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Bad Man Break

Men Need To Be More Aware Of Bone Density

Allen was getting out of his fishing boat when he twisted his left leg and fractured two bones in his ankle.  Six weeks after ankle surgery, he landed in our clinic with considerable pain and a very limited lifestyle.  Allen reported lower back pain that he attributed to his limping and use of the boot on his left leg.  On recommendation from his physical therapist, Allen had further medical assessment of his lower back pain.  An x- ray of his lumbar spine revealed two lumbar vertebrae fractures.

On a recent vacation, Mike went on a horseback ride with his grandchildren.  During the ride, he developed pain in his upper back that “took his breath away”.  A visit to the emergency room with what he thought was a cardiac issue revealed a three-level compression fracture in his thoracic spine.  Further assessment showed significant osteoporosis in his hips, pelvis, and lumbar regions.  Allen started on some bone rebuilding medications and physical therapy.  It took over four months to fully recover from this injury.

Randy was working on his garden and fell onto the lawn.  He had right hip pain and was unable to stand.  His wife called the ambulance and he was diagnosed with a hip fracture.  Four days after the surgery to repair his hip, he suffered an embolism and at the age of seventy-one, he passed away.

All three of these older guys had testing that revealed a significant loss of bone density.  Unfortunately, the tests occurred after and not before injury onset.  We are getting better at keeping men alive longer–less smoking and better medications.  As men get older, the need to monitor bone density becomes a crucial aspect of healthy aging.  Men need fewer commercials for the latest in testosterone replacement and ED medication and more awareness of how brittle their bones can become.

The general public views osteoporosis as a “women’s health issue”, but management of osteoporosis is just as important for men.  Although men are less likely than women to sustain an osteoporosis related fracture, they are much more likely to become permanently disabled or die from the fracture.  Since 2008, the rate of osteoporosis related hip fracture in the American male population is going up at an alarming rate.

Osteoporosis is a silent disease.  Most people do not realize they have a problem until something breaks and they are in the middle of a medical crisis.  Even after a fracture, many physical therapy patients are reluctant to follow up with a bone density screening.  Being proactive is the only method of managing osteoporosis.

We know that individuals that participate in consistent resistance training exercises are more likely to have better bone density.  Just like muscle, bone is a living thing that grows stronger in response to the force that is placed upon it.  The best bone building exercise activities produce a stimulus through your skeleton.  Bone building exercises are easy to understand, but they do require more effort than swallowing a pill or having an injection.  Everyone can perform some form of bone reinforcing exercise.  Proper exercise prescription and consistent progression can work wonders.  See the trainers and physical therapists at Fenton Fitness.

Jane Brody of the New York Times wrote a helpful *article on bone density testing. It covers the latest medical guidelines for testing and the when and why of testing for both men and women.

Michael S. O’Hara, P.T., OCS, CSCS

*New York Times, July 16, 2018, Jane Brody, When to Get Your Bone Density (View Article:here)

Better Tests With More Movement

I attended an overcrowded grade school.  From 1st through 8th grade, we had 40 or more children in a classroom.  One Felician sister kept order by keeping everyone seated and stationary.  During my grade school education, I was stuck in a chair and every day it felt like time had stood still.  When a school day came to an end, the children were so movement deprived they would literally sprint out the doors.  I believe this illustrates the psychological impact of depriving children of movement during the day.

I know we have to be concerned with standardized test scores, and that taking time for physical activity takes away from reading, math, and science.  A long litany of research is revealing that children score better on tests when they are able to move around more.  More movement creates a healthier brain and better test scores.  More of the brain is devoted to movement than language, and if we wish to fully develop intellectual capacity, we need to include movement.  This appears to be even more important for boys.

Everyone involved in improving education needs to read Spark, by Dr John Ratey.  In this book, he discusses how brain function is enhanced by the habit of exercise.  Over the last nine years, more research has documented the positive effects of exercise on brain health.  A teacher friend sent me this *article from the New York Times.  If you have grandchildren or children you need to read this.

Micheal S. O’Hara, PT, OCS, CSCS

* Why Kids Shouldn’t Sit Still in Class, Donna De La Cruz, New York Times, March 21, 2017.  Read the article here: https://www.nytimes.com/2017/03/21/well/family/why-kids-shouldnt-sit-still-in-class.html?_r=0

How Do They Know What Is Wrong Without An MRI?

This is a fairly common question in physical therapy.  Patients with lower back, leg, neck, and arm pain know the test they need is an MRI.  They have friends and relatives that tell them they should have an MRI.  They are concerned that something is being overlooked and that the pictures from the MRI will make treatment more beneficial.  I have some research information on the limitations of a spinal MRI.

In 1994, the *New England Journal of Medicine published a study on physician evaluation of lumbar spine MRIs.  The MRIs of 98 asymptomatic individuals –-no pain, feelin’ good people, were found to have disc abnormalities (82% of the MRIs).
-52% had a bulged disc at one level
-27% had a disc protrusion
-1% had a disc extrusion
-38% had an abnormality at more than one disc

Since that publication, several other studies have backed up these results.  Bulged, protruding, and extruded lumbar discs are a fairly common finding on a lumbar MRI.  Changes in our lumbar discs are probably no different than the wrinkles on your face or the gray in your hair.  Changes in a disc’s shape is not a indicator of pain problems

Another **MRI study of athletes revealed spondylolysis (vertebral fractures) are fairly common, yet less than 50% of the athletes with these fractures ever report any episode of lower back pain.  It appears that lumbar spine fractures do not always produce pain.

In my years in the physical therapy clinic, I have received the MRI reports of many neck and lower back pain patient’s spines that show disc protrusions and foraminal stenosis on one side of the spine but the patient has all of his or her symptoms on the opposite side.  I have treated patients with severe lower back pain and completely normal spinal MRIs.

MRI research has demonstrated that “abnormalities” in our spines are fairly common and difficult to accurately link to any specific pain problem.  We do know that once a patient has an MRI, they are far more likely to progress to ***surgery.  Please read, The Myth of Accuracy in Diagnosis, by Dr. Ron Fudala.  In physical therapy, the resolution of a spinal pain problem starts with a history and thorough physical evaluation.  Imaging tests are a small part of the “big picture” and often provide nothing but confusion.

*Jensen MC et al. Magnetic resonance imaging of the lumbar spine in people with and without back pain, New Engl J Med. Jul 14

**Soler T, Calderon C. The prevalence of spondylolysis in the Spanish elite athlete.  Am J Sports Med, 2000 Jan – Feb.
***Lurie JD, Birkmeyer NJ, Weinstein JN. Rates of advanced spinal imaging and spine surgery. Spine 2003;28:616 –20.

Read more here: http://spineline.net/spine-pain-the-myth-of-accuracy-in-diagnosis/

Michael S. O’Hara, PT, OCS, CSCS

Testing Fitness Readiness

Isometric Spinal Extension Strength Test

A big problem in the fitness industry is that there are no standardized performance evaluations that participants must achieve in order to begin or progress in an exercise activity.  Anyone, no matter how deconditioned, posturally flawed, and orthopedically challenged can walk into the gym and get a workout.  As a strength and conditioning coach, the present “free for all” system is a challenge that at times can be very frustrating.  As a physical therapist treating orthopedic injuries on a daily basis, the present system keeps me busy.  Performance tests and movement assessments identify asymmetries, strength deficits, and potential pain problems.  A good coach uses assessments to determine the appropriate exercise prescription for their client.  I will be posting some basic user-friendly performance assessment tests that should be a part of all fitness programs.  If you pass the tests, congratulations and keep up the good work.  If you did poorly on the tests, you need to get to work on improving your performance.

Isometric Spinal Extension Strength Test
The muscles around your spine and pelvic girdle are designed to reduce and not create motion.  They are isometric muscles that brace the torso and pelvis to create the pillar strength you need to carry in firewood, lift the wheelbarrow, or push the lawn mower.  The Isometric Spinal Extension Strength Test is an assessment of the component of core stability that isometrically resists spinal flexion.  This test is used in industrial medicine to assess a worker’s ability to return to material handling tasks.  In my evaluation of fitness clients, it is often the stability test with the most significant deficits.

You need a Roman Chair or Glute-Ham Developer Bench to perform this test.  The support pad of the bench should be on the front of the thigh just set below the pelvis.  Position your body so that the ankles, knee, hips, and lumbar spine are in one long line that is parallel to the floor.  Cross the arms across the chest and hold a solid, floor parallel position as long as you are able.  Pain with the test is a fail and you need to be evaluated to find out why the test is painful.  Less than thirty seconds is a poor grade.   You need to improve your performance, and in the meantime, avoid activities that require you to resist spinal flexion-resisted squats, deadlifts, kettlebell swings, and bent over rows.  Thirty to sixty seconds is a fair grade and clears you for most resistance training.  Athletes and those involved in occupations that require lifting and carrying need the isometric strength that permits a sixty-second hold.
Michael S. O’Hara, P.T., OCS, CSCS

Chair Check Up

How Functionally Fit Are You?

Image chair testCoaches, trainers, and scouts all want the number of inches in an athlete’s vertical leap test.  The athlete simply jumps up and taps a lever that indicates how many inches he or she can jump straight up off the ground.  This test has proven to be an excellent indicator of how well an athlete will perform in the competitive arena.  NBA players hit impressive vertical leap numbers, so we understand how simple it must be for them to elevate over the rim.  The equivalent test for the 60-year plus population is the Chair Stand Test (CST).  The score you get on the CST is a very reliable indicator of how well you will perform in the game of life.  

Leg power, strength, and lower extremity functional mobility are measured with the CST.  The ability to repeatedly move through the sit to stand transfer without the assist of the arms pushing down on the legs or the armrests of the chair is an important skill everyone needs to maintain an independent lifestyle.  An improved CST score creates carry over to other functional skills. Patients who improve their CST scores develop better gait patterns and standing balance.  

Chair Stand Test: You need a stopwatch, a stable chair with a 17 inch high seat, and an evaluator to monitor your performance and start and stop the timer
1.    Sit in the middle of the chair.
2.    Place your hands on the opposite shoulder with the arms crossed over the chest.
3.    Keep your feet flat on the floor.  
4.    Keep your back straight and your arms against your chest.  
5.    On the order “GO”, rise up to full standing and then sit back down.  
6.    Repeat for as many repetitions as you can in thirty seconds.  
7.    If you are halfway to a standing position when time expires, count that as a repetition.  
8.    Record your results and be concerned if you score below average.

The age adjusted scores for the CST listed below are a composite of the data gathered from several research studies since 2001.  The CST has proven to be a reliable assess-ment of fitness in older adults for over a decade.  Individuals who score below average on this test are more likely to suffer falls and require assisted care in their advancing years.  For the older fitness participant, knowing your Chair Stand Test score is just as important as knowing your blood pressure numbers. 

Men’s Results
Age                    Below Average       Average       Above Average
60-64                       < 14                   14 – 19                > 19
65-69                       < 12                   12 – 18                > 18
70-74                       < 12                   12 – 17                 > 17
75-79                       < 11                    11 –17                  > 17
80-84                       < 10                  10 – 15                 > 15
85-89                       < 8                     8 – 14                  > 14
90-94                       < 7                     7 – 12                  > 12

Women’s Results
Age                    Below Average       Average       Above Average
60-64                       < 12                   12 – 17                > 17
65-69                       < 11                   11 – 16                 > 16
70-74                       < 10                   10 – 15                > 15
75-79                       < 10                   10 –15                 > 15
80-84                       < 9                      9 – 14                > 14
85-89                       < 8                      8 – 13                 > 13
90-94                       < 4                      4 – 11                 > 11

Michael S. O’Hara, P.T., OCS, CSCS

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