Month: May 2017

In Love with Longevity: CrossFit for Older Adults

Posted on by rxphys5bg

In Love with Longevity

Teresa Waser, MScPT, BSc, CAFCI, CFL1 Trainer

Every Tuesday and Thursday morning at a gym in Leduc, my favourite hour begins.  A group of women come together to work out.  The session starts with a group warm-up, then they work on strength training – honing their technique under close supervision and building strength under the barbell.  Finally, they finish it off with a WOD (“workout of the day”), typically involving some interval training.  We laugh, smile and encourage each other as both a sheen of sweat and a sense of accomplishment appear.  These are my Longevity ladies and let me tell you, they are amazing.

Longevity began in the fall of 2016, with the realization that there was a need in the community for safe, appropriate and effective exercise programming for older adults.  In the clinic, I saw that a lot of my older patients were having difficulty maintaining their strength and function as the years went on.  Conditions such as osteoarthritis and osteoporosis often left them feeling as if their bodies were no longer their own – afraid to get active, unsure of what to do and, as a result, becoming or remaining more sedentary.  Unfortunately, this only exacerbates the decline.  We hurt, so we move less.  And when we move less, we get weaker which makes it harder to move and then we get more pain.  Bones deteriorate, balance suffers and falls occur.  Sadly, this is often just chalked up to “aging”, as if there is nothing we can do.  Fortunately, that is far from the truth.

Recent research, including the ground-breaking work performed by The Bone Clinic in Australia, has demonstrated that strength training is both safe and extremely effective in older adults, including osteoporotic patients.  They have demonstrated that bone responds best to progressive strength training.   Although walking, swimming and aquacize are all wonderful activities, they do not provide the stimulus needed to adequately improve bone mineral density.  Additionally, they pale in comparison to the strength gains that can be achieved in the older adult with appropriate, supervised strength training.

But there is more to it than getting stronger and building denser bones.  We all want that, but what really makes me happy is when I hear my patient say she can now play with her grandkids because getting on and off of the floor isn’t so hard anymore, she can now pick up her grandchild, go up the stairs much more easily, and so on.  I see my Longevity ladies and I see the decline in their function is not only slowed down, but reversed.  They are getting stronger, fitter, moving better and they are having so much fun doing it.  We have a number of participants in their 70s, some with joint replacements, many with osteoarthritis and osteoporosis, and they are all making gains.    

The body does not stop listening to us as we get older, we tend to stop talking.  Whatever your starting point, today can be the beginning.  Let’s start the conversation.

Longevity is a registered program held out of CrossFit Leduc for adults over the age of 50.  The program is led by Physiotherapist, Teresa Waser and CrossFit Leduc Coach/Owner, Brad Bendfeld.  Teresa also provides physiotherapy and personal training at her new clinic, RX Physiotherapy.  More information can be found at rxphysiotherapy.com and crossfitleduc.com.

 

Start Today

Don’t Let Medical Imaging Get You Down!

Posted on by rxphys5bg

Don’t Let Medical Imaging Get You Down!

In today’s day and age, medical imaging technology is better than ever before.  We have x-rays, ultrasounds, CT scans, MRIs, bone scans, and the list goes on.  Indeed, technology now allows us to visualize internal changes within our joints and soft tissues.  We can detect if the rotator cuff tendons in your shoulder have been torn, if the discs in your back are bulging, and if osteoarthritis has developed in your joints.  So, with all of this available, why are medical professionals often hesitant to refer you for imaging?

Part of it is time and money.  Most of us already know that medical imaging is costly to our health care system.  Additionally, wait times for imaging can be painfully long.  Consequently, to save healthcare dollars and avoid bogging down the system with any unnecessary referrals, physicians are tasked with only referring those who truly need imaging.  But there is more to it than saving money and keeping wait times down.  In some cases, imaging is just not needed nor helpful.

Now, make no mistake, medical imaging is invaluable in cases where we need to rule out serious injury or disease, such as fracture, dislocation, severe third degree tears, and malignancy.  Your medical team relies on this information to make decisions such as whether you need something like casting or surgery, additional tests, or referral to a specialist.  However, in the absence of anything serious, medical imaging is often not necessary and may actually be detrimental in some cases as imaging results may not be clinically relevant.

The fact is, there is poor correlation between imaging findings and clinical presentation.  This means that how bad something looks on imaging does not always dictate how much pain or restriction the patient will experience.  A patient with severe osteoarthritic joint changes on x-ray may have minimal pain and stiffness while a patient with minor changes may be significantly impaired.  Additionally, a lot of asymptomatic people have positive findings on imaging.  For instance, a 2014 study published in the American Journal of Neuroradiology demonstrated that when individuals with NO back pain were put through a CT scan or MRI, a startling percentage were shown to have disc degeneration and disc bulging.  In 20 year olds, the number was 1 in 3.  By 50 years of age, 80% had disc degeneration and 60% had disc bulging – and again, these were people with NO back pain.

This phenomenon is not limited to the back.  In the shoulder, MRI studies have shown that in those 60 years and older with NO shoulder pain, 50% had rotator cuff tears that they were not aware of.  This occurs in other areas of the body as well. 

So, if degenerative changes and tears can be present without pain or dysfunction, then these findings must be interpreted with caution.  Their presence may just be an incidental finding and they do not necessarily dictate why you are having pain nor your prognosis.

Additionally, if the results of medical imaging are not likely to change your medical management, it’s sometimes better not to know.  Studies have shown that once someone has been given a label of abnormal findings (which may in fact be irrelevant), they are more likely to suffer longer duration of pain, more disability, and a poorer sense of wellbeing.  This makes sense.  We hear someone tell us that we have “disc bulging”, “degeneration”, “osteoarthritis”, and so on.  Hearing this can be very scary and can be accompanied by feelings of finality and hopelessness.  These feelings can make us less likely to stay active and seek treatment, which is usually to our further detriment.

If you have had medical imaging that demonstrated findings such as osteoarthritis, tears, or disc bulges, my best advice is to see a Physiotherapist.  These findings may or may not be clinically relevant, but in any case, we can show you what you can do to improve your strength and mobility to help you lead your best life.

 

Teresa Waser

RX Physiotherapy

The Prescription for Physiotherapy

Posted on by rxphys5bg

The Prescription for Physiotherapy

“I wish I would have come in long ago.”  These are words that I hear frequently in the clinic.  They are words uttered by patients that have come in for physiotherapy, sometimes for the first time and, often, after dealing with pain and reduced quality of life for several months.  Sometimes even longer.

All too commonly, patients will visit their physician for pain in their shoulder, back, knee or another area of their body.  Commonly, they are advised to rest the area, perhaps to try ice or heat, and often provided with a prescription for analgesics, anti-inflammatories and/or muscle relaxants.  Pop these pills, apply this cream, take it easy.  If you have had a musculoskeletal issue, I know you’ve probably been there.  If it’s really bothersome, you may be sent for an x-ray or ultrasound to further investigate the area.  Sometimes mention is even made of a cortisone injection. 

Indeed, all of these interventions – the pills, the cream, the imaging, the injections – they do have their place in certain circumstances.  But, in the majority of musculoskeletal problems, the first prescription should be physiotherapy. 

Why physiotherapy?

Well, first of all, those pills you are prescribed are not risk free.  NSAIDs (nonsteroidal anti-inflammatory drugs), which are often prescribed to reduce pain and inflammation, are notorious for causing stomach pain and ulcers as they also impair the protective lining of the stomach.  In addition, some NSAIDS have been shown to have a detrimental affect on tissue and bone healing.  Additionally, I’m sure you all have heard of the opiod crisis.  Opiod painkillers are highly addictive and responsible for a growing number of prescription drug addicts and deaths due to overdose.  While considered safe under normal use for short durations, most drugs used for musculoskeletal pain have risks and side effects that we’d rather avoid when possible.

As for cortisone injections, these can be helpful in some cases, but also carry risks and potential side effects, particularly with repeated injections. 

Physiotherapy, on the other hand, will not cause stomach pain or ulcers.  And although attending physiotherapy can be an enjoyable experience, I can assure you that you won’t become addicted.  What physiotherapy can do is provide education about your injury/condition and how to best manage your symptoms.  Treatment may include manual therapy, dry needling and modalities to help relieve your pain and stiffness without drugs or, in some cases, in conjunction with your physician’s recommended pharmacological management.  Finally, and most importantly, therapeutic exercises will be taught to help you recover your mobility and strength. 

Studies have shown that adequate physiotherapy produces outcomes comparable to surgery in many orthopedic conditions, without the risk of surgical complications.  In some cases, such as rotator cuff tears and osteoarthritis, physiotherapy can often help patients avoid surgery and, not surprisingly, there are a number of orthopedic surgeons in the province that will only consider surgery for patients that have already undergone a course of extensive physiotherapy. 

Even if your condition does end up requiring surgery, undergoing preoperative physiotherapy to maximize your strength and mobility will greatly improve your postoperative recovery.  For instance, for those undergoing joint replacement surgery, physiotherapy beforehand can help to improve the joint’s flexibility and the strength of the muscles around the joint.  Your physiotherapist can also teach you how to best perform daily activities to reduce strain on the affected area.

Fortunately, a lot of our local physicians know this and are doing a great job of referring patients to physiotherapy.  My hope is that the tendency to refer first to physiotherapy continues to grow.  However, you do not need to wait to be referred.  You can see a Physiotherapist at any time without a doctor’s referral.  So, the next time your shoulder pain wakes you up, your knee sidelines you from your training, or your back pain prevents you from picking up your grandchild – save your doctor the visit and call your local Physiotherapist.  We can help you get moving again!  Don’t be that patient that says “I wish I would have come in long ago.”  Come in today. ❤

 

Teresa Waser, RX Physiotherapy