"Help! I Have Fallen and I Can't Get Up..."

How many times have you turned on the TV and a commercial for the "Life Line" comes on and an elderly person states, "I've fallen and I can't get up!".  This popular device is a great idea for people that are older and may tend to fall, however, we can help prevent that risk of falling with physical therapy.  So, we live in Wisconsin, and let's face it...our winters aren't pretty! As we age, it puts us at increased risk for falling.  And if you're elderly or have poor bone density due to unhealthy diet, lack of exercise, and decreased vitamin/mineral intake, you are at risk for fractures (broken bones) when you fall.  Today I am going to discuss falls risk in the older adult.  You may not think this blog post applies to you if you are still young and "unbreakable", however, you will be elderly some day too and need this information.  Take a look and see what your future holds and help inform your relatives of their risk.  The more we plan ahead, the better chances we have for a healthier, longer life and the more we can protect our family members. 

The Facts:

·         1/3 of people over the age of 65 fall each year

o   Leading cause of unintentional injury and death

§  Every 18 seconds an older adult is treated at the ER for a fall

§  Every 35 minutes an older adult dies from a fall-related injury

·         Those who fall once are 2-3x more likely to fall again

·         10-15% of falls results in injury

·         Falls affect quality of life

·         Wisconsin is 2^nd in the nation in fall-related deaths

Risk Factors for Falling:

·         Age

·         Vision

o   Multi-focal lenses

o   Cataracts

·         Medications – Taking 4+ medications significantly increases risk for falls

·         Vitamin D Deficiency

·         Diabetes

o   Neuropathy – Loss of sensation in the extremities

·         Weakness

·         Neurological Impairments

·         Environmental Factors

·         Hypotension – Low blood pressure

·         Improper Footwear

Falls Screening:

·         All older adults aged 65+…

o   Should be asked whether they have fallen in the past year

o   If a fall is reported, they should be screened about the frequency and circumstances of the fall(s) and if injury occurred

o   Should be screened on their balance or walking difficulties

o   Screening should be done annually

General Prevention:

·         Home Modifications

o   Remove loose rugs

o   Reduce clutter

o   Proper hand railings on stairs/showers/toilet

o   Slip proof flooring for bathrooms or shower

o   Proper lighting

General Prevention Cont’d:

·         High tread footwear when outdoors, especially in winter

o   Yak-Trax   - attach to the bottoms of shoes to help grip the ground

·         Cane/Walker Modifications

General Interventions:

·         Specific balance exercises paired with a walking program

·         Strengthening

·         Vision improvement

·         Vitamin D supplementation

o   Reduces risk of falls by more than 20%

***We suggest that if an individual is at a high risk for falls that they be referred to physical therapy due to individual differences – falls prevention programs must be tailored for each individuals’ needs for safety and effectiveness***

What Physical Therapy Can Do For You:

·         Improve overall strength of your muscles in your legs and core to help decrease pain, improve balance, and improve ability to walk, climb stairs, and perform daily activities you may currently be struggling with.

·         Increase your endurance so you can walk further and make it through the grocery store or neighborhood without needing a rest break.

·         Educate you on safety and the risks of falling and injury with common daily activities such as lifting, squatting to sit down, and walking.

·         Help to improve your body’s proprioception (awareness of where your body is in space) to aid in balance during daily activities such as opening a door, walking, or even standing. 

·         Help improve flexibility to decrease strain on the joints of the body with daily activities.

Resources:

·          http://www.fallpreventiontaskforce.org/index.html

·         Dane County Falls Task Force: www.safercommunity.net

·         Wisconsin Falls Initiative: http://dhs.wisconsin.gov/health/InjuryPrevention/FallPrevention

·         Centers for Disease Control and Injury Prevention:  www.cdc.gov/ncipc

·         Shumway-Cook, A., Brauer, S., & Woollacott, M. (2000). Predicting the probability for falls in community-dwelling older adults using the timed up & go test. Physical Therapy, 80(9), 896-903.

·         Shea, Terry. Falls Prevention 2010. PT 636: Motor Control Dysfunction II.

·         Dewane, Judy. Cognition and Its Impact on Motor Control. PT 636: Motor Control Dysfunction II, 2010.

Help! My Head Hurts....Too Much Stress!

Are you stressed out from work or school? Do you get headaches that are increasing in frequency and related to stress and tension? If so, you may be suffering from the most common type of headache, the muscle tension headache.  This type of headache affects 25 million people in the US.  It usually peaks in men and women, aged 30-40 years of age and also increases with the level of education (most likely because higher educated people usually think wayyyy too much...I can vouch for that!).  These headaches occur as a response to stress. Who doesn't have stress this day and age? Since we are overworked, overbooked, and don't sleep enough, stress can add up causing pain and muscular tension. 

So what defines this type of headache, you ask?  The type of pain you feel is brought on by stress, anxiety, tension, or other factors, is moderate in intensity, and doesn't increase with activity level.  It occurs chronically (repetitively), is on both sides of the head, feels like your head is being squished (vice-like), does not feel like it's pulsing, and muscle spasm is involved.  The tension headache can last from 30 minutes up to 7 days, but usually you have fewer than 15 headache days per month, unless trauma or injury is the cause of this type of headache.  This headache is most common when you are an adult, but can really occur at any age. Let's face it, as you age, you have more stress because life becomes more real and can freak you out.  There is so much more to think about as an adult, unlike as a child where all you care about are insects, scraped knees, and playing with toys....ohhh how those were the good old days.  Back to reality though...this increase in age and stress level causes these terrible headaches.  If you have been in a car accident and had whiplash, you can also start to get tension headaches, but the symptoms can change a bit if that's the case. 

So hmmm...since stress is the culprit here, what exactly causes this headache? Stress itself or chemical changes in the body? Well, there are mixed results from research that can help describe the possibilities, however, it is still unclear.  It could be disturbance in hormones related to the hypothalamus, brain stem, and spinal cord.  It could be caused by changes in the circuits that occur inside the brain.  It has been shown that chemical signals are abnormal during tension headaches, so that could be the cause or effect...hmmm I guess we really don't know.  It is all still being researched.  You will find that most people with headaches have difficulty finding treatments, especially if they are migraines.  My mom is one of these people that struggles to find the answer.  Hopefully with further research, there will be an answer and these headaches will melt away....or one can only hope and pray that is the case.   

So why is a PT talking about headaches? Well, there is something I can do for you if you have tension headaches....something that research actually shows is helpful! Yayyy for an answer for some people!  People with tension headaches, often have poor posture.  As discussed in my post about Work Place Ergonomics (http://www.mononarehabpt.blogspot.com/2012/02/work-place-ergonomics-101.html), posture is very important in maintaining good spinal alignment.  Your head weighs 8-10 pounds (depending on how big your noggin is!).  If you sit all day with your head forward (ears don't line up with your shoulders), gravity pulls on it and all of the muscles in the back of the neck that attach to your head have to hold that sucker up.  Do you know how much tension you are placing on them? A lot...let's just say that.  No wonder they are irritated! Postural education is only the beginning of where I begin with patients.  Next, I evaluate spinal alignment because some muscles that are innervated by the nerves in the upper cervical spine (top of the neck) are usually angry for a reason, if it's not just because of posture.  If any vertebrae are misaligned or caught up by tight tissue, they need to be mobilized (so I get them moving!). There are several manual techniques I can perform to loosen up the spinal joints and get things moving properly again.  If I can't fix the alignment with my techniques, I will refer you to a chiropractor (they are pretty darn helpful, if you coincide chiropractic adjustments with strengthening exercises provided by a PT).   I also perform some soft tissue mobilizations (oooo massage!) to help loosen up the irritated tissues.  A combination of stretches, soft tissue mobilizations, joint mobilizations, and strengthening of the muscles in the mid-back are usually very successful at improving posture and relieving these tension headaches. 

Along with physical therapy, it is important to control stressors in your life.  Regular exercise, yoga, deep breathing, and making sure you're organized will help reduce stress in your life.  Check out http://igo-fitness.com/yoga.html and join a yoga class.  They are fantastic to help reduce stress, improve flexibility, and increase overall mindfulness.  Massages are also a great way to help reduce muscle tension, however the effects are only temporary if you don't fix the underlying problem. Check out Groupon for massage deals in your area.  Also, a healthy diet and regular sleep schedule are necessary to improve your well-being and helps to regulate your body's hormones properly.  You can also make your muscles happy by checking out my post on loving the foam roll (http://www.mononarehabpt.blogspot.com/2012/04/love-foam-roll.html). This foam roll can help loosen up some muscles in the upper back that attach to your neck and head.  If you are struggling with tension headaches, see your doctor for a script for physical therapy and come see me.  The sooner you start physical therapy, the less chronic your condition becomes.  Pain medicine is only temporary and only masks the problem if not used with other treatments such as massage, physical therapy, and chiropractic care.  Come see me and I will help make your tension melt away.  Give me a call today at 608-222-2325 or email me at mononarehabpt@gmail.com.

Resources:

Image from Google Images (Tension Headaches)

Goodman, Fuller, Boissonnault, Pathology: Implications for the Physical Therapist, 2nd Edition, Philadelphia, Saunders, 2003

Love the Foam Roll!

Most people that are trying to get fit focus so hard on exercising, but how many of those people remember that their body needs to recover in order to reduce risk of injury and continue to improve their level of fitness? Hmmm…not too many! Your body needs to be rehydrated and replenished after every workout in order to continue to maintain proper functioning. After every workout, you should perform a cool down routine in order to get the body back to its resting state.  It’s always important to cool down after every workout by:

· Performing lighter exercise (ie. slow paced walking) for 5-10 minutes to reduce your heart rate back to its resting state

· Performing gentle stretching exercises for the total body, especially the muscles just focused on in the workout. Remember to stretch each muscle for at least 30 seconds to get a desired outcome. 

· Performing myofascial release to improve blood flow and loosen up/flush the tissues of the body with a foam roll ***(Topic of today's post! yayyyy!)***

· Rehydrating with plenty of water and eating balanced healthy meal options with plenty of protein, fruits, and vegetables.

Today, I am going to discuss the magical item called the foam roll (shown below).

Most people I talk to have a “love/hate”relationship with the foam roll. Foam rolls can be purchased at the store, through exercise catalogs, and even on Amazon.com or Ebay. Foam rolls come in different sizes and densities. The denser the foam roll, the higher resistance it provides and most often the more pain it may cause on tight muscles/tissues of the body. Yes, you are correct…I just said pain...don’t you know that PT stands for “Pain & Torture”?? Just kidding! But yes, like I said before, most people have this love/hate relationship with the foam roll because the soft tissue massage (myofascial release) this roll provides can be painful if the muscle/tissue is really tight and sore. This is the type of pain that is ok to experience, but you want to make sure you go by your level of tolerance. So if you don’t have a very high pain threshold, you might want to start with the less dense foam roll, which usually is the white roll and work your way up to higher densities. I recommend the 6 inch diameter roll for the exercises I will provide for you today. If you don’t want to purchase a foam roll, you can use a soup can, coffee can, PVC pipe, tennis ball, basketball, etc. *Please note that these items are pretty dense and may be quite painful if you’re doing this for the first time.* It’s always better to start with a light density and work your way up to the high density foam rolls that come in black or other textures. Below is a list of exercises you can perform before and after your workouts to help get the blood flowing and ensure proper tissue movement in the body. Repeat these exercises with 5-10 strokes on each muscle group.

1. Calf (Gastrocnemius/soleus complex): Start with the foam roll just above your heel and roll your body over it so the roll goes up to the back of the knee. Repeat by rolling back and forth slowly, the entire length of the muscle. You can do both legs at once or one at a time. Try rotating your legs in and out (toes in vs. toes out) as well to get all sides of the muscle.

2. Hamstrings: Start with the foam roll at the back of the knee and roll your body over it so it goes up to the buttocks. Repeat by rolling back and forth slowly, the entire length of the muscle. You can do both legs at once or one at a time. Try rotating your legs in and out (toes in vs. toes out) as well to get all sides of the muscle.

3. Quadriceps: Start with the foam roll just above the knees and roll your body so it goes up to the front of your hips. Repeat by rolling back and forth slowly, the entire length of the muscle. If performing this on one leg at a time, try to rotate your body so you get all aspects of the muscle.

4. IT Band (Iliotibial band): Start with the roll at the side of the hip and roll your body so it goes down to the side of the knee. Repeat by rolling back and forth slowly, the entire length of the tissue. Use your arms and bent leg to move yourself along the foam roll.

5. Hip Adductors: Start with your knee bent up so the foam roll rests at your inner thigh. Roll your body over the roll so it goes from the inside of your knee to just below your groin area. Repeat by rolling back and forth slowly, the entire length of the muscles.

6. Buttocks/Piriformis: Start by sitting on the foam roll and leaning to one side. Roll your body back and forth slowly over the buttocks area. Perform on both sides.

7. Upper Back (Thoracic Paraspinals and Scapular Stabilizers): Start with the foam roll at your mid back and roll your body over it until you reach the base of your neck. Stick your arms in the air or hug yourself to ensure you get the rhomboids and middle trap muscles. You can rotate your body side to side as well to get the lats involved. Repeat by rolling back and forth slowly, the entire length of the muscles. You can also improve spinal extension if you extend your back over the foam roll, bringing your head closer to the ground, during this exercise.

8: Lower Back: (Lumbar Paraspinals): Perform slight sit up as you roll over the foam roll from the top of your buttocks to the mid back. Repeat by rolling back and forth slowly, the entire length of the muscles.

There are a variety of foam roll exercises you can perform, but these are the basics for myofascial release to improve blood flow and loosen up those tight tissues before and after workouts. It is important to hydrate and eat well before and after workouts also, in order to reduce muscle soreness and replenish important nutrients for rebuilding damaged tissues and improving mood, fitness level, and energy level. Starting this foam roll routine may make you sore at first like any new exercise routine, but it will get better with time as your tissues and muscles loosen up and get healthier. Try out this routine today and see how much better your workouts go in the future as you make your muscles happier by replenishing their needs.