Tag Archives: Geriatrics

strength training physical therapy

Strength Training: You’re Not Too Old!

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If you think you are “too old” to do strength training exercises, think again! With proper guidance and support, you can benefit from a program of regular strength-training exercises.

Sarcopenia is the loss of muscle and strength often seen in older adults. Although many questions remain about muscle loss and aging, one thing is certain: strength-training exercises can help reduce these effects. Even small changes in muscle size can make a big difference in strength, especially in people who have already lost a lot of muscle.

BENEFITS

According to the North American Spine Society, strength training can provide the following benefits in older adults:

  • Better balance and, consequently, reduced risk of falls
  • Quicker responses, which may also play a role in preventing falls
  • Reduced risk of osteoporosis (weakening of the bones)
  • Improved quality of life
  • Improved mental alertness

EXAMPLES OF STRENGTH-TRAINING EXERCISES

You can increase your strength by regularly using any of the following:

  • Weights
  • Strength-training equipment
  • A resistance band

 

HOW MUCH AND HOW OFTEN?

The National Institute on Aging recommends the following tips on how much and how often you should do strength-training exercises:

  • Exercise all of your major muscle groups at least twice a week.
  • Do not do strength exercises of the same muscle group 2 days in a row.
  • Depending on your condition, you might need to start out using as little as 1 or 2 pounds of weight, or no weight at all.
  • Use a minimum of weight the first week, then gradually add weight. Starting out with weights that are too heavy can cause injuries.
  • When doing a strength exercise, do 10-15 repetitions in a row.
  • Take 3 seconds to lift or push a weight into place; hold the position for 1 second, and take another 3 seconds to lower the weight. Do not let the weight drop; lowering it slowly is important.
  • Gradually increase the amount of weight to benefit from strength exercises. When you can do 2 sets of 10-15 repetitions, then you can increase the amount of weight on your next session.
  • It should feel somewhere between hard and very hard for you to lift or push the weight. If you cannot lift or push a weight 8 times in a row, then it is too heavy for you. Reduce the amount of weight. If you can lift a weight more than 15 times in a row, it is too light for you. Increase the amount of weight. Do not increase more than 5% for all upper body and 10% for lower body exercises.

 

SAFETY TIPS

  • Talk to your doctor or a physical therapist before engaging in a new exercise program.
  • Breathe normally while exercising. Holding your breath (known as Valsalva maneuver) while straining can cause your blood pressure to go up. This is especially true for people with cardiovascular disease.
  • If you have had a hip repair or replacement, check with your surgeon before doing lower body exercises.
  • Avoid jerking or thrusting weights into position. This can cause injuries. Use smooth, steady movements.
  • Avoid locking the joints in your arms and legs in a straightened position.
  • Breathe out as you lift or push, and breathe in as you relax.
  • Muscle soreness lasting up to a few days and slight fatigue are normal after muscle-building exercises, but exhaustion, sore joints, and unpleasant muscle pulling are not. The latter symptoms may mean you are overdoing it.
  • None of the exercises you do should cause pain. The range within which you move your arms and legs should never hurt.

 

Looking for a physical therapist to help start your strengthening program?

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BUILD THAT BRAWN!

Strength exercises can help increase your strength when performed on a regular basis. Here are some examples from the National Institute of Aging:

Wrist Curl
This exercise strengthens the wrists.

  • Put your forearm on the arm of a chair. Your hand should be over the edge.
  • Hold the weight with your palm facing upward.
  • Bend your wrist up and down.
  • Do this 10-15 times.
  • Repeat with the other hand.
  • Do this 10-15 more times with each hand.

Side Arm Raise
This exercise strengthens shoulder muscles.

  • Sit in an armless chair with your back supported by the back of chair.
  • Keep your feet flat on the floor and even with your shoulders.
  • Hold hand weights straight down at your sides, with palms facing inward.
  • Raise both arms to your side, shoulder height.
  • Hold the position for one second.
  • Slowly lower your arms to your sides. Pause.
  • Repeat 10-15 times.
  • Rest; then do another set of 10-15 repetitions.

Chair Stand
This exercise strengthens muscles in your abdomen and thighs. Your goal is to do this exercise without using your hands as you become stronger.

  • Sit toward the front of a chair, knees bent, feet flat on the floor.
  • Cross your hands over your chest and lean back in a half-reclining position. Keep your back and shoulders straight throughout the exercise.
  • Raise your upper body forward until you are sitting upright, using your hands as little as possible (or not at all, if you can).
  • Extend your arms outward so they are parallel to the floor. Slowly stand up, using your hands as little as possible.
  • Slowly sit back down. Pause.
  • Repeat 10-15 times.
  • Rest; then do another set of 10-15 repetitions.

Arm Curl
This exercise strengthens upper-arm muscles.

  • Stand with your feet even with your shoulders.
  • Keep your feet flat on the floor and even with your shoulders.
  • Hold your hand weights straight down at your sides, with palms facing forward.
  • Slowly bend one elbow, lifting weight toward your chest. (Rotate your palm to face your shoulder while lifting the weight.)
  • Hold this position for one second.
  • Slowly lower your arm to the starting position. Pause.
  • Repeat with the other arm.
  • Alternate arms until you have done 10-15 repetitions with each arm.
  • Rest; then do another set of 10-15 alternating repetitions.

Toe Stand
The heel raise strengthens ankle and calf muscles. You can use ankle weights for this exercise if you are able.

  • Stand straight, feet flat on the floor, holding onto a table or chair for balance.
  • Slowly stand on tiptoe, as high as possible.
  • Hold the position for 1 second.
  • Slowly lower your heels all the way back down. Pause.
  • Do the exercise 10-15 times.
  • Rest; then do another set of 10-15 repetitions.
  • Variation: As you become stronger, do the exercise standing on 1 leg only, alternating legs for a total of 10-15 times on each leg. Rest; then do another set of 10-15 alternating repetitions.

Knee Curl
Strengthens muscles in the back of the thigh. You can use ankle weights for this exercise if you are able.

  • Stand straight holding onto a table or chair for balance.
  • Slowly bend your knee as far as possible. Don’t move your upper leg at all; bend your knee only.
  • Hold this position for 1 second.
  • Slowly lower your foot all the way back down. Pause.
  • Repeat with your other leg.
  • Alternate legs until you have done 10-15 repetitions with each leg.
  • Rest; then do another set of 10-15 alternating repetitions.

Front Arm Raise
Strengthens shoulder muscles.

  • Stand with your feet shoulder-width apart
  • Hold hand weights straight down at your sides, with palms facing backward.
  • Raise both arms in front of you to shoulder height. Do not turn your wrist.
  • Hold this position for 1 second.
  • Slowly lower your arms. Pause.
  • Repeat 10-15 times.
  • Rest; then do another set of 10-15 repetitions.

Leg Straightening
Strengthens muscles in front of the thigh and shin. You can use ankle weights for this exercise if you are able.

  • Sit in a chair. Only the balls of your feet and your toes should rest on the floor. Put a rolled towel under your knees, if needed, to lift your feet. Rest your hands on your thighs or on the sides of the chair.
  • Slowly extend 1 leg in front of you as straight as possible.
  • Flex your foot to point toes toward the head.
  • Hold this position for 1–2 seconds.
  • Slowly lower your leg back down. Pause.
  • Repeat with your other leg.
  • Alternate legs until you have done 10-15 repetitions with each leg.
  • Rest; then do another set of 10-15 alternating repetitions.

Back Leg Raise
Hip extension strengthens buttock and lower-back muscles. You can use ankle weights for this exercise if you are able.

  • Stand 12-18 inches from a table or chair, feet slightly apart.
  • Hold onto a table or chair for balance.
  • Slowly lift one leg straight backwards without bending your knee, pointing your toes, or bending your upper body any farther forward.
  • Hold this position for 1 second.
  • Slowly lower your leg. Pause.
  • Repeat with your other leg.
  • Alternate legs until you have done 10-15 repetitions with each leg.
  • Rest; then do another set of 10-15 alternating repetitions.

Side Leg Raise
This strengthens muscles at the sides of your hips and thighs. Use ankle weights, if you are ready.

  • Stand straight, directly behind a table or chair, feet slightly apart.
  • Hold onto a table or chair for balance.
  • Slowly lift 1 leg 6-12 inches out to the side. Keep your back and both legs straight. Don’t point your toes outward; keep them facing forward.
  • Hold this position for 1 second.
  • Slowly lower your leg. Pause.
  • Repeat with the other leg.
  • Alternate legs until you have done 10-15 repetitions with each leg.
  • Rest; then do another set of 10-15 alternating repetitions.

This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health providers prior to starting any new treatment or with questions regarding a medical condition.

RESOURCES:

Family Doctor—American Academy of Family Physicians
http://www.familydoctor.org

National Institute on Aging
http://www.nia.nih.gov

CANADIAN RESOURCES:

The College of Family Physicians of Canada
http://www.cfpc.ca

Public Health Agency of Canada
http://www.phac-aspc.gc.ca

REFERENCES:

Exercise & Physical Activity: Your Everyday Guide from the National Institute on Aging. National Institute on Aging website. Available at: http://www.nia.nih.gov/sites/default/files/exercise_guide.pdf. Published January 2009. Accessed January 2, 2015.

Strength training for the elderly. North American Spine Society Know Your Back website. Available at: http://www.knowyourback.org/Pages/BackPainPrevention/Exercise/StrengthTrainingElderly.aspx. Accessed January 2, 2015.

Content provided by EBSCO.  EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation. 

seniors start exercising

Seniors: It’s Never Too Late to Start Exercising

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For years, seniors have attributed their aches, pains, and illnesses to the normal aging process. Age is often used as a reason to avoid exercise. But a regular exercise program can improve the quality of your life and help you avoid illness, including heart disease, stroke, and diabetes. As always, you should consult with your health care provider before starting any exercise program.

WHAT WE KNOW
Most people know that with age, come certain physiological changes. Studies show that we lose the following as we age:
• Lean muscle tissue—Most of us will lose muscle mass as we get older. We usually hit our peak muscle mass early—around age 20—and begin losing muscle mass thereafter.
• Aerobic capacity—The aerobic capacity is the ability of the heart and the body to deliver and use oxygen efficiently. Changes in the heart and decrease in muscle tissue decrease aerobic capacity.
• Balance—As we age, our ability to balance decreases, making falls and injuries more likely. The loss of muscle is a major contributor to losses on balance.
• Flexibility—Our joints and tendons lose some of their range of motion with age, making it difficult to bend and move around comfortably.
• Bone density—Most of us reach our peak bone density around age 20. After that, bones can become gradually thinner and weaker, which can lead to osteoporosis.

Fortunately, regular exercise can help delay some of these changes and give you the energy you need to do everyday activities like walking, shopping, and playing with your grandchildren. Exercise may even help decrease depression and stress, improve mood and self-esteem, and postpone age-related cognitive decline.

By adding endurance, strength, flexibility, and balance training into your routine, you will be healthier, happier, and more energetic.

senior push ups

ENDURANCE
Decades ago, doctors rarely recommended aerobic exercise for older people. But we now know that most people can safely do moderate exercises. Studies have shown that doing aerobic exercise just a few days a week can bring significant improvements in endurance.

Aim to get 30 minutes of moderate exercise—such as brisk walking, bicycling, or swimming—at least 5 days a week. You do not have to do 30 minutes at once—you can break these sessions up into two 15-minute sessions or three 10-minute sessions. Moderate exercise will cause your heart rate to rise and your breathing to be slightly elevated, but you should still be able to carry on a conversation.

STRENGTH
It is not just aging that makes people lose muscle. One of the main reasons older people lose muscle mass is that they stop exercising and doing everyday activities that build muscle.

Building stronger muscles can help protect your joints, strengthen your bones, improve your balance, reduce the likelihood of falls, and make it easier for you to move around in general. Even small changes in your muscle size and strength—ones that you cannot even see—will make things like walking quickly across the street and getting up out of a chair easier to do.

Aim to do strength exercises (eg, weight lifting) every other day, or at least twice a week. For each exercise, do three sets of 8-12 repetitions.

FLEXIBILITY
Increasing your overall activity level and doing stretching exercises can markedly improve your flexibility.

To improve the flexibility—or range of motion—of your joints, incorporate bending and stretching exercises into your routine. A good time to do your flexibility exercises is after your strength training routine. This is because you muscles will already be warmed up. Examples of exercises that you may enjoy include Tai chi, yoga, Pilates, and exercises that you do in the water.

By regularly stretching, you will be able to move around easier. You may also feel less stressed, and your posture will improve.

BALANCE
Just becoming more physically active will improve your balance and decrease your risk of falling. If you add some basic balancing exercises to your exercise routine, you will begin feeling more stable on your feet. Balance exercises can be done just about anywhere and usually require no more equipment than a chair.

Keep in mind that if you are having severe problems with balance, a fall prevention physical therapy program can be a great way to regain your balance, increase strength or improve flexibility.

GETTING STARTED
To avoid injury, start slowly. Add one or two sessions a week at first and progress from there as you begin to feel stronger. A physical therapist, or other health professional, can help develop a program that will be both safe and effective. Check with your local fitness or community center, which may offer exercise classes designed especially for older adults. Check with your primary health care provider if you are planning to participate in vigorous activities.

Remember, it is never too late to start exercising. The sooner you start, the sooner you will start feeling healthier, more energetic, and less stressed.

RESOURCES:
American Heart Association
http://www.heart.org

The President’s Council on Physical Fitness, Sports, and Nutrition
http://www.fitness.gov

CANADIAN RESOURCES:
Health Canada
http://www.hc-sc.gc.ca

Public Health Agency of Canada
http://www.phac-aspc.gc.ca

REFERENCES:

Effects of aging. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00191. Updated September 2009. Accessed April 4, 2016.

Exercise and physical activity: your everyday guide from the National Institute on Aging. National Institute on Aging website. Available at: http://www.nia.nih.gov/health/publication/exercise-physical-activity-your-everyday-guide-national-institute-aging-1. Updated February 16, 2016. Accessed April 4, 2016.

Physical activity: glossary of terms. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nccdphp/dnpa/physical/terms/index.htm#Moderate. Updated June 10, 2015. Accessed on April 4, 2016.

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

fall prevention physical therapy

Fall Prevention Programs Can Keep You On Your Feet!

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One in every three adults 65 and older fall each year in the United States – WWW.CDC.GOV

The numbers are staggering. Apparently not only does the eyesight go, but balance along with it. The two could be seen as going hand in hand since the worse your vision gets, the more likely you are to bump into or trip on something unnoticed. Fear not worried reader. Physical therapy may not improve vision, but it does improve the ability to manage and reduce the likelihood of a fall and even more importantly, a resulting hip fracture.

Fall prevention physical therapy conditioning programs offered by physical therapists are designed to increase independence with functional activities, functional mobility, and safety awareness while decreasing fall risk. Research has shown that a successful fall prevention program must be multi-dimensional. A program must address all underlying factors in addition to strength and balance. Physical therapists use valid and reliable assessments to determine all the factors affecting each individual’s fall risk. Therapy focuses on reducing the factors and decreasing fall risk. This is consistent with the protocols recommended by: The American Geriatrics Society and the American Academy of Orthopedic Surgeons’ Panel on Fall Prevention Guidelines.

THE MAIN GOALS OF THE FALL PREVENTION PHYSICAL THERAPY CONDITIONING PROGRAM ARE:

  • Increase independence with Activities of Daily Living (ADLs)
  • Increase independence with functional mobility
  • Decrease fall risk
  • Prevent future fall
  • Increase safety
  • Patient education

Still on the fence?
Don’t take our word for it. We have included an adapted Tinetti Balance Assessment Tool to help assess the likelihood of a fall. The Tinetti tool is the oldest clinical balance assessment tool and the widest used among older people (Yelnik, Bonan 2008). The advantages of Tinetti’s balance assessment tool are its inclusion of both balance and gait and its good inter-rater reliability and excellent sensitivity. (You can read more at the US National Library of Medicine).

Once you have taken your test – ask your physical therapist to go over the results and what options are available to decrease the risk of falls. Find your PT HERE!

Tinetti-Balance-Tool

For more information about balance and fall prevention click the links below:


    
back pain

Managing an Aging Back

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Most people at some point in their life will have to deal with a painful back. The time and intensity of the back pain is different for everyone, some will have had symptoms when they were in their teens, mid-life or in their golden years. No matter when you first start to receive symptoms more than likely these symptoms will increase in intensity and frequency as you age. Fortunately there are ways to manage back pain as well as counteract our aging process to prevent further problems from developing.

In the back there are many conditions which can develop. The important thing to remember is that not all back conditions are the same and what works for one condition doesn’t necessarily work for other conditions. This is important because in the age where answers are literally at your fingertips every piece of information on back pain needs to be taken with a grain of salt. In order to help manage your own condition it is important to really pay attention to what makes your symptoms better and what makes them worse. By being in tune with your body and what is going on with your symptoms you can take some beginning steps at managing your back pain.

As we age our body changes dramatically in all areas especially in the back and often once we understand how our back ages it is easier to understand your own symptoms.

1. JOINTS: As we age whether in our back or in other areas of our body our joints begin to break down. By breaking down we literally mean that the edges of the bone that interface with other bones change in shape and surface area. Some joints literally develop bone spurs or extra calcification of a bone surface as well as elimination of bone or jagged surfaces as opposed to flat rounded surfaces. With all the changes in the boney surfaces it causes movement between the surfaces to be less fluid or more restrictive resulting in stiffness, loss of motion and pressure put on other structures such as nerves.

2. MUSCLES: Our muscles during aging also begin to lose fluid and suppleness. As we age certain muscle fibers are lost which are more responsible for strength and power and we are left with more fatty tissue. Our muscles also lose elasticity and become more rigid and tight. This all in turns leads us to have a loss in motion, flexibility and strength.

3. DISCS: As discussed with degenerative disc disease and the conditions associated with the disease, the discs in our back literally shrink down. We lose the big cushiness of the fluid filled disc which unfortunately causes us to loose some shock absorption forcing more force.

With all of the changes described above there is an underlying theme of restricted motion and mobility in the spine. Therefore it is important to remember in order to counteract these changes we need to work on restoring and maintaining appropriate flexibility, mobility and strength. For example as described above our discs shrink which causes our joints to take more brunt of the force of the body. Therefore in order to prevent a constant break down of our joints our muscles must be flexible and strong enough to absorb this force and strain on our body.

Managing your back as you age can be possible but requires many steps and hard work. It isn’t something that can be done in two days or two weeks it takes a long in order commitment to change your body. It took a lifetime for your body to age so it isn’t realistic to expect a change in the aging process in a few weeks. Key aspects in managing your low back are:

lower back pain

1. FLEXIBILITY: As we mentioned motion and stiffness is a key factor in our aging process therefore it is extremely important to make sure our muscles stay as lengthened as possible. Some of examples of these exercises are: press ups, long thoracic rotations, SKTC, DKTC, and corner stretch. Remember these are key exercises for the back but it is important to keep all muscles flexible as all of our joints in our body break down.

2. CORE STRENGTHENING: This is a term which has been widely popularized in the last few years. It specifically describes strengthening the muscles which are responsible for controlling your entire spine. This means these muscles help to absorb the shock and forces put on your spine and body by preventing them from going to your joints. Another term also associated with this is lumbar stabilization exercises. Which means working on strengthening both sides of the spine at one time in order spread the force out evenly throughout the back. Some basic examples of these are: bridges with a squeeze, prone alternating arms and legs, seated marches with and without arms on ball, and supine alternating arm to legs.

3. POSTURE: As we age our posture is certainly affected. As a society we tend to be very prone to sitting and slouching forward and as we age this process is enhanced by the changes in our body which force us more into a forward flexed or “hunched” position. Therefore in order to retaliate against this it is important to work on key exercises which work on extending or maintaining the proper position of the spine. Some of these exercises are described in our stretching exercises but others are: scapular squeezes, extension over a roll, and standing hip extension.

When dealing with back pain it is important to remember that exercising is a key to help manage and control your current symptoms as well as prevent further symptoms. Unfortunately we can not take back the changes that occur as you age but we can change certain aspects of your body to help minimize these effects. By making a commitment to work with your back and body as it ages you can truly change the way your body will perform specific movements and how these movements will affect your body. In exercising with a problematic back it is important to remember that discomfort and general soreness is normal but true pain is not. You need to listen to your body and pay attention to how certain symptoms are affected by your new exercise routine.

If you have had symptoms for a long period of time and they aren’t changing with exercises or are getting worse it may be time to seek formal medical attention. This is especially important if symptoms are beginning to travel into your leg or symptoms are advancing to more neurological signs such as tingling/numbness in your feet/leg and weakness or giving way of your legs. This is a sign that symptoms are progressing and are becoming more neurological.

Physical Therapy can be a successful tool in combating back pain. In going to physical therapy you will have a formal evaluation in order to determine your condition and based on this condition an appropriate treatment strategy. This often will occur with appropriate modalities in order to help with the inflammation of muscles and nerves as well as help reduce pain. Once pain has gotten under control you will be instructed on specific exercises/activities that will be beneficial to your back. You also will be given specific tools to help reduce the inflammation of certain structures and improve the overall condition of your back. Your therapist should also work with you to set you up with a program in which you can continue to perform while you are at your home.

Parkinson’s Disease

Parkinson’s Relief

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The four primary symptoms of Parkinson’s Disease (PD) are:
1.) Tremor, or trembling in hands, arms, legs, jaw, and face
2.) Rigidity, or stiffness of the limbs and trunk
3.) Bradykinesia, or slowness of movement
4.) Postural instability, or impaired balance and coordination

Parkinson’s disease (PD) belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells. The four primary symptoms of PD are tremor, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. PD usually affects people over the age of 50.  1

Should I exercise?
Research has shown that regular exercise benefits people with Parkinson’s disease. Exercise reduces stiffness and improves mobility, posture, balance and gait. Aerobic exercise increases oxygen delivery and neurotransmitters to keep our heart, lungs, and nervous system healthy. General exercise may also reduce depression. Learning-based memory exercises can also help keep our memory sharp.

What types of exercise are best for people with Parkinson’s disease?
Exercise programs that challenge our heart and our lungs as well as promote good biomechanics, good posture, trunk rotation and normal rhythmic, symmetric movements are the best. Exercises that promote attention and learning are also extremely beneficial.

What types of exercises do this? Exercises that require balance and preparatory adjustment of the body. Walking outside or in a mall, dancing, yoga classes, Tai Chi classes, stepping over obstacles, marching to music with big arm swings as well as participating in sports (ping pong, golf, tennis, volleyball) and aerobic or jazzercise classes promote motor learning.

senior workout

When should I request a referral for Physical Therapy?
When first diagnosed, all patients should have a consultation with a physical therapist to define the appropriate exercise program tailored to “you”. This will also establish a baseline of your current physical status. Ideally, all patients with PD should have a good fitness program as well as specific exercises to maintain good posture and balance as well as improve symmetry in flexibility and strength. The therapist will also work on improving gait while using visual and auditory cues.

In some cases, where balance or musculoskeletal problems develop, supervised outpatient treatments a few times per week may be helpful. A program of individualized exercises addressing posture, balance and gait has been shown to be beneficial in decreasing the risk of falling. In every case, a regular home program of exercise is critical.  2

1. National Institute of Neurological Disorders & Stroke https://www.ninds.nih.gov/Disorders/All-Disorders/Parkinsons-Disease-Information-Page

2. Parkinson’s Disease Clinic & Research Center http://pdcenter.neurology.ucsf.edu/ 

Aging Gracefully with Physical Therapy

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The human body goes through a number of changes as one grows older. A decline in muscle mass and bone density can lead to muscle fatigue and joint pain. There is good news. Seniors can remain physically active and lead happy, healthy and productive lives with the help of physical therapy. Exercise in a safe, controlled environment under the supervision of a licensed physical therapist, goes a long way to improving the quality of life. A physical therapist can design exercise programs that help seniors cope with some of the issues associated with aging which include:

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