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osteoporosis and physical therapy

Osteoporosis and Physical Therapy

What is Osteoporosis?

Osteoporosis is a condition that causes degeneration and weakening of the bones. It is most common in women, but can affect men as well. It is also more common as we age, with 55% of Americans 50 or older affected.

Bone is living tissue and like all living tissues, old cells are constantly being removed and replaced by new cells. In normal bone, the removal and replacement of cells happens in a balanced process. In osteoporosis, bone is weakened when the removal of cells outpaces the addition of new cells.

Osteoporosis is often called a “silent disease” because there are often no symptoms until a fracture occurs.

How can Physical Therapy Help?

Your physical therapist will complete a comprehensive evaluation and develop a treatment plan to address your specific needs. In most cases, your PT will include weight bearing activities, or resistance exercises using weights or bands because these types of exercises have been shown to strengthen bones.

Your PT might teach you proper posture to decrease the stress on your spine and help reduce the risk of fracture. Another way to reduce unnecessary bone stress is to learn proper posture and alignment during daily tasks like reaching for items or bending to pick up an object.

To help reduce the risk of fracture from a fall, your PT might incorporate balance activities, or specific strengthening activities.

If you already have a fracture, your PT can work with you to reduce pain. They can also assess you for things like braces or splints that may help you heal or improve your posture.

Get Back Into Balance

Get Back Into Balance

Your physical therapist can play a big role in helping you maintain or improve your balance as you age. Unfortunately, falls are becoming increasingly common in adults age 65 and over. Just because they’re common, doesn’t mean they’re inevitable though. Research shows that falls are caused by a variety of factors, and many of them can be improved. Let’s take a look at some of them and some tips to help you get back into balance.

Lower Body Weakness

As we age, without resistance training we lose muscle mass every year. Weakness in your lower body has been shown to increase your fall risk. A physical therapist can design an exercise program to help you strengthen your legs and lower body safely.

Inactivity

Another reason we lose muscle mass and our balance decreases is inactivity and deconditioning. People who have fallen in the past often have a fear of falling again, which leads them to do less. As their activity levels decrease, they get weaker and even more fearful of falling.

This downward spiral can be stopped with balance training from a physical therapist to build your confidence on your feet and allow you to become more active.

Group exercise classes are another great way to become more active, work on your balance and meet new friends at the same time. Ask your PT for recommendations for a class near you.

Vision Problems

Many people don’t realize that your body uses your vision for balance. If you want to prove this to yourself, try standing with your feet together with your eyes open, then compare that to doing it with your eyes closed. Visual problems can also make you miss things like bumps and changes in the surface you’re walking on, or objects that you could trip over.

If you’re having problems with your vision, see your eye doctor for an exam and recommendations on what can be done.

Medications

Certain medications can increase your risk of falling and impact your balance by making you sleepy, slowing your reactions, or causing weakness. Some examples of medications that can increase fall risk are certain types of antidepressants, blood pressure medications, and water pills.

Your physical therapist can help you work with your doctor or pharmacist to review your medications and consider changes to improve your balance and reduce your risk of falling.

When it comes to helping you improve your balance, and reduce your risk of falling, your physical therapist is an important part of the team. They can evaluate you to determine where your problem areas are, and design an individualized program for you. They can also refer you to other professionals who can help like your eye doctor and your pharmacist. If you’re starting to feel out of balance, your PT can help you stop falls before they start.

Physical Therapy and Fall Prevention

Physical Therapy and Fall Prevention

Every year one in four people over 65 falls. That means that millions of older adults fall every year, and 1 in 5 of those falls results in serious injury like broken bones or a head injury. Less than half of the people who fall will tell their doctor, maybe out of embarrassment or maybe because they assume that falling is a part of the aging process. But falling is not inevitable, and with some help from your doctor and your physical therapist, your chances of falling can be significantly reduced.

Research has shown that many risk factors contribute to falls. Some risk factors can be changed, like lower body weakness, difficulties with walking and balance, vision problems, use of certain medications, foot pain or poor footwear, and home hazards like throw rugs, extension cords, and uneven steps or floors.

A physical therapist can screen you for fall risk. They can also have a positive impact on many factors to reduce your fall risk through interventions like strengthening exercises, balance training, or teaching you to use a device like a cane or walker to keep you more steady when you’re walking. A physical therapist can also teach you how to make easy changes around the house that can reduce your risk of falling. Some easy examples would include:

Using night lights to help your vision at night
Removing throw rugs, extension cords, or clutter that you could trip over
Installing grab bars near the toilet or bathtub

A PT can help you work other professionals like your eye doctor if your vision is increasing your fall risk or with your doctor or pharmacist to review your medications to see if they could be making you feel dizzy, weak, or sleepy.

Falling is common in people over the age of 65, but that doesn’t make it a normal part of the aging process. If you have fallen, your chance of falling again is doubled, but by working with your physical therapist and the rest of your healthcare team, you can reduce your fall risk and maintain your independence.

Walking

A Physical Therapists Recommendation to Walk?

Most people know that physical therapists often recommend exercise as part of their treatment. What most people don’t realize is how simple that exercise can be. Instead of complicated workouts, heavy weight lifting, or running for miles, physical therapists often surprise people when they recommend walking.

While it seems like an easy exercise, walking still has powerful health benefits. Walking 30 minutes a day, 3 times a week has been shown to improve cardiovascular endurance, and reduce blood pressure and weight. Lots of people are using activity trackers and apps to track steps during their daily activities, and this too has been shown to have benefits. These include reducing disability and pain associated with conditions like knee osteoarthritis. While many people aim for 10,000 steps per day, research shows that as little as 6,000 steps a day can reduce pain and disability while boosting cardiovascular health.

If you’re thinking about starting a regular walking program or just increasing the amount of walking you do throughout the day, it’s important that you do it the right way. The general recommendation for building any physical activity is to take whatever amount of the activity you do in a week and increase it by 5% or less per week. A good general starting place would be 3,000 steps per day, and an example program following the 5% rule might look like this:

Week 1: 3000 steps (1.5 miles)

Week 8: 4500 steps (2.25 miles)

Week 2: 3150 steps

Week 9: 4800 steps

Week 3: 3300 steps

Week 10: 5000 steps (2.5 miles)

Week 4: 3500 steps (1.75 miles)

Week 11: 5250 steps

Week 5: 3750 steps

Week 12: 5500 steps (2.75 miles)

Week 6: 4000 steps (2 miles)

Week 13: 5800 steps

Week 7: 4200 steps

Week 14: 6000 steps (3 miles)

If you’re not sure if you’re ready to walk the recommended 6,000 steps a day, you can always visit a physical therapist for a review of your medical history and baseline testing to find out what a safe level for you to start at would be. A PT can also help you design a program to safely meet your goals.

One last thing to consider is footwear. Although walking is less stressful than running, it’s still important to take care of your feet. Shoes designed for running work well to cushion and support your feet when walking too. If you need help picking the right pair, a PT can help and so can the staff at a good specialty running store.

How Much Physical Activity Do Older Adults Need

How Much Physical Activity Do Older Adults Need?

Most people know that physical activity is important. In fact, not getting enough has been linked to illnesses like heart disease, stroke, diabetes, Alzheimer’s, high blood pressure and lung disease. So the important question is not if you need to be doing some form of physical activity to protect against diseases like these, but how much is enough?

The US Department of Health and Human Services answered that question for us in 2008 with their recommendations for physical activity. To improve or maintain health, adults over 65 need to do 2 types of physical activity: aerobic exercise and strengthening.

Aerobic Exercise

To meet the recommendations for aerobic exercise you should try to be active daily, and perform your aerobic activity for at least 10 minutes at a time. Each week you should aim for

150 minutes of moderate intensity activity
OR
75 minutes of vigorous intensity activity.

The general rule is that 1 minute of vigorous activity is equal to 2 minutes of moderate intensity activity, so a combination of moderate and vigorous activity can also be used to satisfy the recommended 150 minutes each week.

Some examples of moderate intensity aerobic activity would be:

Walking
Water aerobics
Riding a bike on a level surface
Doubles tennis

Vigorous intensity activities include:

Running or jogging
Riding a bike fast, or on hills
Singles tennis
Hiking uphill

Strengthening

Muscle strength is important for all daily movement, and in older adults it can help to maintain strong bones, as well as reduce the risk of falling. The recommendation for strengthening is to work each major muscle group twice a week.

Examples of strengthening activities include:

Carrying heavy loads
Lifting weights
Exercises using your own body weight like push ups, sit ups, or squats

For each exercise you should try to perform:

At least one set
8 to 12 repetitions in each set

Your resistance should be heavy enough that the last repetition is hard to complete.

These guidelines are general recommendations and do not take into account previous injuries, medical conditions, or limitations that individuals may have. Your physical therapist is an expert in exercise and physical activity who can help design a program to maintain or improve your health while considering your past medical history, limitations, and goals. Your PT can teach you safe exercise technique, and help you safely progress your program as you get fitter to continue making improvements in your overall health.

Life is a Movement Journey

Life is a Movement Journey, Here’s How PT Can Help

Now that spring has arrived, temperatures are starting to rise in many parts of the country. And that means the transition from heating our homes to cooling our homes is right around the corner. No matter what method you use to cool your home during the warm spring and summer months (central air conditioning, window units, or fans and dehumidifiers), each spring you cross your fingers that your approach still works. If not, you might be calling an expert for a tune-up, or in extreme circumstances, you might need a complete overhaul.

Just like an AC system that has probably been dormant for many months of the year, a body that hasn’t been physically engaged on a regular basis may have trouble getting started again. And yet, this time of year, the warm temps draw many people to city and suburban streets, tracks and trails, ready to take that first run of the season. A good percentage of these spring runners haven’t kept up their strides throughout the winter. It should come as no surprise that a 4-mile run for a previously inactive person is going to stir up a few aches and pains.

Especially as we age, our ability to move undergoes changes. But whether we’re talking about a college student or a retiree, returning to an activity without proper planning is a recipe for disaster. That’s where physical therapy comes in. Physical therapists are trained to treat injuries and ease pain, but they can also help their patients prevent injuries and safely prepare to participate in new activities.

Think of physical therapists as “movement consultants” who can ensure that your body is physically ready to tackle a new challenge—or resume a favorite leisure activity. Here’s another example to illustrate what we’re talking about: Let’s say that you play in an adult soccer league and you’re preparing to play in your first game of the season in a few weeks. You probably hung up your cleats when the last season ended months ago, but expect to pick up just where you left off. But it’s simply too much to ask for your 2019 debut on the field to be on the same level as the last game of the previous season, when you likely had reached peak performance.

This is a good time for your PT to step in and help you shake off the rust. The rehab professional can customize an exercise plan to help you slowly return to sport and avoid an injury that could sideline you for the whole season. Or like cleaning the filters before firing up your air conditioner for the first time this year, the rehab expert can help to ensure that your body is prepared to return to its former activity level following a hiatus.

Physical Therapy For Dizziness

Physical Therapy For Dizziness

We all feel like life is spinning out of control at times, but if you have dizziness, that spinning feeling is for real. A physical therapist can help with many common forms of vertigo and dizziness. In this article we’ll take a look at two examples of conditions that cause dizziness commonly treated by PTs.

BPPV

Benign Paroxysmal Positional Vertigo (or BPPV) is the most common cause of vertigo, a false sensation of spinning. BPPV is a mechanical problem in your inner ear that causes a feeling of spinning with certain head positions or movements. BPPV is caused when some of the small crystals normally embedded in gel in your inner ear get dislodged and end up in the semicircular canals of your inner ear. These canals are filled with fluid and sense head motion. The crystals disrupt the normal function of the canal, which sends an abnormal signal to your brain. Your brain interprets this signal as head movement, even though your head is still, causing you to feel dizzy.

Your therapist can take you through a series of motions to determine which is the problem ear and which canal the crystals are in. After that a specific maneuver involving head motion allows gravity to pull the crystals out of the semicircular canal. Usually symptoms can be greatly improved in 1 to 3 treatments, but some patients continue to feel mild dizziness or sensitivity to head motions even after the crystals are removed from the canal. Your therapist can also evaluate this and prescribe home exercises to correct this problem.

Cervicogenic Dizziness

This is a condition that causes dizziness, but is related to problems in the neck. This is a much more rare condition than BPPV, and does not cause a true spinning sensation. There is no specific test for cervicogenic dizziness, so it’s important to get a thorough evaluation from a qualified professional like a PT to rule out other problems that may be causing your dizziness.

In most cases the dizziness improves with treatment of the neck pathology alone using things like exercise, manual therapy, and education on proper posture. For the patients who don’t improve with treatment of the neck alone, adding vestibular rehabilitation often improves symptoms. Vestibular rehabilitation may include eye exercises, balance exercises, or graded exposure to what makes your dizzy.

Treatment of vertigo and dizziness is a specialized form of physical therapy that requires specific training. If you’re experiencing dizziness or vertigo, getting a full evaluation by a qualified PT is a great first step to stop yourself from spinning out of control. They can diagnose the specific cause of your dizziness and design a treatment plan to address it.

Exercise and Your Mood

Exercise and Your Mood

Exercise has great benefits for your physical health – it can strengthen your muscles, improve your cardiovascular system, and reduce your risk of diseases like stroke and diabetes. But, did you know that exercise can have benefits for your mental health too?

Why exercise lifts your mood

Exercise causes your brain to release chemicals including endorphins, adrenaline, serotonin and dopamine. These chemicals all work together to make you feel good. In addition to the chemical changes in your brain, exercising can lead to a feeling of accomplishment and relaxation of your muscles, also helping you feel good.

Exercise and depression

Exercise on it’s own is not a cure for depression, but research has show it can be as effective as medication for mild to moderate depression. In fact, the most commonly prescribed antidepressants are SSRI drugs, which work by increasing the amount of serotonin in your system. As mentioned above, exercise also increases the amount of serotonin in your system, so the effect on depression shouldn’t be a surprise.

Make time for yourself

Many people believe they are “too busy” for exercise. Being “too busy” for something really just means that you’re prioritizing something else above it. By placing exercise high on your priority list, you’re prioritizing yourself. This is a great way to help boost your mood and your confidence, because you’re taking a portion of your day for yourself.

Choose physical activity you enjoy

While any physical activity will help release endorphins and serotonin, choosing something you enjoy can help boost your mood even further. In addition, by using physical activity that’s fun for you, you’ll be more likely to be consistent. Consistently exercising is important for getting the most benefit out of it.

Improve Your Physical Therapy Experience

The No. 1 Thing You Can Do to Improve Your Physical Therapy Experience

Dealing with the pain and limited mobility associated with an injury or illness can be stressful for so many reasons. You might have questions like, “How long will I be sidelined?” and “What do I need to do to get better?” Or maybe you’re worried about how you’ll pick your children up from school, walk to the train for your commute or prepare meals for your family.

These are all perfectly normal concerns. Luckily, there are some ways that you can gain control over the situation and ensure that you return to the activities you care most about—especially if physical therapy is part of your plan.

What you can do before your very first appointment—and during physical therapy—to take control of that injury-related stress? First and foremost, it’s important to come prepared for physical therapy. And no, I’m not talking about dressing appropriately and arriving on time (or even better, 15 minutes ahead of your scheduled appointment). That stuff is important, of course, but there’s one thing you can do in the days leading up to your appointment that will set you up for success.

Any guesses? I’m talking about starting a list. What kind of list? Well, every time that you feel pain in the affected area or notice an activity that is harder than it was pre-injury, add it to the list! And the more specific you are, the better. Here’s an example to help drive this point home: Let’s say that you’re recovering from a moderate meniscus tear and you have an appointment with your physical therapist in three days. Take notes on how your knee feels first thing in the morning after you’ve been off your feet. How does your knee react when you stand up from a chair—does it feel unstable? Or do you find that you need to clutch the back of the couch on your way to the bathroom? Sharing each of these details helps your physical therapist understand your limitations beyond the injury printed on your intake form.

Now let’s take that list a step farther and add some details about the activities that you typically participate in on a regular basis. Let’s say that you normally play a weekly round of golf, spend your mornings weeding your garden or meet up with friends for a four-mile walk two evenings a week. These activities have become an important part of your life so let’s make sure that they’re factored into your list, perhaps in the “what you hope to get out of physical therapy” category.

Painting a clear picture of how active you are—and what types of activities and sports you participate in—can help your physical therapist design an individualized treatment plan and to better help you on your road to recovery.

Have you been to physical therapy lately for an injury? Did you find anything else that helped maximize your time in rehab or that improved communication with your physical therapist?

Osteoarthritis and Physical Therapy

Osteoarthritis and Physical Therapy

Osteoarthritis (OA) is one of the most common joint disorders, especially in adults over the age of 60. Two of the most commonly affected joints are the hip and the knee. Common symptoms are morning stiffness, where you feel like you need to get up and moving for 20 or 30 minutes before you “limber up”, creaking or popping sounds from your joint, as well as pain and swelling which is typically worse towards the end of the day.

For a lot of people, the thought of knee or hip arthritis leads right to joint replacement surgery. While total hip or knee replacement surgery is an effective treatment for severe pain and disability related to OA, it’s not for everyone and certainly shouldn’t be the first line of treatment. Hip and knee replacements are major surgical procedures and are accompanied by significant risk. On top of that, both require months of recovery and rehab, and neither is a guaranteed solution with data showing that between 1 in 5 and 1 in 10 patients are not happy with the outcome after total joint replacement.

So if replacement isn’t the first and only option, what else is there?

Exercise
Many studies have shown exercise to be beneficial in reducing pain and disability resulting from OA. Exercise can help regain range of motion and reduce stiffness around the joint. It also helps strengthen the muscles surrounding the joint which reduces the stress placed on the joint during activities.

Manual Therapy
Manual therapy is a hands on approach that can including joint manipulation (a quick thrust, often accompanied by a “pop” or “crack”), joint mobilization (more gentle, graded movements of the joint), and soft tissue mobilization (various forms of massage). These techniques have been shown to be effective in treating OA, especially when combined with exercise.

Weight Loss
Significant benefits have been shown in overweight patients with OA who have shown a 10% weight loss. We take thousands of steps in a day, and each step puts stress through our hips, knees, feet, and other joints. When you consider reducing that force by a few pounds a few thousand times a day, a little weight loss can add up to a big difference!

These are three effective and conservative treatment options that your physical therapist can use to help decrease the pain that you’re feeling from arthritis. With a through evaluation, your PT can determine which options will best help you meet your goals and get back to whatever level of activity you’re aiming for. On top of these options you PT can also consider things like bracing, and help you consider options your physician might be able to provide like injections or medications.

Just because joint pain is starting to slow you down, doesn’t mean you have to live with the pain, face surgery, or give up your independence. Conservative treatment options from your physical therapist are an effective way to treat osteoarthritis and can help get you more active with less pain!