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It’s nice to feel supported…but not in this case! Mother Earth, combined with gravity, can be deadly. But it’s not the fall that is the problem, it’s that sudden hard stop of hitting the ground (or some other immovable object) that is. And it’s a big problem! Every 19 minutes an older adult dies from a fall! It’s the leading cause of fatal injury AND non-fatal trauma related trips to the ER in older adults. 

So why are falls so common in older adults? Is it just an inevitable part of aging or can something be done about it?

A lot of research has tried to answer that question: why do people fall. In 2012 a group of researchers in British Columbia, Canada used 24-hour video monitoring in a long-term care facility and found that most of the 227 falls they captured on camera occurred because of a momentary loss of balance, not because of a slip or trip. But the cause of these were hard to pinpoint. There are many possible reasons, and often several are present simultaneously, so it can be hard to determine the exact cause. Here are the top reasons experts in the field attribute most falls to:

  • Medications: many medications have a negative influence on other systems in the body that help maintain balance, movement control, and  awareness of one’s surroundings.
  • Age-related system decline in critical systems like muscle strength & endurance, vision, & nerve conduction velocity
  • Cognitive impairments: changes in mental function like memory, perception, & self-regulation. 
  • Safety of the environment / home: trip and slip hazards like thick carpet or rugs, poor lighting, or the presence of clutter.

Many of these risk factors are controllable, to a degree at least. Meaning individuals can make changes in their lifestyle or environment to decrease their fall risk. Here are some of the most powerful changes one can make:

  • Medications: the medications that increase fall risk the most are analgesics / pain medications, anti-psychotics / anti-convulsants / sedatives. These typically cause sedation & slower reaction times, impaired cognitive function, & resultant increases in loss of balance. The next most risky medications are anti-hypertensives, anti-depressants, cardiac drugs (anti-arrhythmics). Lastly, but still having a negative influence, are the diuretics. So can an elderly individual influence what medications they take? In some cases, no. But in many cases – absolutely! Lifestyle has a HUGE impact on what medications and how much of them are needed in all 3 of these categories. But this discussion must first start with one’s doctor. Then a safe plan can be developed to change lifestyle factors that may allow a decrease in medications and the subsequent fall risk.
  • System decline: it’s true, physiological systems like natural muscle strength & vision decline with age, but that doesn’t mean they can’t be improved. Many studies over the past 2 decades have proven that the health & effectiveness of these systems can, and usually do, improve with the right approach.

It starts with the right testing. Our clinicians are trained in evidence-based tests to determine an individuals fall risk, then prescribe the right type and amount of exercises to help lessen it. Regular exercise, even just simple seated movement routines, help prevent postural hypotension – a leading cause of dizziness, weakness, & fatigue. Balance-focused programs like T’ai Chi and A Matter of Balance are proven to have huge impacts on those balance systems that regulate our position in space and relay changes to the brain that require quick corrective action. For visual and tactile (also known as proprioceptive) systems, it is recommended that feet and eyes are checked at least once a year in individuals over age 65, and more often if there are known impairments. 

          Here are a few of the tests we use to determine one’s fall risk, from simplest to more complex:

           Functional Reach Test: standing distance a person can reach an outstretched arm without losing their balance.

                       Score / Rating: < 18 cm = fall risk

           30-second Chair Rise test: how many times can an individual sit / stand in 30-seconds.

                       Score / Rating to maintain independence: 

                   Age:          60-64           65-69          70-74        75-79        80-84        85-89         90-94 

                  Female:       15                  15                 14              13               12                11                9

                  Male:            17                 16                  15              14               13                11                9

           TUG (Timed Up & Go) test: speed with which an individual can stand up, walk 3 meters, turn around & walk back, then sit back down.

                       Score / Rating:   > 14 seconds = 83% increase in fall risk

           Dynamic Gait Index: how well a person can adjust their gait speed, turn, and stop / start on cue without losing their balance.

                       Score / Rating:   < 19/24 = increased risk of falls

           Berg Balance Test: a variety of tasks, from easy to difficult, measuring ones ability to complete the task all while maintaining balance. 

                       Score / Rating:   41-55 = low fall risk           21-40 = medium fall risk            0-20 = high fall risk

  • Cognitive impairments: there are many degrees and types of cognitive impairments that can happen with age. Some impact fall risk  more than others, so it’s important that an elderly person’s primary care doctor be made aware of changes and be the one to determine the most appropriate testing and course of treatment. A large 2017 study involving 7 developed countries collected data on 2,496 adults of average age of 76 years old and found that impaired executive function (neurological skills involving mental control & self regulation) & dementia, but not memory impairment, is associated with higher incidence of falls in elderly.
  • Environment / home safety: this is the category that individuals probably have the most control over, and it can mean the difference between living independently and not! Even though tripping or slipping may be the least common factor contributing to falls, it just takes 1. Many simple things like getting rid of rugs, installing brighter light bulbs, or clearing clutter from a home can greatly decrease the risks. Checklists, like this one from the CDC’s STEADI program can help point out trip hazards. 

The bottom line: elderly individuals & their family members / care givers should speak up to their doctor or physical therapist about any changes they notice, either cognitively or physically, and be evaluated regularly by their medical professional, like our staff of trained Physical Therapists.  Then, once a program is initiated, stick with it! A regular exercise regimen can lessen the risk of falling and experiencing the devastating, life-changing effects of a fall-related trauma. 

 

Look for next month’s blog on what type of exercise & training can be done to DECREASE YOUR FALL RISK!

Strength vs Flexibility: the age-old question

 

 

At some point in your life you might have wondered: “what’s MORE important for me: STRENGTH or FLEXIBILITY?” Maybe it was trying to answer the question of why you continue to have that nagging back pain? Or perhaps it was during that Yoga class when a static warrior pose was SO hard to hold for 10 breaths? Or maybe you’ve worked with various medical or fitness professionals in which 1 tells you that you need to have more strength and another tells you that you need more flexibility…???

The short answer is: you need both, at least some, to maintain good body balance and minimize injury risk. As with any fitness discussion, start with FUNCTION: what is your body required to do every day (or what are you asking it to do)? Secondly, look at your particular body type and tissue characteristics: are you flexy-bendy like a Gumby doll? Then you most likely need to concentrate more on core strength & endurance. Are you a bulky mass of power? Then you most likely need to focus more on flexibility & joint mobility. We know that there is an inverse relationship between length and tension, meaning basically the more lengthened a muscle is the weaker it is. So very flexible people typically should NOT do more flexibility exercises, which is often exactly what they end up doing because they’re ‘good’ at them and they come easy. Conversely, very bulky, strong people should NOT spend all their time just power lifting, but also putting time & energy towards maintaining good joint mobility and tissue flexibility.

Picture these 2 very different body types and see if you can figure out what each one would benefit most from:

Body #1: the thin, lean body (age is irrelevant, imagine any age you like) who is always doing Yoga so gracefully and beautifully, and no matter what the pose she can always go the full distance no problem…but if you asked her to carry a 5-gallon bucket of water up & down 2 flights of stairs she’d be pooped out after 2 minutes…

Body #2: that big, strong guy you see out working for the utility company, who can probably lift & set those power poles by himself…but if you asked him to bend forward and touch his toes he could barely reach his kneecaps…

Ok, so these are 2 extreme cases, but they’re not that far off from many of the patients I’ve treated over my nearly 20-year career as a Physical Therapist. Most people fall somewhere in the middle, but almost everyone who naturally (genetically) has more flexible tissues struggles with strength (often core muscle strength) and visa-versa; those that have lots of strength often lack flexibility. Of course a person’s lifestyle also effects their strength & flexibility. But how often do you see a skinny person working in a job requiring lots of heavy lifting or moving? By contrast, how often do you see big, bulky people teaching Yoga class? Finding out where your body falls on this strength / flexibility spectrum is a key first step to discovering where to best focus your efforts.

The best option is to see a Physical Therapist experienced in fitness testing and training. Two of our clinicians are Certified Strength & Conditioning Specialists (CSCS) by the National Strength & Conditioning Association and can help define very specifically areas of a person’s body that are more of 1 than the other. 

Here are a few simple, generic tests that can help determine where your body generally lies on the strength vs flexibility spectrum:

 1). Sit and Reach Test: this is often used as a flexibility test of both the hamstrings and the low back. Recent research, however, has shown it to be a poor measure of low back flexibility. Start in seated position, knees fully straight, ankles in neutral (placing feet flat against a step helps keep you from cheating). Slide fingertips along the ruler as you lean forward, reaching as far as you can without pain, then measure the distance.

Scores & Rating:

Adult Men – results in centimeters (cm)

  • Above 34 = Excellent
  • 28 to 34 = Above average
  • 23 to 27 = Average
  • 16 to 22 = Below average
  • Below 16 = Poor

Adult Women – results in centimeters (cm)

  • Above 37 = Excellent
  • 33 to 36 = Above average
  • 29 to 32 = Average
  • 23 to 28 = Below average
  • Below 23 = Poor

2). Side plank hold test: downside elbow may be placed on a pad or pillow, upside hand placed on hip, only lower foot touching the ground. Lift hips up to where trunk + hips + knees are straight (like a plank) and hold. Remember to breathe!

Scores & Rating for adult Males & Females:

  • > 90 seconds = Excellent
  • 75-90 seconds = Good
  • 60-75 seconds = Average
  • <60 seconds = Poor

3). Shoulder Range of Motion (“Back Scratch”) test:

Reach 1 hand behind neck and down along spine as far as able, while the other hand comes up from the low back. Try to get them as close to each other as possible without pain and measure their distance apart.

Scores & Ratings for Men:

Age below average normal (inches) above average
60-64 < -6.5 -6.5 to 0 > 0
65-69 < -7.5 -7.5 to -1.0 > -1.0
70-74 < -8.0 -8.0 to -1.0 > -1.0
75-79 < -9.0 -9.0 to -2.0 > -2.0
80-84 < -9.5 -9.5 to -2.0 > -2.0
85-89 < -10.0 -10.0 to -3.0 > -3.0
90-94 < -10.5 -10.5 to -4.0 > -4.0

Scores & Rating for Women:

Age below average normal (inches) above average
60-64 < -3.0 -3.0 to 1.5 > 1.5
65-69 < -3.5 -3.5 to 1.5 > 1.5
70-74 < -4.0 -4.0 to 1.0 > 1.0
75-79 < -5.0 -5.0 to 0.5 > 0.5
80-84 < -5.5 -5.5 to 0 > 0
85-89 < -7.0 -7.0 to -1.0 > -1.0
90-94 < -8.0 -8.0 to -1.0 > -1.0

 

If you’re not sure about whether your body falls more towards the strength side or the flexibility side, or if you simply want to know more about your body and how it functions best, please call us at 828-225-3838 and schedule your initial evaluation today!

 

So, you’ve just finished your workout, you’re heading for the shower, and you’re feeling great – tired, maybe even exhausted, but your endorphins are still high and your mind is clear of all the stress and worry that was in there not so long ago…here are 3 things to do to maximize the benefit of your hard work:

1. Re-hydrate! Not an option, a must – especially if you sweat a lot… 

 

2. Suck down a healthy carb + protein post-workout smoothie! Quickly replacing spent glucose stores and boosting concentrations of amino-acid protein building blocks for muscle repair is definitely a good idea…

 

 

3. Think! Yes, THINK!

Studies in the U.S., the UK, and British Columbia have shown that our brain’s cognitive might, including problem-solving abilities, are significantly improved both during & after moderate to intense (‘cardio’) exercise. Studies from the University of British Columbia and Harvard showed increase in both the growth & the activation of the thinking, learning, & memory areas of the brain with just 1 hour of intense walking twice a week. Maintaining this regular moderate to intense ‘cardio’ exercise routine for 6 months or longer resulted in even more benefit. And the benefits don’t stop there – behavioral & learning researchers at Stanford showed that creative problem solving abilities were significant improved for a moderate-paced treadmill walking group versus a sitting group. Some studies have shown that even a single bout of exercise can produce cognitive benefits extending 2-3 months after! These types of changes are now being credited with holding off early onset of Dimentia, memory loss, and Alzheimer’s – talk about game (& life) changers!

 

                                                                    PLUS

                                                                                                                                                             EQUALS

 

 

 

 

Bottom line: some type of moderate to high intensity cardio workout, even if it’s just a brisk walk around the neighborhood, needs to be bumped up to high priority on your to-do list, especially when life throws you a mental challenge. Whether it’s that work-related issue you’ve been stressed about, a project you’ve been stewing on, or a personal / relationship problem you’ve been trying to hammer out, this is just 1 more reason to NOT skip that trip to the gym!

 

5 Myths about Healthy Bones & Osteoporosis

  1. Osteoporosis is only in older people.
  2.  It’s genetic – I’m either going to get it or not
  3. As long as I drink milk or eat cheese every day I’ll avoid getting Osteoporosis.
  4. As long as I do some weight bearing exercise once a month I won’t get it.
  5. If I do get it, I can take medications for it.

______________________________________________________________

Truths:

  1. Officially declared a “major health problem” in the U.S., osteoporosis affects 1/2 of older adults (50 or over), especially post-menopausal women more than any other. But the density of one’s bones is established in the young adult years, typically peaking in the mid to late 20’s. So ignoring it or NOT behaving in ways that maximize bone density – such as adequate exercise & proper nutrition – in the teens and 20’s is a big gamble!  Side note: recent statistics show that in the U.S. the prevalence and early onset of osteoporosis will continue to increase with trends towards less physical activity (increased sitting) and poorer overall nutrition. 
  2. Genetics definitely plays a role. You cannot change your body (frame) size, your ethnicity, or your family history – all factors that influence your risk of developing Osteoporosis. But just like every tissue in our body, bone is in a constant state of cellular remodel (new bone cells are built to replace old ones). As we get older, however, the production line gets a bit slower and can’t keep up with demand, so bone cell deterioration out-paces replacement. This sounds hopeless & depressing, but it’s an opportunity for influence! Also like other bodily tissues, bone is constantly responding to it’s environment. So, increasing weight bearing exercise along with adequate intake of bone-building minerals, good overall nutrition, & a healthy gut to maximize mineral absorption can help tremendously.
  3. Calcium & Vitamin D are the key players here and must be in plentiful supply for bones to even have a fighting chance. Yes, dairy products have high levels of Calcium, however there are other foods that have as much or more Calcium per gram. Because many people cannot (or have trouble) digesting dairy foods, these other foods should be added in as much as possible: collard greens, sardines, broccoli rabi, kale, and Calcium fortified milk alternatives like almond or rice milk. As for Vitamin D the highest concentrations are in fatty fish and fish liver oils, such as salmon & cod liver oil. Just 1 tablespoon of cod liver oil contains 340% of your recommended daily allowance of Vitamin D!  
  4. This is definitely the other very important piece: weight bearing, or load-compression, exercise. Bone responds to the stresses it is subjected to. So if it’s being repeatedly stressed, and even better if it’s in various planes or directions (think bending or twisting, but not too far!) it will respond by triggering bone-building cells called osteoclasts to get workin’.  Safe bone-building exercises come in many different forms & variations. What’s best depends on a person’s age and body type, exercise history, presence of high fracture-risk areas, and actual bone density. The important thing is to get evaluated by a specialist before starting any program. Then, once started, that it’s done REGULARLY-at least 3x / week. Our Physical Therapists can help guide this process AND design a safe & effective bone-building exercise program for any level of fitness or function.                                   
  5. Several osteoporosis medication options exist with varied levels of success and severity of side effects. Most studies done by the drug manufacturers show a statistically significant improvement in a percentage of the population to make it worth the risks of the side effects. However, many of the listed side effects are quite serious, life-altering, and more harmful than the potential benefits they pose in many patients. As such, a serious and frank conversation with the prescribing medical practitioner should begin prior to any medications being taken.

As with any health issue or disorder, I strongly recommend finding out as much as possible about a person’s family history related to osteoporosis, including: a). who, if anyone, has(had) it; b). what age were they when they got it or got diagnosed with it; c). did they ever experience a fracture and if so what was fractured and was there another indirect cause (i.e. a trip or loss-of-balance-related fall)? This information can be incredibly insightful in helping not only predict risk or onset age, but also help see other risk factors that strongly contribute to life-altering events related to osteoporosis, like fractures.

Secondly, getting a bone density test is a good idea – even if you’re not worried or have cause to worry, it gives you a baseline measurement so if / when you get another test years down the road you’ll know which direction your bones are going…

The Importance of Having a “Spring” in your Step

Despite what seems like more general awareness of the importance of healthy feet, there’s still a lot of talk of how shoes and shoe-related products are the way to keep our feet happy instead of the brilliantly functional and adaptive structures of our feet. The “experts” tell us about the latest and greatest in shoe advancements, using terms like “bounceback,” “reinforced vamp,” “meta-flex technology,” and (my favorite) “Rope-Tec burn-protecting reinforcements.” I’m not a shoe expert, but these terms are most likely made-up by some marketing company hired by the shoe makers to make their newest product development sound innovative. They’re using terms and phrases that mimic what the foot, in all of it’s beautiful glory, actually does – bounceback, flex, etc….but, honestly, a healthy foot does these things much better than any of the shoe technologies will ever do. 

One of these structures is the Spring Ligament. This is a thick, highly elastic ligament deep in the arch of the foot that not only helps provide shock absorption and rebound (“spring”) with each step, but also helps protect other structures in the middle and inner foot from being overloaded, or even ruptured, during heavy or hard loading (e.g. running or jumping).

The Spring Ligament, like the other dozen plus ligaments in the foot, is made up of dense collagen tissue and is strong and resilient – when it’s healthy and working properly. But (there’s always a “but”) ligaments like this one can get overloaded, and thus injured, when other supporting structures of the foot either (a). DON’T do their job, or (b). CAN’T do their job. 

When (a) happens: other supporting structures DON’T do their job. There are over 100 total muscles, tendons, & ligaments in the foot and ankle, and they’re all beautifully designed to help support one another. Several key muscles, like the Posterior Tibialis, provide active support to the arch of the foot. But like any other muscle, if you don’t use it you lose it! So often after an injury, a surgery, or just not enough regular walking / weight bearing exercise, this muscle can get weak & fatigues prematurely, making it unable to support the arch. Other structures, like the Spring Ligament, then get overloaded. Another scenario is when the calf / Achilles tendon loses flexibility, such as in the aging or sedentary body. It is then unable to lengthen adequately during normal walking, thus transferring large loads (and force) onto the mid-foot and arch with every step. Plantar Fasciitis is a common, and very painful, condition that can come about when the Plantar Ligament gets overloaded due to tightness in the calf / Achilles.

When (b) happens: other supporting structures CAN’T do their job:   This can occur when we provide too much support, mainly in the arch, as is often the case with arch-supporting shoes or inserts. Like anything in the body, tendons & ligaments respond to the stresses we subject them to.  So, if we give too much support, then we don’t give them a chance to be loaded properly and, thus, do their job. This can lead to loss of fiber density, flexibility / elasticity, and strength of the tissue. This subjects other tissues, like the Spring Ligament, to overload and injury. 

The good news is there are simple things most of us can do to maintain strong muscle-tendon structures as well as healthy & elastic tendon tissues. Here are 3 simple strategies to help:

Posterior Tibialis strengthening, Level 1

To strengthen this very important arch-supporting muscle, use a standard resistance band anchored to something solid & wrapped around the ball (forefoot). Then slowly raise up towards ceiling and back down in a smooth motion, as many times as you can, several times daily.

 

 

 

Posterior Tibialis strengthening, Level 2-3

For a more challenging Posterior Tib strengthener, do a standing heel raise, but roll to the outside (little) toes as you raise up. Then lower down, slow & controlled.
For an even greater challenge, try this standing on 1 leg only!

 

 

Calf & Achilles stretch

This is commonly called the “runner’s stretch.” For most people, this stretch should be done daily and held for at least 1 minute.

 

 

5 of MY BEST Basic, Functional, Get-in-Shape Exercises

These can be done just about anywhere, anytime, with no equipment…and with 3 different levels of difficulty, by just about anyone.

Bird Dogs:

This has many different names, but whatever you want to call them, there should be minimal trunk movement, the spine straight & level.

Easy:   start out just 1 leg, then 1 arm at a time

Moderate:   do opposite leg & arm at the same time

Challenging:   tap elbow-to-knee underneath OR try same side arm & leg

 

 

 

Plank:

Yes, the plank – remember doing these in P.E. class? Great things withstand the test of time. Just like with the Bird Dogs, there should be minimal body movement, spine as straight & level as possible!

Easy: start out with forearms on a wall

Moderate: forearms on a countertop, or a chair

Challenging: on the floor. Or for a real challenge try them on an exercise ball!

 

 

 

Squat:

Talk about functional – it doesn’t get much more functional than a squat. Spine should be straight, focus on using the legs!

Easy:  start out holding onto a railing or sink then sit back a bit to focus the effort on the buttocks muscles = less strain on the knees

Moderate:  hold arms out front & increase depth of the squat

Challenging:  raise arms up overhead, staying tall & erect

 

 

 

 

 

“Posterior Chain” Stretch:

What is the “Posterior Chain?” It’s the chain of tissue, including nerves, muscles, & fascia that runs all the way down the backside. The hamstrings, sciatic nerve, and Achilles tendon are all part of this chain.

Easy: start out with hands on a wall or a counter top for support; lower slowly until a stretch is felt

Moderate: lower hands to a coffee table, a low chair, or a foot stool

Challenging:  now hands to the floor, but pay attention – DON’T OVERSTRETCH! You can really do some damage.

 

 

Lunge / Hip Flexor Stretch:

Tight hip flexors are a primary driver of low back pain! The more we sit, the tighter they get, & the more we need to stretch them. Be sure to hold this stretch at least 30 seconds.

Easy:  put forward foot up on a bench / chair / low table; slowly move body forward until stretch is felt

Moderate: both feet on floor, use a chair on each side to support your weight, lower down, bending back leg

Challenging: no hands, go deeper so your back knee touches the floor; try raising arms up overhead & even turning towards front leg

 

 

CONGRATULATIONS! Now your body is activated, loosened up, & you’re ready for whatever’s next!

Trouble or pain with any of these? Please reach out to us via email or phone call, so one of our experts can help you!

Willpower!

Willpower – ask 10 people about willpower and you’ll get answers like: “it’s that special thing that allows some people to just quit smoking, lose weight, or get rich…some people have it and some don’t…,” or “It’s one of those things that comes and goes…sometimes I have it, other times I don’t.”

Is any of that true? Is it some kind of a genetic thing that some people are just born with more of than others? Or is it something that comes and goes with the amount of hard core discipline one has?

And even if you have it, in whatever quantity, does it really work to get us the results we want? Why does it seem to work for some and not for others…?

As science and medicine learn more and more about our genetics and the pre-determined map that makes us who we are, other research shows us that our behaviors and actions are more elastic than what genetics may suggest. We have enormous power to change outcomes in our lives, if we know how to do it. And willpower is like the muscle that helps us do it, getting stronger the more we exercise it.

Common beliefs among experts in the field of willpower and self-discipline say that several things are required to really have the willpower to take control of our lives, from how we look to how we feel to what we achieve. The first of these is intention. What is the eventual goal / outcome / result you intend to achieve? A big part of this is visualization – not just saying it and agreeing with yourself that that’s what you want, but deeply internalizing & seeing the desired outcome play out and the result at the end. If it’s a physical change, that means seeing you as you want to be…if it’s an emotional or relationship change it’s repeatedly (daily) visualizing how you want it to be or happen. An abundance of good research says the more you do this, the more you actually create the outcome you’re visualizing! Successful people almost always have daily ritual(s) where they visualize their goal or target.

The second step is self-monitoring, or simply watching yourself as if from an outsider’s viewpoint, like a coach or mentor. This allows you to better see your path towards your goal and any deviations that might occur along the way. It’s like your GPS on a road trip – if you get off-course it just “re-routes,” but never deviates away from the end target. By the way, this is where an actual partner or coach can help a lot.

Lastly, action is required-duh… This is the part we all see – the results of your actions. If you ask 50 people in a room to take off their clothes it won’t be hard to tell who has regular workout rituals and who doesn’t. But before we give all the credit to our actions, it’s important to see where those actions came from. Strong roots lead to strong trees. And we all know where strength comes from – exercise!

Need help or know someone that does? Our certified personal trainers can help anyone achieve better results, more fitness, and a higher quality of life!

 

2019-the year for Stupid Simple Resolutions

 

1. No more than 3 simple, attainable goals. If you reach them easily or quickly, upgrade them!

 

2. Write them down-multiple places, because seeing them, repeatedly, increases attainment…by a lot!


3. Tell your loved ones & ask for help
– connection & accountability are key to success!

My Adventures in Spain-chapter1: Walking…in sickness and in health

They do a lot of it here in Gijon, in the northern coastal of province of Asturias. Like any city, the roughly 300,000 Asturianos walk for many reasons: transportation to / from work, daily necessities & markets, futbol matches, recreation & fitness (for them and their 4-legged pals) and just to be outside in the fresh air. Also, Spaniards are a very social bunch, so more reason to get out and walk with friends, family, or neighbors.

But what strikes me so much is the number of elderly (some of them very elderly), injured, rehabilitating, sick, etc…that are out with everybody else. Many times it’s with care-givers holding onto, pushing in wheelchairs, or generally acting as crutches for these folks to get out and walk! As a Physical Therapist, I often find myself watching some of these people and cringing, waiting for them to trip, topple, and fall flat on their brittle-bone faces. But they don’t! I haven’t seen 1 elderly person fall yet, and there are a LOT of them here. 

What’s the secret? Well…walking, of course. But it’s also that they’re walking outside (instead of a hospital / rehab floor or a retirement home hallway that’s been intentionally cleared of all obstacles), offering a “real” environment with real obstacles, distractions, varied surfaces, all the aspects of “real” challenges to the body, brain, and balance systems. And not to mention riding on buses-I’ve seen several quite elderly folks climb up the bus steps, balance themselves while they try to find a seat as the driver pulls out oblivious to their slow movement, manage to find a seat, and sit, all the while holding 2 bags of groceries and a purse on their shoulder!

AND NO FALLS – INCREDIBLE! 

 

Back Pain – Part II: What to do?


Ok, hopefully you’ve gained some insight into why your back is spasm-ing, now what should you do about it? Well, it goes without saying, there are lots of “experts” out there with lots of advice. Are they right? At risk of sounding like a broken record – it depends…on what exactly the cause is.  But, again, more and more research points to the soft tissues (i.e. muscles / tendons / ligaments, NOT discs, bones, or spinal nerves) as the usual suspects. So here are my top tips to manage acute back pain:

  1. Don’t freak out! Unless you are having 1 of the “red flags” I mentioned in the previous post, stay calm and know that you WILL recover and the pain will most likely go away fairly soon.
  2. Get comfortable: try to find whatever position makes you have less pain / discomfort, even if just a little bit. This is sometimes tough in the beginning, because your soft tissues are sounding the alarm, and often it’s hard to get them to shut off right away. This is where a short term bout of pain medications and/or muscle relaxers can be beneficial. Position yourself to keep your painful tissues in a shortened position, not lengthened or tensioned. This will help communicate to the brain that all is ok, in hopes of getting the brain to stop guarding & protecting (i.e. spasm-ing) the muscles.
  3. Get moving: in whatever way you are able that does not significantly increase your symptoms. Study after study is showing the longer you remain inactive the longer your pain and disability will ultimately last. So, get moving, even if it’s only walking around the house or apartment initially. If you have access to a warm water pool, walking in warm water is one of the best early exercises to ease acute symptoms.
  4. Exercise & stretching: in the early stages (3-4 days up to 2-3 wks) it is risky to do exercise that loads / challenges or stretches the injured tissue(s). But it’s a trial-and-error thing. If an exercise or stretch makes it feel better, that’s a green light. If it’s worse, red light, stop, try again tomorrow. Generally, gentle non-weight loaded range of motion exercises / stretches (i.e. lying on back doing abdominal “drawing tummy in” isometrics and / or pulling knee(s) to chest stretch) are safe after a short healing period, but it depends. You just have to try  things and see how your body responds. But remember, DON’T PUSH THROUGH THE PAIN.
  5. Massage? Heat or ice? Rubs / creams? If it’s indeed muscular, anything that promotes circulation is good. So heat, muscle rubs / creams, gentle massage, even modalities like Ultrasound or Laser are all good ways to stimulate blood flow. Ice is better if there is a specific nerve that is irritated or inflamed, such as with true sciatica or carpal tunnel syndrome. Because muscles have referring pain patterns that can feel nerve-y, it can be unclear as to which is the source. This is where it’s advisable to get an expert’s opinion…especially if symptoms are not improving after a week or 2.

Physiatrists (non-surgical physical medicine specialists), Physical Therapists, Chiropractors, Acupuncturists, and even some skilled Massage Therapists can help diagnose by doing specific testing or palpating in attempt to reproduce symptoms. Once specific tissues are confirmed to be the primary cause, a plan of care can be initiated. Remember, it’s important not to wait too long to seek help. The longer symptoms remain, the longer it can take to get rid of them.

Lastly, are back belts / braces helpful? If they’re soft or flexible ones like you find at the drug store-yes. There are a lot of misconceptions out there about back braces weakening your back. That is true ONLY for rigid back braces, like the ones you would be given at the hospital for a fractured spine. The flexible, corset-style braces, like you see employees at Lowes and Home Depot wearing, will actually make you safer by helping increase your leg strength because they force more knee bend / squatting motion to pick something up rather than using your back to do it-that’s a good thing! So, spend the $20 and get one, whether you’re in recovery or prevention.

Once symptoms start to ease off and mobility is returning, gradually advancing exercises to get the abdominal and gluteal (buttocks area) muscles working is usually best, as these are supporting muscles to the back. Things like bridges (pictured here), side-lying leg raises, donkey kicks or bird dogs (pictured above) are all safe early exercises. Progressing from there should be the start of pushing, squatting, lunging, and eventually pulling & lifting – all of which should continue to be done regularly to prevent low back pain from coming back. T’ai Chi and Yoga are also excellent practices to bring awareness and knowledge of the body, all the various muscles & connective tissues, and how it’s all connected.