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MOBILE SENIOR FITNESS
  • Home
  • About
  • FAQ
  • Services
    • Post rehab personal training
    • Balance training
    • Older Adult Fitness Training
    • Parkinson’s disease personal training
  • Testimonials
  • Contact
  • Blog
  • Store

My parents are inactive and my dad fell. Should I hire a Senior Fitness Specialist for them?

11/13/2023

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             We grew up and they took care of us. Now that we are getting into our 4th, 5th, or 6th decade, some of our aging parents may beginning to worry us with their declining health, lacking energy, decreasing abilities and suddenly we may feel the need to take care of them. What is a son or daughter to do? Are there any resources out there? Will my parents be amenable to help? Can they “age” better?

            It is difficult to see our parents get older. We often don’t get a chance to see them enough and when we do, we cringe watching dad try to get out of his favorite chair and mom shuffling her feet on the ground while complaining of aches and pains. Oh, let’s not forget, Dad fell last month and hurt his elbow and shoulder. While we can’t stop the clock on aging, there are some things we can do to make the last decades of our/their life more energetic, productive, and filled with less fear.

            It is true that as we age between our 50’s to our 70’s, we TEND to lose muscle mass and strength/power (3-5% per decade on average) with the curve further accelerating after the age 70. As our strength and power decrease, our chance of falling tends to increase as we have less resources to catch ourselves in the event of losing our balance. This coupled with a slowing nervous system, potential visual and vestibular system changes, as well as slower reaction times. Finally, and on top of all this, fear of falling often creeps in which makes this vicious cycle even more…vicious!

            Ok, most of us know the above information fairly well already. What is a son or daughter to do if they want to get their parents on board? This is a great question and one that will vary depending on the parent in question. There may be some parents that are 100% against receiving help while others who are gung ho to get started yesterday. Most of our aging parents will fall somewhere in the middle and may need some level of persuasion to get started. This is where a good personal trainer with decades of experience in helping our aging population can come into play. They can talk with your parents during a free consultation to figure out THEIR WHY! Most of the population could care less to exercise. We don’t need to talk about exercise. But we will flesh out what their fears are that may be getting in the way. We can route out WHAT they still want to do in their lives and make that the reason behind getting help. Do they want to travel with their partner? Do they want more energy to play with their grandkids? Do they have other hopes and dreams that are fading out of reality that can still be a possibility if they just had more strength, stamina, balance, and less fear?

            Hope is not lost. I can help your aging parents get back on track. If your parents need some outside persuasion, then perhaps I can chat with them during a free consultation to find out what makes them tick and come up with some strategies to get them back on track. I’m here, I’m keenly listening and ready to help.
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Falls and fractures...

6/25/2023

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 Falls and Fractures in Older Adults: Causes and Prevention
    This is an article that I'm posting here from the NIH regarding falls in the older adult population. There are many contributing factors that may lead to a fall. The important thing is...can you get up after a fall (assuming you have not been injured? Training yourself to be able to get on and off the floor is important and takes a fair level of mobility, balance, coordination, and strength. If you would like to improve your mobility, balance, coordination, and strength and need help, reach out! I can help!
                                                     Article website and source is below

https://www.nia.nih.gov/health/falls-and-fractures-older-adults-causes-and-prevention


     A simple accident like tripping on a rug or slipping on a wet floor can change your life. If you fall, you could break a bone, which thousands of older adults experience each year. For older people, a broken bone can also be the start of more serious health problems and can lead to long-term disability.
On this page:
  • What causes falls in older adults?
  • Steps to take to prevent falls
  • What to do if you fall
  • Keep your bones strong to prevent fall-related fractures
     
     If you or an older adult in your life has fallen, you’re not alone. More than one in four people age 65 years or older fall each year. The risk of falling — and fall-related problems — rises with age. However, many falls can be prevented. For example, exercising, managing your medications, having your vision checked, and making your home safer are all steps you can take to prevent a fall.

     Many older adults fear falling, even if they haven’t fallen before. This fear may lead them to avoid activities such as walking, shopping, or taking part in social activities. But staying active is important to keeping your body healthy and actually helps to prevent falls. So don’t let a fear of falling keep you from being active! Learn about what causes falls and how to lower your risk of falling so you can feel more comfortable with staying active.
What causes falls in older adults?

Many things can cause a fall.
  • Your eyesight, hearing, and reflexes might not be as sharp as they were when you were younger.
  • Certain conditions, such as diabetes, heart disease, or problems with your thyroid, nerves, feet, or blood vessels can affect your balance and lead to a fall.
  • Conditions that cause rushed movement to the bathroom, such as incontinence, may also increase the chance of falling.
  • Older adults with mild cognitive impairment or certain types of dementia are at higher risk of falling.
  • Age-related loss of muscle mass (known as sarcopenia), problems with balance and gait, and blood pressure that drops too much when you get up from lying down or sitting (called postural hypotension) are all risk factors for falling.
  • Foot problems that cause pain, and unsafe footwear such as backless shoes or high heels, can also increase your risk of falling.
  • Some medications can increase a person’s risk of falling because they cause side effects such as dizziness or confusion. The more medications you take, the more likely you are to fall.
  • Safety hazards in the home or community environment can also cause falls.




      What is sarcopenia? Derived from the Greek root words sarx (flesh) and penia (loss), sarcopenia is defined as a decline in muscle mass, strength, and function. It is often associated with older adults, but some forms of sarcopenia can also affect middle-aged people. Sarcopenia has been connected to weakness; fatigue; lower energy levels; and difficulty standing, walking, and climbing stairs. Sarcopenia is more likely to occur in people with chronic diseases and may contribute to a risk of falls, fractures, other serious injuries, and premature mortality. Poor nutrition and lack of exercise can increase the odds of developing sarcopenia. If you or a family member is feeling general weakness, talk with a doctor. It could be related to sarcopenia or another medical condition. Learn more about age-related loss of muscle mass and how strength training can help build healthier bodies as people age.

     Steps to take to prevent fallsIf you take care of your overall health, you may have a lower chance of falling. Most of the time, falls and accidents don’t just happen for no reason. Here are a few tips to help lessen your risk of falls and broken bones, also known as fractures:

Read and share this info graphic and help spread the word about how to help prevent falls.
  • Stay physically active. Plan an exercise program that is right for you. Regular exercise improves muscles and makes you stronger. Exercise also helps keep your joints, tendons, and ligaments flexible. Mild weight-bearing activities, such as walking or climbing stairs, may slow bone loss from osteoporosis, a disease that makes bones weak and more likely to break
  • Try balance and strength training exercises. Yoga, Pilates, and tai chi can all improve balance and muscle strength. You can also try lifting weights or using resistance bands to build strength. Learn more about different types of exercises to improve balance and strength.
  • Fall-proof your home. Check out these tips for changes you can make to your home that will help you avoid falls and ensure your safety.
  • Have your eyes and hearing tested. Even small changes in sight and hearing are linked to an increased risk for falls. When you get new eyeglasses or contact lenses, take time to get used to them. Wear your glasses or contacts as your eye doctor advises. If you have a hearing aid, be sure it fits well and wear it.
  • Find out about the side effects of any medicines you take. If a drug makes you sleepy or dizzy, tell your doctor or pharmacist.
  • Get enough sleep. If you are tired, you are more likely to fall.
  • Avoid or limit alcohol. Too much alcohol can lead to balance problems and falls, which can result in hip or arm fractures and other injuries.
  • Stand up slowly. Getting up too quickly can cause your blood pressure to drop. That can make you feel wobbly. Get your blood pressure checked when lying and standing.
  • Use an assistive device if you need help feeling steady when you walk. Using canes and walkers correctly can help prevent falls. If your doctor tells you to use a cane or walker, make sure it’s the right size for you. Walker wheels should roll smoothly. If you borrow walking support equipment from a friend, ask your health care provider to make sure the equipment is the correct size and is safe to use. This is exceptionally important when you’re walking in areas you don’t know well or where the walkways are uneven. A physical or occupational therapist can help you decide which devices might be helpful and teach you how to use them safely.
  • Take extra caution when walking on wet or icy surfaces. These can be very slippery! Use an ice melt product or sand to clear icy areas by your doors and walkways.
  • Keep your hands free. Use a shoulder bag, fanny pack, or backpack to leave your hands free to hold on to railings.
  • Choose the right footwear. To fully support your feet, wear nonskid, rubber-soled, low-heeled shoes. Don’t walk on stairs or floors in socks or in shoes and slippers with smooth soles.
  • Consider staying inside when the weather is bad. Some community services provide 24-hour delivery of prescriptions and groceries, and many take orders over the phone.
  • Always tell your doctor if you have fallen since your last check-up, even if you did not feel pain when you fell. A fall can alert your doctor to a new medical problem or issues with your medications or eyesight that can be corrected. Your doctor may suggest physical therapy, a walking aid, or other steps to help prevent future falls.
      What to do if you fall. Whether you are at home or somewhere else, a sudden fall can be startling and upsetting. If you do fall, stay as calm as possible and take the following steps:
  • Breathe. Take several deep breaths to try to relax. Remain still on the floor or ground for a few moments. This will help you get over the shock of falling.
  • Decide if you are hurt. Getting up too quickly or in the wrong way could make an injury worse.
  • Crawl to a sturdy chair. If you think you can get up safely without help, roll over onto your side. Rest again while your body and blood pressure adjust. Slowly get up on your hands and knees, and crawl to a sturdy chair.
  • Slowly sit down in the chair. Put your hands on the chair seat and slide one foot forward so that it’s flat on the floor. Keep the other leg bent so the knee is on the floor. From this kneeling position, slowly rise and turn your body to sit in the chair.
  • Get help. If you are hurt or cannot get up on your own, ask someone for help or call 911. If you are alone, try to get into a comfortable position and wait for help to arrive. Prepare for a fall by keeping a well-charged cordless or mobile phone with you at all times and arrange for daily contact with a family member or friend. Emergency response systems are another option: These systems enable you to push a button on a special necklace or bracelet to call for help. Some smartwatches also have this feature.
      Keep your bones strong to prevent fall-related fractures. Having healthy bones won’t necessarily prevent a fall, but if you do fall, healthy bones may help prevent serious injury, such as breaking a hip or other bone. Bone breaks and fracture can lead to a hospital or nursing home stay, long-term disability, or even death. Getting enough calcium and vitamin D can help keep your bones strong. So can staying active. Try to get at least 150 minutes per week of physical activity.

     Other ways to maintain bone health include quitting smoking and avoiding or limiting alcohol use. Tobacco and alcohol use may decrease your bone mass and increase your chance of fractures. Additionally, try to maintain a healthy weight. Being underweight increases the risk of bone loss and broken bones.

     Osteoporosis is a disease that weakens bones, making them thin and brittle. For people with osteoporosis, even a minor fall may be dangerous. Talk to your doctor about osteoporosis.

     Falls are a common reason for trips to the emergency room and for hospital stays among older adults. Many of these hospital visits are for fall-related fractures. You can help lower your risk of fractures by keeping your bones strong and following the tips above to avoid falls.
__________________________________________________________________________________
                      Please reach out if you have any questions or need help!



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Yoga for anyone?

3/17/2023

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     Hey there, and welcome back. Back in the day, I used to teach yoga. Yes, I taught yoga for over 10 years and created my own style that I termed '3d Yoga'. 3d meaning we moved the body more in a circular/spherical fashion and focused on "functional" and dynamic movements. I had a pretty good following. I stopped teaching though secondary to work requirements and then my hip pain got in the way...fast forward...two years post hip replacement, and I'm looking to get into moving my body like I used to and thought I'd bring y'all along! Let me know if you have any questions. This yoga is for all levels and can of course be advanced or regressed as needed. As always, listen to your body, keep your ego in check, and do what you can. If you need help, reach out!

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Can you stand on one leg for more than 10 seconds?

3/12/2023

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     This is a quick video for those who have lost the ability to stand on one leg and want to be able to do this again. Please remember to do this in a safe place and/or have a spotter. Of course, standing on one leg is not the only parameter for how well one can "balance". With that said, it is one parameter and a common one for most of us who have lost the ability to stand on one leg. If you need extra help, reach out to a professional to help improve your strength, coordination, power, and general balance to mitigate fall risk and enhance your functional abilities so you can enjoy life and do the things that make you happy!!

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How to improve your golf game with a few movements...

2/28/2023

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Whether you play golf or not, give this a video try to feel better, have less neck/shoulder discomfort, and it's a great warm up for golf, tennis, and even pickleball!
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The role of strength and power training in mitigating fall risk

2/28/2023

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                                      Strength and power training to mitigate fall risk
 

            We have all heard the negative press, as we get older, we are more likely to have a fall. With that sobering statistic is the even more negative one, that shows that as we age, we are more and more likely to be at risk of hospitalization secondary to a fall. According to the CDC, approximately 3 million people aged 65 and over fall every year that requires a trip to the emergency room. Roughly 20% of those have serious injuries such as head trauma, fractures, and other serious injuries and/or complications resulting from these falls.  Is this something that we are doomed to repeat for ourselves and/or our loved ones? Or is this something that we can potentially improve via an appropriate intervention?
 
            Biology is constantly adapting to our environment and requires a certain level of stress to maintain itself. Too much stress of course is bad, like a hard fall that fractures a bone, but carefully measured stressors are great thing and needed for a strong organism. Now, we of course have an upper limit on this, and no one lives forever but why not spend the time on this planet with the ability to continue to do the things that we enjoy? As mentioned above, if we combine the right kind of stressors with good sleep and rest, optimal nutrition, then we can augment our ability to continue to do the things that we enjoy.
 
            Balance training and mobility training is a good start to help improve ones balance and potentially decrease our risk of falls. Balance training is good in that it can help improve our ankle and hip strategy to help catch ourselves in case of a fall and may also improve our coordination. While mobility training can help keep our joints supple while also potentially help increase our awareness of our bodies ability to move in space. Again, these are a good start and still needed in the overall picture of helping decrease the potential for falls as well as possibly decreasing the fear of falling which is almost another topic in and of itself!
 
            Strength and power training can help advance your program and allow you to continue to enjoy doing the activities you love. By definition, strength is the ability to move a force that is acting on a body. Remember, your body weight does count, but also being able to manage outside forces as well (think a grocery bag or walking up stairs with a suitcase in your hand). Power is the ability to produce or slow down a force with speed (think tripping on your carpet and quickly getting your leg under your body to catch yourself before hitting the ground). It has been shown by working on strength and power training type of exercises, then we can improve our body’s ability to adapt to the environment, potentially mitigate fall risk, and at the same time continue to do the things that we enjoy.
 
            This knowledge may seem pretty obvious to many people but you may be wondering: I’ve never done this before and I don’t even know where to begin. This is quite common and nothing to be ashamed of. We need each other! When we want the best, we should hire a pro right? Just make sure that you hire someone that you are comfortable with, knows your relevant medical history, listens to your needs, and has a history of working with people in the population that is most at risk. I am ready to listen to your story! I can also help you improve your balance, coordination, mobility/flexibility, strength, and power.
 
Let me know how I may help you continue your journey with less fear, reduction of risk, and help you regain your confidence!


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A Deeper Understanding of Pain: A Biopsychosocial Approach

2/19/2023

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I gave this fun, interesting, and intriguing talk back in 2020 at the height of Covid to a empty auditorium secondary to covid restrictions at Sandia Labs. It is a talk on Pain Science and how understanding how pain works may be helpful to those who are experiencing it as well as give options to alleviate pain.

Remember, always talk with your doctor or physical therapist if you are experiencing pain as this talk is informative and NOT in any way giving medical advice.

Enjoy! Click link below to play.

https://digitalops.sandia.gov/Mediasite/Play/e382e5a5aa744124a9a5d7875c7be4251d

 


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I’m inactive, feeling weaker, and scared of falling. Should I hire a Senior Fitness Specialist?

2/14/2023

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      It’s crept up on you. The things that you used to do with ease are more of a burden now and when you attempt them, you feel slow, not as coordinated, and you might even feel vulnerable doing them. You don’t want to ask for help, you never had to and you may feel that asking for help makes you sound feeble. At the same time, there is this lingering fear that you are losing control of your body and you don’t like it. You want a change. You want to feel better and have less fear. You want to be able to do the activities you grew up enjoying. If there was only a way to get out of this situation. A situation that makes you feel too weak to do the things you want to do. Not to mention you feel more uncoordinated and there is this underlying fear of falling as your balance has been more unsteady the last few years or so and getting on/off the floor sounds borderline dreadful. Hopeless? Not at all.
 
     The hard truth is that biological organisms (including you) do have a shelf life. It can be scary to think about, but one might argue that it’s even scarier to think about how one can be on this planet for several decades and lose large scale capabilities, not because of age, but because we stopped pushing ourselves. Biology needs challenge. Without challenge, we literally prune our systems that are not in use. This includes our nervous system (coordination/balance), our muscles (weakness/poor power), our cardiovascular system (stamina/endurance), and our skeletal system among (bones more brittle) others. Now, these changes do happen if we get “old enough”, but we can  S L O W  these trends down with consistent and intelligent stresses. These stresses are movement based and can go along way to help mitigate this downward trend and we can actually, to a certain point, improve on our systems. Yes, we can get stronger, improve balance, get better coordinated, increase our mobility/flexibility, and get MORE out of life well into our 6th, 7th, 8th, and even 9th decades. But how does one navigate this?
 
    This is where investing in a caring and educated senior fitness specialist can have a role. First, they can ask the right questions. They need to know YOUR WHY. Why do you want to improve your health, your strength and balance? Without the proper why, movement and exercise seems too difficult, out of reach, and often burdensome to many. Nailing down your why layers in context and makes making behavioral change easier and often results in longer lasting and even quicker attainable goals! Secondly, a good senior fitness specialist is educated on exercise for aging bodies and often many of them have physical therapy backgrounds and can assure that you have success without causing damage. Along these lines, many potential clients are often being discharged from physical therapy and the need to find a qualified and educated Senior Fitness Specialist who is also a good listener is imperative! Finally, this Senior Fitness Specialist is mobile and they can help you in the comfort of your own home. They have basic exercise equipment they can bring, work with the equipment you have, make recommendations on purchasing new equipment, and the creative ones are amazing at just using gravity to help improve your strength, balance, stamina, and help improve your life.
 
   In conclusion, there is hope and there is help out there. Your fears are real but tangible results are attainable for the vast majority of people. You just have to take the first step. Most Senior Fitness Specialists offer free initial consultations and are eager to hear your story. I know I am. Tell me your story. I’m listening.

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My parents are inactive and my dad fell. Should I hire a Senior Fitness Specialist for them?

2/6/2023

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           We grew up and they took care of us. Now that we are getting into our 4th, 5th, or 6th decade, some of our aging parents may beginning to worry us with their declining health, lacking energy, decreasing abilities and suddenly we may feel the need to take care of them. What is a son or daughter to do? Are there any resources out there? Will my parents be amenable to help? Can they “age” better?
            It is difficult to see our parents get older. We often don’t get a chance to see them enough and when we do, we cringe watching dad try to get out of his favorite chair and mom shuffling her feet on the ground while complaining of aches and pains. Oh, let’s not forget, Dad fell last month and hurt his elbow and shoulder. While we can’t stop the clock on aging, there are some things we can do to make the last decades of our/their life more energetic, productive, and filled with less fear.
            It is true that as we age between our 50’s to our 70’s, we TEND to lose muscle mass and strength/power (3-5% per decade on average) with the curve further accelerating after the age 70. As our strength and power decrease, our chance of falling tends to increase as we have less resources to catch ourselves in the event of losing our balance. This coupled with a slowing nervous system, potential visual and vestibular system changes, as well as slower reaction times. Finally, and on top of all this, fear of falling often creeps in which makes this vicious cycle even more…vicious!
            Ok, most of us know the above information fairly well already. What is a son or daughter to do if they want to get their parents on board? This is a great question and one that will vary depending on the parent in question. There may be some parents that are 100% against receiving help while others who are gung ho to get started yesterday. Most of our aging parents will fall somewhere in the middle and may need some level of persuasion to get started. This is where a good personal trainer with decades of experience in helping our aging population can come into play. They can talk with your parents during a free consultation to figure out THEIR WHY! Most of the population could care less to exercise. We don’t need to talk about exercise. But we will flesh out what their fears are that may be getting in the way. We can route out WHAT they still want to do in their lives and make that the reason behind getting help. Do they want to travel with their partner? Do they want more energy to play with their grandkids? Do they have other hopes and dreams that are fading out of reality that can still be a possibility if they just had more strength, stamina, balance, and less fear?
            Hope is not lost. I can help your aging parents get back on track. If your parents need some outside persuasion, then perhaps I can chat with them during a free consultation to find out what makes them tick and come up with some strategies to get them back on track. I’m here, I’m keenly listening and ready to help.
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What is BPPV?

1/14/2023

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Fear of Falling?

10/9/2022

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     Can a fear of falling make one more likely to fall? The short and simple answer to this is yes. Of course, it’s a lot more complicated than that. So, let’s flush this out so we can have a better understanding of why this is and how you can potentially help mitigate some of your risks of falling and serious injury. According to the CDC, approximately 3 million people aged 65 and over fall every year that requires a trip to the emergency room. Roughly 20% of those have serious injuries such as head trauma, fractures, and other serious injuries and/or complications resulting from these falls. That is a staggering number, and it is no wonder that many seniors are afraid of falling and the potential ramifications of a fall. Looking at these statistics, it makes one wonder if falling is just part of aging and something that is inevitable and there is nothing one can do to change their lot in life. Now, it is true that accidents and falls will still happen to many people. But one thing that most certainly increases that risk is the fear of falling.
 
            Fear is a normal biological protection mechanism that protects the organism against real or perceived threats. Now, on one hand, falling and getting hurt is certainly something to be aware of as a possibility. But, on the other hand, often this fear of falling is exorbitant and will likely make someone even more likely in the future to fall. How is this so? People that have a huge fear of falling will limit their activities so much that over time they lose strength, endurance, power, and the ability to control their bodies when they inevitably do lose their footing from a bump, a trip, a slip, or miscalculation. We should remember that our body literally prunes what it doesn’t use. When we limit our activities and do no form of exercise, we quickly lose strength, power, endurance, coordination, and vastly increase the likelihood of injury because we don’t have the RESOURCES to control ourselves when accidents to happen….and accidents do happen!
 
            While this information may be sobering to many and wonder what the point of doing anything because it almost seems that so many falls happen to our aging population and one is doomed to fit into the current statistical model. I would urge you to modify your thoughts on this and work on changing your behavior so you don’t have to fall (Pardon the pun) into the category of someone needing emergency services secondary to falling.
 
            It is widely known that exercise can be a game changer for the senior population. Exercise that can be helpful should focus on mobility, strength, power, endurance, and balance. This generally means weight bearing activities that are standing (if possible) are going to give you the most bang for your buck. Let’s list out some activities that are great possibilities to show you that there are some options!
-Dancing
-Tai Chi
-Yoga
-Pilates
-Resistance training with machines, free weights, heavy duty resistance bands, body weight, kettlebells, sandbells, ViPR’s,
-Balance training which includes a whole gamut of types including coordination activities such as catching/throwing objects, reaction drills, and working on the ability to be more resilient to perturbations (such as getting bumped in the store).
-Cardiovascular exercises including walking outdoors or on treadmills, biking, ellipticals, hiking, swimming, and potentially other areas of group fitness too big to mention.
 
            I would like to conclude that you are not alone! You can join a growing population of seniors who are working daily to improve their lives through a change in mindset and making their weakness their strengths! You can maintain your independence for a long time and decrease your risk of falls while also expanding on your abilities and enjoy life and continue your journey. Please consider me a resource if you would like assistance to help you along the way. I’ve been doing this for a long time, I will listen to your needs, and come up with a plan to help you become a stronger and more resilient version of you.
 

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Easy, portable, and cheap equipment ideas!

7/17/2022

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     I often get asked what kind of equipment does one need to workout in the home for seniors. It's a great question and the answer of course, it depends. I don't believe in treating seniors with "kid gloves" and feel that ageist thoughts can hamper what our seasoned citizens can truly do. I still hope that I'm able to do heavy deadlifts, kettlebell swings, Turkish get ups, and really any intense workouts I want to do in my 70's and beyond! Limiting thoughts can truly get in your way of your goals/journeys/independence!

     With that said, the practical side of me knows that many of you out there have not really had the opportunity to exercise intensely most of your life because you were working all those years, raising kids and grand-kids, and have not really had the time to dedicate to your own health! In those cases, simple is best and starting S L O W L Y. One of the best tools out there to use is simple gravity based exercises using your own body weight, and that is often where I start with clients. Beyond that though, there are some really simple, portable and non expensive piece of equipment that I've been using for about twenty years. Lifeline Tubing The company builds solid heavy duty tubing in various levels of resistance and I highly recommend it in your home. One can do very basic and simple exercises including various types of rows, pressing, and curls for starters! I know what you may be thinking! So,  no, I don't work for this company and I don't make a cent off suggesting them. If you are intrigued by these bands and want to hire me for just a session or two including planning on how your can program this workout, then contact me know to get started!

Below is the link for the tubing on amazon!
https://www.amazon.com/Lifeline-Resistance-Training-Cables-Handles/dp/B00N1Y1IJY/ref=sr_1_4?crid=3746XALQ9992S&keywords=lifeline%2Btubing&qid=1658070071&sprefix=lifeline%2Btubing%2Caps%2C141&sr=8-4&th=1
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Get a Grip!

7/8/2022

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Get a Grip!
 
     Do you have trouble opening jars and carrying objects? Do you feel that your hands and grip strength are a limiting factor to you leading a full and productive life? Then read on because grip strength is even more important than we give it credit for.

     Grip strength is now considered an important biomarker of mortality. Similar to how low bone density (osteopenia/osteoporosis), high blood pressure, 30 second sit to stand test, and lipid profiles are also biomarkers that can potentially predict mortality.  Evidence is beginning to show there is a predictive link between grip strength and all-cause and disease-specific mortality, future function, bone mineral density, fractures, cognition and depression, and problems associated with hospitalization. Furthermore, evidence is showing that the routine use of grip strength can be recommended as a stand-alone measurement or as a component of a small battery of measurements for identifying older adults at risk of poor health status.
     Ok, so now we know that grip strength is important to your health, as well as your ability to do the things that you continue to love to do. So, what can you do about it? Biology prunes what it doesn’t use. Bones, muscles, skin, and our nervous system atrophies with disuse. You can reverse a lot of this atrophy, but it does take time and some effort. It also helps to have a plan of attack. A guided strength training program with a qualified personal trainer can go a long way to helping you get back to a level where you feel more confident doing the things you enjoy. I’m going to show some tidbits and tools below to get you started. If you have any questions, please feel free to reach out!
 
Strengthening
 
Wrist flexion- Use water bottle, dumbbell, or even elastic band and begin with palm facing up with item in hand. Allow wrist to bend down to floor. Keep it pain free. Pause for a moment and then bend wrist back up to above starting position. Repeat at sets and repetitions encouraged by your trainer.
 
Wrist extension – Use water bottle, dumbbell, or even elastic band and begin with palm facing down with item in hand. Allow wrist to bend down to floor. Keep it pain free. Pause for a moment at the bottom and then bend wrist back up to above starting position. Repeat at sets and repetitions encouraged by your trainer.
 
Pronation/Supination -Use water bottle, dumbbell, or even elastic band and begin with palm facing down with item in hand. Keeping wrist in neutral position. Rotate hand to the palms up position. Keep it pain free. Pause for a moment and then slowly return to starting position. Repeat at sets and repetitions encouraged by your trainer.

 Radial Deviation -Use water bottle, dumbbell, or even elastic band and begin with thumb side up with item in hand. Allow wrist to bend down with pinky side going down to floor. Pause and  then slowly return to starting position. Repeat at sets and repetitions encouraged by your trainer. One can challenge this activity by holding the end of the resistance thus increasing lever.

 Ulnar deviation Use water bottle, dumbbell, or even elastic band and begin with forearm in neutral position with arm down by your side. Allow wrist to bend down with pinky side going up and back.  Pause and then slowly return to starting position. Repeat at sets and repetitions encouraged by your trainer. One can challenge this activity by holding the end of the resistance thus increasing lever.

 Finger extension -Use rubber band, hair tie, or elastic rubber band as resistance. Start with fingers in closed position (like gripping a pencil) and extend fingers out as wide as you can. This can be done with elbows bent or straight. Also, repeat at sets and repetitions encouraged by your trainer.

Gripping -Grab putty and squeeze. Don’t squeeze into sharp pain. Increase force, putty strength, and time of squeezing over time!


 
 
 
 
 
 
 
 

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July 07th, 2022

7/7/2022

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Healthy Recipe, Stout-and-Soy-Roasted Chicken with Onions 
Few foods more reliably hit the spot on a Sunday night than roast chicken. It’s as nutritious as it is comforting, pairs perfectly with any vegetable side, and makes great leftovers for the week ahead if you don’t have a family to feed. This savory rendition, adapted from “Sunday Best: Cooking Up the Weekend Spirit Every Day,” gives this classic a savory twist by allowing it to first bathe in a garlicky marinade of stout beer and soy sauce (or  tamari if you’re avoiding wheat). Serves 4-6. RECIPE HERE. – Susan Puckett
 
Ingredients
  • 1 (12-ounce) bottle of Guinness or other stout beer
  • 1 tablespoon fish sauce or Worcestershire sauce
  • ½ teaspoon ground white or black pepper
  • 6 to 8 garlic cloves, minced
  • 2 large white or yellow onions, sliced in ¼-inch rounds
  • 1 (3- to 4-pound) whole chicken, cut in serving-size pieces
  • 1 cup soy or tamari sauce
  • 2 tablespoons unsalted butter, at room temperature 
Instructions
  1. In a large bowl, combine the beer, fish sauce or Worcestershire sauce, pepper, garlic, ½ cup of the water, and half of the sliced onions (reserve the other half).
  2. Add the chicken pieces, skin-side down. Cover the bowl with plastic and place in the refrigerator to marinate for at least 2 hours and up to 8 hours, stirring occasionally.
  3. Position a rack in the upper third of the oven and.
     preheat the oven to 450 degrees.
  4. Arrange the unmarinated sliced onions on a large, rimmed sheet pan.
  5. Remove the chicken pieces from the marinade, pat them dry with paper towels, and place them skin-side up in the center of the sheet, on top of the onions. Rub the butter over and under the skin.
  6. Add 1/3 cup of water to the baking sheet and transfer to the oven.
  7. Roast for 20 minutes, baste the chicken with its juices, and continue roasting 10 to 20 minutes longer or until the skin is deep brown and crispy, and a meat thermometer registers 165 degrees when inserted into the thickest part of a breast piece.
Susan Puckett is an Atlanta-based food writer and cookbook author. 

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Healthy cookies?        July 05th, 2022

7/5/2022

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Healthy Recipe, Chickpea-Tahini Chocolate Chip Cookies

After an intense workout, you’ve earned a little indulgence. That reward need not come in the form of empty calories, however. Consider these rich-tasting, just-sweet-enough cookies adapted from “The Miller’s Daughter: Unusual Flours & Heritage Grains”  by Emma Zimmerman ($29.99).
 
Chickpea flour, now available in most supermarkets, replaces most of the refined wheat flour here, adding a layer of mildly sweet, nutty flavor and significantly boosting their nutritional value in several ways. Made by grinding chickpeas (also called garbanzo beans) into a powder, chickpea flour contains ample fiber and protein, along with a host of minerals such as iron and magnesium. Tahini, the sesame paste used in hummus, amps up the flavor and protein even more. Dark chocolate chips are lower in sugar than the sweeter varieties and can also contribute small amounts of B12 and other nutrients to your diet if eaten in moderation.
 
These cookies will be good for several days if stored airtight, but best warm out of the oven. To help you resist overindulging, you can freeze the frozen dough after scooping it into balls on a cookie sheet, transfer the balls to plastic zip-top bags, and remove a few at a time to bake whenever a craving strikes. Makes about 2 dozen. RECIPE HERE. – Susan Puckett
 
Ingredients
  • 1 ½ cups chickpea flour
  • ½ cup all-purpose flour
  • ½ teaspoon fine sea salt
  • ½ teaspoon baking soda
  • ½ cup (1 stick) unsalted butter, softened
  • 1 ½ cookies packed light or dark brown sugar
  • ¼ cup granulated sugar
  • ½ cup tahini (if it’s a little dry, stir in a splash of warm water to make it the consistency of honey)
  • 1 large egg
  • 1 teaspoon vanilla extract
  • 2 tablespoons water
  • 1 cup dark chocolate chips
  • Flaky sea salt for sprinkling 
Instructions
  1. Adjust a rack to the middle of the oven. Preheat the oven to 350 degrees. Line two large cookie sheets with parchment paper. 
  2. In a large bowl, whisk together the chickpea flour, all-purpose flour, salt, and baking soda.
  3. In the bowl of a stand mixer fitted with the paddle attachment, combine the softened butter, brown sugar, and granulated sugar and blend on high speed until creamy.
  4. Turn off the mixer and add the tahini, egg, vanilla, and water. Return the speed to the high setting until the mixture is pale and fluffy.
  5. Reduce the speed to low and slowly add the flour mixture, blending just until well combined.
  6. Stir in the chocolate chips. Scoop out balls of dough the prepared cookie sheets, about 12 per sheet, setting them at least 2 inches apart.
  7. Chill in the freezer 5 minutes to reduce spreading in baking.
  8. Place one of the cookie sheets on the middle rack of the oven and bake for 15 minutes, or until lightly browned around the edges and puffed in the center.
  9. Remove the cookies from the oven and give the sheet a tap on the countertop to flatten them. Sprinkle lightly with the flaky sea salt while warm, let cool in the pans for 10 minutes, then transfer to wire racks to cool completely.
  10. While the first batch of cookies cools, place second batch in the oven and repeat.
  11. Store cookies in an airtight container for up to 3 days.
Susan Puckett is an Atlanta-based food writer and cookbook author.

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July 04th, 2022

7/4/2022

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Time is tiking…do you want to continue down this path or prefer a new story where you have some control? Tick tock…
 
               As well all know, aging is often associate with a reduction in ____________. Yes, basically we can fill that blank in with muscle mass, endurance, balance, strength, power, mobility, and many other things that can affect our quality of life as well as our independence. While we may have little control over some aspects of aging including things like genetics, we can influence our epigenetics to a certain point by continuing to stress our bodies! Yes, we need to continue to stress our biology for it to continue to adapt. Without any stress, everything in our biology can get weaker and or “get pruned”, with the old adage “if you don’t use it, you lose it” ringing true.
 
            But how? Start small! If you are doing nothing now to stress your body, then doing simple things such as going on small walks (even 3-5 minutes is better than nothing), marching in place, standing more, taking the stairs, get in and out of the chair 5 times in a row, standing on your tippy toes, and many other things one can potentially do depending on your starting point. It really doesn’t have to be that complicated and we can often do this in the comfort of our own home!
 
            Don’t know where to start? Afraid you might get hurt? One can completely understand the hesitancy to get a program going. It could start with working with a personal trainer that has the biological and psychological experience and understanding to work with a population of people who may have not had much movement in years! Let us guide you safely to help improve your strength, mobility, power, and balance so you can regain your independence to continue your journey! When would you like to start?
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One year Hip Replacement Anniversary-​Quick Collection of thoughts

5/11/2022

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​Today is May 11, 2022 and it is one year since my hip replacement. I had some Right hip pain off and on for bits of my life and around 2016, my hip had a sudden sharp pain while walking my dog and she lurched on the leash to my right. From that moment on, pain would come and go but it steadily got worse despite my own physical therapy knowledge, exercise, truncating my activity level, and using other things such as heat and or ice. It got to the point where I had trouble sleeping, had trouble walking without pain and a limp despite using two walking sticks, and it began to affect my daily life on a consistent basis.
 
​A PT colleague of mine (a few of them actually) knew that I needed a hip replacement and I also knew but had a lot of fear of the procedure. This despite me having helped rehab and post rehab hundreds of these surgeries and knowing their success. It is a medical “miracle” and most hip replacements are very successful. I’m thankful to my colleagues for pushing me in the direction of getting it done.
 
​Dr Garcia in Sante Fe New Mexico was the surgeon I choseand I opted for an anterior approach hip replacement. I do know that after one year, it doesn’t matter all that much of the approach as the outcomes are similar. With that said, I really didn’t want to entertain the posterior hip precautions and wanted a quicker recovery. The surgery was an ultimate success. I had some pretty intense pain post surgery but after a few weeks, I was already back to walking distances with very little to no pain. 
 
​I did my own PT which shouldn’t be much of a shock. I’m a big believer in the power of movement including strengthening, working on balance, and general stamina. If you don’t do your PT, you will not recover as fast and it’s much more difficult to getting back to life again!
 
​As a mobile personal trainer who specializes in the senior market, if you’ve had your hip replaced, did your Physical Therapy, were discharged (or about to be), and would still like to get stronger, work on your balance, and enhance your ability to achieve bigger goals, then give me a call. I’d like to help get you to the next level of your journey!
 
PS…please forgive my not so well written post. I wrote it quickly and wanted it to read like I was talking directly to my audience. 😊



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May 09th, 2022

5/9/2022

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Weight Shifting for Better Balance

5/8/2022

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                                                                        Want better balance? Try this…


     I’m often asked what are some simple things to help improve someone’s balance. I often hesitate to respond quickly because the answer it usually, it depends. The answer is often population specific as well as task specific. Meaning that improving someone’s balance goes deeper than just having them try generic things such as thinking everyone will benefit from just standing on one leg. With that said, how am I going to actually write a blog on how YOU or your loved one can potentially improve your/their balance by reading this post?

     Balance is controlled by three major systems in the body. The systems include vision, vestibular system, and the proprioceptive system. All three can potentially be great targets to attack when trying to help someone improve their balance. Like all systems in biology, they tend to not perform as well as we age. Our vision becomes less sharp and often affected by low light situations as we age. Likewise, our vestibular system and proprioceptive system as well tends to not perform as acutely as we did when we were younger. Along those lines, as we age we often STOP doing activities because of many reasons. And, one of the primary reasons that these systems don’t work quite as good is because we stopped challenging them! We all know the use it or lose it phenomenon and our biology PRUNES what is doesn’t use. Neuroplasticity works at any age thankfully and you can improve your balance at any age as well. You just have to challenge it and challenge it at the right level consistently. I will write more articles on others ways to improve balance including topics such as getting stronger, improving power, enhancing mobility, and working on timing/coordination because all of things are crucial in keeping our two legged selves from meeting the earth and damaging precious bones and egos!

    This routine I’m about to explain can be done by anyone. It’s one of the basics I like to start with and it may seem even to easy for some of you. If that is you, then continue to work on it but perhaps challenge yourself by S L O W I N G the movement down even more and coordinating it with your breath to that you can make it into a type of moving meditation which can be of great benefit to all of us.


Weight shifting routine (Side to Side)

 1.    Stand up
 2.    Feet can start in shoulder width position. If you feel unsteady, please either have a spotter or do this in the    corner of a room (kitchen counter corner may work ideally) so that you have protection from a wall/counter to help keep you safe.
 3.    Slide bend in your knees, hands by your sides or on your hips, shoulders relaxed, and eyes on the horizon. 
 4.    Focus on the PRESSURE through the bottom of your feet.
 5.    Notice if you have more weight in the left foot or the right foot and remember, you are just observing not   judging.
 6.    Notice if you have more weight on your toes, heels, or if it is spread evenly.
 7.    Take time with the above before proceeding…don’t rush it!
 8.    I want you to know imagine that your whole pelvis, trunk, shoulders, and head is ONE unit…think of a large pot of water and you don’t want to spill any of the water.
 9.    Shift your weight to the right foot and FEEL the weight transfer to the right while you keep your “pot of water” from spilling. It’s common for us to want to dip the shoulders or pelvis down…don’t do that!
 10.    Shift your weight to the left and again, focus your attention on the weight transferring to the left while everything above your hips stays absolutely level. Repeat several times until it feels natural. This might take some of you a lot of practice as it may feel very awkward.


                                                                Weight shifting routine (forward/backward).
 1.    Stand up
 2.    Feet can start in shoulder width position. If you feel unsteady, please either have a spotter or do this in the corner of a room (kitchen counter corner may work ideally) so that you have protection from a wall/counter to help keep you safe.
 3.    Slide bend in your knees, hands by your sides or on your hips, shoulders relaxed, and eyes on the horizon. 
 4.    Focus on the PRESSURE through the bottom of your feet.
 5.    Notice if you have more weight in the left foot or the right foot and remember, you are just observing not judging.
 6.    Notice if you have more weight on your toes, heels, or if it is spread evenly.
 7.    Take time with the above before proceeding…don’t rush it!
 8.    Shift your weight forward towards your toes by bending through the ankle joint. Don’t lift your heel but you will notice the pressure in your heel becomes less.
 9.    As you are shifting forward, your pelvis, trunk, and head should stay as level as possible. It’s common to bend at the waist or hips…don’t do that! 
 10.    Shift your weight backward through the arch and back toward the heels. Keep your toes on the ground but you should feel the weight go from toes to the heels. Now, many of us don’t have the resources to catch ourselves so be careful and consider either a spotter or a wall behind you to catch yourself if you get into trouble.
 11.    Repeat the above for a few minutes until it feels natural.



                                                                                           Summary

     You’ve learned a very valuable and elementary step in improving balance. This is one I often start with depending on the population and have used this in many different settings from personal training to physical therapy clinics. This weight shifting uses ANKLE strategy which is a crucial first step in our two legged creatures ability to stand and adapt to our environment. Without this ankle strategy, we are easily more prone to having our balance disrupted and relying on hip strategy, arm strategy, and stepping strategies to keep us upright. Of course, those other strategies are very important as well but I’d argue starting with ankle strategy is so important to begin with and akin to learning your numbers before learning how to multiply and divide in school. Please reach out if you have any questions and share the info with others who could benefit! Stay safe and remember to practice with a partner or in a area of your home where you are protected and want trip, slip, or fall on anything hard and you can use your hands to grab or reach if needed.
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What is balance?

5/1/2022

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                                What is balance?

     Balance is being able to control our bodies in space despite what’s going on in the world around is. Many of us as we get older begin to lack the adequate mobility, strength, power, and coordination to control ourselves in many environments and can put us at greater risk of falls. Many falls are preventable and gaining better strength, power, coordination, mobility, and working on a balance can help improve your odds as well as allow you to get back to doing what you enjoy!
               
​                    
You can improve your balance at ANY AGE!


                    Facts About Falls according to the CDC     
     Each year, millions of older people—those 65 and older—fall. In fact, more than one out of four older people falls each year, but less than half tell their doctor. Falling once doubles your chances of falling again. In New Mexico, over one in four adults (29.6%) age 65 and older, report falling each year.

Falls Are Serious and Costly
  • Each year, 3 million older people are treated in emergency departments for fall injuries with 20% causing serious injury including fractures.
  • Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.
  • Each year at least 300,000 older people are hospitalized for hip fractures.
  • More than 95% of hip fractures are caused by falling,8 usually by falling sideways.
  • Falls are the most common cause of traumatic brain injuries (TBI).
  • In 2015, the total medical costs for falls totaled more than $50 billion.11 Medicare and Medicaid shouldered 75% of these costs.

     I don’t mention these facts as a way to make you fear more as I don’t believe changing one’s weaknesses and behavior is best done by creating more fear. I do, however, want to empower you that YOU can improve your balance at any age, if you are willing to put in the work and the time!

     If you are wanting to work with a 
personal trainer that has the skills, experience, and tools to help you improve your balance so you can continue to do the things you want to do or improve or at least maintain your independence, then we should talk! I can help you get back to not fearing activity again. Life is an adventure… how can I help you continue yours?
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My Hip Replacement

5/19/2021

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One week out from hip replacement:

     Well, I guess I can now call myself bionic. On May 11, 2021, I had my right hip replaced by Dr. Garcia and his team up in Santa Fe. He performed the anterior approach which I wanted because there are less precautions overall and a slightly lower just dislocation rate. Overall, my experience at the facility was very good. The place is extremely clean and everyone was very professional, very caring, and often times humorous which I like. My anesthesia did not wear off as intended it seems and had some issues maintaining consciousness while trying PT the day of the surgery towards the end of the afternoon. We gave up and I wasn’t able to resume PT until the next day. Anesthesia can be a tricky thing at times it seems and it is what it is. I was discharged to the very next day around 2:30 PM and came home hungry for pizza!

I think I underrated how big of a surgery this is and had expectations that were not warranted regarding how I would feel after surgery. The pain was way more intense than I thought it would be. I’ve had difficulty sleeping because of pain and being uncomfortable. Ive also had the typical fog and poor mental clarity secondary to narcotic use as prescribed from the Doctor. I have a newfound respect for people that go through the surgery and other surgeries as I work with people after surgery in a outpatient clinic. I hope to utilize this newfound empathy to be a better PTA.

I have been working on my own physical therapy which I’m totally cool with. I was evaluated by a home health company and found I have progressed far enough to not need their services. The PT thus far is been pretty basic with mostly supine activities and walking. I’m not gonna lie, even getting my right leg on the bed it was a great challenge and still is. My hip flexor strength has really decreased quite a bit As well as my abduction strength. This is pretty much to be expected as the body is still in ‘protect mode”. My quadriceps strength is definitely improving and getting range of motion from extension to flexion back, although it’s still quite limited. I don’t have any of the typical posterior approach hip precautions but I still have pain much beyond 90° of hip flexion whether it’s active or passive at this point. Also, pain with rotation and still unable put on my socks without assistance or use of a device. That’s frustrating to say the least but will change over time. My gait has improved quite a bit and I’m able to ambulate with crutches or a walker was a heel to toe pattern and nearly equal stride length as long as my weight is supported enough. Pain limits the ability to walk without an assistive device and I listen! It’s sharp!

Its time for a nap, so sorry for the sudden stoppage. I also apologize for the typos and the less than high school writing style here. I’ll blame the narcotics. I will write more later and have more photos. Please comment or ask questions if you’d like.

:)
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April 18th, 2021

4/18/2021

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My upcoming hip replacement…

Date of Surgery: 5/11/21
What: Right anterior hip replacement
Surgeon: Dr. John Garcia in Sante Fe, NM
Why: I've had some sharp pains as a child and into my teens and as an adult. Just over 4 years ago while walking my dog Keeta, she took off to the right of me and caught me off guard. My right hip went into relative internal rotation and I felt a very sudden and sharp pop with pain. The pain said at a high intensity for several months. It did calm down a bit so I did have a few months within the first year that were not that bad. Over the last two years though, my ability to do things I enjoy have slowly eroded. In the last year, even basic ADL's such as standing and walking have become problematic. Even sleeping is painful most nights and I have more bad days vs good days. The time has come to get my life back. I'd like to be able to:

Hike again
Run again
Slackline again
Teach 3d Yoga again
​

I can still deep squat ass to grass and I hope to maintain that!

Im hoping to monitor my progress and keep you all posted during my rehab!
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November 18th, 2014

11/18/2014

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What is balance?

BALANCE IS NOT STATIC…IT’S CONTROLLING MOTION


So there you are comfortably sitting down reading an article on balance and stability. I’m truly am quite thrilled that you are interested in this topic, but sitting down while reading this will simply not do, so please stand up and get ready for some movement! From the words of Physical Therapist Gary Gray, “If you want to learn to dance you must get off of yours pants!”

Ok, that is much better. This is the first of a four part series of articles to touch upon a popular and important topic, balance. This first articles focus is to shed light upon the basic principles of what keeps us upright and doing the activities we desire to do. In this piece, we will very briefly discuss the basic sensors that detect our surroundings and help us control our bodies against gravity. Next, we’ll discuss some of the common misconceptions about balance training that appears to perpetuate themselves in many programs. Finally, we will go over a few quick exercises to try that are “balance” oriented.

In opening, we thoroughly take it for granted, but our bodies are amazing machines. In order to survive and thrive we have a vast network of systems (such as the cardio-respiratory, nervous, endocrine, etc) working in harmony constantly.In order to move about our surroundings, we must use our nose, ears, eyes, vestibular system, and proprioceptive systems to take information in and to somehow use it to move through our environment seamlessly. We will focus on the proprioceptive system in this short article.

The proprioceptive system can be thought of as an extensive network of sensors that assist in detecting what is going on in our surroundings and gives us the ability to quickly react and take action. These various proprioceptors can be found in skin, fascia, ligaments, joint capsules, tendons, and muscles. They all work together to detect strain, pressure, pain, position AND motion (movement turns them on the most) of skin, muscles, and joints at any given moment. These detectors collect data, interpret it, and perform a response typically before we even know about it. The fact that most of the network of sensors in our body is mostly subconscious is of extreme benefit to us. Just the simple act of walking across the room would be nearly impossible if we’d have to try to interpret all of that information as it was coming in.

Next, lets build a brief foundation in order to understand what are some common misconceptions regarding balance training. Most of us have heard the phrase “I need to work on my balance” or “My trainer is working on my proprioceptors.” Since our bodies are CONSTANTLY receiving information, everything is proprioceptive. Plus, the more we are moving, the more information we are receiving from ALL body sensors! This is why trying to work on balance by being still or static is not very effective.A better question would be: “How do I work my proprioceptive system best?” That all depends on what our goal is. For example, if my objective was to be able to navigate across a crowded street with curbs and potholes that would certainly be a different task then if my goal were to have better balance after a ballistic tennis serve. Our training should be geared for the task. Remember balance is never static. Balance is controlling motion! We can look at it as the bodies ability to sense motion going in one direction, decelerate to a stop, then move us into another direction(Transformational Zones--Gray Institute Credit for this), only to do it all over again. These transformation zones occur in every activity and are the key to improving balance or an even better word, function.

I went a very long way in order to finally come back and mention a couple of misconceptions of balance training. The following are popular yet misleading:

*Static standing on one leg.

*Standing on wobbly boards or discs.

Doing various exercises standing on one leg or working on unstable surfaces are tools that have their place, but should be used appropriately! Why? How often do you truly ever stand statically on one leg? In real life, how often do you stand on an artificial unstable surface? Remember, you are teaching your body constantly how to react and respond. Balance training on unstable objects is tools that we should tweak into our program to add variety once we’ve mastered the ability to decelerate our own body weight against gravity and ground reaction forces, and the utilization of momentum to our advantage.

So now you may be wondering what are some simple exercises that you can do today to help improve dynamic balance for tomorrow? By now, you should know that there are millions of exercises, maybe even billions! This is why I had trouble narrowing it down for such a broad audience, but I realize I have to put something on paper, so here goes! Since you are standing let’s get to it! For those of you who are visual learners, I posted this video on my YouTube sight at:

http://www.youtube.com/watch?v=k5qhEbfk1uU www.

Exercise #1

1. Keeping your feet shoulder width apart, step your right foot forward about 2-3 feet in front of the left. Your feet are pointing forward.

2. Take your hands and reach down for your feet as if you are going to tie your shoes. (Allow your knees to bend if you like)

3. Then reverse direction and take your hands as high overhead and behind you as possible. Repeat! To challenge this you can narrow the stance, go faster, close your eyes, etc.



Exercise #2

1. Same stance as above, places arms overhead with an emphasis on lifting your ribcage.

2. Allow arms and trunk to rock side to side as far to the left and as far to the right as possible. To challenge this you can narrow the stance, go faster, close the eyes etc.

Exercise #3

1. Same stance as above, place arms overhead with an emphasis on lifting your ribcage.

2. Circle the arms pelvis and ribcage around as if you have a hula-hoop around your hips Increase the range and the speed to challenge.

So how do you feel after those simple movements? For many of you, you were obviously way below your threshold for success. On the other end of the spectrum, there may be some of you seasoned citizens who had difficulty with these exercises and you felt quite unstable. We will address BOTH ends of the spectrum in the upcoming articles.


In conclusion, balance training is a very complex endeavor that must be addressed specific to the needs, abilities, and goals of the client. There is no cookbook approach that works for everyone, so we must learn to think out of the box. We are three-dimensional creatures, and once we start working with clients with a chain reaction mindset we can have a dramatic affect on function! Email me with any questions, and I look forward to digging deeper into this topic next time!
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Multiple Sclerosis--What is it? Is movement beneficial?

11/18/2014

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Multiple Sclerosis--What is it? Is movement beneficial?

The human organism is truly an amazing machine. We are brilliantly designed in our architecture and function. All to often, unfortunately, things go awry for various reasons and the once perfectly functioning body ceases to operate at the same level it once did. This is the case for many diseases including Multiple Sclerosis. Multiple sclerosis (or M.S.) is a condition that attacks the myelin sheaths of the Central Nervous System (CNS). This essay will focus on what Multiple Sclerosis is, the possible causes and risk factors that can lead to one acquiring MS, and how movement may help improve the function and decrease the symptoms of people with this condition.

            Multiple sclerosis is an autoimmune disease in which myelin sheaths of nerve fibers degenerate. The myelin sheaths responsibility is to insulate the nerve fiber which speeds along transmission of impulses from the periphery to the brain and vice versa. With a deteriorating myelin sheath, communication through the nervous system is not as effective as the nerve signal is slowed or stopped thus affecting multiple organs and organ systems. Additionally, M.S. is considered a chronic, inflammatory disorder of central white matter (7) with a prognosis that can vary from asymptomatic to severe disability to death.  Briefly, there are four types of M.S. that are known to researchers. Most people (~85%) who have M.S. have what is known as Relapsing Remitting Multiple Sclerosis (RRMS). RRMS is characterized by periodic immune attacks against the white matter of the CNS. Quite often, people with RRMS develop what is known as Secondary Progressive Multiple Sclerosis (SPMS). SPMS tend to have fewer episodes of acute attacks but more of a steady chronic attack against the CNS. The most uncommon form (~5%) of M.S. is referred to as Progressive Relapsing Multiple Sclerosis (PRMS) which is similar in nature to Primary Progressive Multiple Sclerosis (PPMS). PPMS is the most difficult to treat and characterized by a steady onslaught of attacks (15). Symptoms vary greatly amongst people diagnosed with MS. As stated above, some people are completely asymptomatic, but that is rare (15). Possible symptoms of M.S. include balance disturbances, muscle spasm, gait and limb function disorders, numbness, coordination issues, tremors, weakness, bowel malfunction, bladder issues, visual disturbances, pain, hearing loss, dizziness, vertigo, decreased attention span, depression, speech and swallowing symptoms. (12,15) As one can see, the effects of MS are systemic and can affect activities of daily living in a profound way. 

            So what are the risk factors for acquiring Multiple Sclerosis? So far, women have approximately twice the risk of being diagnosed, as the disorder tends to be diagnosed between the ages of 20 and 40. There also might be a genetic tendency as a risk factor, but it’s not a very strong one if isolated from other co-factors. In addition, Caucasians tend to have the highest risk especially if they originated from the northern latitudes of Europe. M.S. seems to be much more uncommon amongst people living closer to the equator (13). Finally, multiple sclerosis is much more common in certain geographical regions such as northern United States and Canada, Europe, Southeastern Australia, and New Zealand (12) which highlights areas that are further away from the equator and exposed to less UV light.

            Moving beyond risk factors, multiple sclerosis definitive cause is a bit of an ongoing mystery, Currently, researchers believe there are multiple variables involved. Some scientists believe that there is a link with geography of the northern latitudes and ones genetics, which may cause an epigenetic risk that might alter gene expression. With less UV light exposure, there may be a lower tendency to make Vitamin D and this might put some people at greater risk (8). Another possible cause of M.S. includes Epstein Barr Virus and smoking (Pubmed). Both of which can alter mitochondrial DNA and possibly affect the immune system. Finally, some researchers point out that M.S. is a possible mitochondrial disease although the mechanism is unclear at this point (7). As with most disease processes, more studies need to be done to narrow down the risk factors as well as the scope of variables at play.

            So what is the typical treatment of Multiple Sclerosis? Since M.S. has no current cure, there are a few pharmaceutical grade drug options that patients can chose that may help slow the progress of the disease and to possibly help mitigate the symptoms of M.S. attacks. Treatment for attacks generally includes corticosteroids, which help lower inflammation and severity of attacks especially during spikes. Next, since this can and often leads to being a progressive disease, drugs that help slow the progress of it includes beta interferon’s, Tysabri, Gilenya, Copaxone, and Mitoxantrone. Thirdly antidepressants may be used to help quell various mood and behavioral symptoms including depression. Finally, Baclofen, Zanafelx or benzodiazepine may be used to control muscle spasms. Of course, many of these pharmaceutical drugs have major side effects. Some of which include liver damage, nausea, and can cause damage to the heart among other systemic complications. Not to mention they drugs can be very expensive. So unfortunately, taking pharmaceutical drugs is often a double edge sword (12).

            Since pharmaceutical grade medications may contribute to some harsh side effects, many people with M.S. turn to alternative and complimentary modalities to help possibly slow the progress of their disease as well as to help manage symptoms. Physical therapy, yoga, tai chi, balance training and resistance training are all modalities that have some research behind them. We will briefly summarize them. Physical Therapy (Chiropractors may also manage care in a similar fashion) is a medical science that uses a hand on approach to deal with many orthopedic and neurological conditions. For M.S. patients, the goal is helping to lower the symptoms of pain, improve balance, enhance strength, and decrease muscle spasms. Physical Therapy (P.T) can lower thresholds of pain by introducing novel and non threatening stimuli that can help down regulate the perception of pain from the cerebral cortex. Next, Physical Therapy may also introduce strength and balance training that is important in maintaining functional capacity of people suffering from M.S. Additionally, Physical Therapists may introduce electrical stimulation, which can help improve functional gains and decrease muscle spasm. Finally, Physical Therapists can fit and discharge patients with various kinds of orthosis depending on functional needs of the patient; especially as it pertains to gait improvement (1,2,5,10,11).

            Going a little bit deeper with resistance training, researchers have tried to find out what parameters of strength training work best. While, research is still on going there are a few interesting items to consider. It seems that heat sensitive persons with M.S. are more tolerant to resistance training as compared to endurance training (cycling, biking, etc). Since heat sensitivity is reported by nearly 60% of people with M.S, it’s good to be aware of training modalities that won’t have a tendency to exacerbate symptoms (14). Next, strength training with an emphasis of resistance at 50-70% of maximal voluntary contraction and repetitions in the 5-12 range has been shown to improve muscular strength and enhance functional capacity. Finally, relatively short sessions are encouraged as to not increase core temperature of the body especially for heat sensitive persons. More research is needed as far as more specific parameters, which includes time under tension, volume of exercise, repetition range, rest between sets, complex and dynamic vs. machine based, and how many sessions per week. There is much to learn. (3,4,11)

            Finally, mind body modalities such as Yoga and Tai Chi have also been reported in the literature. Both Yoga and Tai Chi have shown to help lower pain, improve balance, enhance mobility, and increase the function of participants (1,6,9). As with resistance training, mind body modalities still need more research especially with coming up with better parameters of what kind of Yoga and Tai Chi works best, how much, and progression of these two ancient arts (1,6,9). It’s also possible that it is case dependent and an N=1 might tell us more than large group studies. The future looks promising as long as we keep asking questions.

            In conclusion, Multiple Sclerosis is thought of as an autoimmune condition in which the body attacks the myelin sheaths of the central nervous system. Multiple Sclerosis affects numerous organ systems and it currently has no cure. While medications can help manage symptoms they come at great financial cost and often have side effects that are harmful. It has been shown in many studies in the literature that mindful movement, resistance training, and balance training can be beneficial in helping manage symptoms and potentially slow the progression of the disease. More research is needed to pinpoint exact parameters and help slow the rate of acquiring this disease via public prevention programs.


  Bibliography

1. Cattaneo D, Jonsdottir J, Zocchi M, Regola A. Effects of balance exercises on people with multiple sclerosis: a pilot study. Clinical Rehabilitation. 2007: 21; 771-781.

2. Coote S, Garrett M, Hogan N, Larkin A, Saunders J. Getting the balance right: a randomized controlled trial of physiotherapy and Exercise Interventions for ambulatory people with multiple sclerosis. BMC Neurol. 2009;9:34.Garrett M, et al. 

3. Dalgas U, Stenager E, Jakobsen J, et al. Resistance training improves muscle strength and functional capacity in multiple sclerosis. Neurology. 2009;73(18):1478-84.

4. Eftekhari E, Mostahfezian M, Etemadifar M, Zafari A. Resistance training and vibration improve muscle strength and functional capacity in female patients with multiple sclerosis. Asian J Sports Med. 2012;3(4):279-84.

5. Garrett M, Hogan N, Larkin A, Saunders J, Jakeman P, Coote S. Exercise in the community for people with minimal gait impairment due to MS: an assessor-blind randomized controlled trial. Mult Scler. 2012.

6.Husted C, Pham L, Hekking A, Niederman R. Improving quality of life for people with chronic conditions: the example of t'ai chi & multiple sclerosis. Altern Ther Health Med. 1999;5(5):70-4.

7. Mao P, Reddy PH. Is multiple sclerosis a mitochondrial disease? Biochim Biophys Acta. 2010 Jan;1802(1):66-79. doi: 10.1016/j.bbadis.2009.07.002. Epub 2009 Jul 14.

8.Munger KL, Ascherio A. Prevention and treatment of MS: studying the effects of vitamin D. Department of Nutrition, Harvard School of Public Health, Boston, MA 02115. Mult Scler. 2011 Dec;17(12):1405-11.

9.  Oken BS, Kishiyama S, Zajdel D, Bourdette D, Carlsen J, Haas M, Hugos C, Kraemer DF, Lawrence J, Mass M. Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurology. 2005; 62:2058-2064 

10. Physical Therapy for Multiple Sclerosis. WebMD. http://www.webmd.com/multiple-sclerosis/guide/multiple-sclerosis-physical-therapy. 11. Rietberg MB, Brooks D, Uitdehaag BMJ, Kwakkel G. Exercise therapy for multiple sclerosis. Cochrane Database of Systematic Reviews 2005;1.

12 Risk factors; Multiple Sclerosis. Mayo Clinic. http://www.mayoclinic.com/health/multiple-sclerosis/DS00188/DSECTION=risk-factors. 

13. Sharpe RJ. “The low incidence of multiple sclerosis in areas near the equator may be due to ultraviolet light induced suppressor cells to melanocyte antigens”. Med Hypotheses. 1986 Apr;19(4):319-23. 

14. Skjerbæk AG, Møller AB, Jensen E, et al. Heat sensitive persons with multiple sclerosis are more tolerant to resistance exercise than to endurance exercise. Mult Scler. 2012;

15. Understanding the Different Types of Multiple Sclerosis; WebMD. http://www.webmd.com/multiple-sclerosis/multiple-sclerosis-understanding-the-differences-in-ms. 16. Zieve David, MD, MHA. Multiple sclerosis-MS; Demyelinating disease. September 26, 2011. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001747/
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What we should know about pain science

11/18/2014

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What we should know about pain science

     There has been a paradigm shift of information that has come on to the medical and movement world as it pertains to pain science in the last 20 years. Unfortunately, most of it has not quite made it to the inner layers of academia, but the information is out there and to utilize for those of us who are interested in dealing with a huge segment of the population that needs our help. This article is written for the movement professional as an addendum to how we already treat and train our clients and patients.

BACKGROUND- 

What is pain?

      For centuries (this includes what most people think now), pain was thought to come from sensors in the skin that detected pain and were sent to the brain for us to feel and thus do something about. In fact, the famous scientist Rene Descartes highlighted this supposed phenomena with the illustration to the left.


     Unfortunately, this gross oversimplification of pain is highly inaccurate and the last 2 decades or so of neuroscience which utilizes fMRI have shown that pain is much more complex than 2+2=4.

So what is pain?

     According to world renowned pain researcher and Australian Physiotherapist, pain “…is produced by the brain after a person’s neural signature has been activated and concluded the body is in danger and action is required.” Another definition of pain comes from a brilliant Psychologist by the name of Ronald Melzack. Melzack summarizes pain as:

     “The neuromatrix theory of pain proposes that pain is a multidimensional experience produced by characteristic "neurosignature" patterns of nerve impulses generated by a widely distributed neural network-the "body-self neuromatrix"-in the brain. These neurosignature patterns may be triggered by sensory inputs, but they may also be generated independently of them. Acute pains evoked by brief noxious inputs have been meticulously investigated by neuroscientists, and their sensory transmission mechanisms are generally well understood. In contrast, chronic pain syndromes, which are often characterized by severe pain associated with little or no discernible injury or pathology, remain a mystery. Furthermore, chronic psychological or physical stress is often associated with chronic pain, but the relationship is poorly understood. The neuromatrix theory of pain provides a new conceptual framework to examine these problems. It proposes that the output patterns of the body-self neuromatrix activate perceptual, homeostatic, and behavioral programs after injury, pathology, or chronic stress. Pain, then, is produced by the output of a widely distributed neural network in the brain rather than directly by sensory input evoked by injury, inflammation, or other pathology. The neuromatrix, which is genetically determined and modified by sensory experience, is the primary mechanism that generates the neural pattern that produces pain. Its output pattern is determined by multiple influences, of which the somatic sensory input is only a part, that converge on the neuromatrix.”

     While this may seem confusing at first, it basically means that all it takes for someone to experience pain is to have a neural signature activated and it is perceived by the organism as being threatening in some way.

So what is a neural signature?

     A neural signature (or neurotag) is essentially a pattern of neural activity in the brain that allows us to put a sensory experience into a greater context.  This context is filtered through our past, emotional context of the situation, our beliefs, consequences of this experience, and whether or not we perceive the information as dangerous to the organism or not.

There is no single pain center

     The neuromatrix is where pain is perceived by humans. There is no one area of the brain. The neurosignature can be traced as a sensory experience goes from one brain region to the another for processing and then output. Brain areas that are part of the neuromatrix include:

A. Premotor motor cortex- which helps organize and prepare movement.

B. Prefrontal cortex- memory and problem solving.

C. Cingulate cortex- ability to focus and concentrate on a task.

D. Amygdala-Area where fear, fear conditioning, and addiction are processed.

E. Sensory cortex- Ability to discriminate between objects that are sensed by the periphery.

F. Hypothalamus and Thalamus- Stress response, motivation, and autonomic regulation.

G. Cerebellum- Fine tuning of movement and memory.

H. Hippocampus- Fear conditioning, memory, and spatial recognition.

I. Spinal Cord/Dorsal Root Ganglion-Acts like the bouncer. It can control the information the brain receives. The brain CAN actually control the amount of information it WANTS to receive. This can include increasing the amount of information the brain wants to hear as well as putting a damper on the information. This is important especially with hyper sensitization and CRPS for the former as well as how the bodies endogenous opiod system works in the latter.

 There is no such thing as a pain fiber

     It was once thought that (and illustrated in the Rene Descarte image) that there are pain fibers in the body in which when they are triggered, they would send a painful stimulus to the brain. While there are no pain receptors in the body, there are nociceptors that relay information to the brain regarding nociception and danger. Nociceptors relay information related to mechanical deformation of neural tissue, chemical changes, and thermal changes. This information is relayed to the spinal cord. It’s at the dorsal root where the information can be relayed via a interneuron and potentially on to a second order neuron  if the information is deemed important enough. Once in the brain, this information goes through the neuromatrix for processing and then output or in human terms, perception and experience. So in other words, “No brain, no pain” and along those lines one doesn’t need a body to experience a pain. A useful exercise I do with my patients is to have them close there eyes and picture a dog, a white elephant, and an airplane. We can clearly see without eyes. We can also clearly smell, taste, and feel (including pain) without actually getting input from a sensory organ. So it’s clear that it is helpful to communicate with patients and clients where pain comes from.

But what about chronic pain?

     Chronic pain is pain that has been experienced after 3-6 months. Most tissues heal within 6 months after an injury and thus nociception generally lessens/stops but quite often the patient still experiences pain. This is a huge population and can’t be ignored by us in the AFS (Applied Functional Science) community. It is estimated that there are 100 million adults in the US alone who experience chronic pain at any given time. This is a population that would benefit greatly from pain education and an novel approach to movement that GIFT fellows can deliver as we can tweak movements and individualize stress to tissues. 

But shouldn’t we still tell patients about their anatomy and their injuries? 

     Maybe. Maybe not. But before you do, it might be in the patients interest to tell them that 40% of the general population has a significant bulging disc but no pain. 25-50% of the asymptomatic general population has any of the following:

-Annular tears

-Disc protrusions

-Assymetrical leg lengths and pelvis, and/or spine

-Facet joint degeneration

-Foraminal Stenosis

     But wait, there is more! 35% of the population has tears in the rotator cuff, and by the time we are 70 2/3’s of us have asymptomatic tears in our rotator cuffs! Further more, there is about 50% correlation between knee pain and arthritis, while one study showed 35% of college basketball players with NO knee pain had significant damage shown on MRI.

     We are not defined only by what a radiologist can find on a scan! Tissues heal and we are more robust that we think. By GIFTing patients with a basic understanding of where pain comes from and educating them we are ahead of the curve. GIFTing patients with mental ammunition that we can have pain and no tissue damage and also significant tissue damage with no pain, we can have patients and clients who can go about their lives with less chronic pain and more FUNCTION. This “mental ammunition” would include not using words that can re-activate a persons threat response or neurotag for their pain. Words that may increase threat response include terms such as:

-Deterioration

-Wear and Tear

-Collapsing

-Dysfunction

     Instead, we could say something like: “As we age we get gray and our skin wrinkles. On the inside, things ‘gray and wrinkle’ but it doesn’t mean it has to hurt.” We already do a great job at GIFTing people with movement. By adding current pain science we are going to be only that much better with a huge patient population that needs our expertise. 

Summary

-This isn’t a either or argument. Understanding pain can only help more people in pain.

-Recent neuroscience based on fMRI have shown that pain is an output of the brain. 

-This pain is a complex experience (neurotag) that comes from many brain areas that may or may not mean there is still actual tissue damage. 

-Tissues heal, but often an organism will still feel there is a perceived threat and hold on to a neurotag of pain much like a computer keeps playing the same program over and over again.

-Chronic pain is pain that persists after 3-6 months after healing of tissue.

-Chronic pain means we are dealing with more than just tissue and pain science education is very helpful at more quickly mollifying pain perception.

-We are in a place where we can use AFS plus pain neuroscience to affect ~100 million people

-Keep up the great work!

Case Study 
    Female patient of 55 years of age. Comes to clinic complaining of full body pain of 8/10 especially pain the back, neck, and shoulders. Owner of the clinic evaluated her and was unable to get much information as the patient had panic attacks and generally fearful of movement secondary to increasing pain and fear of increasing pain. X-ray and MRI negative. Major diagnosis as per referring MD is obesity, Fibroymalgia and Chronic Fatigue. She also has experienced PTSD as she was a victim for 20 years of violence from her now deceased husband.

     Upon first visit with this therapist, patient was waiting in waiting room and extremely anxious. In fact, her daughter said her mom was just about to leave secondary to increased anxiety and pain at 8/10. This therapist, approached and sat with patient and talked in a quiet and non threatening voice and small talked with patient for a few minutes. Then, this therapist asked the patient what she wanted out of therapy and how to proceed. She said she wanted to walk on the treadmill. So we did. 5 minutes forward and 5 minutes backward which decreased her perception of pain to a 5/10. We did a few other simple exercises including sit to stand, and played catch with a lightly weighted medicine ball on the rebounder. After 30 minutes of treatment which only included movements she wanted to do, her pain was a 2/10.

     Patient was seen twice a week for 4 weeks. During this time, the patient was felt to be in charge of her treatment with this therapist being a facilitator. I talked about pain and where pain comes from and why we have pain and how it can be managed without medication. The patient understood and slowly started to be able to do more and more with her ADL’s. By week two she was cooking and cleaning around her house by herself which she has not done in a long time. She drive independently by week 3 which is something she has not done in 2 years. By week three she walked outside in her neighborhood independently which was also new to her. By discharge, patient was eager to join a gym and continue her own therapy. By this time, patient’s pain level around the house was no more than a 2/10 which occasionally went to 0/10. This is remarkable as the patient had chronic and severe pain for over a decade that medications couldn’t quell. It was the down regulation of the perception of pain utilized via chronic pain education, putting client in charge of her therapy, and simple functional movements that helped patient the most it seems.
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Bibliography

1.http://www.ncbi.nlm.nih.gov/pubmed/11780656

J Dent Educ. 2001 Dec;65(12):1378-82.

Pain and the neuromatrix in the brain. Melzack R.

2.http://www.ncbi.nlm.nih.gov/pubmed/22814445

Phys Ther Sport. 2012 Aug;13(3):123-33. doi: 10.1016/j.ptsp.2011.12.001. Epub 2011 Dec 27.

A neuroscience approach to managing athletes with low back pain.Puentedura EJ1, Louw A.

Resources for more information.

http://www.bodyinmind.org

http://www.noigroup.com

http://www.iasp-pain.org

http://www.ispinstitute.com







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