With aging often comes worry about falls and the bone fractures they cause. Now, a panel of U.S. experts has new advice on what helps and what doesn’t when it comes to staying upright.
For starters, get off the sofa. And don’t rely on vitamin D to keep you from falling.
In a change from its 2012 recommendations, the U.S. Preventive Services Task Force (USPSTF) is recommending against vitamin D supplements for “community-dwelling” (those living at home) adults over 65 for preventing falls. A review of existing research showed insufficient evidence to recommend a supplement.
So what does help people prevent falls? Exercise, the task force said.
“The strongest evidence is for exercise. If you’re at risk of falling, you should think about exercise,” said the task force’s vice chair, Dr. Alex Krist, from Virginia Commonwealth University in Richmond. He added that about 20 percent of Americans over 65 have a fall each year.
The review and recommendations were published April 17 in the Journal of the American Medical Association.
An author of an editorial that accompanies the new recommendations agreed exercise can be beneficial.
“These recommendations are suggesting that we need to go beyond popping pills in order to have a major impact in preventing falls and fractures,” said Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital in Boston.
“Regular exercise can reduce falls with injury and it can also reduce heart disease, stroke, type 2 diabetes, dementia and some forms of cancer,” Manson said.
“Physical activity is as close to a magic bullet as there is. And it doesn’t take that much — just 30 or 40 minutes three times a week can make a difference,” she added.
Both Krist and Manson advocated for a variety of exercises. They said for someone healthy enough, the general physical activity guidelines of 30 minutes of aerobic activity most days of the week, and strength training twice a week, are a good place to start.
But not everyone over 65 can achieve that goal. Krist said to start with your doctor to get a better idea of what exercise might be right for you. For some people, the supervision that comes with physical therapy is helpful. For others, a class such as tai chi might work best. And for others, more vigorous activity may be fine.
The USPSTF is a volunteer panel of national experts. They develop recommendations for disease and injury prevention after a rigorous review of scientific evidence.
The new recommendations suggest that doctors should selectively offer multifaceted interventions to seniors at a high risk of falling.
These might include: group or individual exercise, psychological therapy, nutrition therapy, education, medication management, urinary incontinence management, environmental modification, and physical or occupational therapy. Social services and referral to specialists such as an ophthalmologist, neurologist or cardiologist are other options.
Referrals can be important because some issues may be reversible. For example, sometimes addressing problems with vision can aid in fall prevention.
“Often, older individuals assume vision loss is inevitable and a normal part of the aging process. Very often, though, problems such as cataracts or glaucoma are treatable,” Manson said.
“Falling is a major concern for older adults, and some are afraid to go outdoors because they’re afraid of falling,” she said. That leads to a double whammy as they stay inside, their muscles may atrophy, they don’t get any sunlight and may develop a vitamin D deficiency, and they’re losing out on important social interactions, Manson explained.
“I recommend at least doing strength training inside the home, or getting a treadmill to use at home. Or find a friend or family member that can go out for a walk, or start a walking club in your neighborhood,” she suggested.
The task force also recommended against daily supplementation of 400 international units of vitamin D and 1,000 milligrams (mg) or less of calcium to prevent fractures in postmenopausal women living at home.
It wasn’t clear, however, if higher doses might provide a benefit, according to the new USPSTF recommendations. There also wasn’t enough evidence for the task force to determine whether vitamin D and calcium supplements could help men or premenopausal women avoid fractures.
SOURCES: Alex Krist, M.D., M.P.H., U.S. Preventive Service Task Force vice chair, and professor, family medicine, Virginia Commonwealth University, Richmond; JoAnn Manson, M.D., Dr.P.H., professor, medicine, Harvard School of Medicine, and chief, preventive medicine, Brigham and Women’s Hospital, Boston; April 17, 2018, Journal of the American Medical Association
Is arthritis pain getting in the way of your fitness plans? That need not be the case.
In fact, physical activity can be vital to your continued mobility.
Osteoarthritis is a joint disease that affects about 27 million Americans — most often in the knees and hips, but also in the lower back and neck.
Doctors describe it as a degenerative disease — meaning the joint has worn down. Usually that’s from simple wear-and-tear over the years, or from overuse.
This occurs when there’s a breakdown of the cartilage that covers the end of each bone. The cushioning effect is lost. The result is pain, swelling and problems moving the joint that’s been affected. Over time, the bones themselves can be damaged.
What to do? Get moving.
It may be hard, especially at first, but physical activity is key to treating osteoarthritis. Studies have shown that exercise not only helps reduce pain but also improves mobility.
Being active should help with weight loss, too — and excess weight contributes to the pain of osteoarthritis.
Start slow and simple, suggests the Arthritis Foundation. Just walking around the neighborhood can help. So can a fun and easy exercise class.
Adding some strengthening exercises will help build muscle around whatever joint is affected by osteoarthritis. Range-of-motion exercises can help you become more flexible and less stiff. Simply start with gentle stretches that take your joints through their full range of motion.
Yoga and tai chi can help relieve stiffness and improve flexibility, too.
Whatever activity you choose, just make sure it’s easy on your joints. No twisting and pounding. Besides walking, good options are biking, water aerobics, swimming and dancing.
A key to success, though, is to pay attention to how your body tolerates your new activity. And be patient. When you have arthritis, it can take your body longer to adjust to new activity, notes the U.S. Centers for Disease Control and Prevention.
If you haven’t been active, start with just three to five minutes of activity twice a day. Once your body has adjusted, add 10 minutes to your activity time. Then add 10 minutes more, and so on, until you’re as active as you want to be.
For those who have a hard time even walking at first, consider working with a physical therapist. This specialist can create a program tailored to your abilities — and one that can adapt as you get stronger.
One important reminder: Check with your doctor before adding new activity and any time you experience unusual pain or swelling in the joint affected by osteoarthritis.
Professional athletes’ speedy recoveries from injuries have nothing to do with superhuman abilities. Instead, it’s all about proper preparation and planning.
It’s no surprise that professional athletes tend to be in much better shape than those of us who don’t play sports for a living — but what might seem more puzzling is that they also seem to recover more rapidly from injuries. Think of D’Angelo Russell, the Brooklyn Nets’ star point guard. After suffering a knee injury in November, he underwent arthroscopic knee surgery and fully recovered in just over two months, returning to the court by the middle of January.
Such a speedy recovery isn’t evidence of superior physical fitness, however, so much as a clear strategy in the wake of an injury. Professional athletes have access to some of the best orthopedic specialist available — and these doctors, trainers, and therapists help them follow strict guidelines throughout the process of rehabilitation, ensuring that they can return to action as soon as possible.
While you might not have a dedicated team of doctors at your disposal, there are many steps you can take to enjoy a similarly quick recovery. ACL tears — a rupture of the anterior cruciate ligament, one of several ligaments that stabilize the knee — are a common injury affecting star basketball players and casual gym-goers alike. Here’s what you can learn from the professional athletes’ approach to ACL rehabilitation.
1. KEEP YOUR BODY HEALTHY
In order to help your body best respond to arthroscopic surgery, you need to stay healthy and hydrated. For at least a week before your surgery, be sure to drink plenty of water and eat a nutritious, wholesome diet rich in antioxidants, both of which can boost your body’s ability to heal.
2. STRETCH AND EXERCISE BEFORE SURGERY
Staying healthy requires more than just eating right, of course. Your preparation for surgery should include regular stretches and massages, which can strength the tissues surrounding the ACL and increase their flexibility. These measures ensure that the knee joint remains relaxed and enjoys proper circulation, both of which foster optimal surgical conditions.
3. DON’T BE AFRAID TO ASK QUESTIONS
Nobody expects an injury, so when these unfortunate events happen, you might not know what to expect. Athletes have a whole team on hand — ranging from surgeons to physical therapists — to guide them through the process, and while you might not have the same resources readily available, you should do your best to stay informed. Your doctor and surgeon are there to help you, so be sure to voice your concerns and ask any questions you may have.
4. FORMULATE AND WRITE DOWN THE RULES
When it comes to recovery, you can’t break the rules. A rehabilitation plan isn’t something you can come up with on the fly, so be sure to consult with your doctor, therapist, and surgeon to formulate a concrete plan centered around defined protocols and regular benchmarks to help you stay motivated and focused.
5. STAY STOCKED UP ON SUPPLIES
Proper recovery requires keeping plenty of tools on hand, such as ice packs and non-steroidal anti-inflammatories. You may struggle to get out of the house while you recover from the procedure, so ensure that you have an ample supply of everything you might need before you undergo surgery.
6. MAINTAIN A POSITIVE MOOD
As a minimally invasive procedure, arthroscopic surgery is designed to shorten recovery timelines, but you’ll still need to spend some time resting immediately after surgery. Since you won’t be able to participate in many of your daily activities, try to have some projects at the ready to keep you happy and occupied. Maintaining a positive mood will help boost your morale, and ultimately assist in recovery.
If you’re considering arthroscopic surgery for an ACL tear, CompOrtho is ready to help. Our team of specialists has decades of combined experience in treating knee injuries, providing every patient with the care and attention they need from the initial diagnosis to the final follow-up. Call us today to schedule a consultation!
When you’re dealing with an injury involving bones, muscles, or joints, the first healthcare professionals who probably come to mind are orthopedic surgeons or sports medicine doctors. These are the physicians we most often turn to when it’s the musculoskeletal system that needs treatment.
But there’s another type of doctor, called a physiatrist, who is just as dedicated to problems of the muscles, bones, and joints, and who just might play an important role in your recovery from a sports injury or other musculoskeletal problems.
Dr. Vashi is our Physical Medicine and Rehabilitation specialist, who is also Board Certified in Sports Medicine. This blog will explain what physiatrists do, what they treat, and what role they play in your continuum of care.
What does a physiatrist do?
Physiatrists, or rehabilitation physicians, are doctors who specialize in nonoperative physical medicine, meaning treatment of musculoskeletal problems, involving muscles, bones, joints, tendons, ligaments, and nerves, without the use of surgery. Their ultimate goal is to restore your function, mobility, and quality of life. They diagnose and treat physical injuries and disabilities through a wide variety of methods, from overseeing medications and physical therapy programs to nerve conduction testing and electromyography. They are also able to perform minimally invasive procedures to restore mobility and function, such as fluoroscopic guided epidural injections and ultrasound guided injections of the joints, tendons and ligaments.
Physiatrists focus on highly personalized and comprehensive treatments, which extend beyond the care they provide to you one-on-one. In fact, a physiatrist’s role involves directing your whole treatment and rehabilitation team, including physical therapists, occupational therapists, and other physicians and health professionals.
What conditions does a physiatrist treat?
Physiatrists treat a wide scope of conditions, ranging from sports injuries to spinal cord injuries and patients who have suffered from a stroke or severe burns, just to name a few.
At Comprehensive Orthopaedics, Dr. Vashi specifically focuses on nonoperative treatment for spine and sports injuries, along with other musculoskeletal problems throughout an adult’s lifetime. Some of the conditions and areas we treat include:
Acute and chronic joint pain
Acute and chronic back pain
Running injuries and other sports injuries
Degenerative joint conditions such as osteoarthritis
Tennis elbow, golfers elbow, rotator cuff problems and other overuse injuries
Nerve entrapments, such as carpal tunnel or cubital tunnel syndromes
What role does a physiatrist play in my treatment & recovery?
There are a number of ways in which a physiatrist plays a part in treatment and recovery from sports, musculoskeletal and spine-related injuries or disorders. After a comprehensive evaluation, a physiatrist will create a custom, nonoperative treatment plan tailored to your unique needs. This often includes identifying and managing outside therapy and/or rehabilitation programs such as physical therapy and occupational therapy. It also includes prescribing and overseeing medications and supporting devices like orthotics, if they will be beneficial.
A physiatrist can also perform a wide range of minimally invasive procedures that help relieve pain and restore function and mobility – all without the need for surgery. This includes nonoperative treatments such as:
Joint and bursa injections
Ultrasound guided injections of the tendons and ligaments
Fluoroscopic or X-ray guided epidural injections
Facet joint injections, medial branch blocks, and radiofrequency denervation for back and neck pain
Sacroiliac joint injections
Prolotherapy, platelet-rich plasma (PRP), and stem cell (bone marrow aspirate concentrate, or BMAC) therapy
Trigger point injections to relieve musculoskeletal pain
A physiatrist can play a major role in helping to restore both your function and mobility when you’ve suffered from a sports injury or are dealing with an orthopedic condition. Physiatry places an emphasis on non-surgical physical medicine and rehabilitation that’s personalized to you and your unique needs.
If you’re facing a potential surgery for a musculoskeletal problem, a consultation with a physiatrist might be worth exploring. Get started by making an appointment at Comprehensive Orthopaedics today to learn more about what non-surgical treatment methods are available.
If you have stiff, aching fingers and hands, you’re not alone — a new study reports that 40 percent of people will be affected by the pain of arthritis in at least one hand.
The rate seen in the new research is “just slightly below the percentage of osteoarthritis seen in knees and is significantly greater than that seen in hips,” noted Dr. Daniel Polatsch. He’s co-director of the New York Hand & Wrist Center at Lenox Hill Hospital in New York City.
Arthritis “affects hand strength and function and causes difficulty doing activities of daily living,” Polatsch said.
The study team was led by Jin Qin, of the Arthritis Program at the U.S. Centers for Disease Control and Prevention. The researchers looked at 1999-2010 data on more than 2,200 people from North Carolina. All people in the study were aged 45 or older.
The information collected included symptoms the participants reported as well as hand X-rays.
Women were at higher risk than men, with nearly half of women (47 percent) developing hand arthritis. Only about a quarter of men had hand arthritis, Qin’s team said. Whites were more prone to the ailment than blacks, with rates of 41 percent and 29 percent, respectively.
Excess weight was also a risk factor for hand arthritis. Lifetime risk among obese people was 47 percent, compared to 36 percent for non-obese people, the study found.
Dr. Steven Carsons is chief of rheumatology at NYU Winthrop Hospital in Mineola, N.Y. He said the finding that hand arthritis is more common in women “has been long thought to have a genetic and hormonal basis.”
The obesity link is more intriguing, Carsons said.
“While obesity has always been assumed to be a risk factor for osteoarthritis of weight-bearing joints, such as the knee, these data reveal the somewhat surprising association of obesity and lifetime risk of development of hand osteoarthritis,” he said.
Recent studies have suggested that obesity may set up “systemic inflammation” in the body, Carsons said, which may raise the odds of arthritis in a non-weight-bearing joint, such as the hand.
Because arthritis in the hands can be disabling, Polatsch said, “treatment options and access to hand specialists need to improve in order to minimize the impact of this potentially disabling condition in our aging population.”
The study was published May 4 in Arthritis & Rheumatology.