ALZHEIMER'S DISEASE + PHYSICAL THERAPY

US population estimates indicate that 5 percent of people over age 65—about 5.2 million—and more than 40 percent of people over the age of 85 have Alzheimer's disease. Along with memory loss and other cognitive problems, people with Alzheimer's disease may have difficulty performing simple tasks of daily living. Physical therapists partner with families and caregivers to help people with Alzheimer's disease keep moving safely and delay worsening of the condition.

What Is Alzheimer's Disease?

Alzheimer's disease is a progressive condition that damages brain cells and affects how we speak, think, and interact with other people. It's the most common cause of dementia, a group of brain disorders that cause a decline in memory and the ability to perform daily activities. And it's the fifth leading cause of death among adults over age 65 in the United States, after heart disease, cancer, stroke, accidents, and respiratory disease.

The risk of getting Alzheimer's disease increases with age; it's rare to get it before age 60. Having a relative with Alzheimer's disease raises your risk of getting it, but most people with the disease do not have a family history of it.

One of the major symptoms of Alzheimer's disease is confusion. There are several other potential causes of confusion, some of which may be reversible if discovered early:

• If confusion comes on suddenly, schedule a visit with a physician or a neurologist immediately.
• If confusion occurs or gets worse after a fall or a head injury, immediately call 911 or emergency medical services (EMS) so that an ambulance can be sent.

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Signs and Symptoms

There are 10 important warning signs of possible Alzheimer's disease:

• Memory changes that disrupt daily life
• Difficulty making decisions, especially in planning or solving problems
• Difficulty completing familiar tasks
• Confusion about time and or place
• Trouble understanding visual images or the way things physically fit together (spatial relationships)
• Finding the right words to say when speaking or writing
• Misplacing items and losing the ability to retrace your steps
• Poor or decreased judgment about safety
• Withdrawal from work or social activities
• Changes in mood or personality

People with Alzheimer's disease also may get lost in once-familiar places. In the later stages of the disease, they might get restless and wander, especially in the late afternoon and evening (this is called "sundowning"). They may withdraw from their family and friends or see or hear things that are not really there. They may falsely believe that others are lying, cheating, or trying to harm them.

Along with these "cognitive" symptoms, people with Alzheimer's disease may develop difficulty performing simple tasks of daily living in the later stages of the disease. Eventually, they may need assistance with feeding, bathing, toileting, and dressing. The physical ability to walk is usually retained until the very last stage of the disease; however, due to confusion and safety concerns, people with Alzheimer's disease may need supervision or an assistive device to help them get around safely.

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How Is It Diagnosed?

The exact cause of Alzheimer's disease remains unknown and is most probably due to many factors, which makes diagnosis difficult. Researchers are getting closer to making a diagnosis by using brain imaging studies such as computed tomography scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, or ultrasound. These tests can show abnormalities in brain structure or function. Mental function tests, cerebral spinal fluid tap, biomarkers, and genetic testing also can be used to help make a diagnosis. But a definitive diagnosis can be made only on autopsy.

Your physical therapists may play an integral role in recognizing early signs or symptoms of this disease. If they recognize you or your loved one is exhibiting signs or symptoms consistent with Alzheimer’s, they will make an appropriate referral to the necessary specialist.

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How Can a Physical Therapist Help?

For people with Alzheimer's disease, research shows that:

• Physical activity can improve memory.
• Regular exercise may delay the onset of dementia and Alzheimer's disease.
• Regular exercise may delay the decline in ability to perform activities of daily living in people who have Alzheimer's disease.

As the movement experts, physical therapists can design exercise programs for people with a variety of health conditions, including Alzheimer's disease.

In the early and middle stages of Alzheimer's disease, physical therapists focus on keeping people mobile and help them continue to perform their roles in the home and in the community. In the later stages of the disease, physical therapists can help people keep doing their daily activities for as long as possible, which reduces the burden on family members and caregivers. Physical therapists also can instruct caregivers and family in how to improve safety and manage the needs of a loved one with Alzheimer's disease. Physical therapy can help improve quality of life and possibly delay the need for institutionalization.

People with Alzheimer's disease develop other conditions related to aging, such as arthritis, falls, or broken bones. Physical therapists are trained to treat these conditions in people who have underlying Alzheimer's disease. Therapists take into account the impact of the disease on other health conditions, on general health, and on the individual's ability to understand important instructions.

The therapist may use various teaching methods, techniques to simplify instructions, and unique approaches, including:

• Visual, verbal, and tactile cueing - The physical therapist provides "cues such as pointing to objects or gesturing. For instance, lifting up both arms can signal the person to stand up. Cues can also be given verbally with short, simple, or one-step instruction. Tactile clues holding someone's hand to have them walk with you. Sometimes, 2 or 3 cueing techniques are used simultaneously.
• Mirroring - With this technique, the physical therapist serves as a "mirror," standing directly in front of the person to show them how to move. To help the person raise his or her right arm, the therapist's left arm would be raised.
• Task breakdown - Physical therapists are trained in how to give step-by-step instruction by breaking down the task into short, simple "pieces" to be completed separately. For instance, if the therapist wants to teach a person how to safely move from lying in bed to sitting in a chair, the therapist might have the person practice rolling to the side, then pushing up to sitting, then moving to a chair in separate steps.
• Chaining- The physical therapist can provide step-by-step instructions by linking one step to the next step in a more complicated movement pattern. This technique usually is used once task breakdown has been successful and unites the separate steps of moving from lying in bed to sitting in a chair, to make it one fluid movement.
• Hand over hand facilitation - The physical therapist takes the hand or other body part of the person who needs to move or complete a task and moves that body part through the motion.

Although people with Alzheimer's disease usually maintain the ability to walk well into the late stages of the disease, balance and coordination problems often lead to walking difficulties. The physical therapist will train the muscles to "learn" to respond to changes in the environment, such as uneven or unstable surfaces.

Train Family Members and Caregivers

The family and caregiver may need instruction in how to safely move, lift, or transfer the person with Alzheimer's disease to prevent injury to the caregiver as well as the person with Alzheimer's disease. In addition to hands-on care, physical therapists provide caregiver training to improve safety and to decrease the risk of injury. For instance, the therapist can show caregivers how to use adaptive equipment and assistive devices, such as special seating systems, canes, or long-handled reachers, and how to use good "body mechanics" (the way you physically move to do a task).

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Can this Injury or Condition be Prevented?

Although the answer to this question is still unknown, many research studies have found that people who are physically active are less likely than sedentary people—even in later life—to have cognitive decline or dementia as they age. Some research suggests that increased cardiorespiratory fitness might even prevent brain atrophy. Your physical therapist can design an exercise program to help you improve your odds for healthy aging.

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Real Life Experiences

Mr C is 76 years old and was diagnosed with possible Alzheimer's disease 2 years ago. Recently, he began having difficulty doing simple things he once took for granted, such as getting up from a chair and walking to the porch. His physical therapist will develop specific exercise programs to help Mr C keep his balance and decrease his risk of falling. His therapist explains to him that exercise programs also can help him improve his ability to participate in social activities, such as playing with his grandchildren. Exercise can lead to increased blood flow to the brain, which may help to improve his memory and other cognitive abilities.

Mr C's physical therapist will determine which assistive devices would improve Mr C's safety in the community. The therapist also will train Mr C's daughter in how to help Mr C make smoother movements when he rises from sitting to standing or puts dishes in the sink. The therapist also will develop cues to assist Mr C in completing more complex tasks.

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

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What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat conditions or injuries. You may want to consider:

• A physical therapist who is experienced in treating people with conditions related to aging. Some physical therapists have a practice with a geriatric focus.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in geriatrics physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family and friends or from other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have underlying Alzheimer's disease.
• During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

TIPS TO RECOVER FROM A WORKOUT

Proper recovery following a workout is as essential as the workout itself. Whether you are beginning to work out for the first time or are altering your regimen, proper recovery is crucial to sustaining a long-term workout plan.

Why It's Important:

During exercise, the body undergoes a controlled amount of stress. Tissues in our bodies need this stress in order to improve their function and your performance. In fact, when you exercise, your muscles actually undergo “micro-trauma” due to the imposed demand of your activity. Recovery is your chance to build yourself back up stronger than before; it is the link between short-term, immediate benefit and long-term, lasting outcome.

The following tips can help you attain maximum benefit from your workout and reduce the risk of developing an injury.

Stretching

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.

Refueling (Hydration and Nutrition)

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

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..

(See "The Difference between Soreness & Pain During Exercise" for more detailed information.)

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.

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 considercan benefit from finding another form of exercise.

Cross training doesn't require a special shoe. It’s 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. A physical therapist can help you determine where you have deficiencies or might be at risk for overuse injuries based on your workout regimen.

Planning Ahead

When life is busy, it’s hard to schedule enough time in your day to workout at all, let alone take care of yourself afterward. Try to plan your day or week so you have adequate time following each workout to implement the strategies above. This way you won't feel as rushed and cut out important recovery activities.

Sleeping

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.

Fortunately, not only is your physical therapist trained to design an individualized exercise program for you, but she will also provide guidelines and strategies to ensure that you recover in the most effective way.

EXERCISE COUNTERS COGNITIVE DECLINE

A recent study in the journal, Medicine Science in Sports & Exercise, adds to the ever-growing body of evidence supporting the benefits of exercise. In addition to the plethora of physical benefits, it was found that moderate-to-vigorous exercise can reduce the risk of cognitive decline by 36%, as reported in Time (Exercise Keeps the Brain Young: Study - December 29, 2016).

With an aging population and continued projected increases for age-related cognitive impairments such as Alzheimer’s disease and other forms of dementia, these findings give hope that older adults can help delay the onset of cognitive decline. 

The study provided 6,400 people aged 65 years and older with an activity tracker for a week, and assessed their cognitive abilities during tasks. After 3 years, people who performed moderate-to-vigorous levels of physical activity were significantly less likely to experience cognitive problems than those who were sedentary or did light physical activity. 

Other studies have shown that receiving physical therapy first for low back pain lowers costs, including basic education from a physical therapist prior to back surgery, and in instances when advanced imaging has been prescribed. 

As movement experts, physical therapists can design exercise programs for people with dementia or Alzheimer’s disease to include keeping them active and independent for as long as possible.

PROPER SQUAT TECHNIQUE

Provided by a video blog endorsed by the American Physical Therapy Association. Copy and past the link below into your URL search bar above to view! 

http://www.moveforwardpt.com/PatientResources/VideoLibrary/detail/exercise-proper-squat-technique

EXERCISE OVER PHARMACEUTICALS FOR CANCER - RELATED FATIGUE

The results of a recent systematic review in Jama Oncology validated the use of exercise as treatment over pharmacological interventions for cancer-related fatigue (CRF).

These findings (Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue: A Meta-Analysis – March 2, 2017) are important, as CRF is a prevalent adverse reaction in patients during or after cancer treatment.

Authors reviewed 113 studies and compared the effect of the 4 most commonly recommended treatments for CRF: exercise, psychological, combined exercise and psychological, and pharmaceutical treatments. Exercise intervention had the largest overall improvement in reducing CRF and significantly better than pharmaceutical options. Clinicians were recommended to prescribe exercise interventions as first-line treatments for CRF. 

Exercise prescribed and supervised by physical therapists can help patients exercise safely and comfortably during cancer treatment. It may also relieve many of the side effects of cancer treatment. 

EXERCISE COUNTERS COGNITIVE DECLINE

A recent study in the journal, Medicine Science in Sports & Exercise, adds to the ever-growing body of evidence supporting the benefits of exercise. In addition to the plethora of physical benefits, it was found that moderate-to-vigorous exercise can reduce the risk of cognitive decline by 36%, as reported in Time (Exercise Keeps the Brain Young: Study - December 29, 2016).

With an aging population and continued projected increases for age-related cognitive impairments such as Alzheimer’s disease and other forms of dementia, these findings give hope that older adults can help delay the onset of cognitive decline. 

The study provided 6,400 people aged 65 years and older with an activity tracker for a week, and assessed their cognitive abilities during tasks. After 3 years, people who performed moderate-to-vigorous levels of physical activity were significantly less likely to experience cognitive problems than those who were sedentary or did light physical activity. 

Other studies have shown that receiving physical therapy first for low back pain lowers costs, including basic education from a physical therapist prior to back surgery, and in instances when advanced imaging has been prescribed. 

As movement experts, physical therapists can design exercise programs for people with dementia or Alzheimer’s disease to include keeping them active and independent for as long as possible.

EXERCISE - INDUCED BRONCHOCONSTRICTION (Sports Asthma)

What is it?
“Exercise-induced bronchoconstriction” (EIB) occurs when a person’s airway becomes temporarily narrowed, either during, or soon after, exercise. Depending on the population being examined, anywhere from 10-70% of people may be affected by this. Those with asthma are most likely to experience exercise-induced bronchoconstriction. Other factors that increase the risk of this include having seasonal allergies, having a family member with asthma or allergies, smoking, and environmental exposures such as to chlorine in a swimming pool.

Symptoms
Those affected by exercise-induced bronchoconstriction experience excessive shortness of breath with exercise. It is often accompanied by wheezing, coughing, and chest tightness. Some athletes might mistake these symptoms for simply being out of shape. The intensity of EIB varies – some athletes experience shortness of breath with any exercise, while others have symptoms only during or after vigorous exercise.

Sports Medicine Evaluation
A sports medicine physician will use a stethoscope to listen for wheezing in the lungs, although this is only occasionally present during or immediately after exercise. Direct measurement of airflow before and after exercise can be done to confirm the diagnosis. Measurement of airflow before and after giving a patient medicine to open up the airways also helps screen for baseline asthma. Occasionally, a physician may suggest using an inhaler prior to exercise before any testing is done. If this makes the symptoms go away, no additional testing may be required. If a person is experiencing a decline in his or her athletic performance, a sports medicine physician may also assess for other causes in addition to exercise-induced bronchoconstriction.

Treatment and Injury Prevention
If a person has asthma, the first step is to get it under control. Those with known triggers (such as allergens and cold air) should avoid them if possible. Treatment may simply be limited to this. For most people with exercise-induced bronchoconstriction, an inhaler that opens up the airways can be used 15-30 minutes before exercising with good effect.

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When symptoms are adequately controlled, there are no restrictions on exercise or athletic competition. Having an inhaler available during practices and competitions is important for athletes with exercise-induced bronchoconstriction.

AMSSM Member Authors
Brett Toresdahl , MD and Chad Carlson, MD

SITTING OR PROLONGED PERIODS CAN BE HARMFUL TO YOUR HEALTH

Inactivity researchers are discovering that sitting isn't just harmful to your health, it's so detrimental that a little bit of exercise doesn't offset its negative effects.

As The Washington Post put it, "The message is clear: Sitting for hours at a time might be a health risk regardless of what you do with the rest of your day." ("Desk jobs can be killers, literally" - July 17, 2013).

The Post cited Alpa Patel's 2010 study, published in the American Journal of Epidemiology (Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults), which found a common link between physical inactivity and cardiovascular disease mortality even after adjusting for smoking, body mass index, and other factors.

"Up until very recently, if you exercised for 60 minutes or more a day, you were considered physically active, case closed," Travis Saunders, a PhD student and certified exercise physiologist told Runner's World ("Sitting is the new smoking-even for runners" - July 20, 2013). "Now a consistent body of emerging research suggests it is entirely possible to meet current physical activity guidelines while still being incredibly sedentary, and that sitting increases your risk of death and disease, even if you are getting plenty of physical activity."

Adding to the concern, a study published in the Journal of Physical Activity and Health found that sitting too much "may increase the risk of disability in people over the age of 60" for "activities of daily living such as bathing, dressing, and walking," USA Todayreported ("Don't just sit there! It could be harmful later in life" - February 19, 2014).

HOW CAN A PHYSICAL THERAPIST HELP WITH CANCER?

Physical therapists are trained and educated to understand all of your health conditions, including a cancer diagnosis, and apply them to human movement - we are human movement specialists. Your physical therapist will work with you to develop a specialized treatment program to address your specific needs and goals.

The American Cancer Society recommends people undergoing cancer treatment, and cancer survivors, perform consistent physical exercise to decrease fatigue, and improve the ability to perform normal daily activities. Studies show that exercise can improve an individual’s chances of surviving cancer. Physical therapists can design individualized exercise and treatment programs to reduce or prevent many cancer-related problems.

Physical therapists help people diagnosed with cancer before and after surgery. Before surgery, they evaluate individuals for any of the problems listed above, and help address them. After surgery, they can help with the healing of the incision site, improve circulation, reduce pain, and minimize scarring. They evaluate individuals for any physical therapy treatment needs, and, by designing individualized treatment programs, help them recover and heal faster than they would on their own.

Your physical therapist may work with you to improve your:

Comfort and well-being. Cancer and cancer treatments can cause symptoms such as pain, burning sensations, numbness, tingling (neuropathy), cramps, spasms, and weakness. Your physical therapist may apply hands-on techniques (manual therapy) or technologies like electrical stimulation to help decrease your pain and alleviate your symptoms. The physical therapist may teach you gentle exercises or techniques to perform at home to aid your recovery. All of these options may reduce or eliminate the need for opioid pain medication.

Aerobic capacity. Cancer or cancer treatment may have decreased your ability to process oxygen (aerobic capacity), causing fatigue. Research shows that aerobic exercise, such as walking on a treadmill for at least 20 minutes 3 times per week, may help improve aerobic capacity, reduce fatigue, and optimize healing. Your physical therapist can assess your aerobic capacity and determine the best aerobic activities for you.

Bone density. Lack of activity and certain cancer treatments can cause weakening of your bones, which could lead to bone fractures. Certain types of exercise can prevent bone loss and maintain bone strength. Your physical therapist can teach you safe and effective exercises to help steadily build your bone strength.

Lymphedema and swelling. Certain cancer treatments can result in lymphedema (swelling in the arms or legs) or other types of swelling. Your physical therapist can use several methods to reduce, control, and prevent lymphedema and swelling, such as specialized gentle massage, special movements and exercises, and application of compressive garments such as arm sleeves, gloves, and leg stockings.

Surgical incisions. Your physical therapist can help you care for any surgical incisions and sutured areas, by checking for infection and assisting with dressing changes. The physical therapist also can help prevent some kinds of scarring and skin tightness as the suture line heals. Your physical therapist can use very gentle massage or certain technologies to keep the skin as soft and pliable as possible.

Body weight. By creating an exercise and physical activity program tailored just for you, your physical therapist will help you reduce body fat and maintain a healthy body weight, which can improve your energy levels.

Mood. Exercise helps elevate mood and reduce depression in everyone, including cancer patients and survivors. A diagnosis of cancer, and cancer treatment, can be stressful and cause mood changes in anyone. Proper exercise, individualized for each person by a physical therapist, can help reduce stress and improve mood.

Brain fog. Exercise helps relieve brain fog. Your physical therapist can design an individualized program of exercise that can help reduce memory loss and brain fog.

Daily activities. Your physical therapist will discuss activity goals with you and use them to design your treatment program. Cancer survivors usually increase their physical activity gradually; your treatment program will help you reach your goals in the safest, fastest, and most effective way possible.

Walking. Your physical therapist will help improve your ability to walk using techniques such as strengthening exercises, walking training, and balance activities. If you have nerve damage (neuropathy), your physical therapist may provide bracing and other techniques to make it easier or safer for you to walk. Your physical therapist also may recommend using an assistive device, such as a walker or cane.

Sports training ability. Athletes undergoing cancer treatment can continue to train for their sport to a degree, depending on the type of cancer and treatment. Physical therapists design safe, challenging, sport-specific training programs to help athletes reduce loss of fitness and strength during cancer treatment.

Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in any stiff joints. These might begin with "passive" motions that the physical therapist performs for you, and progress to active exercises and stretches that you do yourself. You can perform these motions at home to help hasten healing and pain relief.

Flexibility. Your physical therapist will determine if any muscles are tight, start helping you to stretch them, and teach you how to stretch them at home.

Strength. If your physical therapist finds any weak or injured muscles, the physical therapist will choose, and teach you, the correct exercises to steadily restore your strength and agility.

Coordination. Your physical therapist will help you improve and regain your coordination and agility, so you can perform household, community, and sports activities with greater ease.

Balance. Your physical therapist will examine your balance, and choose specific exercises that you can perform in the clinic and at home to improve your balance and prevent falls. Your physical therapist may also teach you how to use a cane or walker to help maintain your balance when walking and standing.

Home program. Your physical therapist will teach you strengthening, stretching, and pain reduction exercises to perform at home. These exercises will be designed specifically for your needs.

WHY YOU SHOULDN'T EVER SKIP YOUR STRETCHES

Here at Champion Performance and Physical Therapy, we have a number of patients who, while they eat healthy, exercise consistently, and get plenty of nourishment and water, are in pain because they're missing one of the most under appreciated aspects of physical health in their daily lifestyles - stretching. 

It may seem like the most basic additive, but you must remember: the skeletal body is a lever system manipulated by musculature. In other words, your skeletal system will not move without the help of your muscular system, and each bone is almost entirely surrounded by muscles for this purpose.

During exercise (and after your warm up), your body is warm due to increased blood flow, the muscles are loose and firing.  Afterward, the muscles will cool, and if not properly stretched, will stiffen due to the biochemical aftereffects of exercise. While an effective fitness program should absolutely consist of cardiovascular training and strength training, the flexibility component is often overlooked. 

This is where skeletomuscular injuries come into play, specifically those relieved via physical therapy. When muscles tighten and stiffen, they pull just slightly on the bones in their direction. For example: runners often have tight hip flexors and quadriceps (the front of the thigh).  These muscles attach and originate along the anterior aspect (front) and inside of the pelvis. When they stiffen, they pull the pelvis slightly forward. Over a long period of time, the pelvis will shift so far forward that it will start to cause low back pain that can sometimes radiate into the hips, and SI - sacroiliac - joint, which is the point of attachment between the spine and pelvis. This can even radiate down the leg and into the knees, as the muscular insertion for the quadriceps are just below the knee on the tibia (shin bone).  Often times when patients come in with knee pain and all X-rays and MRI scans show no injury, it is because the muscles have pulled the skeletal system just out of sync enough for you to notice. 

Flexibility exercises are not only an essential part of recovering from aerobic activity, but can reduce your risk for further injury. The American Academy of Orthopaedic Surgeons (AAOS) encourages individuals to incorporate these exercises into their daily workouts.

EXPERT ADVICE
“Increasing your flexibility improves your ability to move easily,” said orthopaedic surgeon and AAOS spokesperson Raymond Rocco Monto, MD. “Some joints lose up to 50 percent of motion as we age. There are many ways to improve your joint flexibility including controlled stretches held for 10-30 seconds, stretches that rely on reflexes to produce deeper flexibility, as well as yoga and pilates.”

Before skipping flexibility exercises during your next workout, consider these five benefits of adding them to your workout regimen:

• Less back and joint pain: A 2011 study in the Archives of Internal Medicine found that regular stretching was effective in relieving chronic back pain. Other research has shown quadriceps stretches helped decrease knee pain.
• Better circulation: A 2009 study in the American Journal of Physiology discovered that torso stretches decreased stiffness and improved blood flow. This also may be why regular bedtime hamstring and calf stretches decrease the frequency and intensity of night-time leg cramps.
• Improved joint motion: Flexibility naturally decreases with age. Stretching can help restore lost joint motion and improve function.
• Better athletic performance: Like a good rubber band, muscles and tendons generate more force under tension when they are supple and compliant. 
• Improved muscle health: Mobility exercises can increase the amount of stress muscles can handle in high tension activities that involve jumping and cutting movements.

Get the most out of your flexibility training by following these simple guidelines:

• Always warm up before your stretch. Stretching cold muscles can cause injury.
• Stretch slowly and gently. Breathe into your stretch to avoid muscle tension. Relax and hold each stretch 10 to 30 seconds.
• Do not bounce your stretches. Ballistic (bouncy) stretching can cause injury.
• Stretching should not hurt. If you feel pain, take the stretch easier, breathe deeply and relax into it.
  
  Stretching is important and can be tough to master to maximum efficiency. The trouble is, it takes some time to stretch muscles back out to a healthy length. A combination of stretching, manual therapy to help relieve some tension in the joints that are being pulled on, and strengthening the opposing muscles to those inflicting pain should easily solve the problem and have you pain free within weeks. Here at Champion Performance and Physical Therapy, this is probably the most common cause of injury we see, and we approach it with a unique, biomechanically-based mechanism meant to relieve pain and tension through multiple planes of your body. Why?  Because your body doesn't move in just one plane. 
  
  Talk to your doctor today about what physical therapy can help do for you. For more information, visit us on the SW corner of 75th and State Line Road in Prairie Village, or by phone at 913-291-2290.