Age Strong Live Well V. 3

Hello everyone and welcome to the third edition of our Age Strong, Live Well newsletter!

First up:

Let’s talk about the power of a diagnosis and how this 22-second video helps us understand that even though we may have certain challenging and (at times) scary, diagnoses we can still harness the power of strength training and physical activity to better our quality of life.

***Only 22 seconds and it comes with guaranteed smiles for those who watch this video***

Throughout our life we get different diagnoses that can come with life changing consequences. How we are given these diagnoses and the support (or lack thereof) that we encounter makes all the difference in how we understand the effects of these diagnoses and how severely they will (or will not) alter our life. Summit Physical Therapy & Performance is here to help you understand your diagnoses, how to live well with them, and how to ensure that you are not unnecessarily limited by them. Not sure what exercise looks like if you have diabetes? What about a knee replacement? Is it safe to strength train after you’ve had a lumbar fusion? What about Multiple Sclerosis? The answer is yes to all of these, but they don’t all look exactly the same.

All these different diagnoses come with their own set of challenges. We’re here to help you sort out what they mean for you and your physical activity, your independence, and most importantly - your quality of life.

A great question from last edition!

“Why do I feel off balance during some activities like when I turn around but when I walk I feel completely fine. Is balance a thing to train or are there certain parts of ‘balance’ that I should be working on?”

This is a great question. Balance (our ability to stay upright) is made up of different systems of the body and therefore balance “testing” needs to look at many different contributing factors. For instance - someone may be off balance because …

-They have a musculo-skeletal strength deficit. This would be someone who may fall over when trying to get out of a chair because it’s very challenging for them to stand up.

-They have a musculo-skeletal pain-related deficit. This would be someone who may fall over because they have intense pain in their knee, foot, hip etc. and in an effort to avoid the pain they feel with, let’s say walking, they end up changing their movement pattern and losing their balance. This deficit often times comes hand in hand with a musculo-skeletal strength deficit.

-They have a vestibular deficit (sometimes referred to as an inner-ear issue.) This would be someone who may suddenly fall because they felt like the room was spinning.

-They have an endurance deficit. This would be someone who gets tired or fatigued, let’s say after walking or standing for a certain amount of time and it’s this fatigue that causes them to fall or lose their balance.

-They have a cardiovascular deficit. This would be someone who gets dizzy when they stand up and this dizziness is what causes them to fall over.

-They have a coordination/proprioception deficit. This would be someone who trips often, catches their feet when walking, or cannot balance when their feet are close together.

-They have a reactive/dynamic balance deficit. This would be someone who is completely steady when they are standing but if they get knocked off balance they have trouble regaining their balance.

-They have an eyesight deficit (e.g. cataracts.) This would be someone who sees poorly at night or may trip not because they have a coordination or proprioceptive deficit but because they simply do not see well.

So as you can see, working with adults who may be at risk of falling is not a straight forward process. Training ‘balance’ is not quite as simple as it may appear. To improve one’s balance first requires a thorough and detailed evaluation to find out which deficit (or deficits) are contributing to someone’s risk of falling and then making sure the treatment plan addresses these specific deficits (in a way that is testable and measurable) to ensure progress is being made.

However, here is a quick run down of some things you can try at home to improve your balance.

-Initiate a strengthening program for your legs. This is quite literally the best thing you can do to improve your balance, risk of falling now (or later in life) and your ability to live independently in your home. Not sure how to initiate a strengthening program, scroll on up and sign up for the seminar on April 29th at the Keswick Wise and Well Center!

-Practice your balance in a safe area of your home! Practice standing with your feet close together for 30 seconds. Have a chair behind you and your counter in front of you so you can hold on to the counter if you begin to wobble. Too easy? Try some modifications to make it harder such as slowly turning your head side to side and up and down. Still too easy? You are likely ready for more progressions, give us a call and we can design a balance program specific to your needs and goals.

Research Corner!

Knee Extensor Strength and Risk of Structural, Symptomatic, and Functional Decline in Knee Osteoarthritis. A Systematic Review and Meta-Analysis.

Whoa- lots of big words here in the title. This study (linked here for your reading pleasure) looked at knee-extensor strength (the strength of your quadricep, the big muscle in the front of your thigh) and how the strength of this thigh muscle relates to your risk of having structural and/or symptomatic knee osteoarthritis (OA) as well as functional decline (decline in your ability to do basic things like live independently, climb stairs, get up and down from a chair etc.)

For the record:

Functional decline: The decline in your ability to do certain daily tasks like go up and down stairs, get up and down from a couch/chair, walk etc.

Symptomatic Knee Osteoarthrits = Pain in your knee along with the confirmation of structural knee osteoarthritis.

Structural Knee Osteoarthritis = The appearance of osteoarthritis on an x-ray. Despite findings of osteoarthris on an x-ray, the patient may be experiencing knee pain or be completely pain free. In other words, you can have structural knee OA without having symptomatic knee OA.

Okay so what did they find?

These researchers looked at a multitude of studies including over 8,000 individuals. They took measurements of patient’s quadriceps strength and compared that to the patient’s rating of how symptomatic (painful) their knee was. They also looked at the patient’s quadricep strength and compared it to the patient’s reports of functional decline as well as the x-rays of their knees so that they could assess the degree of "structural” osteoarthritis present.

They found that there is a significant relationship between lower quadricep strength (weaker thigh muscles) and increased knee pain (symptomatic knee OA) as well as increased rates of functional decline. Putting this simpler, weaker muscles around the knees = more pain and more disability.

They also found (interestingly) that weaker quadriceps strength DOESN’T change how your x-rays look. In other words, it doesn’t change the “structural” osteoarthritis. But this shouldn’t be a surprise because we already know that just because your knees (or hips, or shoulders, or back etc.) look bad on an x-ray or MRI doesn’t mean you are going to be symptomatic or in pain…just like how people without “bad” looking MRIs or X-rays can still have lots of pain. Imaging doesn’t necessarily correlate with symptoms.

So what should your take away from this be? Don’t get hung up on what the x-ray says about your knees. If you want your knees to feel better and you want to avoid functional decline…STRENGTHEN YOUR QUADS!

What If I Have Pain With Exercising?

This is where we often help people the most. Pain should never be a barrier to movement. Movement should never be a barrier to improving health. Whether it’s arthritis, stiffness, an old injury, a new injury, weakness, or some combination that is contributing to your pain, we’ll get you in for an evaluation and get you on the path to moving pain-free.

Questions? Email me at Dan@ChapmanPT.com

About Me

I’m Dan, a Doctor of Physical Therapy, Orthopedic Clinical Specialist and personal trainer. It’s my goal to help people move without pain, and most importantly, help people increase ownership of and independence in their own bodies. One day, I hope to find myself to be what many consider “old”. If I’m lucky enough to see that day, I still plan on playing with my son, traveling with my wife, and opening jars with my hands. To do that, I plan on keeping good care of my body the best I can, with the best evidence we have, in a way that is not burdensome on my lifestyle. This newsletter is a way to share all the knowledge I gather and my experience along the way. If that sounds like something you’d like to be included in, good news! You’re already on the list. If you have friends and family that you think may be interested in being on this list, please share this newsletter with them. They can click HERE to be added to it! I’d also love to hear from you about content you’d like to see and questions you’d like answered in future newsletters. Please feel free to reach out to me at any time at Dan@ChapmanPT.com.

Great experience with Summit Physical Therapy & Performance?

We want to hear about it.

Building a small business that focuses on patient-centered care is not easy in our current healthcare system. I choose to treat patients 1:1 for 45-60 minutes because I strongly believe that’s how care should be provided. I want to send a big thank you to everyone who has written a wonderful review. If I’ve helped you in some way, please consider writing a review on Google. Patients searching for help have lots of options to choose from, and your words and testimonials make all the difference in helping them find high quality care. Also, I read every one and they mean the world to me!

Thank you to Kate, for her recent phenomenal review!

“I wish there were more than 5 stars for Dan! I came hobbling into his office, unable to walk, with a disc injury and massive lower back pain and nerve pain running down my leg. Dan's one on one attention to my specific issues, his care and expertise, have been completely fantastic! Only 2 weeks later, I have no pain, am stronger already and feel like Dan is the first PT who has ever completely tailored a program just for me. I cannot say enough good things about my experience!”

Thank you so much, Kate. Reviews like this truly make me the happeist PT in the City :)

All my best,
Dan Chapman DPT, OCS