard to pump blood to and from your toes. You can utilize a common ACE wrap, but I highly recommend that you purchase a mild over the counter compression sock (at least thigh high) such as Jobst Relief Therapeutic Thigh High Stockings. Do not apply any compression too tightly that it causes numbness or tingling in the legs, feet, or toes. In cases of spinal paralysis, an abdominal corset (binder) may be necessary to maintain a normal blood pressure.
Stand up slowly. If you’re suffering from OH, take your time when you first sit up after lying down or after you first stand up. Moving slowly will decrease your risk of injury (should you fall) while feeling dizzy.
Perform a cardiac warm up to get the blood in your legs moving prior to standing and performing an activity or exercise. Begin with tapping your toe 15 times on each foot. Then perform a seated knee extension by moving your leg straight out 15 times on each leg. Next, remain sitting, but march in place 15 times on each leg. Once you have completed this routine, stand up slowly (if you don’t feel dizzy) and proceed with your activity. Be sure to pause briefly to insure that you’re not experiencing dizziness as a delayed response of a few seconds is typical.

In most cases, OH is a common and benign condition. It can affect anyone for many different reasons. In most cases, dizziness can be easily treated with hydration and possibly a small increase in salt intake. Elder adults should take care if they are experiencing dizziness. Seek medical advice to determine if dizziness is a symptom of a more serious condition. If the condition worsens or you lose consciousness, please consult with your medical physician as OH is just one of many forms of dizziness.

Thank you, Jill, for your question. I hope these treatment options for OH will not only help you to determine the cause of your dizziness, but that they also decrease the frequency of your symptoms. For additional information on dizziness, please refer to Q & A: Vertigo – Causes & Treatment and Q & A: How Do I Improve Balance? (Part I).

Have you ever experienced OH symptoms? Which treatments for dizziness are the most effective for you? Please share any recommendations that you may have by leaving your comments below.

Posted on Tuesday, February 24, 2015

Why You Should Practice Tai Chi

When was the last time you saw an American elder person perform a full squat or be able to move up and down from the ground? Now ask that same question about an elder person in China or India. The answer is much different. We notice some interesting differences in how people age when we study other cultures around the world. Many societies have fewer infirmed and immobile elders than does America. Elders in many of the Mid East and Eastern cultures tend to function at a much higher level. Lifetime participation in activities, such as Tai Chi and yoga, is one reason for this difference in healthy aging.

Aging healthfully and successfully involves integrating the body, mind, and spirit. Few activities and exercises simultaneously address all three aspects of a person’s life. Tai Chi and yoga are two forms of exercise that have an effect on all three aspects.

Tai Chi, also known as Tai Chi Chuan (TCC), is a soft form of martial arts that originated in China hundreds of years ago. Its basic movements allow for full body strengthening and balance. A focus on relaxed breathing and mental attention helps to achieve balance between body, mind, and spirit. It doesn’t require special equipment–only a small space indoor or preferably outdoor to perform. Research on Tai Chi supports many wonderful medical benefits. The major outcome of regular practice is reduced frailty.

12 Reasons Why You Should Practice Tai Chi:

Increase your lower extremity and core strength.
Improve your lower body and upper body arm control.
Improve your balance and postural stability.
Improve your flexibility.
Reduce your body fat.
Reduce your number of falls.
Utilize your practice as part of a cardiovascular rehabilitation program for prevention and/or post surgically.
To produce higher peak oxygen uptake during exercise and reduce your blood pressure.
Safe and beneficial exercise if you have diseases such as rheumatoid arthritis (RA), osteoarthritis (OA), and multiple sclerosis (MS).
Benefits your immune system and aids in hormone regulation.
Improves your bone mineral density. Regular Tai Chi exercise can help to treat osteoporosis and osteopenia (the loss of bone density and associated with fractures of bones in the elderly).
Improves your mood and reduces stress, tension, depression, anger, fatigue, confusion, and anxiety.

No wonder why Chinese doctors utilize Tai Chi to treat hypertension, stress, depression, mental strain, chronic indigestion, insomnia, and arthritis!

Tai Chi offers a wonderful method to maintain your mobility and health as you age. With people living longer, the focus should be on health span versus life span. Older adults participating in Tai Chi exercise report a sense of improved well-being, increased alertness, relaxation, an improved mental outlook, and greater confidence.

I strongly recommend finding a local Tai Chi class to participate in with a group. Active engagement in your community is a critical part of successful aging as well maintaining meaningful relationships with others. If you are unable to locate a group or Tai Chi instructor, then utilize the free resources available on YouTube. Daily Tai Chi, a free instructional video, will teach you how to perform the basic Tai Chi movements. Tai Chi for Beginners discusses the origins of Tai Chi and offers a sample lesson.

America is heading into a generational change as the baby boomers move into their elder years. For a more thorough discussion on successful aging, please refer to How to Age Successfully. For an excellent read on America’s aging population and how it will re-shape our expectations, check out Ken Dychtwald’s Age Power: How the 21st Century Will Be Ruled by the New Old.

Do you participate in Tai Chi? What benefits have you experienced? Please leave your comments below.

Posted on Wednesday, February 11, 2015

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. Not all bodies are built to run. 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.

There are many wonderful methods to stay fit and improve your cardiovascular system, but running may not be the best choice for you if you have any of the following conditions:

Certain Forms of Arthritis – There are 171 different kinds of arthritis. Although causes and presentations vary, the most common form is osteoarthritis (OA). You can still run if you have OA, but you may choose not to if you are symptomatic (experiencing pain). Running would be ill-advised for those with other types of arthritis such as gout or rheumatoid arthritis (RA). The risk of joint injury during repetitive impact based activity (like running) is too high. For more information specifically on RA, please refer to Q & A: Exercises Beneficial in Managing Rheumatoid Arthritis.
Joint Replacement – As America’s population continues to age, total joint replacement has become an increasingly more popular method to treat pain and arthritis in joints. The procedures continue to improve and evolve. Although you may be capable of running after a total joint replacement, I don’t recommend it. Running on a total joint replacement, particularly in the knee or ankle, increases the likelihood that the replacement will wear out and/or fail prematurely. If you have had a total joint replacement, I recommend a less impactful method of cardiovascular exercise.
Morbid Obesity – Running can be an excellent form of exercise and a wonderful method to help one reach his/her desired weight. However, running may not be the safest choice initially if you are morbidly obese. Morbid obesity is defined as a Body Mass Index (BMI) greater than 40 or having more than 100 lbs. of body weight. Running with excessive body weight increases your risk of injury and permanent damage to joints throughout the body. Initially, pursue non-impact activities. As your weight decreases, you may choose to participate in a running program.
Recent Medical Procedures or Injury – The inability to run can be temporary. Often after a medical procedure, physicians will advise not to run or participate in overly strenuous exercise during recovery. The list of possible conditions is long, so refer to your physician and physical therapist regarding when to avoid activity. Once you have sufficiently healed, you can taper back into your prior level of activity or even progress into a new activity. Your physician or physical therapist can offer advice on how to safely resume your activities.
Severe Osteoporosis – Osteoporosis is the weakening of the bones. Running is not contraindicated for all forms of osteoporosis, but it is for severe cases. In mild cases, the repeated impact during running can be beneficial to bone formation if the mileage or time spent on your legs isn’t excessive. In severe cases, running increases your risk of fractures. Initially, the best course of treatment, besides dietary modification, would be weight bearing activities such as weight training and walking.

The key is to rule out possible issues which may make running unsafe. Being well informed initially allows you to tailor an exercise program which can be safe and effective in maximizing your particular goals and needs. For a more thorough discussion on the safety of running, please refer to Is Running Safe? In most cases, running is safe with proper training and a strong focus on technique.

What are the benefits of walking?

Improves circulation and blood flow to the entire body.
Releases stress reducing hormones.
Releases hormones that can control blood sugar levels for up to 24 hours.
Burns calories.
Helps to prevent constipation.
Walking in a fasted state can help your body to learn how to utilize fat more efficiently as an energy source.
We are naturally good at walking. Do it daily!
It is a weight bearing activity that can be beneficial in reducing osteoporosis.
Keeps the spine healthy. The walking motion is vital to nutrient exchange in the spinal discs.

Choose walking as an intentional exercise, and add it to your daily activities as part of a healthy lifestyle. To increase the amount of calories burned during a walk, you may need to make a few changes to your morning or evening stroll. Don’t walk at your preferred speed. The trick is to make your body inefficient by walking slower, faster, uphill, downhill, or at varying speeds. Perform a high intensity workout by walking uphill briskly or using the Fartlek method.

Do you prefer to walk or run? What might be holding you back from participating in an exercise program? I encourage you to get started now by walking. You may be surprised how quickly you see results! Please leave your comments below.

Posted on Wednesday, February 4, 2015

How to Age Successfully

America’s population is rapidly changing. We are in the midst of a giant generational shift. Members of the Greatest Generation (those who experienced the Great Depression and fought in World War II) and the Silent Generation (those who were children during that time) are rapidly aging, and their population is quickly decreasing. During this shift, the Baby Boomers are rapidly approaching elder status. At the present pace, over 8,000 baby boomers are turning 65 every day! Aging baby boomers are transforming our society by re-defining what it means to age. This is affecting society at every level including health care, retirement planning, housing, community, and family life.

Baby boomers’ demands and expectations of what it means to age successfully are different compared to past generations. Baby boomers present an interesting dichotomy of desiring to live longer, stay active, and age in place. Aging in Place: An Intergenerational Priority, a recent Huffington Post article by Susan Blumenthal, addresses the new expectations and unmet needs that seniors will face. The ability to live safely, independently, and comfortably regardless of age is the greatest desire for seniors.

We are all capable of successfully aging if we are intentional about the process. The outcome will wildly vary. Successful aging has a different meaning for each of us, but commonalities exist in most scenarios. In order to age successfully and gracefully, you will need to fully embrace what it will take to accomplish this goal. To live safely, independently, and comfortably, consider your physical, mental, and emotional health as well as your community and any financial implications.

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 may include adequate balance, strength, and endurance. For more information on balance, please refer to Improving Balance by Using a Water Noodle, How Do I Improve Balance? (Part I), and How Do I Improve Balance? (Part II). For more information on strength, please refer to Q & A: How to Jump Start a Healthy Lifestyle and 15 Strategies to Make 2015 Your Healthiest Year.
Maintain sharp mental health. Regardless of age, it is important to remain engaged and mentally sharp through constant and varied mental stimulation. Proper nutrition and exercise have an impact on your mental health and can help to prevent depression, Alzheimer’s disease, and dementia. For more information, please refer to My Top 10 Anti-Aging Tips.
Share the love. Research clearly notes that those who are more loving and caring tend to live longer and healthier. Be generous with the knowledge and wisdom that you have acquired throughout the years. Love others and purposefully share that love.
Be active in your community. Active engagement in your community is a critical part of successful aging. People find community in a variety of ways including family, friends, church, civic organizations, or volunteer projects. Others may choose to continue to work. Your profession can have a positive impact on the community and your finances.
Plan for a long life span. It is likely that life spans will continue to increase if epidemics, such as diabetes and metabolic syndrome, are properly addressed. Be proactive in how you plan to manage your finances. When planning, assume that you will live well into your 90s. The fear for many will be running out of money during their elder years. The only way to avoid this issue is to be proactive and thoughtful in your planning. The sooner, the better! Seek competent financial advice from a financial adviser. Be realistic about the math as you project into the future. Plan for the worst. Expect low interest rates and high inflation. Don’t believe the rosy projected rate of returns. If you underestimate, at least you will have more money than you anticipated rather than being broke.

How we plan for this giant generational change will affect everyone at some level. As a society and as an individual, we must prepare for the changes in expectations and demographics. As the population ages in the United States, my desire is to see the most physically fit and active seniors in history. I hope over the next ten to twenty years that the paradigm of successful aging is re-written and that old stereotypes of the elderly, the aged, and seniors will be lost in the dust of a new healthier, long lived population. For an excellent read on America’s aging population and how it will re-shape our expectations, check out Ken Dychtwald’s Age Power: How the 21st Century Will Be Ruled by the New Old.

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. The Physical Therapy Advisor blog will continue to the lead the way in providing useful and practical types of “how to” information, including methods to safely self-treat and manage common physical therapy related conditions. My desire is to help you address the aspects of optimizing your life while promoting well-being in order to manage pain and improve mobility.

What does it mean to YOU to age successfully? How can I help you in this endeavor? Please leave your comments below.