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Senior-Woman-Balance-Yoga

Why We Lose Balance and How We Fix It 

It’s no secret that balance tends to decline with age. Your clients may notice they are swaying a bit more while standing and walking, or feeling weaker or less steady. We all want it, but what is balance? We need to understand what it is in order to restore what was lost, safely, effectively and efficiently. 

Balance is the ability to maintain the body’s center of mass over its base of support. Your center of mass is a few inches below your belly button or can be thought of as your trunk. Your feet are your base of support (unless you are performing a handstand!) 

Balance is the ability to stay upright when standing (static balance) or when moving and performing activities like walking or climbing stairs (dynamic balance). The most common question I hear from older adult clients is, “Why am I losing balance?”  Let’s find out why. 

What is Balance?

Balance is a sense that lives in the brain. Balance relies on information constantly flowing into the brain from three main sensory systems including our visual, vestibular and proprioceptive systems. Moving properly depends on the ability of the brain to gather and interpret the sensory information provided by eyes, ears and joints.  This is essential because the brain then tells the body how to respond to stay upright and balanced.

The quality of the sensory input gathered directly impacts the quality of movement. The stronger the sensory signals sent to the brain, the more accurate the instructions sent to the body will be. On the flip side, as sensory signals become impaired, movement quality dwindles, as reaction time becomes slower. 

Making Sense of Balance: The 3 Systems

Let’s explore the sensory systems that make up balance.

Visual System: Your eyes tell your brain about where your body is relative to the environment, whether you are walking inside your home, in a busy airport, or strolling on the beach. With aging eyes, a great many people don eyeglasses to function day to day, and as our eyesight weakens, so too does the quality of the sensory input.

Vestibular System: The ears relay information to the brain about the motion and position of the head to adjust posture to maintain balance. Semicircular canals in the inner ears  contain fluid and tiny hair cells. As the head nods up and down, moves left to right, or tilts to the side, the fluid in the inner ear moves and the tiny hair cells sense the speed and direction the head is moving in. 

By age 70, it’s typical to have lost 40% of those sensory-detecting hair cells (Zalewski 2015).  

Proprioceptive System: Proprioception, literally meaning “sense of self”, is your sense of body awareness and is a prerequisite for balance. It’s how you understand the parts that make up your body, where they are located, how they feel and even what they can do. It’s the way your body communicates with itself so you can walk without looking at your feet. 

Proprioceptors are sensory nerves that live in and around joints, in ligaments, joint capsules, tendons, muscles and connective tissues. They sense and send signals to the brain about joint position and motion, as well as the muscle force involved in movement.  

As we age, our sense of body awareness is impaired leading to poor joint function, body alignment, control and coordination. The result: poor balance and higher risk of falling. 

Losing and Restoring Balance

As our eyes, ears and joints lose their sensory capabilities, this is why balance is gradually lost. 

To regain what was lost, we apply the SAID principle (Specific Adaptations to Imposed Demands) to improve function with targeted training. Up to 70% of the sensory input for balance comes from your joints (Peterka 2002), so improving joint function can be a highly efficient way to improve proprioception at any age so clients can enjoy better balance and more confidence to prevent falls. 

Most Efficient Balance Training

I start each balance training session using the MoveMor® Mobility Trainer to warm up clients’ lower body, restore ankle mobility and foot stability while increasing proprioception. Clients are thrilled to experience improved functional abilities so they can save themselves in time to prevent falls.  

With 12-points of resistance, MoveMor® makes it simple to restore joint flexibility and strength in less time than any other tool, all from a safely seated position! This wakes up proprioceptive sensory nerves essential for balance while stimulating motor nerves for quicker reflexes. 

You can get started with training clients on their journey to feeling steadier, stronger and more confident by visiting MoveMor.com/exercise-programs. There are 7 exercise programs to choose from that vary in length from 5-30 minutes. Our Take 10 to MoveMor exercise program is proven to improve balance, ankle flexibility, strength and more in just 10 minutes! An exercise guide makes it simple to identify weaknesses and tailor exercises. 

MoveMor® seamlessly integrates into your balance and fall prevention training to accelerate functional outcomes and satisfaction so your clients can enjoy better balance and an extra spring in their step today!


Cate Reade, MS, RD is a Registered Dietitian, Exercise Physiologist and Functional Medicine Practitioner candidate on a mission to improve functional mobility and health span utilizing the power of lifestyle medicine. She has been teaching, writing and prescribing healthy eating and exercise programs for over 25 years. Today, as CEO of Resistance Dynamics and inventor of the MoveMor™ Mobility Trainer, she develops exercise products and programs that target joint flexibility, strength and balance deficits to help older adults fall less and live more.

adaptive-fitness-wheelchair-fitness

The Importance of Exercise for the Disabled or Handicapped

Everyone must remain active. This is only achievable with the help of exercise. Contrary to popular belief, handicapped people also wish to stay fit and healthy. On the other hand, some of handicapped individuals do not realize the importance of it.

Let’s discuss the importance of exercise for handicapped people.

Prevention of Heart Disease

Exercise can help reduce the risk of developing diseases relating to the heart. This includes high blood pressure, heart attack and ischemic heart disease. Furthermore, exercise is essential for preventing various other medical conditions.

Prevention of Comorbidities

Inactivity is a disease in itself. Being inactive makes the body less productive. This makes them more prone to the development of illness, ranging from something as small as flu to as big as cancer. Disabled and inactive individuals have a higher chance of developing colon cancer and diabetes.

Prevention of Anxiety and Depression

Being inactive and indoors can lead to depression and anxiety. You may feel down most of the time. Exercising releases endorphins in our body. These help in regulating mood; those who exercise regularly experience improvement in their moods.

Alleviates pain

Inactivity can cause harm to your bones and muscles as well. The majority of people suffer from pain in joints and other complications. Stiff muscles are also an additional drawback of inactivity.

Handicapped people who exercise more often do not suffer from these symptoms. They report relief of pain. Furthermore, such people also have faster healing of wounds and injury from trauma.

Clears the mind

Exercising not only helps with our physical well-being. It also aids in improving our mental health as well. Brain fog is a real thing; people can be doubtful about the decisions they make. Exercising helps people to think clearly. They can divert their mind from useless jargon to more productive thoughts.

DO NOT LET OTHERS STOP YOU FROM EXERCISING

Being handicapped has a certain societal stigma with it. The perception of people can often stop you from exercising. Always remember that exercising will only benefit you alone. Don’t worry about what others think!

Conclusion

Being disabled can be a hard thing. But, exercise is an activity that will help you to gain self-esteem. You do not need to start with rigorous workouts.

This journey begins with a single step, time will help you get better in the long run. So what are you waiting for?  Start looking for an exercise regimen that suits you best.

Here’s to your health!


Terrance Hutchinson is the Owner of Your Best Lifestyles Fitness and Nutrition. He is a Certified Personal trainer specializing in Exercise Therapy, Corrective Exercise, Sports Nutrition, and Corporate Wellness. He an author of 3 books, he has his own podcast, he has contributed articles to major newspapers and magazines, Terrance has spoken at health events, webinars, seminars, hospitals, schools, doctors offices and has been featured nationally syndicated television platforms. Terrance has clients in many states and counties and is looking to help others bridge the gap between the medical and fitness industries. To learn more about Terrance, visit yourbestlifestyles.com

Large group of fit and active people resting after doing exercise in nature.

Exercise Outdoors: Cross Training & Hydrate

Exercise outdoors when it’s hot can be a challenge. Cross training exercises are a good way to mix up your workouts and give yourself time to cool off, drink water and stay hydrated in summer heat. 

Although I’m away from home, in the mountains, and not as affected by this huge triple digit heat wave, I did get a wake-up call of my own that I thought would be important to share.  I was shooting an exercise video this week in 90-degree heat. It was hot, but I got on a roll and forgot about the time. Less than an hour in, I started to swoon. Not a good shot on an exercise video. I realized immediately what had happened; I’d gotten so involved, I forgot to drink water between takes. I can say from experience that it creeps up on you. So you need to take steps to keep yourself cool and well-hydrated when you exercise outdoors. Cross-train with strength exercises mixed in with your cardio gives you a lower intensity interval so you can drink water, stay hydrated and cool off.

According to the American College of Sports Medicine losing more than 2 percent of your body weight through dehydration puts your body at risk for heat illness. This is serious business. We’ve all read the stories of team athletes who have actually died.

When you exercise in the heat you can lose up to five cups of water per hour. So it’s important to drink water before, during, and after vigorous exercise. The rule of thumb is to drink 2 cups of water a couple of hours before you start exercising so you are fully hydrated. Remember to bring that water bottle with you and drink a cup of water every 15 minutes or so while you are exercising. Don’t wait till you’re thirsty. If you’re thirsty, you’re already getting dehydrated.

But you’re not done yet. You need to drink another 2 cups over a two-hour period after exercise.

Sounds like a lot of water. It’s not. It’s just making up for the water you lose when you exercise in the heat.

Pouring water over your head during exercise won’t help you rehydrate, but it does make you feel better. A study at Cal State Fullerton with trained athletes showed that athletes exercising in 92-degree heat in a controlled setting felt cooler and that the workout was easier to perform.

But you know what Noel Coward said about “mad dogs and Englishmen.” Give yourself a break. If you can, exercise outdoors when it’s cooler, early mornings or late afternoons when the sun is less direct. Try finding shady areas.

Instead of keeping up your brisk pace for the whole workout, break it up. Go at normal pace for a bit, do a short light interval and then pick up your speed again.

Another idea is when you exercise outdoors do cross training exercises. Add intervals of strength training between shorter bouts of cardio. You’ll get a chance to drink and pour some water over your head too! Stop at a wall, a tree or a fence, and do these five exercises: two for your upper body and three for your lower.

Exercise Outdoors Video

Here is an Exercise Outdoors video with some easy cross training exercises to tone you up, no equipment necessary.  (Please subscribe to my YOUTUBE channel; I have several more health & fitness videos!)

Exercise Outdoors: Strength Exercises Using Your Own Body Weight

With all these Strength training exercises, remember to exhale on the exertion.

Standing Push Ups: Stand facing a surface with legs hip width apart and place hands shoulder width apart. Keeping your body straight, lower yourself down to the surface and then push back upright again. Muscles Worked: Chest, Triceps, and Shoulders

Calf Raises: Face surface and hold on for balance. With feet together pointing straight ahead, slowly lift your body up on to your toes, while tightening calf, abs and buttocks muscles. Then slowly lower yourself back down again.

Muscles worked: calves, abs, and buttocks.

Squats: Face surface, legs hip with apart. Hold on for balance. Shift weight back into heels. Keeping back straight, abs pulled in, gently bend at the knees and squat to about a 90-degree angle. Hold for a moment, then, using just your leg muscles, return to an upright position.

Muscles worked: Front of thigh (Quads), Back of thigh, (Hamstrings) Buttocks, Abs

Wall Sit: Stand against surface for back support. Holding on as needed for balance, slide down to a sitting position against wall, knees at about a 90-degree angle. Pull your abs in and hold for 10 to 30 seconds.

Muscles worked: Thighs and Abs

Upper Back Squeeze: Stand with your back to the surface, feet shoulder width apart. Place hands behind you on surface. Straighten your arms behind you and squeeze your shoulder blades together. Hold for 10 to 30 seconds.

Muscles worked: Back, Shoulders, Back of arms (Triceps)


Mirabai Holland MFA, EP-C, CHC is one of the foremost authorities in the health and wellness industry. Her customer top rated exercise videos are now available online 24/7 at on her website for Age-Onset health issues like Osteoporosis, Arthritis, Heart Disease, Diabetes, Orthopedic Issues & more. Mirabai also offers one-on-on Health Coaching as well as a NEW Weight Management 8 Week Course Lose To Win™ on ZOOM or Phone. For more info, visit mirabaiholland.com. Contact her at askmirabai@movingfree.com

Woman Holding Her Father's Hand

What Brings You Peace of Mind?

Your thoughts can run in your head like a broken record–or can you sit still and “hear” the quiet?

Is there an activity, exercise, religious or meditation practice you do regularly to slow your mind? Or do you take medications which can have multiple side effects? For example, I experienced a severe emotional strain while dealing with my mom’s death. Before her passing, I cleared my calendar and rearranged my schedule so I could be more involved in her care. Both my sister and I were with her every day.

I decided to reintroduce yoga and meditation and good eating habits into my weekly practice to ease the stress and mindless chatter in my head. The benefits were almost immediate.

Adding more diversity into my weekly routine (that always includes exercise) made it easier to cope with the stress and strain that this new event presented. Each night when I put my head down on the pillow, I meditate on how grateful I am for my good health, family, the right care my mom received, and my ability to cope with all the obstacles and challenges of the day.

My new routine is here to stay. So far it has saved me emotionally. Will it again when the next crisis comes up? I don’t know, I hope so. It would have been easier to go down a more familiar (negative or hopeless) path, but I choose to take a different, more positive, approach. I can’t control everything; I know that logically, I can still try. Control has been part of my DNA since I was a teenager. I remember the 1994 Northridge earthquake only amplified those feelings.

Pick up any health-based magazine or newspaper and it talks about the power of meditation. The research is there: it works! Discover what brings you peace of mind when you feel you’ve reached your breaking point. 


Lori Michiel, NASM-CPT, Founder, Lori Michiel Fitness seniors in the home

Lori has been assisting seniors in their homes since 2006 with customized exercise programs including those designed to address Parkinson’s, metabolic disorders, arthritis and diabetes. These adaptive programs are specifically designed to improve balance, circulation, flexibility, mobility and promote independence. Lori Michiel Fitness has over 40 certified trainers who are matched with clients in Los Angeles, Ventura and Orange Counties.

Knee joint anatomy, 3D model

The Importance of Isometrics for the Joint Replacement Client, Part 2

In Part 1 of this article, we defined isometrics and discussed the two basic types of isometric exercises, yielding and overcoming, and why you might choose one over the other. In Part 2, we’re going to discuss the benefits of isometrics, especially for joint replacement clients, and ideas on how to use and program isometrics.

What are the benefits of isometric exercises?

Isometric exercises are beneficial for everyone – athletes, fitness enthusiasts, those with musculoskeletal pain, those in rehab, etc. But they are especially beneficial for joint replacement fitness. Here are the primary benefits of isometrics training:

You control the effort level – The client has complete control over the amount of effort/force they are producing. This not only contributes to the safety of isometric training, but it also helps joint replacement clients (or anyone recovering from injury or motor control issues) learn how to control their force production. Isometrics specifically activate pre-motor and supplementary motor areas in the brain.

Isometrics are the least neurologically threatening form of strength training[1] – Because the client is in total control of the effort level and that force is being produced without joint movement, isometrics are a very low threat to the nervous system. This very often allows clients to utilize isometrics well before dynamic exercises, and feel safe producing force, which is very important as joint replacement clients relearn neuromuscular activation patterns.

Larger amounts of force can be generated than dynamic training – If you are doing multiple reps of an exercise, you are, by definition, not producing maximum force. Isometrics allow a client to work up to max force production in a safe and pain-free manner.

Isometrics promote joint health and strength – The synovial fluid in joints is a Non-Newtonian Fluid, meaning that when increased pressure occurs through the joint, the viscosity of the synovial fluid increases, to provide more protection for the joint. Thus, isometrics take advantage of the hydrodynamics of the joint fluid, which increases joint stability as increasing amounts of force are put through the joint.

Pain reduction – Isometric exercises have been shown to reduce pain in patellar tendinopathy[1] and lateral elbow tendinopathy[2], sometimes used by itself or with other modalities. In our experience, isometrics can be a very powerful tool to mitigate musculoskeletal pain.

How do you use isometrics?

There are three primary parameters we can adjust when doing isometrics:

  • Effort level – This is the percentage of effort/force output at which you are engaging the target musculature. You could get objective numbers by using a dynamometer, but these can be expensive and most medical fitness trainers will not likely have access to one. We have found at a practical level that a subjective estimate by the client works just fine (e.g., “push at 50% effort… now increase to 75%… now ease into 100% effort if there is no pain.”
  • Time of contraction – A full, 100% effort level of contraction can be held at most for six to eight seconds. But this does not mean that longer, sub-maximal effort isometrics are not useful. In fact, most of the studies that have used isometrics for pain reduction do just that – isometric holds at 30-60 seconds at 50-75% effort.
  • Joint angles – An old myth about isometrics was that strength increases were only gained at the exact joint angle at which the isometrics we done. We now know this is not the case, and that strength increases can be found at multiple joint angle positions from isometrics, although how large of an increase can depend upon which joint angle was used.[1]

A good place to start with joint replacement clients would be lower effort levels, longer times of contraction, and the most comfortable joint angle. For a knee replacement client this could look something like:

  • Exercises: Standing Knee Flexion and Standing Knee Extension
  • Effort: 25-75% (highest possible without pain)
  • Time: 30-45 seconds
  • Joint Angle: 90o / mid-range
  • Volume: 2-3 sets of the 30-45 second holds

Unilateral, open chain exercises like these are great as they force stabilization to happen on the non-working side, so you would want the client to do isometrics on both sides. When the non-replaced side is doing the isometric, the replacement side must do the stabilization. This is just as important as the strength work. However, depending on the client’s starting point for stabilization, you may need to start with closed chain exercises.

As the joint replacement client becomes stronger and more stable, you could shift into higher effort levels, shorter times of contraction, and multiple joint angles. For a hip replacement client this could look something like:

  • Exercises: Lunge / Split Squat Stance
  • Effort: 75-100% (highest possible without pain)
  • Time: 6-8 seconds
  • Joint Angles: 1) Near fully stretched, 2) 90o / mid-range, and 3) near fully contracted
  • Volume: 1-3 sets of 6-8 second holds at all three positions (e.g., 1 set = a 6-8 second hold at positions 1, 2, and 3)

Isometrics can be a very useful and powerful tool when training joint replacement clients but also for general fitness, performance, and pain clients! You can learn more about isometrics, specific isometric exercises for joint replacement clients, and about taking a neuro-centric approach to medical fitness with our Joint Replacement Fitness Specialist online course, available through the MedFit Classroom!


Pat Marques is a Z-Health Master Trainer and NSCA-CPT specializing in training the nervous system to improve performance and get out of pain. After retiring from the Active Duty Army, Pat pursued his education and certifications in exercise science, initially working with wounded, ill, and injured soldiers. During this time that Pat discovered the power of using a neurological approach to training to get out of pain and improve fitness and performance. He currently provides exercise therapy, movement reeducation, and strength and conditioning for all levels of clients at NeuroAthlete, from chronic pain sufferers to Olympic-level and professional athletes.

References

[1] Cobb, E. (2017). 9S: Strength & Suppleness Course, Z-Health Performance Solutions.

[2] van Ark M, et al. (2015). Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A randomised clinical trial. J Sci Med Sport (2015).

[3] Vuvan, V., Vicenzino, B., Mellor, R., Heales, L., & Coombes, B. (2019). Unsupervised Isometric Exercise versus Wait-and-See for Lateral Elbow Tendinopathy. Medicine & Science in Sports & Exercise.

[4] Kubo, K., Ohgo, K., Takeishi, R., Yoshinaga, K., Tsunoda, N., Kanehisa, H., & Fukunaga, T. (2005). Effects of Isometric training at different knee angles on the muscle-tendon complex in vivo. Scandinavian Journal of Medicine & Science in Sports.

isometric1

The Importance of Isometrics for the Joint Replacement Client, Part 1

Isometric exercises are the most highly under-utilized form of exercise in fitness in general, but they are especially important in a medical fitness context. In this two-part blog series we’re going to discuss what isometrics are, why they are so good (especially for joint replacement fitness), and how you can use them.

In Part 1, let’s define what we are talking about.

What are isometric exercises?

Isometric exercises utilize an isometric contraction of the muscle, which is a contraction in which the muscle is neither shortening nor lengthening as the muscle contracts. A concentric contraction is when the muscle belly is shortening as the muscle contracts (e.g., flexing the elbow as you raise the weight during a biceps curl). An eccentric contraction is when the muscle belly is lengthening as the muscle contracts (e.g., extending the elbow as you lower the weight during a biceps curl).

With isometrics we are contracting/flexing the muscle, but there is no movement (shortening or lengthening) of the muscle.

What are the types of isometric exercises?

There are many ways to do isometrics, but they all essentially fall into two broad categories:

Yielding isometrics

Yielding isometrics are when you are trying to resist a force, weight, or gravity. These are sometimes called “holding” isometrics. If you were a disruptive student in gym class as a kid, like me, you may fondly remember wall sits… a great example of a yielding isometric exercise.

With yielding isometrics, think deceleration. You are essentially fighting the eccentric (lengthening) contraction. Other examples include:

  • Holding the top position of a chin-up for the back and biceps
  • Holding the top position of a push-up for the chest and triceps

You do not have to be in the fully contracted position like the two examples above. Holding a mid-range position, like the wall sits example or holding a weight halfway through a rep range, would also be a yielding isometric.

Overcoming isometrics

Overcoming isometrics are when you are trying to produce force against an object that will not move. These are sometimes called “pushing” isometrics.  

With overcoming isometrics, think acceleration. You are engaging the concentric (shortening) contraction, but the shortening of the muscle is blocked by the immovable object (i.e., bar, strap, etc.). Using a hip belt connected to a strap you are standing on would be an example for a squat pattern. Other examples include:

  • Pressing an unloaded barbell into the safety pins in rack (i.e., for bench press, squat, deadlift, etc.)
  • Using an ankle cuff on the wrist or ankle attached to a strap (NOT a resistance band) and setting up a direction of push or pull so the strap resists your contraction

Which type of isometric is best for joint replacement clients?

Both types of isometrics are very useful for regaining muscular force production capability. Some studies have shown that under equal force generation, a muscle will fatigue faster during a yielding isometric, possibly due to the more complex neural control strategies involved.[1]

When choosing between the two types, consider the SAID Principle – Specific Adaptation to Imposed Demand. Does your joint replacement client most need to work on getting up out of a chair? If so, then overcoming isometrics will likely help them the most (more concentric contraction focused). Conversely, if they are having the most difficulty in descending stairs, yielding isometrics may be of more benefit (more eccentric contraction focused).

In Part 2, we’ll talk about the specific benefits of isometrics, especially for joint replacement clients, and ideas on how to use and program isometrics.

Continued Education for Fit Pros

Begin learning a neuro-centric approach to medical fitness and how to work with joint replacement clients with our Joint Replacement Fitness Specialist online course, available through the MedFit Classroom!


Pat Marques is a Z-Health Master Trainer and NSCA-CPT specializing in training the nervous system to improve performance and get out of pain. After retiring from the Active Duty Army, Pat pursued his education and certifications in exercise science, initially working with wounded, ill, and injured soldiers. During this time that Pat discovered the power of using a neurological approach to training to get out of pain and improve fitness and performance. He currently provides exercise therapy, movement reeducation, and strength and conditioning for all levels of clients at NeuroAthlete, from chronic pain sufferers to Olympic-level and professional athletes.

References:
[1] Schaefer, L & Bittmann, F. (2017). Are there two forms of isometric muscle action? Results of the experimental study support a distinction between a holding and a pushing isometric muscle function. BMC Sports Science, Medicine, and Rehabilitation, 9:11.

rma1

Aquatic Pre-Hab for Joint Replacement

By 2030, the demand for primary total hip arthroplasties is estimated to grow by 174% to 572,000. The demand for primary total knee arthroplasties is projected to grow by 673% to 3.48 million procedures.

Pre-surgical or prehabilitation (prehab) programs have been gaining increased popularity and show promising results in getting clients moving quicker after surgery. Prehab can be defined as an individualized physical conditioning program to improve strength, endurance, and range of motion prior to surgery.

I have found in my experience that by incorporating an aquatic program six or more weeks prior to surgery can have significant benefit post-operatively.

A multicenter study performed at New England Baptist Hospital, Beth Israel Deaconess Medical Center and Harvard Medical School found that knee- and hip-replacement surgery patients who had participated in prehab for just six weeks prior to surgeries reduced the need for inpatient rehabilitation by 73 percent. This study involved water-and land-based strength training, plus aerobic and flexibility exercises.

Why Use the Water to Help with Pre-hab?

Reduced Pain & Swelling

Clients awaiting joint replacement surgery are usually in a significant amount of pain. They may experience pain not only at the specific joint but also in corresponding joints that have compensated for improper biomechanics. Using the water’s unloading properties to reduce pain, as well as the hydrostatic pressure to help with swelling reduction, are tremendous benefits.

Restore Range of Motion (ROM)/Muscle Balance

I always tell my clients, “Motion is Lotion.” This means that the more you move correctly, the better you will feel. Gaining as much ROM prior to joint replacement is very important. I also share, “The doctor will be replacing your joint, not your ligaments, tendons or muscles. The more muscle balance we can get the better you will do post operatively.” I give the example of a worn out tire on a car. Over time the cars suspension adapts to that worn tire and pulls out of alignment. The replaced joint represents the new tire; now we have to realign the suspension so everything rides correctly.

In the water using flotation equipment on the lower extremities allows the client to gain much more ROM.

Buoyancy unloads the joint and assists the motion, but more importantly the client has control over the movement.  If try to manually stretch a client, he/she is automatically guarded, no matter how much I remind them to “relax”. Moving freely in the water, the client is more likely to push their ROM than if I stretch him/her manually.

Improve Strength

Pain causes muscle inhibition and hence muscle weakening. Neuromuscular control needs to be restored prior to surgery in order to facilitate muscle recovery post-operatively. The stronger the muscles are, the faster the recovery. Strengthening exercises to help balance all muscle groups are much easier and comfortably performed in the water. Water provides an accommodating three-dimensional resistance which allows multiple muscle groups to be strengthened simultaneously.

Improve Proprioceptive Awareness & Normal Movement Patterns

Any functional movement depends on the coordination and fine tuning of the neuromuscular system. Joint degeneration affects the soft tissues that contain proprioceptors, which will cause significant reduction in the awareness of joint movement.

Proprioceptive exercises can be be started prior to surgery to stimulate the neuromuscular mechanisms and make them more responsive after surgery. The water provides a surrounding proprioceptive enriched environment to help restore neuromuscular function, including balance and proprioception.

Improve Gait

Degeneration of lower extremity joint will commonly result in a compensated gait pattern. This pattern is often continued, even after surgery, because of abnormal motor patterns. Use the water to correct gait patterns prior to surgery, which will assist with alignment, weight shift and proprioceptive input, and therefore facilitate a normal post-op gait pattern.

Client Education

Surgeons often do not tell the client what they will experience post operatively. Thus, another benefit of prehab is the opportunity to educate the client on the post-op process. Clients often compare themselves to other people who have had a similar surgery, which can lead to frustration. By educating the client and with the understanding that everyone progresses at a different rate.

In my experience, by utilizing the water for prehabilitation prior to a total joint replacement is one of the best ways to get clients moving and feeling better faster!


If you’re interested in sponsoring a Medically Based Aquatics (MBA) course at your facility, please contact Rick McAvoy at rick@rickmcavoyaquatics.com

Dr. Rick McAvoy has specialized in Aquatic Physical Therapy and Sports Performance for over 30 years and promotes aquatic fitness, rehab and training. He is the Owner of Rick McAvoy Aquatics, an Aquatic Fitness and Sports Performance Training and Consulting Company. Rick is also a published author and researcher in the field of Aquatic Therapy and Fitness as well as Sports Performance.

senior-man-and-trainer-treadmill

Coaching Hardiness of Heart: Buffers vs. Band-Aids

Like a leaky roof, do we just patch the hole, and hope for the best?  Or do we replace and restore it, and do the maintenance to optimize it, despite extreme weather conditions?  In ski-speak, we joke about variable conditions, never predictable.  In life, it’s the same thing.  Are we prepped and ready for the curveballs and Murphy-strikes that WILL come our way?  Do we have an ample buffer, a reserve capacity to pull from?  Can we bounce back, repeatedly, take hits and remain solid?  Hardy folks can and do!   Think of a hardy person you know.  What keeps them surviving, and thriving?     

Today, it is well-accepted that cardiovascular disease (CVD), the leading cause of death in the U.S., is rooted in inflammation, insulin-resistance, oxidative stress (rusting), hormonal imbalances and exposure to toxins.  We also know that a lousy diet, long-term micro-nutrient deficiencies, physical INactivity, chronic DIStress, and various toxins, raise cholesterol and blood pressure exacerbating an inflammatory response in our arterial endothelium. Remember that half of the people who experience heart attacks do NOT suffer from hypercholesterolemia. To quote Mark Hyman, M.D., Founder, Cleveland Clinic Center for Functional Medicine, “CVD is not about cholesterol; it is about inflammation in a cholesterol environment.”    

So, when 45 year old 2-stent Charlie, husband, father of three, small business owner, with a passion for hunting and fishing comes to me, I need Whole-Charlie coaching.  A Hardiness model fills the bill.

Hardiness Coaching is designed to fortify FIVE structural pillars: 1) Movement, 2) Diet, 3) Rest-Recovery-Regeneration, 4) Stress Resistance and, 5) Purpose-Relevance-Meaning. The Pillars are grounded in a foundation of DAILY habits, patterns and practices, not programs with a start and end date. They are interconnected, and the robustness of one supports the others; if one crumbles, the others bear the brunt. By repairing cracks and leaks within a given pillar, we boost overall resilience, durability, and robustness, not just the CV issue at heart (no pun intended). Hey, what’s good for the heart, is good for the brain is good for the gut is good for the immune system is… 

Our clients come to us with the desire to move better, feel better and get back to living life, even surpassing it, despite their issues. Their current health does NOT define them, nor does their age. It’s our responsibility to meet them where they’re at, know where they have been [for decades], and get them where they want to go. Keeping their hopes and dreams alive is paramount.

As Hippocrates so eloquently stated, “Know the person who has the disease, not just the disease that has the person.” 

So, when we hear ‘cardiac or cardiovascular’, think beyond the heart and vasculature for transport and waste removal. Think integration with the lymph and respiratory systems, and their role in running a well-oiled machine, one where the other six systems [gut microbiome, immune/inflammatory, energy production (mitochondria), waste disposal – detoxification, communication (neurotransmitters, hormones), structural (cells, tissues, organs) synergistically thrive. This is a Functional Medicine model. Check it out. 

Clinical psychologists, physical therapists or medical doctors, we are not. But, we impact lives in a multitude of ways, some measured by hard data, and others, by those intangibles like confidence and joy. Yes, we work within the physical realm, but when we take the integrated pillar approach to coaching Hardiness, we sync and link the pillars, buttressing them to exponentially resist and adapt better to the stresses and strains of life. Buttresses, NOT band-aids! 

Coaching MUST transfer to performing and feeling better, at home, in labor, care-giving, recreation and even competition. For example, with regards to the movement pillar, there are three realms:  1) physical activity, as in walking, stairs, labor and chores, 2) recreation, as in sport, dance, all-seasons GO on snow, ice, sand or water, and 3) TRAINING, exercising with purpose. ALL contribute to the robustness of our movement pillar. Training is only one piece of the movement pie, so yes to targeted training, AND to more movement in labor, hobbies and play.  

When training any adult, there are 7S Buckets that may need to be restored and refilled. The 7th Bucket is Specificity and Specifics. Specificity refers to “we get what we train for; we keep what we do!” Specifics are those things unique to our client; in this case, those CV conditions that propelled the client in our direction in the first place. It may have been a primary care Doc, a referral from cardiac rehab or simply the client’s grit to BE better. Whatever, we are here to fortify all their pillars of hardiness.

Don’t get me wrong. We must know CVD pathologies, physiology, metrics and measurement, and network with relevant healthcare professionals. But more importantly, we must customize and personalize coaching to provide the springboard for Charlie to thrive, as a husband, father, business owner and outdoorsman, to optimize his health-span, and his zest for living life to his fullest.

So, from pacemakers, stents, meds and more, to risk factors, co-morbidities, MSK challenges and all else in store, we practitioners are here to reboot, rebuild, coach, train and restore.  

Specialization for Fit Pros

Join Pat VanGalen in the online course, Cardiac REHAB Fitness Specialist. Learn the nuts and bolts of coaching hardiness within the cardiovascular system. Evidence-based facts, figures, updates AND case studies will tweak your coaching.  Integrate, don’t isolate!


Patricia ‘Pat’ VanGalen, M.S. brings a unique blend of education, practical experience, common sense application, science and research to her lecturing, teaching, training and coaching. She launched her professional career 40+ years ago in physical education and coaching, then spent the next 10 years in corporate-industrial fitness, health promotion, cardiac rehab and injury risk reduction programming design, implementation and management. Visit her website, activeandagile.com