2006-04-14 / Columnists

Eye On Physical Therapy

By Dr. Tim Rohrs, DPT

It is game of cat and mouse. Is that patient getting a drink of water at the water cooler or making a mad dash for the front door? Are they waiting for the bicycle to become available or are they waiting for the most opportune time to flee? Why all the cloak and dagger?

One word: EXERCISE!

There are days in my office that I feel more like a security guard than a physical therapist. I closely monitor the front door that leads from the gym to freedom. A distraction on my part and the patient has grabbed their belongings and is gone without completing their exercise program. I often joke to the staff to "release the hounds" a la Mr. Burns of the Simpson's.

Unfortunately, the ones that need the exercises the most are the ones that try to avoid them the most. "I can't lift that," "I can't walk that long," "I can't do that." To which I usually answer, "I know, that's why you're in therapy." I don't mean to be flip or sarcastic, but if they could lift that weight, or balance on one leg, or stand up from their wheel chair, I wouldn't be seeing them. Exercise is the most important component of any physical therapy intervention.

According to Martha Pyron, M.D. writing in the American College of Sports Medicine's Fit Society Page , "Researchers found that many bodily functions start to decline at a rate of two percent per year after the age of 30. But, with exercise, this aging process is slowed to a rate of one-half percent per year! This means that a person who does not exercise will have lost 70 percent of their functional ability by the age of 90. In contrast, a 90 year-old exerciser will have only lost 30 percent of their functional ability and still be 70 percent strong!"

Even a flexibility program of just stretching is beneficial. With aging the following changes take place:

+ Erosion of cartilage in heavily used joints - particularly of the knees and hands.

+ Decreased elasticity in joint capsules, tendons, and ligaments with the development of cross-linkages between adjacent fibrils of collagen.

+ Increased dehydration and loss of joint lubricants in connective tissue.

+ Changes in the chemical structure of the tissues protect them from injury.

Older adults are more susceptible to muscle injury and it takes longer for their injuries to heal properly. In many cases, healed muscles may not perform as well as prior to the injury. According to Diane Austrin Klein, Ph.D., "It has been suggested that performing flexibility and stretching exercises stimulate production and retention of connective tissue lubricants and can reduce flexibility losses."

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