7 STAGGERING STATISTICS

America's opioid epidemic is being felt nationwide.

Recent guidelines and consensus studies from The Centers for Disease Control and Prevention (CDC),  the American College of Physicians, and the National Academies (Health and Medicine Division) encourage health care providers to pursue safer alternatives, like physical therapy, for most non-cancer-related pain management. Choosing physical therapy is a safe and effective alternative to manage and treat pain, and can help you avoid the risks and side effects of opioids.

Statics from the CDC, the Substance Abuse and Mental Health Services Administration, the Agency for Healthcare Research and Quality, and the Henry J. Kaiser Family Foundation reveal the gravity of the problem.

1. In 2016, health care providers across the US wrote more than 214 million prescriptions for opioid pain medication, a rate that demonstrated 66.5 prescriptions per 100 people. Some counties had rates 7 times higher than that.

2. As many as 1 in 4 people who receive prescription opioids long-term for noncancer pain in primary care settings struggle with addiction.

3. From 1999 to 2015, more than 183,000 people have died in the US from overdoses related to prescription opioids.

4. While opioid abuse is down in younger Americans, it has risen among older adults. For adults aged 50 years and older, opioid abuse doubled from 1% to 2%.

5. Every day, more than 1,000 people are treated in emergency departments for misusing prescription opioids.

6. Veterans are twice as likely to die from accidental opioid overdoses as non-veterans.

7. Opioid-related hospitalizations among women in the US increased by 75% between 2005 and 2014.

Do you know someone in pain? Encourage them to talk to her or his physician or physical therapist about safe ways to manage pain.

The American Physical Therapy Association’s #ChoosePT campaign raises awareness about the risks of opioids and the safe alternative of physical therapy for chronic pain management.

9 THINGS YOU SHOULD KNOW ABOUT PAIN

1. Pain is output from the brain.While we used to believe that pain originated within the tissues of our body, we now understand that pain does not exist until the brain determines it does. The brain uses a virtual “road map” to direct an output of pain to tissues that it suspects may be in danger. This process acts as a means of communication between the brain and the tissues of the body, to serve as a defense against possible injury or disease.

2. The degree of injury does not always equal the degree of pain.Research has demonstrated that we all experience pain in individual ways. While some of us experience major injuries with little pain, others experience minor injuries with a lot of pain (think of a paper cut).

3. Despite what diagnostic imaging (MRIs, x-rays, CT scans) shows us, the finding may not be the cause of your pain. A study performed on individuals 60 years or older who had no symptoms of low back pain found that 36% had a herniated disc, 21% had spinal stenosis, and more than 90% had a degenerated or bulging disc, upon diagnostic imaging.

4. Psychological factors, such as depression and anxiety, can make your pain worse. Pain can be influenced by many different factors, such as psychological conditions. A recent study in the Journal of Pain showed that psychological variables that existed prior to a total knee replacement were related to a patient's experience of long-term pain following the operation.

5. Your social environment may influence your perception of pain. Many patients state their pain increases when they are at work or in a stressful situation. Pain messages can be generated when an individual is in an environment or situation that the brain interprets as unsafe. It is a fundamental form of self-protection.

6. Understanding pain through education may reduce your need for care.A large study conducted with military personnel demonstrated that those who were given a 45-minute educational session about pain sought care for low back pain less than their counterparts.

7. Our brains can be tricked into developing pain in prosthetic limbs. Studies have shown that our brains can be tricked into developing a "referred" sensation in a limb that has been amputated, causing a feeling of pain that seems to come from the prosthetic limb – or from the "phantom" limb. The sensation is generated by the association of the brain's perception of what the body is from birth (whole and complete) and what it currently is (post-amputation).

8. The ability to determine left from right may be altered when you experience pain. Networks within the brain that assist you in determining left from right can be affected when you experience severe pain. If you have been experiencing pain, and have noticed your sense of direction is a bit off, it may be because a "roadmap" within the brain that details a path to each part of the body may be a bit "smudged." (This is a term we use to describe a part of the brain's virtual roadmap that isn’t clear. Imagine spilling ink onto part of a roadmap and then trying to use that map to get to your destination.)

9. There is no way of knowing whether you have a high tolerance for pain or not. Science has yet to determine whether we all experience pain in the same way. While some people claim to have a "high tolerance" for pain, there is no accurate way to measure or compare pain tolerance among individuals. While some tools exist to measure how much force you can resist before experiencing pain, it can’t be determined what your pain "feels like."

AMPLIFIED PAIN SYNDROMES: WHAT SHOULD YOU KNOW

Amplified pain syndromes (APS) is an umbrella term used to describe increased sensitivity to pain due to abnormal nerve connections in the nervous system. Diagnoses in children that fall under this umbrella term include juvenile fibromyalgia, central sensitization, and generalized chronic pain, among others.

In combination with a variety of factors, APS may be caused by:

• Injury
• Illness
• Psychological stress

 Individuals with APS may experience:

• Pain that is localized or widespread
• An onset of pain that is sudden or gradual
• Pain with an unknown cause
• Pain triggered by stress, illness, or prior injury, with pain continuing beyond a typical healing phase
• Pain described as achy, dull, sharp, shooting, burning, throbbing, and/or stabbing
• Pain that affects function and the ability to participate fully in daily activities
• Decreased school attendance, decreased involvement in sports, and disinterest in social participation

Signs and Symptoms

• Pain that is heightened in response to a normal event or minor injury that wouldn't typically be perceived as painful
• Impaired muscle endurance and weakness, poor cardiopulmonary (heart) endurance, poor posture, impaired balance, and/or impaired functional abilities
• Pain in response to a sensation such as a light touch, pressure, temperature, and/or vibration that would not normally provoke pain
• Swelling, temperature, and/or color changes to the skin of the affected area

Other common associated signs/symptoms may include: headache, blurry vision, memory problems, chest pain, heart palpitations, dizziness, abdominal pain, nausea, vomiting, diarrhea, constipation, abnormal limb movements, sleep disturbance, and fatigue.

Treatment

Physical therapists work with other medical professionals to provide physical therapy and education for people experiencing APS. Working one-to-one with individuals with APS, physical therapists teach exercises to decrease the fear of movement and apply exposure-based treatments to help desensitize painful areas. They aid in shifting focus from pain to function, encourage the use of stress management strategies, and help people recognize daily causes of stress.

Treatment may be provided in an inpatient or outpatient setting and may include:

• Exercise therapy: Daily strengthening and aerobic exercise to retrain the nervous system, decrease the fear of movement, and help people work through pain and discomfort and focus on functional improvements
• Desensitization: Daily repeated exposure to sensations that are perceived as painful in order to retrain the nerves' response to light touch, pressure, vibration, and temperature
• Stress education: Guidance about stress management, which may include recommended counseling services, relaxed breathing exercises, mindfulness training, and/or self-regulation strategies
• Decreased attention to pain: Education on how to limit discussion and decision makingdue to pain in order to decrease its importance to the brain, and return to normal daily activities.

Authored by: Brandi Dorton, PT, DPT, and Danielle Feltrop, PT, DPT, of Children's Mercy Hospital

PELVIC PAIN AND WHAT TO DO ABOUT IT

Pelvic pain is pain felt in the lower abdomen, pelvis, or perineum. It has many possible causes and affects up to 20% of the population in the United States, including women and men. Pelvic pain is considered "chronic" when it lasts for more than 6 months. Physical therapists help people experiencing pelvic pain restore strength and flexibility to the muscles and joints in the pelvic region, and reduce their pain.

What Is Pelvic Pain?

Pelvic pain can be caused by:

• Pregnancy and childbirth, which affect pelvic muscles and cause changes to pelvic joints
• Pelvic joint problems from causes other than pregnancy and childbirth
• Muscle weakness or imbalance within the muscles of the pelvic floor, trunk, or pelvis
• Changes in the muscles that control the bowel and bladder
• Tender points in the muscles around the pelvis, abdomen, low back, or groin areas
• Pressure on 1 or more nerves in the pelvis
• Weakness in the muscles of the pelvis and pelvic floor
• Scar tissue after abdominal or pelvic surgery
• Disease
• A shift in the position of the pelvic organs, sometimes known as prolapse

How Does it Feel?

The pain in your lower abdomen and pelvis may vary; some people say it feels like an aching pain; others describe it as a burning, sharp, or stabbing pain, or even pins and needles. In addition, you may have:

• Pain in the hip or buttock.
• Pain in the tailbone or pubic bone.
• Pain in the joints of the pelvis.
• Tender points in the muscles of the abdomen, low back, or buttock region.
• A sensation of heaviness in the pelvic region or even a sensation as if you are sitting on something hard, like a golf ball.

Signs and Symptoms

• Inability to sit for normal periods of time.
• Reduced ability to move your hips or low back.
• Difficulty walking, sleeping, or performing daily activities.
• Pain or numbness in the pelvic region with exercise or recreational activities, such as riding a bike or running.
• Pain during sexual activity.
• Urinary frequency, urgency, or incontinence, or pain during urination.
• Constipation or straining with bowel movements, or pain during bowel movements.
• Difficulty using tampons.
• Imbalance when walking.

How Is It Diagnosed?

Your physical therapist will complete a thorough review of your medical history, and perform a physical examination to identify the causes of your pelvic pain and any joint issues, muscle tightness or weakness, or nerve involvement. The exam may include:

• Pelvic girdle screening.
• Soft tissue assessment.
• Visual inspection of the tissues.
• Reflex testing.
• Sensation testing.
• Internal assessment of pelvic floor muscles.

Your physical therapist also will determine whether you should be referred to a physician to assist in your interdisciplinary plan of care.

How Can a Physical Therapist Help?

Based on the examination results, your physical therapist will design an individualized treatment program to meet your specific needs and goals. Your physical therapist may:

• Show you how to identify the appropriate muscles, such as the pelvic floor, deep abdominals, and diaphragm.
• Educate you on how to use these muscles correctly for activities like exercise, posture correction, getting up from a chair, or squatting to pick up a child or pick something up from the floor.
• Teach you exercises to stretch and strengthen the affected muscles and retrain them, so they work together normally.
• Teach you techniques to improve blood flow and tissue function in the pelvic area.
• Teach you appropriate pelvic floor muscle exercises.

 Depending on your symptoms and level of discomfort, your physical therapist may decide to use biofeedback to help make you aware of how your pelvic floor muscles work, and how you can control them better. Your physical therapist may attach electrodes to the area to measure your muscle activity as it displays on a monitor, and will work with you to help you understand and change those readings. Your physical therapist also may use gentle electrical stimulation to improve your awareness of your muscles.

5 TIPS TO AVOID CHRONIC PAIN

1. Know Pain, Know Gain. There is a growing body of evidence suggesting that understanding how our pain systems work is an excellent strategy in managing it. The great news is that you don’t need to know a lot! Simply knowing the basics of how our brain and nerves work, and their role in pain, can help reduce your chance for developing chronic symptoms. Learn more.

2. Keep moving. Gradually and steadily. Living an active, healthy lifestyle not only improves our general well-being and health, but can also reduce our chances of developing chronic pain. Our body was built to move, and we need to understand that not all aches or soreness is cause for concern. Learn more.

3. Spend time with a good PT. If you experience an injury, or develop the onset of pain, seeing a physical therapist (PT) early on can help address and manage your symptoms. PTs are movement experts who can diagnose and treat injuries and help you identify strategies to better manage your pain. The earlier you seek care, the better the chances you have for not developing chronic symptoms. And there’s no reason to wait: you can see a physical therapist without a physician’s referral in all 50 states and the District of Columbia. Learn more.

4. Don't focus on an image. While most of us want a diagnostic image (ie, x-ray, MRI) to tell us “why we hurt,” images actually give us little information about what’s causing pain. A study performed on individuals 60 years or older, who had no symptoms of low back pain, found that more than 90% had a degenerated or bulging disc, 36% had a herniated disc, and 21% had spinal stenosis. What shows up on an image may or may not be related to your symptoms. Once imaging has cleared you of a serious condition, your physical therapist will help guide you back to the life you want to live!

5. Addressing depression and anxiety helps. Your chances of developing chronic pain may be higher if you also are experiencing depression and anxiety. A recent study in the Journal of Pain showed that depression, as well as some of our thoughts about pain prior to total knee replacement, was related to long-term pain following the procedure. Make sure that you talk to your medical provider about your mental health throughout your treatment; it can help make your journey go much more smoothly following an injury or surgery.

The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management. Learn more at our #ChoosePT page.

Authored by Joseph Brence, PT, DPT, FAAOMPT, COMT, DAC @ www.APTA.org

9 THINGS YOU SHOULD KNOW ABOUT PAIN

1. Pain is output from the brain. While we used to believe that pain originated within the tissues of our body, we now understand that pain does not exist until the brain determines it does. The brain uses a virtual “road map” to direct an output of pain to tissues that it suspects may be in danger. This process acts as a means of communication between the brain and the tissues of the body, to serve as a defense against possible injury or disease.

2. The degree of injury does not always equal the degree of pain. Research has demonstrated that we all experience pain in individual ways. While some of us experience major injuries with little pain, others experience minor injuries with a lot of pain (think of a paper cut).

3. Despite what diagnostic imaging (MRIs, x-rays, CT scans) shows us, the finding may not be the cause of your pain. A study performed on individuals 60 years or older who had no symptoms of low back pain found that 36% had a herniated disc, 21% had spinal stenosis, and more than 90% had a degenerated or bulging disc, upon diagnostic imaging.

4. Psychological factors, such as depression and anxiety, can make your pain worse. Pain can be influenced by many different factors, such as psychological conditions. A recent study in the Journal of Pain showed that psychological variables that existed prior to a total knee replacement were related to a patient's experience of long-term pain following the operation.

5. Your social environment may influence your perception of pain. Many patients state their pain increases when they are at work or in a stressful situation. Pain messages can be generated when an individual is in an environment or situation that the brain interprets as unsafe. It is a fundamental form of self-protection.

6. Understanding pain through education may reduce your need for care. A large study conducted with military personnel demonstrated that those who were given a 45-minute educational session about pain sought care for low back pain less than their counterparts.

7. Our brains can be tricked into developing pain in prosthetic limbs. Studies have shown that our brains can be tricked into developing a "referred" sensation in a limb that has been amputated, causing a feeling of pain that seems to come from the prosthetic limb – or from the "phantom" limb. The sensation is generated by the association of the brain's perception of what the body is from birth (whole and complete) and what it currently is (post-amputation).

8. The ability to determine left from right may be altered when you experience pain. Networks within the brain that assist you in determining left from right can be affected when you experience severe pain. If you have been experiencing pain, and have noticed your sense of direction is a bit off, it may be because a "roadmap" within the brain that details a path to each part of the body may be a bit "smudged." (This is a term we use to describe a part of the brain's virtual roadmap that isn’t clear. Imagine spilling ink onto part of a roadmap and then trying to use that map to get to your destination.)

9. There is no way of knowing whether you have a high tolerance for pain or not. Science has yet to determine whether we all experience pain in the same way. While some people claim to have a "high tolerance" for pain, there is no accurate way to measure or compare pain tolerance among individuals. While some tools exist to measure how much force you can resist before experiencing pain, it can’t be determined what your pain "feels like."

NON-OPIOID TREATMENT AFTER SURGERIES

The results of a recent consumer survey found that 79% of patients who have undergone surgery would choose a non-opioid option for treatment of pain over opioids. These findings make clear the high level of interest patients have in nonopioid treatment after surgery, despite the nation’s growing opioid epidemic.

The survey (Opioid Addiction and Dependence after Surgery Is Significantly Higher Than Previously Known- June 13, 2016) provides valuable insight into the issue, and suggests more patient education is needed.

The study polled 500 adults in the United States who had orthopedic surgery or soft tissue surgery in June 2016, and was conducted in support of the Plan Against Pain campaign, an effort designed to educate patients about their choices in managing pain following a surgical procedure. 

According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States. In response to the growing epidemic, the CDC released opioid prescribing guidelines in March 2016, urging prescribers to reduce the use of opioids in favor of safe alternatives like physical therapy.

Physical therapists partner with patients, their families, and other health care professionals to manage pain through movement and exercise.

The American Physical Therapy Association launched a national campaign to raise awareness about the risks of long-term use of opioids and the fact that physical therapy is safe alternative pain management. Learn more at our #ChoosePT page.

COULD YOU HAVE PATELLOFEMORAL PAIN SYNDROME?

Patellofemoral pain syndrome (PFPS) refers to pain at the front of the knee, in and around the kneecap (patella). PFPS is one of the most common types of knee pain experienced in the United States, particularly among athletes, active teenagers, older adults, and people who perform physical labor. Patellofemoral pain affects more women than men and accounts for 20% to 25% of all reported knee pain - and is very, very common in adolescence and young adulthood for active or athletic individuals. Physical therapists design exercise and treatment programs for people experiencing PFPS to help them reduce their pain, restore normal movement, and avoid future injury.

What is Patellofemoral Pain?

Patellofemoral pain syndrome (PFPS) refers to pain at the front of the knee, in and around the kneecap. (The kneecap, or patella, is the triangle-shaped bone at the front of the knee joint.) Pain occurs when friction is created between the undersurface of the kneecap and the thigh bone (femur). The pain also is usually accompanied by tenderness along the edges of the kneecap.

Current research indicates that PFPS is an "overuse syndrome," which means that it may result from repetitive or excessive use of the knee. Other contributing factors may include:

• Weakness, tightness, or stiffness in the muscles around the knee and hip
• An abnormality in the way the lower leg lines up with the hip, knee, and foot
• Improper tracking of the kneecap

These conditions can interfere with the ability of the kneecap to glide smoothly on the femur (the bone that connects the knee to the thigh) in the femoral groove (situated along the thigh bone) during movement. The friction between the undersurface of the kneecap and the femur causes the pain and irritation commonly seen in PFPS. The kneecap also may fail to track properly in the femoral groove when the quadriceps muscle on the inside front of the thigh is weak, and the hip muscles on the outside of the thigh are tight. The kneecap gets pulled in the direction of the tight hip muscles and can track or tilt to the side, which irritates the tissues around the kneecap.

PFPS often occurs in people who are physically active or who have suddenly increased their level of activity, especially when that activity involves repeated knee motion, such as running, stair climbing, squatting, or repeated carrying of heavy loads. Older adults may experience age-related changes that cause the cartilage on the undersurface of the kneecap to wear out, resulting in pain and difficulty completing daily tasks without pain.

How Does it Feel?

People with PFPS may experience:

• Pain when walking up or down stairs or hills
• Pain when walking on uneven surfaces
• Pain that increases with activity and improves with rest
• Pain that develops after sitting for long periods of time with the knee bent
• A "crack" or "pop" when bending or straightening the knee

How Is It Diagnosed?

Your physical therapist will review your health history, perform a thorough examination, and conduct a series of tests to evaluate the knee. Your therapist may observe the alignment of your feet, analyze your walking and running patterns, and test the strength of your hip and thigh muscles to find out whether there is a weakness or imbalance that might be contributing to your pain. Your physical therapist also will check the flexibility of the muscles in your leg, paying close attention to those that attach at the knee.

Generally, X-rays are not needed to diagnose PFPS. Your physical therapist may consult with an orthopedic physician who may order an X-ray to rule out other conditions.

How Can a Physical Therapist Help?

After a comprehensive evaluation, your physical therapist will analyze the findings and, if PFPS is present, your therapist will prescribe an exercise and rehabilitation program just for you. Your program may include:

Strengthening exercises. Your physical therapist will teach you exercises targeted at the hip (specifically, the muscles of the buttock and thigh), the knee (specifically, the quadriceps muscle located on the front of your thigh that straightens your knee), and the ankle. Strengthening these muscles will help relieve pressure on the knee, as you perform your daily activities.

Stretching exercises. Your physical therapist also will choose exercises to gently stretch the muscles of the hip, knee, and ankle. Increasing the flexibility of these muscles will help reduce any abnormal forces on the knee and kneecap.

Positional training. Based on your activity level, your physical therapist may teach you proper form and positioning when performing activities, such as rising from a chair to a standing position, stair climbing, squatting, or lunging, to minimize excessive forces on the kneecap. This type of training is particularly effective for athletes.

Cross-training guidance. PFPS is often caused by overuse and repetitive activities. Athletes and active individuals can benefit from a physical therapist’s guidance about proper cross-training techniques to minimize stress on the knees.

Taping or bracing. Your physical therapist may choose to tape the kneecap to reduce your pain and retrain your muscles to work efficiently. There are many forms of knee taping, including some types of tape that help align the kneecap and some that just provide mild support to irritated tissues around it. In some cases, a brace may be required to hold the knee in the best position to ensure proper healing.

Electrical stimulation. Your physical therapist may prescribe treatments with gentle electrical stimulation to reduce pain and support the healing process.

Activity-based exercises. If you are having difficulty performing specific daily activities, or are an athlete who wants to return to a specific sport, your physical therapist will design individualized exercises to rebuild your strength and performance levels.

Fitting for an orthosis. If the alignment and position of your foot and arch appear to be contributing to your knee pain, your physical therapist may fit you with a special shoe insert called an orthosis. The orthosis can decrease the stress to your knee caused by low or high arches.

Can this Injury or Condition be Prevented?

PFPS is much easier to treat if it is caught early. Timely treatment by a physical therapist may help stop any underlying problems before they become worse. If you are experiencing knee pain, contact a physical therapist immediately. 

Your physical therapist can show you how to adjust your daily activities to safeguard your knees, and teach you exercises to do at home to strengthen your muscles and bones—and help prevent PFPS.

Physical therapists can assess athletic footwear and recommend proper choices for runners and daily walkers alike. Wearing the correct type of shoes for your activity and changing them when they are no longer supportive is essential to injury prevention.

HOW PHYSICAL THERAPISTS MANAGE PAIN

As America combats a devastating opioid epidemic, safer, non-opioid treatments have never been of greater need.

Physical therapy is among the safe, effective alternatives recommended by the Centers for Disease Control and Prevention in guidelines urging the avoidance of opioids for most pain treatment.

Whereas opioids only mask the sensation of pain, physical therapists treat pain through movement. How movement? 

The Movement System is the new, widely-accepted way to approach injury and pain by the American Physical Therapy Association. It encompasses all aspects involved with an injury, from the skin to the nervous system - and everything involved, in-between. Most musculoskeletal pain is due to a discrepancy between muscle tightness and weakness which pulls bones into the wrong place to the point where it becomes painful. So what do we do to help?

Here's how:

1. Exercise. A study following 20,000 people over 11 years found that those who exercised on a regular basis, experienced less pain. And among those who exercised more than 3 times per week, chronic widespread pain was 28% less common1. Physical therapists can prescribe exercise specific to your goals and needs.

2. Manual Therapy. Research supports a hands-on approach to treating pain. From carpal tunnel syndrome2 to low back pain3, this type of care can effectively reduce your pain and improve your movement. Physical therapists may use manipulation, joint and soft tissue mobilizations, and dry needling, as well as other strategies in your care.

3. Education. A large study conducted with military personnel4 demonstrated that those with back pain who received a 45 minute educational session about pain, were less likely to seek treatment than their peers who didn't receive education about pain. Physical therapists will talk with you to make sure they understand your pain history, and help set realistic expectations about your treatment.

4. Teamwork. Recent studies have shown that developing a positive relationship with your physical therapist and being an active participant in your own recovery can impact your success. This is likely because physical therapists are able to directly work with you and assess how your pain responds to treatment.

Read more about Pain and Chronic Pain Syndromes.

The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management. Learn more at our #ChoosePT page.

References

1. Holth HS, Werpen HK, Zwart JA, Hagen K. Physical inactivity is associated with chronic musculoskeletal complaints 11 years later: results from the Nord-Trøndelag Health Study. BMC Musculoskelet Disord. 2008;9:159. Free Article.

2. Fernández-de-las Peñas C, Ortega-Santiago R, de la Llave-Rincón AI, et al. Manual physical therapy versus surgery for carpal tunnel syndrome: a randomized parallel-group trial. J Pain. 2015;16(11):1087–1094. Article Summary in PubMed.

3. Delitto A, George SZ, Dillen LV, et al. Low back pain. J Orthop Sports Phys Ther. 2012;42(4):A1–A57. Free Article.

4. George SZ, Childs JD, Teyhen DS, et al. Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military cluster randomized trial. BMC Med. 2011;9:128. Free Article.

Author: Joseph Brence, PT, DPT, FAAOMPT, COMT, DAC

HEALTHY TIPS FOR EACH DECADE

• Starting healthy habits early can help stave off many age-related health conditions. In addition to 9 things physical therapist want you to know about healthy aging, here are some decade-based tips from physical therapists.
   

• 2 Tips for 20s:

  1. Be active 30 minutes per day to make it a habit for life. Regular exercise in the present is a great way to keep serious health issues such as heart disease and diabetes out of your future.
  2. Did you realize bones begin losing density in your mid-20s? Then put down your smartphone and get up and move! Dance. Jump rope. Run. Weight-bearing exercises are key to avoiding osteoporosis later in life.
      

  3 Tips for 30s:

  1. Feeling pressed for time? Chances are you’re being asked to do more at work and at home. But this isn't the time to cut corners with your health. Make sure you continue to eat well, get adequate sleep, and exercise regularly.
  2. Saving for retirement? Adopt the same attitude about your long-term health. Just like a financial planner can make sure you're putting enough money in the bank, a physical therapist can evaluate your current weaknesses and outline a plan to make them future strengths.
  3. Testing your physical limits? Many people in their 30s challenge themselves with road races, bike rides, and obstacle courses. These activities are an excellent way to stay motivated and active. But be sensible, too. Ease into new routines and allow your body time to adjust to stresses that could lead to injury.
      

  4 Tips for 40s:

  1. Stand up for your health! Some inactivity researchers believe that prolonged sitting is so detrimental to your health that exercise doesn’t offset its negative effects. So get up from sitting at least once an hour, and more if you can.
  2. It's time to diversify. Does your exercise routine include aerobic exercise, strength training, and flexibility activities? If not, have a physical therapist evaluate you and make recommendations for safely addressing areas you’re neglecting.
  3. Women who experience bladder leakage after childbirth should know that urinary incontinence is common but not normal. It's treatable, too. Find a physical therapist who specializes in women';s health.
  4. Don't start acting "over the hill." Sure, aches and pains may increase in your 40s. But that doesn';t mean you have to live with them. Act your age by doing something about it. Physical therapists can often treat your pain without the need for surgery or long-term use of prescription medication. What are you waiting for?
      

  5 Tips for 50s:

  1. See the world, and exercise, too. Traveling for work or pleasure shouldn’t derail your healthy habits. Physical therapists can suggest exercises you can do on the go, anywhere.
  2. Bone up on your bone health. Menopause contributes to increased loss of bone density, making bones more brittle and prone to breaking. The older you get, the more important it becomes to get the recommended amount of calcium and vitamin D, and perform weight-bearing or resistance exercises 30-60 minutes at least 3 times per week.
  3. Imitate a flamingo. If you can’t stand on one leg for 5-10 seconds, that’s a sign your balance needs immediate improvement. Don’t let a fall be your wakeup call.
  4. Be active every day. The older you get, the more important it becomes to be vigilant about your health. Each week, you want 2.5 hours of moderate-intensity aerobic physical activity, 1.25 hours of vigorous-intensity activity, or an equivalent combination of the two. The best way to do that is to strive for activity every day.
  5. Get a second opinion. People in their 50s often experience the first major signs of aging. If you've tried to manage your health on your own thus far, now is the time to get off of the Internet and in front of a physical therapist, who can provide an expert assessment of your health that will be key to your ability to maintain your independence.
      

  6 Tips for 60s and Beyond:

  1. Take the pressure off. Regular physical activity is more crucial than ever, but if aches and pains are making walking or jogging a chore, move some of your exercise to a pool, where you can work just as hard with less pounding. (Oh, and see a physical therapist about those aches and pains!)
  2. Get balanced. One-third of adults over age 65 are likely to fall each year, and those falls will lead to more than 700,000 hospitalizations. Unfortunately, too many people realize they are falls-prone when they experience their first fall. Be proactive. See a physical therapist for a balance assessment and a personalized improvement program.
  3. Preserve your mental health with physical activity. People who are physically active—even later in life—are less likely to develop memory problems or Alzheimer's disease.
  4. Maintain your intensity! Studies show that people in their 60s, 70s, and even 80s and older can make improvements in strength and physical function, which is associated with improved health and quality of life. But that can’t happen unless your physical activity is intense enough to produce gains in muscle strength. Don't do this alone. A physical therapist can prescribe an exercise dosage adequate enough to generate results.
  5. Strive for 60 minutes. Not the TV show! Set a goal to be physically active 60 minutes a day. You don't have to do it all once. Ten-minute increments count, too.
  6. Team up. If you're retired, what better way to stay close to longtime colleagues than to make time to walk together? Whatever the activity, doing things as a team will keep you accountable and provide social interaction.

  As experts in movement, physical therapists will work with you to help you prepare for aging, treat the effects of aging, and help you #AgeWell at any age.