3 Balance Exercises to Help People with Osteoporosis

Your chances of suffering a fracture from osteoporosis increase with age and if you are female.  Many fractures lead to immediate pain.  Other fractures go unnoticed at first and slowly lead to increasing pain and disability over time. Falls are a leading cause of fracture in people with osteoporosis.  Even a minor fall can fracture a weakened and susceptible bone.  This article teaches you how to get started with balance exercises so you don’t have to worry about falling.

A Proven Way to Decrease Your Fear of Falling and Improve Balance

A recent study supported by the International Osteoporosis Foundation and the National Osteoporosis Foundation investigated the effectiveness of exercise in 149 women with osteoporosis.  These women were all 65 years and older.  All had sustained a previous spine fracture.

Half of the women performed a 12-week exercise program of strength training and balance exercises.   These women met twice per week for a one-hour group exercise class.  The other half of the research participants performed no exercise for the 12-week study period.

The women who performed the 12 weeks of exercise showed significant improvements in several areas.  Balance scores, sit-to-stand time, arm strength, and fear of falling all improved in the exercise group.  The group performing no exercise showed no improvement in any of these areas.  These results suggest women with osteoporosis benefit from an ongoing exercise program that includes both strength and balance exercises.

3 Simple Balance Exercises for Osteoporosis to Help You Start

Balance exercise is performed along with strength training.  Squats, step-ups, and lunges are great exercises to build strength, bone density, and improve your balance.  However, you also want to work in exercises that are specific to balance.  These should be done at least 2 to 3 days per week.

We recommend you start with static balance exercises.  These are exercises where you are standing in one place.  It is easy to do these near a chair or wall just in case you become unbalanced.  Common exercises are single-leg standing or standing in tandem with 1 foot in front of the other.  Perform these exercises with at least 10 second holds.  Work up to 30-second holds for at least 3 repetitions on each side.

After you master the static balance exercise, start moving a little more.  Dynamic balance exercises are more challenging and typical of what you will encounter during everyday activities.  An example is walking heel to toe in tandem.  Also, stepping over objects is a simple but challenging balance exercise you can do in your home.  Perform 10 steps in each direction for at least 2 to 3 sets.

Do Balance Exercises Anytime and Anywhere

You do not have to do balance exercises at a gym or at any dedicated time of day.  We recommend you incorporate balance exercise into your daily activities.  For example, balance for 10 to 30 seconds while waiting for the kettle to boil, or cooking.  During television commercials, stand up and practice tandem walking.  Try different things and stick with what works for you.

See Your Physical Therapist for a Personalized Exercise Program

Combining weight-bearing strength training with balance exercises will get you the best results.  You may have difficulty getting started.  This is normal especially if you have some fears about falling.

Many people we work with prefer to get started with the help of their physical therapist.  This is a safer approach for a lot of people who have fallen in the past.  Your therapist will guide you along until you are ready to exercise on your own.  Contact us for help developing the program that is best for your abilities and goals.

 

Knee Replacement: Improve Your Balance and Walking

Knee replacement surgery is a proven way to decrease pain from knee arthritis.  Surgery also results in substantial improvements in your walking and overall mobility.  However, surgery alone cannot restore your muscle strength or balance.  For this reason, many people who undergo knee replacement are plagued by poor balance and falls.  This article highlights several exercises to decrease your risk of falling after your knee replacement.

Avoiding Falls After Knee Replacement

A 2019 review of more than 1 million patients undergoing knee replacement showed the following factors increase your risk of falling:

  1. Females
  2. Living alone
  3. Previous history of falls
  4. Previous history of joint replacement surgery
  5. Use of pain or psychiatric medications

Proven Exercises to Improve Your Balance after Knee Replacement

A 2018 review article in Sports Medicine looked at more than 700 people undergoing knee replacement surgery.  Greater improvements in walking and balance were observed following physical therapy programs placing a greater emphasis on balance training when compared to conventional methods of rehabilitation.  Balance training also improved function and knee range of motion to a greater extent than conventional methods of rehabilitation.

Balance training

Research from the University of Pittsburgh identified specific exercises that improve your balance and walking after knee replacement surgery.  5 of these exercises are described in this article. They can be easily performed in your own home or under the guidance of your physical therapist.

For the best results, perform balance exercises daily.  At a minimum start with 3 times per week.  These exercises will only take you about 20 minutes to perform. For safety, perform each exercise close to a wall or counter in case you need some extra support.  It is best to wear sneakers or walking shoes while exercising.

Side Step Walking

Stand facing a wall or counter.  Space your feet about 2 inches apart with your toes pointing straight ahead.  Focus your eyes forward with your head up.  Walking with your head down and eyes on your feet is one of the early signs of a balance problem.

Take 5 small steps to the right.  Do not allow your feet to touch.  Keep your chest and shoulders up.  After 5 steps to the right, take 5 steps to the left.  Perform 5 laps right to left and left to right.

Shuttle Walking

Walking with changes of direction can be challenging for people with balance problems.  The shuttle walk helps with this problem.  Place 4 cones or objects (shoes are fine) on the floor about 5 to 10 feet apart.

Start at the first cone and walk to the second cone.  Stop at the second cone and then walk backwards to the first cone.  Next, walk to the third cone.  Stop.  Walk backwards to the first cone.  Finally, walk to the fourth cone.  Stop.  And walk backwards to the first cone.  Complete this cycle 5 times.

Carioca Walking

Carioca’s are a progression of the sidestepping exercise.  With this exercise, alternate front, and back cross-over steps.  It is best to start holding on to a counter or wall until you become confident with this exercise.  This exercise requires adequate flexibility in your hips and legs.  If this is a problem for you, incorporate some stretching exercises into your routine.

Toe and Heel Walking

Stand on your tiptoes.  Walk forward 10 steps without allowing your heels to touch the floor.  Turn your body around and try walking on your heels for the same 10 steps.  Do not allow your toes to touch the floor. Perform 5 laps each on your toes and heels.   If this is not difficult for you, try walking backward on your toes and backward on your heels.

Tandem Walking

You may notice that your feet have become spaced further apart when you walk.  A wide base gait pattern is one of the early signs of a balance problem.  Tandem walking corrects this.

Stand near a wall or counter.  Walk with a narrow base of support like you are on a “tight rope”.  Your heel of one foot touches the toes of your other foot with each step.  This is a challenging exercise.  It is okay to use one hand or finger on a counter for light support when first starting out.

Closing Thoughts on Improving Your Balance after Knee Replacement

The right rehabilitation is crucial to your outcome after knee replacement surgery.  Range of motion and strength require dedicated exercise to make improvements.  Balance training is often left out of physical therapy programs after knee replacement.  However, research shows high-intensity exercise combined with balance training is best.  The 5 exercises included in this article can get you started.  If you would like more help, give us a call.

Knee replacement
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The Best Balance Exercises for Hip and Knee Arthritis

Are you having trouble walking, climbing stairs, or standing up from a chair?  Is your knee or hip pain interfering with these activities?  Are you losing muscle strength because of painful arthritis?  Your daily activities require both strength and good standing balance. Balance problems are extremely common in people with arthritis. Balance problems lead to poor mobility and falls. If you are dealing with hip or knee arthritis, standing balance exercises are essential to improve your quality of life.

A Proven Approach: The Otago Balance Exercise Program

The Otago Exercise Program (OEP) is a proven fall prevention program for older adults.  The OEP is especially beneficial for adults 75 years and older.  A 2018 clinical trial looked at the OEP to improve balance, fear of falling, and fall risk in older adults with knee arthritis.

Older adults performed the OEP 3 times per week in their own homes.  After 6 months, people consistent with performing their exercises showed significant improvements in balance and reduced their fear of falling.  This study provides a framework to build your own home balance exercise program.

The Basics of Balance Exercise

Physical therapy for balance

Balance exercises can be easily performed in your own home or under the guidance of your physical therapist. For the best results, perform balance exercises daily.  At a minimum start with 3 times per week.

These exercises will only take you about 20 minutes to perform.  This investment in time and energy is well worth the reward.  For safety, start by performing each exercise close to a wall or counter in case you need some extra support.  It is best to wear sneakers or walking shoes while exercising.

Toe and Heel Walking

Stand on your tiptoes.  Walk forward 10 steps without allowing your heels to touch the floor.  Turn your body around and try walking on your heels for the same 10 steps.  Do not allow your toes to touch the floor. Perform 5 laps each on your toes and heels.  If this is not difficult for you, try walking backward on your toes and backward on your heels.  

Tandem Walking

You may notice that your feet are spaced further apart when you walk.  A wide base gait pattern is one of the early signs of a balance problem.  Tandem walking corrects this.

Stand near a wall or counter.  Walk with a narrow base of support like you are on a “tight rope”.  Your heel of one foot touches the toes of your other foot with each step.  This is a challenging exercise.  When starting out, it is okay to use one hand or finger on a counter for light support.

Sidestepping

Stand facing a wall or counter.  Space your feet about 2 inches apart with your toes pointing straight ahead.  Focus your eyes forward with your head up.  Walking with your head down and eyes on your feet is one of the early signs of a balance problem.  Take 5 small steps to the right.  Do not allow your feet to touch.  Keep your chest and shoulders up.  After 5 steps to the right, take 5 steps to the left.  Perform 5 laps right to left and left to right.

Carioca

Carioca’s are a progression of the sidestepping exercise.  With this exercise, alternate front, and back cross-over steps.  It is best to start holding on to a counter or wall until you become confident with this exercise.  This exercise requires adequate flexibility in your hips and legs.  If this is a problem for you, incorporate some stretching exercises into your routine.

Shuttle Walk

Walking with changes of direction can be challenging for people with balance problems.  The shuttle walk helps with this problem.

Place 4 cones or objects (shoes are fine) on the floor about 5 to 10 feet apart.  Stand at the first cone and walk to the second cone.  Stop at the second cone and then walk backward to the first cone.  Next, walk to the third cone.  Stop.  Walk backward to the first cone.  Finally, walk to the fourth cone.  Stop.  And walk backward to the first cone.  Complete this cycle 5 times.

Get Started with Improving Your Balance

Arthritis pain causes you to change your daily activities and lifestyle.  You may start to avoid long walks, avoid stairs, or limit your social outings because of pain. The more you change or reduce your activities, the weaker your muscles become and the more your balance is affected.  You can change this.  Home strengthening exercises and balance exercises are the safest and most effective ways to overcome limitations from arthritis.

If you don’t feel like you can do it alone, call your physical therapist.  The physical therapists at BSR are committed to helping you move without pain.  Exercise is the first treatment for arthritis before resorting to drugs, shots, or surgery.  We want to help you take back control of your quality of life.

Arthritis exercise
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How to Avoid Falling: Start a Home Exercise Program

More than 30 percent of people 65 and older fall each year. This increases to 50 percent for those in their 80’s.  Two-thirds of those who fall will fall again within 6 months.  Those who fall are more likely to move into a nursing home.  Worse, falls are the leading cause of injury, deaths, and hospital admissions for traumatic injuries in people 65 and older.  Falls and problems with balance will not resolve on their own.  If you are feeling unsteady or you have already experienced a fall, the time is now to do something about it.

Falls in older adults

The Answer: An Exercise Program Proven to Reduce Falls

Researchers from New Zealand developed the Otago home exercise program to reduce falls in older adults.  This fall prevention program improves strength and balance and reduces falls and fall-related injuries among older adults.  Completing the exercise program has been proved to reduce falls by an astounding 46%!  Results have been even better in adults over the age of 80.   Besides these exercises being beneficial for reducing fall risk, most participants find them enjoyable.  In fact, 70% continued exercising after one year.  This is very important because any effective exercise program must be maintained in order to sustain any benefits.

Balance Exercises within Your Own Home

The Otago exercise program is composed of strengthening exercises, balance exercises, and a walking program.  The exercises are performed 3 times per week over course of a full year.  The strengthening and balance exercises take about 30 minutes total to complete.   These can be performed at once or spread over the course of the day.

The walking program includes 30 minutes of walking at least twice per week.  If needed, the walk can be broken up into 2 or 3 smaller walks.  For example, instead of walking continuously for 30 minutes, you could spread 3 10-minute walks out over the course of your day.

The program is very flexible but is designed to become more challenging as your strength and balance improve.  The following 5 videos show examples of some of the exercises included in the program.

The Role of Your Physical Therapist

 Your exercise program is prescribed after your physical therapist performs an assessment of your balance.  This includes evaluation of your walking, ability to stand from a chair, and a four-stage balance assessment.  It is important that you start with the most appropriate exercises.  Beginning with exercises that are too easy for you will result in little improvement.  Also, beginning with exercises that are too challenging may be dangerous.  An individualized assessment helps identify the exercises which are right for you.  A list of standardized exercises is rarely effective.

After the initial assessment, you are provided with instructions for your home exercise program.  You will follow up with your physical therapist every few weeks in order to assess your progress and advance your exercises.  Your physical therapist guides you in the right direction.  However, results are dependent on your ability to remain consistent with the program.

Get Started Right Away

The doctors of physical therapy at BSR have extensive experience working with older adults who have experienced falls in the past.  Many have benefited greatly.  Still, some people attempt to justify or explain away their fall.  Some say, “The curb was too high.”  Others say, “The floor was wet.”  Denial of your balance problem only magnifies the danger.  A fall is a fall.  Once you have experienced one, no matter what the cause, your risk for another rises exponentially.  Take charge of your own balance, your health, and your freedom.  Get started with an exercise program that is right for you.  Give us a call and your physical therapist will help you begin and stay on track.

 

Neck Pain and Dizziness

Each year many people suffer from neck pain and dizziness. The number of patients who visit their doctor and the emergency room for dizziness is on the rise.  Dizziness accounts for 7% of doctor visits for people over the age of 45 and is the leading reason to see a doctor in those over the age of 65.  Most people with dizziness are looking for a straightforward diagnosis.  However,  those who present to the emergency department only receive a confirmatory diagnosis in 49.2% of cases.  The purpose of this article is to describe how a physical therapist examines a person suffering from one particular form of dizziness called cervicogenic dizziness.

Cervicogenic dizziness occurs as a result of pain originating from the neck or cervical spine. This occurs because of faulty signaling from the neck to the brain about where your head is in space.  This faulty signaling results in the sensation of dizziness. There is no gold standard test for this type of dizziness.  Instead, the diagnosis is made by excluding other causes of dizziness ranging from cardiovascular causes to metabolic causes, and inner ear causes.

Examination of the Patient with Dizziness

When performing an examination for a person with dizziness there is a 5 step process.  Part 1 includes listening to the patient’s history and determining if their symptoms are consistent with cervicogenic dizziness . Next, part 2 includes testing to see if this patient is appropriate for physical therapy.  Part 3 includes testing the inner ear. The inner ear, or vestibular system, consists of structures connecting with your brain which tell your head where it is in space.  Finally, steps 4 and 5 involve testing the cervical spine.

Testing of the cervical spine may include testing range of motion of the neck, strength of deep neck muscles, and performing a variety of special tests. These tests may include tests for motor control, the neck’s awareness of position sense and the mobility of each vertebra in your neck.  Oftentimes, an examination of one spinal vertebra (shown below) will reproduce the person’s complaints of dizziness.  A treatment plan is developed based on the results of these tests.

neck pain

Treatment of Neck Pain and Dizziness

There are various research papers showing manual physical therapy and exercise reduces neck pain and dizziness. The videos below illustrate two of these exercises.  Thankfully, research shows a year after physical therapy patients who complete these programs are able to maintain their improvements.

Final Thoughts on Neck Pain and Dizziness

Cervicogenic Dizziness is a condition described as neck pain and dizziness originating from the cervical spine. The diagnosis is made by first ruling out other problems.  Successful treatment includes manual physical therapy and exercise.  Thankfully, when a proper diagnosis is made by your physical therapist, this simple approach significantly reduces neck pain and dizziness.  Contact us today if you have neck pain and dizziness or simply have questions about which treatments are right for you.

Afraid of Falling? Try These Balance Exercises

Almost 10 million Americans report problems with balance.  About 40% of people over the age of 60 years experience problems with their balance.  One-third of adults in this age group and over half of people over the age of 75 years fall each year. Men and women are affected about equally.  Loss of muscle and changes in the vestibular and nervous systems are partly responsible for increasing falls as with age.  Thankfully you can do things to improve your balance and reduce your risk of falls.

Your eyes, inner ear, joints, and muscles all relay information to your brain.  Your brain interprets all the incoming information to determine where you are in your environment.   The brain then coordinates your response in order to maintain balance.  This is accomplished through pathways from your brain to your nerves and on to your muscles.  Existing pathways can be strengthened and new one can be created.  Performing exercise which is at an appropriate level to challenge and develop these pathways will improve your balance.  Below are 3 examples of such exercises.

Step Taps

Stand in front of a step or small step stool.  Place your hands on your hips or across your chest.  Place one foot gently on top of the step.  It is best to alternate steps with each foot.  The aim is to place the foot on the step as softly and quietly as possible without looking at your feet.  Begin by performing 10 slow repetitions with each foot.  Progress the exercise by using a higher step.

4-Square Stepping

Make 4 squares on the floor with objects such as clothing, rope, or yard sticks.  Step forward then to the side, then backwards, and then back to the starting square.  After a brief pause, reverse the direction.  Alternate directions with each reach repetition.  It is best to perform the exercise without looking at your feet.  Your stability is compromised then they head is held down.  Perform 5 repetitions in each direction.

Tandem Walk

Stand with the arms across your chest.  Step with a narrow base of support as if walking on a tightrope.  The heel of one foot touches the toes of the other foot.  Take 5 to 10 steps then pause in the narrow stance position for 5 seconds.  For a greater challenge perform the exercise both forward and backwards.  It is best to perform this exercise in a narrow hallway or near a counter in case you begin to lose your balance.

Closing Thoughts on Balance Exercises

Balance exercises must be performed frequently in order to influence your nervous system.  With consistent practice over time, balance and reaction time will improve slowly.   Don’t expect a rapid change in a few days.  In order to continue to make improvements, the challenge of each exercise is progressed over time.  Balance exercises work best when performed in conjunction with strength training.  See your physical therapist to determine which exercises are best for you.

 

Fall Prevention: Strength Training Reduces Your Risk of Falling

More than 1 of 4 adults, 65 years and older, fall each year.  Falling once doubles your chances of falling again.  One out of 5 falls causes a serious injury like a broken bone or head injury.  Falls are responsible for more than 95% of hip fractures.  One in 5 hip fracture patients dies within a year of their injury.

Over the last 10 years, death from falls has increased by 30% in the United States.  By the year 2030, falls will result in 1 death every 7 hours.  There is a need for fall prevention programs.

Every 20 minutes one older adult dies from a fall
Fall prevention programs reduce fall risk

Falls are associated with extrinsic and intrinsic factors.  The extrinsic causes are related to the home environment such as rugs, stairs, and poor lighting.  The intrinsic causes are related to problems with balance, muscle weakness, poor vision, cognitive deficits, the presence of chronic disease, abnormal blood pressure, or medications.  Research shows the most effective ways to prevent falls are through balance exercises and strength training.

Strength Training is Your Key to Fall Prevention

Fall prevention exercise programs for older adults reduce fall rates.  They also prevent injuries resulting from falls when they do occur.  Not only does strength training improve muscle size and strength but it also improves your bone density.  Therefore, strength training improves an individual’s protective responses during a fall.  The result is a more resilient adult who is less likely to sustain a debilitating hip fracture from a fall.

We recommend older adults perform weight-bearing lower body strength training a minimum of 2 to 3 days per week.  Stick it out for at least 26 weeks to get the best results.  Bodyweight exercises, like squats and lunges, are best.

However, using weights, in addition to your body weight, will give you the best results.  Light, moderate, or heavy loads are all beneficial.  Multiple sets of each exercise produce greater improvements in strength compared to single-set routines.  Performing 6 to 10 repetitions per set is best for strength and muscle size.  Perhaps most importantly, all strength training exercises initially focus on proper form.  Then, you should progress the amount of weight.

The most frequent exercise utilized in fall prevention exercise programs is the sit-to-stand exercise.  This exercise involves an activity that older adults perform frequently in their daily lives.  You lower your risk for falls when you can do this without needing your hands.  It can be easily performed in the physical therapy clinic or at home.  Progress the exercise by lowering the height of the chair.  Or try holding a weighted object like a medicine ball or kettlebell.

Fall Prevention: Trunk Muscle Strengthening Exercise

Other factors, in addition to lower body strength, are considered when developing the best fall prevention program.  One such factor that influences fall risk is your core or trunk muscle strength.

Your abdominal, pelvic, hip and low back muscles make up your core.   These muscles transfer forces from your lower body to your upper body during whole-body movements like walking or climbing stairs.   Your trunk muscles are highly active during a trip suffered while walking.  These muscles act in order to stabilize your trunk over your feet when you begin to lose balance.  Your ability to react to unexpected disturbances (i.e., suddenly being thrown off balance) is delayed in most older adults.

Trunk muscle exercises significantly improve balance in older adults.  Trunk muscle-strengthening programs are individually prescribed and progressed by doctors of physical therapy.  Also, many personal trainers, strength coaches, and Pilates instructors are skilled at instructing older adults in these exercises. Often, resistance bands, light dumbbells, and medicine balls are incorporated based on the individual’s goals.  The 90/90 leg lower and Pallof press are two examples of trunk strengthening exercises but there are many more.

Seek Help from Your Physical Therapist

Research supports the benefits of both lower body and trunk strengthening exercise for reducing falls in older adults.  Many people overlook the strength of their trunk muscles.  Leave these exercises out and you will see only small improvements in your balance.

Individually tailored fall prevention programs get the best results.   If you are not sure about how to get started, give your physical therapist a call.  The physical therapists at BSR have been helping the people of Southern Ocean County move without pain since 2007.  We are always here for you.