Ask The Therapist Issue No. 3: Falls and Aquatic Therapy

ASK THE THERAPIST By Carol Pietromonaco PTMBA

Question: My mother is an active 77-year-old woman. Lately I’ve noticed she’s been loosing her balance while walking around her house or reaching for something in her kitchen. I am fearful of her falling. My doctor told me about aquatic physical therapy and thought this might help. Does pool therapy really work to improve balance?

Concerned son, in Taunton.

Facts

More than one third of adults 65 years old and older fall each year. The following factors contribute to maintaining good balance. These include strength, flexibility, vision, vestibular & sensory feedback, cognitive factors, medication and medical conditions. As a person ages these factors become impaired due to immobility, pain and various medical conditions. Some factors can however be altered. These include strength, flexibility, and balance reaction time.

Your doctor is correct. Exercise and particularly aquatic exercise, or aquatic physical therapy can be very helpful in preventing falls.

You can’t argue with science?

Two principles of physics can be used to help explain why aquatic exercise is beneficial.

Buoyancy in water diminishes joint loading by reducing the effect of gravity. This reduces the force on the joints of the body and makes movement in the water easier and less painful.

Turbulence occurs when an unstreamlined object, such as a body part, moves through water or when the speed of movement increases. The faster one attempts to move in water, the greater the resistance.¹

Buoyancy and turbulence help explain why flexibility and mobility exercises are easier, more effective, and less painful in water. Turbulence in water helps explain why muscles can be strengthened through aquatic exercise, and balance challenged.

How our body rights itself?

It might be helpful to understand the steps your body takes to stay balanced.

For example, imagine you are standing and someone pushes you with a backwards force by placing their hands on your shoulders. Your center of gravity is now shifted backwards and immediately your muscles (proprioception) send a message to your brain and tell it you are now leaning backwards. Your brain senses that there is now pressure on your heels (sensation). Your brain says, “you can’t lean backwards you’ll fall, and tells your toes and ankles to adjust so that your weight shifts from your heels to your toes (strength and flexibility in your lower body are required).

Many common elder medical conditions such as osteoporosis (arthritis), diabetes and stroke alter the above physical factors. Aquatic Physical therapy helps restore them.

Why believe me?

A series of aquatic exercise studies were conducted to ascertain the effectiveness of aquatic exercise on lower limbs affected by arthritis and to determine its ultimate contribution to improving balance. In all studies the Arthritis Foundation Aquatic Program (AFAP) exercise protocol was used.² The 69 exercises of this program are designed to promote strength, range of motion, and stability.²

In 1997, researchers Suomi and Lindauer found that patients had an increase in strength and range of motion in the lower limbs affected with arthritis following aquatic exercise. If balance is affected by the inability of the lower extremity to work to perform proper postural control strategies due to decreased strength and/or range of motion, then the exercise mode chosen for intervention must be effective in alleviating these deficits.

In a second study, Suomi and Koceja (2000)³ examined the postural sway characteristics of 14 women with lower extremity arthritis before and after a six-week aquatic exercise intervention. The aquatic exercise subjects significantly reduced lateral sway.

For an exercise intervention program to have value for the participants it should demonstrate benefits in functional, day-to-day activities that require balance.

In this study 10 men and women with lower extremity arthritis demonstrated significant improvements in strength and self-reported significant improvement in their perceived ability to perform specific tasks of daily living and a significant reduction in pain while doing so.

Call you local physical therapist to set up an appointment for your mother. Most insurances pay for aquatic therapy. A doctor’s prescription is usually required for your insurance to reimburse.

Thank you for your question. I hope this helped.

Resources:

1. Ferrell KM. Aquatics for people with arthritis. Lippincott’s Prim Care Pract 1996;2(1):102-104.

2.National Arthritis Foundation. Aquatic Program Instructor’s Manual. Atlanta: Arthritis Foundation National Office, 1997 (138).

3. Suomi R, Koceja DM. Postural sway characteristics in women with lower extremity arthritis before and after an aquatic exercise intervention. Arch Phys Med Rehabil 2000;81(6):780-785. 4.http://www.biomech.com/db_area/archives/2001/0109.aquatic.ger.bio.shtml

About the Author:

Carol Pietromonaco graduated from McGill University, Montreal, Canada, in 1996 with a degree in Physical Therapy. She has been practicing in Massachusetts for 11 years. She has experience in a variety of settings from acute care to outpatient orthopedics. She received her MBA from Babson College in 2005. She is currently the primary treating therapist & Clinic Manager at N.E. Physical Therapy Plus Inc.’s Quincy location. N.E. Physical Therapy Plus Inc. has seven locations in the greater Boston area. Carol is happy to answer any health, injury or Physical Therapy related questions you may have. Please email Carol your questions at contact@neptplus.com or cpietromonaco@neptplus.com

For further information call 800.428.2224 or find other articles written by Carol and more about her education and experience, online at www.neptplus.com

ASK THE THERAPIST By Carol Pietromonaco PTMBA

Question: My mother is an active 77-year-old woman. Lately I’ve noticed she’s been loosing her balance while walking around her house or reaching for something in her kitchen. I am fearful of her falling. My doctor told me about aquatic physical therapy and thought this might help. Does pool therapy really work to improve balance?

Concerned son, in Taunton.

Facts

More than one third of adults 65 years old and older fall each year. The following factors contribute to maintaining good balance. These include strength, flexibility, vision, vestibular & sensory feedback, cognitive factors, medication and medical conditions. As a person ages these factors become impaired due to immobility, pain and various medical conditions. Some factors can however be altered. These include strength, flexibility, and balance reaction time.

Your doctor is correct. Exercise and particularly aquatic exercise, or aquatic physical therapy can be very helpful in preventing falls.

You can’t argue with science?

Two principles of physics can be used to help explain why aquatic exercise is beneficial.

Buoyancy in water diminishes joint loading by reducing the effect of gravity. This reduces the force on the joints of the body and makes movement in the water easier and less painful.

Turbulence occurs when an unstreamlined object, such as a body part, moves through water or when the speed of movement increases. The faster one attempts to move in water, the greater the resistance.¹

Buoyancy and turbulence help explain why flexibility and mobility exercises are easier, more effective, and less painful in water. Turbulence in water helps explain why muscles can be strengthened through aquatic exercise, and balance challenged.

How our body rights itself?

It might be helpful to understand the steps your body takes to stay balanced.

For example, imagine you are standing and someone pushes you with a backwards force by placing their hands on your shoulders. Your center of gravity is now shifted backwards and immediately your muscles (proprioception) send a message to your brain and tell it you are now leaning backwards. Your brain senses that there is now pressure on your heels (sensation). Your brain says, “you can’t lean backwards you’ll fall, and tells your toes and ankles to adjust so that your weight shifts from your heels to your toes (strength and flexibility in your lower body are required).

Many common elder medical conditions such as osteoporosis (arthritis), diabetes and stroke alter the above physical factors. Aquatic Physical therapy helps restore them.

Why believe me?

A series of aquatic exercise studies were conducted to ascertain the effectiveness of aquatic exercise on lower limbs affected by arthritis and to determine its ultimate contribution to improving balance. In all studies the Arthritis Foundation Aquatic Program (AFAP) exercise protocol was used.² The 69 exercises of this program are designed to promote strength, range of motion, and stability.²

In 1997, researchers Suomi and Lindauer found that patients had an increase in strength and range of motion in the lower limbs affected with arthritis following aquatic exercise. If balance is affected by the inability of the lower extremity to work to perform proper postural control strategies due to decreased strength and/or range of motion, then the exercise mode chosen for intervention must be effective in alleviating these deficits.

In a second study, Suomi and Koceja (2000)³ examined the postural sway characteristics of 14 women with lower extremity arthritis before and after a six-week aquatic exercise intervention. The aquatic exercise subjects significantly reduced lateral sway.

For an exercise intervention program to have value for the participants it should demonstrate benefits in functional, day-to-day activities that require balance.

In this study 10 men and women with lower extremity arthritis demonstrated significant improvements in strength and self-reported significant improvement in their perceived ability to perform specific tasks of daily living and a significant reduction in pain while doing so.

Call you local physical therapist to set up an appointment for your mother. Most insurances pay for aquatic therapy. A doctor’s prescription is usually required for your insurance to reimburse.

Thank you for your question. I hope this helped.

Resources:

1. Ferrell KM. Aquatics for people with arthritis. Lippincott’s Prim Care Pract 1996;2(1):102-104.

2.National Arthritis Foundation. Aquatic Program Instructor’s Manual. Atlanta: Arthritis Foundation National Office, 1997 (138).

3. Suomi R, Koceja DM. Postural sway characteristics in women with lower extremity arthritis before and after an aquatic exercise intervention. Arch Phys Med Rehabil 2000;81(6):780-785. 4.http://www.biomech.com/db_area/archives/2001/0109.aquatic.ger.bio.shtml

About the Author:

Carol Pietromonaco graduated from McGill University, Montreal, Canada, in 1996 with a degree in Physical Therapy. She has been practicing in Massachusetts for 11 years. She has experience in a variety of settings from acute care to outpatient orthopedics. She received her MBA from Babson College in 2005. She is currently the primary treating therapist & Clinic Manager at N.E. Physical Therapy Plus Inc.’s Quincy location. N.E. Physical Therapy Plus Inc. has seven locations in the greater Boston area. Carol is happy to answer any health, injury or Physical Therapy related questions you may have. Please email Carol your questions at contact@neptplus.com or cpietromonaco@neptplus.com

For further information call 800.428.2224 or find other articles written by Carol and more about her education and experience, online at www.neptplus.com

Ask The Therapist. Issue No. 2: Yoga for Back Pain

N.E. PHYSICAL THERAPY PLUS INC.

800.428.2224

Malden - Hyde Park - Dorchester - Quincy - Stoughton - Raynham - Natick

ASK THE THERAPIST

By Carol Pietromonaco, PTMBA

Question: I am 60 years old and have struggled with back pain for several years. I suffer from low back achiness and stiffness. I do not have leg pain or what my doctor calls “sciatica”. I read a lot and have found that several studies have shown yoga to be helpful with back pain. Do you feel yoga could help me? Do you have to be flexible to try yoga? There are many different kinds of yoga classes, which king of yoga should I try?

Curious, in Braintree.

Dear Curious in Braintree,

You are indeed correct! Yoga is a wonderful way to help decrease back pain. In fact, a double blind study published in the December 2005 edition of the Annals of Internal Medicine showed that 3 months of a specifically designed yoga practice provided significant relief for subjects suffering from chronic back pain.

What is Yoga?

Yoga is approximately 4,000 years old and is a methodology aimed at uniting the mind, body, and spirit. Yoga is said to bring about not only physical benefits, but mental benefits as well. This unique characteristic has prompted many back pain patients to incorporate yoga as part of their treatment program.

There are many different types of yoga including Hatha, Kripalu, Svaroopa, Viniyoga and Power Yoga. The types of yoga I would suggest for back pain are Hatha, Kripalu, Svaroopa yoga. Each type of yoga stresses a particular theory or mindset, and each is comprised of numerous postures and areas of focus. While the actual practice of yoga is extremely extensive and detailed, in its essence yoga focuses on three main components:

◦ Body position/posture/strength & flexibility

◦ Breathing

◦ Meditation/state of mind

How does Yoga help your back pain?

We all have stress in our daily lives. This stress often makes muscles tense and can worsen back pain. Learning how to relax and decrease stress can help your back muscles relax. Hatha and Kripalu yoga are done slowly. Stretches and yoga positions are held for several minutes. Holding these postures helps develop strength in your core, legs and arms. It is important to distinguish what type of back pain can be relieved by Yoga. I have found that yoga is most helpful for chronic conditions. It is most helpful when the pain is localized to your back, and not sharp or shooting into your legs. A good Yoga instructor will shows you different adaptations to the postures. There are beginner, moderate and advanced levels to the postures. There are also variations based on age or if you have complicating medical problems. Let your yoga instructor know that you have back problems before starting the class and ask her if she could point out variations to the postures as you go along. Sometimes back pain is the result of mal-alignment in your hips and pelvis. Yoga can help stretch tight muscles and realign your spine. For people with lower back pain, stretching is very important. For example, stretching the hamstring muscles (in the back of the thigh) helps expand the motion in the pelvis, decreasing stress across the lower back

What if I’m not flexible? What if my balance is poor?

A good yoga instructor will tell you to “honor” your body and listen to it. You should only stretch as far as you can. You can also use equipment such as yoga stretching belts and yoga blocks to assist you. If your balance is compromised, use a chair. Most postures can be modified to be performed with a chair. Again, check with your instructor at the beginning of class and let her know that you would like the postures to be modified secondary to your balance problems. Either way, if your flexibility or your balance is an issue, Yoga will help you increase your flexibility and your balance gradually with practice and time. Consistent practice and application will result in improved posture. Proper body alignment and good posture, which helps maintain the natural curvature of the spine, is an important part of reducing or avoiding lower back pain.

In general, yoga is a very safe form of exercise for most people. For those with specific back conditions, it is advisable to speak with a physician prior to starting yoga (or any exercise program). Anyone with severe or ongoing back pain should be evaluated by a physical therapist for an accurate diagnosis and treatment program before beginning yoga. Many physical therapists, such as me, practice yoga and are now incorporating it into their treatment plans for back care. This could be a good opportunity for you to begin your practice with a gradual transition into a yoga class.

Thank you for your question. I hope this helped.

Carol Pietromonaco, Physical Therapist

Please contact Carol at 617.770.2224 to ask any questions you may have about using Yoga to relieve back pain.

www.neptplus.com