Daily Activity Shown To Improve Brain Health In Aging Adults And Elderly Even Those With Brain Pathology
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The cognitive benefits of aerobic exercise are well established with trained individuals demonstrating decreased risk of mental health disorders, including anxiety and depression, and improvements of cognitive function and memory compared to their sedentary peers. More recent research has documented daily physical activity is also associated with decreased risk of dementia in aging adults even in those with pathology on brain imaging such as neurofibrillary tangles and amyloid plaques. Both of these brain pathologies are associated with dementia and alzheimer’s disease. Further previous research has shown moderate walking, 45 minutes/day for 3 days/week, actually increased brain volume among particpants. A recent study suggests even general activity such as light housework and gardening may be enough to improve brain health within this population.

Buchman and colleagues examined the impact of daily movement (gardening, housework, exercise) on cognitive and motor function, as well as, brain health (Neurology. 2019). Researchers performed a well designed trial of over 450 aging adults (> 70 y.o.) and monitored their mental and physical function, as well as, daily activity each year over a 20 year period. Of these adults, 191 demonstrated clinical signs of dementia during the study period. In addition, researchers studied the donated brains of these individuals after their deaths to determine the presence of brain abnormalities and pathology.

Consistent with prior research, more active participants demonstrates higher scores on cognitive, memory, and physical tests. Interestingly, these results held up even among individuals with brain pathologies including neurofibrillary tangles and amyloid plaques. Although all of these individuals could have been diagnosed with neurological diseases such as Alzheimer’s, 30% tested normally on cognitive function tests at the time of their deaths. Authors suggested exercise and activity may have a protective effect on brain health (symptoms) even in the presence of brain changes (signs of dementia). Authors recommend more research in this area to determine if there is a cause and effect relationship between these two factors.

The Benefit Of Physical Therapy Before Knee Replacement Surgery
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Knee arthritis is most effectively treated in its’ early stages with Physical Therapy including manual therapy and exercise interventions. These interventions have been shown to reduce pain and disability, as well as, prevent or post pone the need for future knee surgery. In later stages of disease progression, knee arthritis is most effectively treated with a total knee replacement. This major surgery involving the replacement of joint surfaces in the knee was first performed in the 1960s. Since this time it has become one of the most successful orthopedic surgeries due to its’ ability to improve pain and function among this end stage patient population. In our Boulder physical therapy practice, we often find patients who enter their orthopedic surgery with optimal range of motion, strength, and function have the best outcomes after surgery. A recent review article supports our clinical findings.

Authors in the journal Physical Therapy reviewed the available evidence on the use of pre operate Physical Therapy among patients electing for total knee replacement (Devasenapathy et al. 2019). They were interested in finding the importance of pre operative treatments on post operative function including gait speed, stair climbing, and function. Authors reviewed 12 studies and found an association between pre operative quadricep strength and post operative function. They noted pooling of information was limited in this meta analysis due to the different methodologies used in the available studies. They called for additional studies of higher methodological quality to improve predictor analysis.

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Reducing Your Risk Of Alpine Skiing Injuries
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Alpine skiing remains one of the most popular outdoor winter sports in Colorado. It is estimated over 6.8 million skiers participated in the sport over the 2016/2017 winter season. There are inherent risks of death and injury in both skiing and snowboarding, but thankfully due to technological updates and innovations overall injuries have fallen by half over the last 30-40 years. Although injuries on the whole have decreased some traumatic cases, such as ACL tears, remain common today. A recent article summarized the available evidence on the most common ACL tears, as well as, offered an update on injury prevention strategies in alpine or downhill skiing.

Davey and colleagues published the review article recently in the journal Sports Health (2018). Authors reviewed the available evidence on ski injury prevalence including injury location, known risk factors, and ski injury prevention. Data was available from a total of 64,667 ski injuries over a 25 year period. They reported the average age of skiers injured was 30 years old with a range of 24 to 35 years. Those found at highest risk included both the young, adolescents and children, as well as, older adults (>55 years). While males were more likely to experience lower extremity fracture, consistent with other sports females are more prone to ACL tears.

As expected, the lower extremity remains the most commonly injured area of the body accounting for up to 77% of all injuries. Further, 14% of injuries involve the thumb and shoulder and 13% involve the head and neck. The knee ligaments (ACL and MCL) remain the most common injury followed by thumb and head and facial injuries. Trend data showed a drop in tibial fracture, but an increase in ACL tears. Most common mechanisms included deep knee flexion with rotation or knee hyper extension and forward movement of the thigh over the stationary leg in the boot. In addition, despite advances in helmet use and technology, the number of traumatic skiing fatalities remained constant.

Ski technological advances, including helmets, bindings, and ski poles, deserve the most credit for the 50% reduction of ski injuries. Helmet use has increased to 80% of all skiers and has been a significant advancement in the safety of participants and reduction of head and face injuries. As expected, helmets have consistently been shown to reduce both the prevalence and severity of head injuries without a subsequent increase in “risky skiing”. The risk of death with head injury has stayed relatively constant either because the forces of impact exceed the protective capacity of the helmet or the skier sustained other bodily injury causing death despite sparing their head and face.

Ski boot binding systems have contributed to the large decrease in leg fractures and contusions due to improved release mechanisms. In addition, skiers who routinely have their bindings checked by certified ski shops sustain fewer injuries than those who ski without inspected bindings. These bindings are designed to prevent fracture and leg injuries, not knee ligaments, and bindings often do not release with common ACL injury mechanisms in skiing.

Established programs such as “lids on kids” and “heads up” remain effective at improving the awareness and utilization of helmets. ACL prevention programs (Vermont Ski Safety Equipment) have focused on educating skiers to avoid situations most associated with knee sprain, as well as, instructions in how to fall with decreased risk to your knee. These programs have been shown to reduce a skier’s risk of knee injury by 60%. Interestingly, ski lessons have not been shown to reduce the risk of knee injury among skiers. In our practice, strength also remains a key component of injury prevention programs. Skiers are recommended to work with a local Physical Therapist to design an effective ski injury prevention exercise program.

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Quad Weakness After ACL Surgery Associated With Decreased Cartilage Health
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ACL injury is one of the most common traumatic sports medicine injuries seen in Boulder Physical Therapy practice. For patients who elect for surgical repair post operative Physical Therapy is key to facilitating a safe return to activity and sports. Common limitations for individuals returning to activity after ACL repair include: a loss of range of motion, balance and agility impairments, as well as, hip and quadricep weakness. The quadriceps are key muscles in maintaining strength and stability of the knee joint and when healthy improve weight bearing across the knee joint surfaces. Abnormal weight bearing in the knee joint leads to a decrease in joint space and increases the likelihood of knee osteoarthritis development. When undergoing surgical procedures of the knee, any effort to decrease progression of post-traumatic osteoarthritis should be taken.

Previous research has shown patients who sustain an ACL tear, treated either with PT or surgery, have an increased risk of knee arthritis. A recent study examined the cartilage and joint health of patients who had undergone ACL surgery (Pietrosimone et al. 2017). Consistent with prior research, authors found a decrease in quadricep strength in individuals 6 months after ACL repair. Concurrently, the authors found a greater T1p relaxation time within the joint which is a key marker of articular cartilage health. Thus, patients with quadricep weakness demonstrated decreased joint health compared to their stronger post operative peers. This emphasizes the importance of restoring quadricep strength after ACL surgery in order to optimize cartilage and joint health.

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Optimizing Glut Activation During The Crab Walk
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Strengthening the muscles of the hip, gluts, is a key component of rehabilitation for patients with low back pain, hip pain, and knee pain. These muscles help to optimize movement in the lower quarter improving joint mechanics and force distribution during life and recreational activities. In our Facebook posts, we have shown videos on optimizing the firing in the muscles on the back and side of the hips. These videos detail beginning, intermediate, and advanced exercises for each muscle group. One commonly utilized exercise is the crab walk which incorporates a lateral side stepping movement against a resistance band. A new research article highlights how placement of the band can optimize recruitment of the glut muscles.

Lewis and colleagues analyzed the activation of the glut muscles during a crab walk exercise using different elastic band positions (J Athletic Training. 2019). 22 healthy adults were asked to side step with the elastic band around the knees, ankles, and feet. During each 3 of the conditions, researchers analyzed EMG activity from the hip muscles including the TFL, gluteus medius, and gluteius maximus. As expected, increased glut work was found when the band was moved from the knees to the ankles lengthening the lever. Interestingly, placing the band around the feet increased the glut work without increasing the contribution from the TFL (often a muscle we try to utilize less during exercise). Thus, placing the band around the feet may be an optimal position to recruit the hip with less contributing from compensatory muscles.

If I Am Active At Work Do I Still Need to Exercise?
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Studies reported the United States lost 1/3 of all manufacturing positions between 1999 and 2010. Many of these individuals have not returned to their prior manufacturing jobs and may have started more sedentary occupations. While prior U.S. generations relied upon their work to provide daily activity, more recent generations must actively pursue aerobic and strength training exercise to receive the incredible health benefits associated with consistent exercise. Individuals who continue to work in active jobs such as construction, shipping, or manufacturing often believe their jobs provide all the activity they need, but new research questions the ability for these occupational activity to meet each individual’s exercise requirements.

A review article in the British Journal of Sports Medicine discussed the available research on occupational activity and health benefits, as well as, made arguments as to why workers with more active occupations should exercise (Holtermann et al. 2018). Previous research in this area has shown occupational activity does not improve an individual’s health. Further, many studies have shown these individuals have poor health and an increased risk of cardiovascular disease and early death.

Individuals in jobs with higher occupational activity often perform repetitive, low load movements with periods of heavy lifting and/or abnormal postures. This is in contrast to the shorter duration, higher intensity body movements associated with physical activity and exercise. Specifically, authors report aerobic capacity utlization of 30-35% and 60-80% between occupational activity and exercise, respectively, These lower aerobic intensities do not meet the minimal aerobic levels required for cardiovascular health benefits.

Aerobically trained individuals demonstrate decreased resting heart rate and blood pressure measurements compared to their sedentary peers. Conversely, research shows individuals involved in occupational active jobs demonstrate increased inflammation, heart rate, and blood pressure in the 24 hours following their shifts. If sustained, elevations in heart rate and blood pressure have been shown to be independent risk factors for the development of cardiovascular disease. These increases may be explained in part due to the lack of adequate recovery following occupational activities. Resistance training participants take 1-2 days off between sessions while this category of workers often perform job duties longer hours over consecutive days within the work week. Based on these aforementioned factors, workers in these jobs are encouraged to meet the same weekly exercise goals as the general population.