Osteoporosis: Gym Machines to Avoid

Many women are diagnosed with osteoporosis, which is basically loss of bone density.  With "weak bones," there are a few movements and machines that you should avoid using in the gym, because they place excessive strain on certain bones of the body.  First, the seated hip abductor machine may apply too much stress on the hips/femurs.  This may actually create femur or hip fractures, resulting in a total hip replacement.  The crunch machine as well as the seated trunk extension machine may cause spinal fractures due to vertebral shearing anterior/posterior upon muscle contraction.  Lastly, the seated row machine, especially without chest support may cause compression/spinal fractures.  So if you are working with a client with the diagnosis of Osteoporosis, beware of these machines.  Use your imagination and find other ways to work these hip and trunk muscles.

Simple Technique To Help Improve Posture

Almost all of my patients who come to me with neck pain and headaches require some sort of postural education and retraining.  Many of them work on a computer 8 hours a day for their job.  They feel relief from their symptoms following a therapy session.  However, after working for a day or two, the symptoms return.  When I am discussing this with them, I am always observing their posture.  Most of them revert back to the "slumped over" position in their chair.  Training your posture is not a '3 sets of 15 reps' type of training.  Yes, seated rows do work the scapular retractors which are very important for maintaining correct posture.  Unfortunately, many times you will notice someone performing the rows with great posture, and when they finish their set and stand up to walk over to the next exercise, they have that forward head posture with protracted shoulders again ("slumped").  Postural muscles need to have great endurance.  They must 'hold you' in proper alignment all day long to prevent injuries.  Basically, maintaining proper posture is an isometric exercise.  When retraining posture, you are creating new habits.  Initially, you will feel the medial scapula muscles burning and aching as you focus on holding proper posture.  Because of this, you will go back to your comfort position (protracted scapula and slumping).  You need to be constantly reminded to correct your posture.  One easy way to do this, especially for those of you who work long hours on the computer, is to tape a post-it to the monitor screen.  Write the word "POSTURE" on the post-it.  Everytime you look at the monitor, you will be reminded to correct yourself.  90% of the time when you first start this, you will catch yourself slumping.  Do this long enough and the new habit will take over.  Your proper, upright posture will become your new comfort zone, while the slumped posture will become uncomfortable.  Give it a try!

Too much tactile cueing may not be good

I have spoken of the importance of using tactile cues in order to get a particular muscle contraction or movement to occur.  However, continuing from the previous entry, when dealing with older clients/patients, sometimes too much manual cues may be detrimental.  When you are performing the higher risk exercises mentioned before (standing exercises without support), you are trying to build your patient's self-confidence --- SELF- Confidence.  They must rely on THEMSELVES.  You are there to perform a job, and usually can only work with your patient for a limited time, so you really want them to be safe when you are not there.  Having them walk or perform exercises with your hand on them for security purposes, when they do not really need that much assistance, provides a false sense of security.  When you are not there, they do not feel your support, so their self-confidence may be greatly diminished.  If they do not need it, do not provide it.  I feel the same way about gait belts.  Many therapists use gait belts no matter what.  Usually, a clinic or hospital makes it protocol for liability purposes.  But when the patient is discharged, they will be walking on their own without that gait belt -- without that sense of security.  Use common sense.  If your patient needs the assistance, provide only what they need.  Do not over-assist because you will be under-rehabilitating.  Sometimes you are causing more harm than good by training your patient in an overprotected environment.

Allow Self-Corrections

Many times I will be performing balance training with a patient and he will lose his balance slightly, frequently falling backward.  As I am by his side, I am able to prevent him from falling.  But instead of preventing the fall and completely bringing him to his upright posture, I tell him to "fix it."  As I physically support him, I ask him to maneuver himself back to his stable upright position.  This forces him to use the ankle, hip, core musculature to regain his center of gravity over his base of support.  This is used as an exercise as well as a motor development skill.  If we can get him to regain his balance by synchronizing all the necessary muscles, we are hoping he will incorporate this same technique the next time he feels himself falling backward, thereby correcting it.  So my advice is: Let them make mistakes, be there to protect them and prevent injury, but allow them to attempt corrections on their own.   Let them figure out the solutions and this will enhance their motor planning abilities.

Small Adjustments Produce Big Changes

As a Physical Therapist, I treat many deconditioned patients in their home.  Most of these patients suffer from generalized weakness, balance deficits and difficulty walking.  Initially, depending on the extent of their weakness, I may start them with seated or supine (lying down on their back) exercises.  They then progress to standing exercises, usually holding onto their kitchen sink.  These exercises include heel raises, marching, squats, etc.  We use the sink because it is a stable surface that will not move while the patient holds onto it for balance.  Most of these patients have a fear of falling due to poor balance.  As time goes on, they begin to have less trouble with these standing sink exercises.  However, what is the true functional value of these exercises?  If your patient's goal is to walk without a cane or walker, they are definitiely not going to be walking while holding onto a sink, right?  So how do we get them ready to be independent with their daily activities?

One small adjustment to their position during your sessions will make a big change in their confidence, strength, balance and walking ability.  Have them step back away from the sink, into the middle of their kitchen, with nothing else at arm's reach except for you.  Make sure you remain close to them, but only place your hands on them to prevent a fall.  Now have them perform the same standing exercises that they did when they held onto the sink.  They will seem very cautious, almost fearful.  Progress slowly with this.  Perform only a few reps of each exercise.  This is a confidence building exercise as well as balance and strength building.  They will feel a much greater challenge due to the mental aspect.  The difference here is the risk or fear factor.  They no longer have their security blanket, the kitchen sink.  They must rely on their own abilities (as well as your ability not to let them get injured).  Once they accomplish these tasks over numerous sessions, you will see improvement in confidence, strength, balance and walking ability.  You will see that one minor change can have a very beneficial effect on your patient's progress.  Remember, you are not just training their body, you are also working on their mind.  Take away their "crutch" to get them to the next level.

Functional Training & Observation Skills

We have all heard of Functional Training.  Many of us think of High Intensity Training using Kettlebells, Sandbags, Suspension Training, but it does not stop there.  That may be beneficial for an athlete to maximize his/her performance.  However, what about clients in their 50s, 60s or older, who are looking to improve their quality of life, not their athletic performance?  How do we incorporate Functional Training into their life? 

Just like any of your other clients, find out what their goals are upon the initial evaluation.  For example, presently I have a patient who is recovering from a fractured femur.  She had corrective surgery and during her first session, she stated how happy she would be if she could get down into the bath tub again.  My first goal is to improve her 'quality of life' by helping her return to her prior functional level.  I need to get her to be able to take a bath again.  Initially, if she is having trouble with the basics, such as getting up and down from a chair or is unsteady when walking, I will need to give her a standard strength and balance program (for her legs especially).  I will also need to assess her bathroom, including the size of the tub and the direction of the faucet controls so that I can make the transfer as efficient as possible.

Now here is where the task observation comes into play.  In order for her to transfer safely into the tub I need to break the entire task down into its individual parts, and focus on each part prior to attempting the entire task.  First, she needs to be able to approach the tub, and lift each leg high enough to get into the tub.  Then she needs to be able to transfer into a lunge, then tall kneeling, side-sitting, and sitting with legs stretched in front of her.  To get out of the tub she will need to roll over into quadruped (on hands and knees), into tall kneeling, lunging, standing and finally lift each leg high enough to get out of the tub safely. 

Who would have thought it took so much work to get in and out of the bath tub?  Each session, I work on these individual components, and will eventually take her into her bathroom in order to practice the entire task. 

Your goal is to be observant of the task at hand.  Learn your client's strengths and weaknesses and customize the task to their abilities.  Break down the activity that your client is trying to relearn into its component parts, which will be easier for your client to initially learn and master.   Then, for proper carryover, you need to have your client perform as many of the individual components in proper order as soon as possible, so that it makes sense to your client why she is performing all these exercises/activities.  

Repetition of the task will establish motor patterns in the brain. And before you know it, your goal will be accomplished.   Remember, if you must break the task down into component parts, the trick is to 'bring it all together' as soon as safely possible for actual learning and retention to occur.