Posted September 18, 2018 by FIT Physical Therapy
When to choose Physical Therapy over pain medication
According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States, even though “there has not been an overall change in the amount of pain that Americans report.” In response to a growing opioid epidemic, the CDC released their opioid prescription guidelines in March 2016. The guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations, if properly dosed. But for other pain management, the CDC recommends non-opioid approaches including physical therapy.
Here are 5 reasons why patients should consider PT over opioids
1. The risks of opioid use outweigh the rewards.
Potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms when stopping opioid use. Because of these risks, “experts agreed that opioids should not be considered first line or routine therapy for chronic pain,” the CDC guidelines state. Even in cases when evidence on the long-term benefits of non-opioid therapies is limited, “risks are much lower” with non-opioid treatment plans.
2. Patients want to do more than mask the pain.
Opioids reduce the sensation of pain by interrupting pain signals to the brain. Physical therapists treat pain through movement while partnering with patients to improve or maintain their mobility and quality of life.
3. Pain or function problems are related to low back pain hip or knee osteoarthritis or fibromyalgia.
The CDC cites “high-quality evidence” supporting exercise as part of a physical therapy treatment plan for those familiar conditions.
4. Opioids are prescribed for pain.
Even in situations when opioids are prescribed, the CDC recommends that patients should receive “the lowest effective dosage,” and opioids “should be combined” with non-opioid therapies, such as physical therapy.
5. Pain has been present for 90 days or more.
At this point, the pain is considered “chronic,” and the risks for continued opioid use increase. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that non-opioid therapies are “preferred” for chronic pain and that “clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient.”
Before you agree to a prescription for opioids, consult with a physical therapist to discuss options for non-opioid treatment. “Given the substantial evidence gaps on opioids, uncertain benefits of long-term use and potential for serious harm, patient education and discussion before starting opioid therapy are critical so that patient preferences and values can be understood and used to inform clinical decisions,” the CDC states.
Physical therapists can play a valuable role in the patient education process, including setting realistic expectations for recovery with or without opioids.
Darren Marchant MSPT
FIT Physical Therapy
filed under: Physical Therapy
Posted August 20, 2018 by FIT Physical Therapy
We see patients every day in our clinics that have lost hope in their bodies ability to move and function very well. And it’s not hard to understand why. Our patients are in pain, they have arthritis, they have had injuries and surgeries. They have seen their doctor who has told them they have this disease, or that problem. They are given drugs and told that they have to take them the rest of their lives. They have consulted Dr. Google on the Internet and learned any number of scary and strange things about their problem.
A sad result of all this negative information fed to people over time is that they stop moving. They stop moving because it hurts to move, and so they don’t’, fearing movement will make things worse. They feel physically defeated and lose hope that they can ever regain any physical measure of their former selves. Sadly, over time they become more sedentary, losing important muscle strength and flexibility and function. Things that used to be easy such as getting out of a chair or going for a walk is now difficult. They don’t improve. Then they rationalize the decline to “just getting old”, which unfortunately only confirms their fears and doubts and perpetuates the problem.
As physical therapists, our message to these patients is that all hope is not lost and that improvement is possible, at any age. In short, we tell our patients to get moving, and believe in your body!
Now I don’t mean to minimize the reality of aging and that our bodies do get injured, diseases happen and things deteriorate over time. There is a natural decline that happens, but the rate of the decline to a large extent is controllable. What I tell my patients, and wish more people knew is that our bodies are amazingly adaptive. They can take some pretty serious hits and still keep going. and physical change and improvement is possible, at any age!
The key is having a positive movement mindset. To encourage this way of thinking I often tell my patients: Movement is medicine! Motion is lotion! Our tissues, however injured can and do heal over time. Just because it hurts to move doesn’t mean you should stop. Hurt does not always equal harm. You may be a little sore but you are safe to do these exercises.
This doesn’t mean you should just run out and join the gym, not yet at least. A good place to start is to see a Physical Therapist. As physical therapists we prescribe exercise, similar to how your doctor prescribes medication. With their professional judgment they prescribe the correct type and amount of medication for your specific need. We prescribe exercise and movement in the same way. Understanding what you need we prescribe the appropriate type and amount of exercise and movement to improve your health. We take seriously our claim that we are movement and exercise experts and have spent years learning so that we can be the number one trusted and recommended health care providers in the medical community for exercise and movement. Try us out! After a successful stint of physical therapy, you very well may be ready for the gym, but start with PT first!
If you find yourself frustrated because of your physical decline. If you are not as active as you would like to be, or if pain or injury or disease is keeping you from living the life you desire. Don’t give up! See an encouraging, patient, understanding physical therapist. We can truly make a difference and help you get moving and believe in your body again!
filed under: Physical Therapy
Posted July 6, 2018 by FIT Physical Therapy
Let me share an example with you. Two people, Mike and Dan sustain a similar low back injury at work. Both of them have pain, miss some work, see the doctor and get the same medical care initially. After a few days Mike starts feeling a little better and shortly thereafter returns to work and life as before. His back bothers him occasionally but he has found that with some regular stretching he is good to go.
Dan’s low back pain on the other hand does not get better; in fact it seems to get worse. When his pain persists he re-visits the doctor and has more testing done. He is given a stronger pain medication which seems to at least keep the pain manageable. He visits with his neighbor about his condition and he tells him of someone he knows who had back pain that was actually cancer. He sees a health care provider whose explanation of his pain was confusing and even scary, especially when he pulled out the spine model and started talking about herniated disc ruptures, tears and bulges. Some days he feels better than others but his job is physically demanding so he is afraid that going back to work will only increase his pain. He doesn’t really like his job and does not get along with his boss. He is afraid that he may end up losing his job over the injury. His wife is getting worried as well and tells him she is not sure they will have enough money to pay the bills this month because of being him being off work.
His doctor calls and says that his MRI results show a herniated disc and tells him that he should do more therapy but that if that doesn’t work he may need surgery. The only thing that seems to give him relief now is the pain medication and he is carefully counting his pills, worried that he may run out before he can get a refill. He can’t help but feel depressed, anxious and fearful of his ability to return to work and life as before.
Let me remind you that Mike and Dan sustained the same type of injury, one was not worse than the other! Yet, despite their similar injury, Mike was able to go down the path of recovery and healing where Dan was on the path of fear, anxiety, stress, job loss as well as possible medication dependency and long term disability. One may argue that Dan had a “positive” MRI finding of a herniated disc that would explain why his pain persists. But researchers have found that approximately 40% of people with absolutely no low back pain have a bulging disc on MRI! That means that he could have had the same MRI findings before he had the back injury.
My previous article on pain talked about our nervous system and how our nerves become sensitive after an injury but then most of the time slowly calm down. This is what happened to Mike.
For others, like Dan, after an injury occurs the nervous system does not calm down and remains in an elevated, sensitive state. Factors that are called “yellow flags” such as, different explanations for the problem, job issues, persistent pain, fear and anxiety, family concerns and failed treatments can all be drivers to keeping the nervous system ramped up.
Now, let’s talk about how our bodies were designed to handle stressful situations. You may have heard of the sympathetic nervous system also known as the flight or fight response to stress. This system works like this:
Imagine you were sitting in your house watching your favorite TV show and suddenly a roaring lion jumps into your room! Certain automatic, physiologic responses happen in your body. Your heart starts to beat faster delivering blood to the large strong muscles of your body so you can run out of the room, or fight the lion if trapped. Language is influenced, you may shout, scream, or say some choice words. Your breathing becomes faster and shallower, your food digestion is slowed or put on hold allowing all possible energy and blood flow to be allocated to the immediate, much needed other systems. Other functions of your body like pain, sleep, reproduction, immune etc. are shunted to deal with the lion in your room. These responses are automatic and normal and were and are integral in our long term, evolutionary survival as a species.
Now imagine that the animal control officer comes in and captures the lion and removes it from your house. You probably won’t return immediately to your TV show, and it may take a few days to calm down but after a few days you may actually laugh about it. But what if the lion was not captured?
In our previous example, Mike and Dan both figuratively had a lion jump into their room when they were injured. The difference is that in Mike’s case, the Lion was captured and his nervous system calmed down. In Dan’s case, the lion has never left his side. The lion is a metaphorical description of the aforementioned yellow flags; all stressors that keep his sympathetic system out of balance and nervous system elevated.
The neat thing is that our understanding of how pain works is increasing and alternative treatment options like Physical Therapy and Pain Neuroscience Education are showing to be very effective in helping calm the nervous system by addressing and eliminating the “yellow flags” that keep our nervous system extra sensitive.
Darren Marchant MSPT
FIT Physical Therapy
filed under: Physical Therapy
Posted June 7, 2018 by FIT Physical Therapy
Pain is a normal and necessary part of life. Pain is also essential for survival. If we didn’t experience pain we would be much less likely to avoid those situations that are threatening and dangerous to our health and survival.
Living with frequent or persistent pain is not normal. Unfortunately there are millions of people who suffer from chronic pain. Our health care system has grappled with how to effectively treat pain for as long as doctors have had patients. I believe a reason why pain rates are increasing is because as health care providers our training and education is steeped in the biomedical model of treatment with diagnosis and treatment directed at our tissues such as as muscles, ligaments, and joints. Of course these tissues can become injured and be the source of pain, especially in the first few days or even few months after an injury has occurred. Medical treatments and medicine can be very effective in this stage of healing. But what about the pain that persists beyond normal tissue healing times? This chronic pain state has not been as well understood or treated by our medical/pharmaceutical system.
Thankfully, times are changing. In the last several years our knowledge of how pain works has increased considerably. New innovations and research have allowed brain scientists to better understand our nervous system; brain, spinal cord and nerves, and how they play a central role in a pain experience. Call me a geek, but I find it is fascinating stuff. And the cool part is that the research shows that if you are a chronic pain sufferer, understanding your nervous system a little better, and understanding why you hurt, has a very real therapeutic benefit in helping you overcome your pain. To this end, I would like to ‘explain pain’ to you.
Each area in our body has nerves. In fact, our bodies contain 45 miles of nerves and more than 400 individual nerves! These nerves are all connected like a network of roads. The nerves connect our body parts to the spinal cord (The super nerve network that runs through our spine), which then connects at the base of our skull to our brain.
Nerves are continually active to some extent. If you are alive, they always have little energy buzzing through them. They serve as monitors of your body and environment and inform you and your brain of anything going on in your body. Some nerves work like a living alarm system. Take for an example when you step on a nail. You want to know about it right? Of course, so that you don’t step on more nails, so that you will give it some attention, put a bandage on it and maybe get a tetanus shot. Nerves send messages using electrical impulses. When there is danger, such as a nail in the foot, the nerves increase electrical activity and “wake up”, sending a lot of danger messages to your spinal cord and then up to your brain. They let the brain know there is danger and action is required. Pain is produced by your brain essentially to get your attention and take action.
Once you take care of the nail and your foot, the nerves (alarm system) gradually settle down and returns to its normal resting level of activity.
When you hurt yourself, have an accident, undergo surgery or experience a lot of emotional stress, the same process as the nail in the foot occurs. When you develop pain in a certain body part, the nerves in these areas “wake up” alerting your brain to the danger in the area. The nerves around the area alert the spinal cord, which in turn, tells the brain there is a problem in the area and action is possibly required. This process is normal; it’s simply the nerves doing their job. After a few hours or days, the nerves return to their normal, resting state.
Now, here’s the problem. In some people, the nerves that “wake up” calm down very slowly and do not return to their normal level of sensitivity. They stay more sensitive. In this state, it does not take much activity to get the nerves to fire off danger messages to the brain. This is what has been described as an extra sensitive alarm system. With this increased nerve sensitivity, activities that used to be easy and pain free, like walking, doing the dishes or washing laundry are painful. We naturally stop doing these things and believe that something must be wrong. Often we blame the tissues (muscle, joint, tendon etc.) not realizing that the tissue is probably not the issue any longer but rather you have an extra sensitive nervous system.
One way to know if your alarm system is overly sensitive ask yourselves the following questions:
Have your activity levels before reaching pain decreased a lot?
Is pressure on your skin or around the painful area very sensitive?
When doctors or therapists test or move your body parts are they very sensitive?
Are you currently taking medicine to calm your nerves such as Cymbalta, Lyrica, Neurontin or anti-depressants such as Paxil, Zoloft and Prozac?
If you answered yes to any of these questions, or if you have persistent pain past a normal amount of healing time then there is a good chance your nervous system is extra sensitive. In future articles I will discuss some of the reasons why the nerves become so sensitive and what you can do to help calm them down.
Darren Marchant MSPT
FIT Physical Therapy
filed under: Physical Therapy
Posted May 11, 2018 by FIT Physical Therapy
Balance problems and a fear of falling are a big concern for many. They can make simple but vital daily activities such as walking, dressing, and bathing very difficult, if not impossible. Furthermore, balance problems put people on a path of significant muscle loss, frailty and loss of independence. Nursing homes and long-term care facilities are filled with people who have lost their ability to be safe and live independently. Emergency departments and hospitals see many who have fallen and sustained serious injury. Fortunately there is help. Physical Therapists trained in balance and vestibular therapy can do much to help improve balance, prevent falls and preserve strength, function and independence.
A team approach between therapists, medical doctors and audiologists trained in balance and inner ear disorders is important to accurately identify the causes of balance loss and design a customized treatment program. Balance problems are best addressed on an individual basis because there can be numerous causes of balance loss. There are also numerous treatment options and they must match the cause of the balance loss to be effective.
Physical therapists are trained to evaluate multiple systems of the body, including the muscles, joints, inner ear, eye tracking ability, skin sensation, and position awareness in the joints (proprioception).
Here are 8 specific ways physical therapy can help balance and dizziness problems:
1. Reduce Fall Risk
Your physical therapist will assess problem footwear and hazards in your home that increase your risk of balance problems or falling. Household hazards include loose rugs, poor lighting, unrestrained pets, or other possible obstacles.
2. Reduce Fear of Falling
By addressing specific problems that are found during the examination, your physical therapist will help you regain confidence in your balance and your ability to move freely, and perform daily activities. As you build confidence in your balance and physical ability, you will be better able to enjoy your normal daily activities.
3. Improve Mobility
Your physical therapist will help you regain the ability to move around with more ease, coordination, and confidence. Your physical therapist will develop an individualized treatment and exercise program to gradually build your strength and movement skills.
4. Improve Balance
Your physical therapist will teach you exercises for both static balance (sitting or standing still) and dynamic balance (keeping your balance while moving). Your physical therapist will progressively increase these exercises as your skills improve.
5. Improve Strength
Your physical therapist will teach you exercises to address muscle weakness, or to improve your overall muscle strength. Strengthening muscles in the trunk, hip, and stomach (i.e., “core”) can be especially helpful in improving balance. Various forms of weight training can be performed with exercise bands, which help avoid joint stress.
6. Improve Movement
Your physical therapist will choose specific activities and treatments to help restore normal movement in any of your joints that are stiff. These might begin with “passive” motions that the physical therapist performs for you, and progress to active exercises that you do yourself.
7. Improve Flexibility and Posture
Your physical therapist will determine if any of your major muscles are tight, and teach you how to gently stretch them. The physical therapist will also assess your posture, and teach you exercises to improve your ability to maintain proper posture. Good posture can improve your balance.
8. Increase Activity Levels
Your physical therapist will discuss activity goals with you, and design an exercise program to address your individual needs and goals. Your physical therapist will help you reach those goals in the safest, fastest, and most effective way possible.
filed under: Physical Therapy
Posted April 30, 2018 by FIT Physical Therapy
One of the most commonly injured areas in our knees is called the meniscus. The meniscus is a rubbery, C-shaped piece of cartilage that cushions your knee. Each of your knees has 2 menisci (plural of meniscus); one on the inner (medial) part of the knee, and the other on the outer (lateral) part. Together they act to absorb shock and stabilize the knee joint.
A meniscal tear typically is caused by twisting or turning quickly on a bent knee, often with the foot planted on the ground. Although meniscal tears are common in those who play contact sports, anyone at any age can tear a meniscus.
Meniscus tears come in different shapes and sizes and can occur at different locations in the knee. Tears are usually described by where they are located and their appearance (for example, “bucket handle” tear, longitudinal, parrot beak, and transverse). While physical examination may predict whether it is the medial or lateral meniscus that is damaged, a diagnostic procedure, like an MRI can locate the specific part of the cartilage that is torn and how it appears.
Because there is different blood supply to each part of the meniscus, knowing where the tear is located may help decide how easily an injury might heal (with or without surgery). The better the blood supply, the better the potential for recovery.
If you are older and your meniscus is worn, you may not know what you did to cause the tear. You may only remember feeling pain after you got up from a squatting position, for example. Pain and slight swelling are often the only symptoms.
Your health care provider may diagnose a torn meniscus, but meniscal injuries can very often be managed without surgery. A short course of treatment provided by a physical therapist can help determine whether your knee will recover without surgery. The physical therapist plays an important role by controlling pain and swelling and by restoring full strength and mobility to your knee.
Patients with more serious meniscal tears, or those that don’t respond to a course of physical therapy, may need surgery. Surgically removing the torn cartilage (a procedure called a menisectomy) usually is a simple procedure that requires a brief course of physical therapy treatment after surgery. Most people are able to return to their previous level of activity, including sports, in fewer than 2 months.
Sometimes the surgeon will decide that the torn meniscus can be repaired, instead of removed. Research studies show that if a meniscal repair is possible, the long-term outcome is better than removal because the repair can reduce the risk of arthritis later in life.
Rehabilitation following a meniscal repair is slower and more extensive than with removal because the repaired tissue must be protected while it is healing. The type of surgical technique performed, the extent of your injury, and the preferences of the surgeon often determine how quickly you will be able to put weight on the leg, stop using crutches, and return to your previous activities.
filed under: Physical Therapy
Posted March 1, 2018 by FIT Physical Therapy
We’ll that body position you are in now may be the cause of current and/or future orthopedic problems, especially in your neck.
We spend a lot of time each day with our devices. Cell phones, tablets, computers etc. According to the Kaiser Family Foundation, 8- to 18-year-olds spends an average of seven and a half hours using “entertainment media” every day.
But it’s not just kids. The average amount of data used on a smartphone tripled from 2010 to 2011, according to Cisco’s Global Mobile Data Traffic Forecast Update. And each tablet generates 3.4 times more traffic than the average smartphone.
A recent study published in Surgical Technology International’s 25th edition says texting may be hurting your neck. Conducted by New York spine surgeon Kenneth Hansraj, the study found that bending your head to look at your mobile device held in your hands can put up to 60 pounds of pressure on your neck.
Hansraj’s study includes illustrations of what happens when mobile users bend their heads at at 15, 30, 45 and 90 degrees to look at their devices. He advises users be cognizant of their bodies.
“We recommend that people should continue to enjoy their smart devices, but that they pay specific attention to where their head is in space,” Hansraj told the Huffington Post. “You want to be careful that your head is straight up with you’re using a smart device.”
The average human head weighs 10 pounds in a neutral position — when your ears are over your shoulders. For every inch you tilt your head forward, the pressure on your spine doubles. So if you’re looking at a smartphone in your lap, your neck is holding up what feels like 20 or 30 pounds.
All that extra pressure puts a strain on your spine and can pull it out of alignment. Dr. Tom DiAngelis, former president of the American Physical Therapy Association’s Private Practice Section, compared it to bending your finger back all the way and holding it there for an hour.
“As you stretch the tissue for a long period of time, it gets sore, it gets inflamed,” DiAngelis said. “The real question … is ‘What are the long term effects going to be?’
In physical therapy we label this problem as “forward head posture”. Over time it leads to muscle strain, disc herniations and pinched nerves. It can also reverse the natural curve of your neck.
The other problem, less often recognized is the lack of oxygen taken in our bodies through this forward head posture.
Try to take a deep breath in a slumped position. Now sit up straight and try again. Experts say slouching can reduce the capacity of your lungs by as much as 30%!
Here are a few tips to avoid problems when using our devices:
Keep your feet flat on the floor, roll your shoulders back and keep your ears directly over them so your head isn’t tilted forward. Use a docking station and wrist guards to support the weight of a mobile device. Buy a headset.
Take frequent breaks while using any mobile device or desktop computer. About every 20 minutes, stand up, roll your shoulders and neck or go for a short walk to improve blood flow.
filed under: Physical Therapy
Posted January 30, 2018 by FIT Physical Therapy
filed under: Physical Therapy
Posted December 19, 2017 by FIT Physical Therapy
Stretching is an important part of recovery, but it rarely receives the time or attention it deserves. The purpose of stretching is to maintain the flexibility of tissues that are tight or stiff from an activity or prolonged position.
There are a variety of methods of stretching (using the hamstring muscle as an example):
Static/Isolated Stretching: Static, or isolated stretching is holding a stretch position for a long period. (Example: A static hamstring stretch would be when you sit on the ground with one leg pointing outward and you simply reach for your toes and hold for at least 30 seconds.)
Dynamic stretching: Dynamic stretching is using movement to combine muscle groups. (Example: A dynamic stretch for the hamstring would be walking toe touches, as you bend down and grab your toe with every step for 2 to 3 seconds.)
Foam Rolling: Foam rolling is a type of self-mobilization and massage. (Example: To foam-roll the hamstring muscle, you will simply put a foam roller under your legs and let your weight rest on top so the foam roller will push out any knots in your hamstring.)
A very general rule for stretching is dynamic stretching before exercise, static stretching after exercise, and foam rolling throughout. Utilizing various stretching strategies will allow you to maintain and improve your mobility.
2. Refueling—Nutrition and Hydration
Proper fueling before exercise is important to optimize performance, but nutrition for recovery from exercise is often overlooked. Our bodies rely upon a well-balanced array of nutrients, vitamins, and minerals to aid in rebuilding the parts of our body that have been stressed during exercise. Refueling after a workout with a well-rounded set of carbohydrates, proteins, and healthy fats will help your body reap the most benefit from your hard effort.
Water is also absolutely essential to overall health. In particular, following exercise, proper hydration is key to replace the fluids that you have lost during your activity. Water also helps regulate your temperature, maintain healthy joints, and eliminate wastes that build up in your system during activity. Pay special attention to your total water intake if you are exercising in extreme hot or cold climates or if you feel as though you may be getting sick. Make a habit of keeping a water bottle in your purse, gym bag, car, or workplace for easy, reliable access.
RICE stands for Rest, Ice, Compression, Elevation. If you find yourself having pain or swelling following exercise, particularly in a joint like your knee, ankle, or shoulder, you may consider using this four-part strategy to decrease inflammation and pain. If you continue to have symptoms several days following a workout, it may be important to seek the advice of a healthcare provider to further examine your complaints.
4. Listen To Your Body
The only person who knows how your body feels after a workout is you. Allow yourself to listen to your body, and appropriately. This includes recognizing the signs of fatigue, pain or soreness and increasing recovery time between exercise bouts. This may also mean pushing yourself to work harder when you feel well. Don’t succumb to peer pressure at the gym. Trust yourself and what your body is telling you. When you are starting a new exercise program, don’t be afraid to ask your physical therapist for helpful hints on how your body may give you feedback after exercise, and how you should respond to that information.
5. Cross Training
Even if you love to run, your body may not like you running seven days a week. No matter what your exercise of choice may be (walking, running, swimming, cycling, weightlifting, yoga, recreational sports, etc.), you may benefit from finding another form of exercise.
Cross training is simply about challenging your body with different tasks so that certain tissues are not over-stressed, which often leads to overuse injuries. For example, a swimmer will benefit from strength training in addition to the hours spent in the pool in order to build different muscle groups and allow momentary rest for those that are used repetitively in the pool. Remember to do the exercises your body needs, not just the exercises you want to do.
Often taken for granted, sleep is your body’s prime opportunity to recover.
When the body is at rest, the repair of our muscular, cardiovascular, skeletal, and immune systems can go to work. The CDC recommends that, in general, teens have 9-10 hours and adults 7-8 hours of sleep each day. These guidelines are especially important if you are demanding more of your body through regular exercise or stressful daily activities.
To get the most out of your shut-eye, strive for consistent bedtimes, avoid stimulating activities in bed (like TV and electronic devices), and a comfortable environment. You may find that you sleep better on days that you exercise, and will definitely notice a more effective, pleasant exercise experience if you are giving your body the rest it needs and deserves.
filed under: Physical Therapy
Posted November 10, 2017 by FIT Physical Therapy
Balance Doesn’t have to Slip Away
You wobble slightly stepping off a curb, and then down you go. It happens fast, and leaves you to wonder what happened to that great sense of balance you used to have. Balance doesn’t stay steady throughout life. Like muscles and bones, steadiness can deteriorate if not maintained. And balance training just isn’t part of most workouts.
Balance is often something most people don’t think about. That is, until a slip, trip or fall happens. Maintaining balance is easy for most younger people, but as we age our bodies loses muscle mass (about 1% a year starting after middle age) and bone mass. And senses involved with balance start to dull too as we get older: vision as well as senses of touch, pressure and proprioception (the sense of body placement and how it moves through space).
Certain medications can affect balance too. And the end result can be serious: Falls in older people can result in a broken hip, which, in turn, can trigger a downward spiral into dependence and ill health. Even a fear of falling can keep someone housebound for months leading to feelings of loneliness and depression.
Skills such as timing and coordination that are involved in balance are learned and practiced and honed. The more we sit, the more those skills erode. The old adage: “Use it or lose it” certainly applies to our balance.
But balance can be shored up, even in very old age. A 2007 study in the journal Osteoporosis International looked at the effect of a yearlong balance training program on women with osteoporosis. By the end of the study, the women’s functional and static balance improved, as did mobility. Falling frequency also declined.
Another study in the International Journal of Rehabilitation Research in 2010 found that elderly people enrolled in an eight-week balance or weight training program were less likely to slip and were more likely to recover if they did slip.
Balance training starts with stretching and strengthening all the muscles in the body. To do the activities of daily living as they relate to balance — walking down the stairs, getting in and out of the bathtub — is really about maintaining good muscle movement and strength. This can be done with an overall weight training program. For those who haven’t been to the gym in a while — or ever — that training should start with the basics and get progressively more difficult so that the muscles are always challenged.
When it comes to balance-specific training, your ultimate goal is to be able to maintain your balance in tricky situations. In Physical Therapy when we have a patient with poor balance skills, we will start off with safe floor exercises, then progress to standing on two feet, then on one leg. As a patient progresses the exercises also progress thus always providing the challenging effect that must be present for balance to improve. Balance training almost always involves targeting core muscles — the ones surrounding the trunk and the back, as well as our powerful and important leg and hip muscles.
People who want to advance their balance training can invest in equipment such as balance pads, therapy balls and discs. These objects are wobbly when stood on or sat upon — can be used without any other equipment, or with light weights or other gear for even more demanding workouts. Just doing a simple squat or a soft cushion offers great balance training.
Even cardio workouts should involve some instability. Elliptical trainers, stationary bikes and other cardio machines may raise the heart rate sufficiently, but they always offer an even, steady surface — and that does precious little for preserving someone’s balance. Taking a class, playing a sport, or walking, running or cycling outside on a variety of surfaces force the body to travel in more planes of movement and are more challenging to our balance systems and thus much more effective at improving balance.
Pilates and yoga can help develop balance as well. These methods of exercise are particularly good at improving balance because they help improve body awareness, improve flexibility and strength.
For individuals who have had falls, or are at a risk of falling, a supervised balance program designed by a physical therapist trained in balance and vestibular therapy is appropriate.
filed under: Physical Therapy