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Functional Movement Patterns in Exercise For MS

You’ve heard the terms functional exercise, functional movement or functional movement patterns… but what do these terms actually mean?

The term “functional movement patterns” is confusing because it is really not a specific term. Trainers, especially those putting MSers on exercise programs, will usually take them through a program of upper and lower body exercises incorporating compound movements that ask your body to do several things at once. They tell you this is a functional exercise routine and that it’s the best way to help you with your MS limitations. Every exercise is NOT considered a functional one. So what’s the difference?

Functional, by definition, means, “of or having a special activity, purpose, or task; relating to the way in which something works or operates”.  In this case, the task is being a functional MSer with the ability to use your body to do what you’d like it to do like you did before your MS diagnosis.

And even though being “functional” is different from one person to the next—for instance, a triathlete needs to be able to run, bike, and swim without limitation or pain, while a homemaker (male or female) needs to be able to do household chores such as lifting groceries out of a car, moving a vacuum cleaner and loading and unloading a dishwasher without limitation or pain—the actual movement patterns required for these activities aren’t really that different.

When you think of functional movement patterns, you should see them as movements that engage your whole body in a variety of different active ways that involve coordinating your upper and lower body with areas that alternate from being steady to moving, and back again.

So where exercises like squats are considered functional because they require full-body coordination, strength, and stability exercises like biceps curls aren’t considered functional because they lack the full-body mental and physical engagement that comes into play with basic motion.

The main difference between functional training and other exercises that work each muscle is that exercises such as biceps curls or leg extensions attempt to isolate that muscle. When doing these movements we’re working individual body parts as separate from the others creating stimulus within those parts. Functional movements put the emphasis on using your whole body at once. 

The focus on functional movement patterns, in theory, is to train your body to move effectively as a fully connected single unit so it is able to sit, stand, bend or change direction effectively when you need it to.  Some of the functional exercises I use are squats, lunges, and pushups. These movements effectively engage the whole body in the exercise although they emphasize specific muscles as the main force of action.

I believe in functional movement patterns and agree there is a place for them in MS training BUT without the individual muscle-specific training it would be impossible to do a functional movement. If your legs are so weak from MS limitations how are you going to perform a proper squat that uses all the muscles in your legs?!  You won’t be able to. This is why specific muscle training is so important. And the only way to get muscle-specific strength is through resistance training. But it doesn’t end there…

You must strength train each major muscle group, individually and specifically to gain the ability to “function”.  I know you keep hearing about functional exercise for MS and how important it is. You are told that you MUST be in a program using functional movement patterns to help your MS limitations.  I HAVE MS and I have been a fitness expert for more than 40 years. The real FACT is that functional movement patterns are secondary to strength training. They are important but more important to your physical abilities are training methods that incorporate resistance exercises with principles that cause “thought-based training” ™ which create muscle fiber activation, neuroplasticity, and brain to muscle reconnection. 

So where am I going with all this?

Please be careful with who and what you take in as being the right fitness information for MS, especially coming from fitness “experts” who do not understand MS.  There is much more to proper exercise for MS than jumping into the next repetitive functional program.  And any trainer who says he/she is teaching you how to place mental attention on your workouts but only tells you to concentrate on what you are doing does not understand the significance of proper focus. It is not just a simple matter of paying attention to your exercises and form. It is the training methods you use that force that focus and concentration that is of key importance in your MS exercise program.  Exercise programs pushing functional pattern movements with no focus driven process or training method behind them other than the standard and cookie-cutter, “do 10 reps of 3 sets”, are of little value in bringing results to our MS bodies.

Continued Education for Fit Pros

Learn what you need to help MSers… check out the Multiple Sclerosis Fitness Specialist online course for fitness and health professionals!


David Lyons, BS, CPT, is the founder of OptimalBody, which touches the lives of fitness enthusiasts of all kinds. OptimalBody has been named The Most Comprehensive MS Fitness Program worldwide since its release. His book, Everyday Health & Fitness with Multiple Sclerosis, was a #1 New Release on Amazon at its release. He is the 2013 recipient of the Health Advocate of the Year Award; in 2015, he received the first ever Health Advocate Lifetime Achievement Award, and the Lifetime Fitness Inspiration Award in Feb 2016. In 2017, David received the Special Recognition Award from the National Fitness Hall of Fame.

foot-pain

Plantar Fasciitis: Heel to Toe Pain

Overly stretched, tiny tears can lead to inflammation and pain in the arch of the foot. This condition, called plantar fasciitis, accounts for nearly one million doctor visits per year. Our foot has a thick band of tissue called fascia that runs from our heel to our toe. This troublesome foot issue is actually more common in women than men. We need to spend time on our feet moving, so this foot problem, if left untreated, can cause excessive pain and greatly limit our mobility.

Contributing Factors

Plantar fasciitis is more common as we age (specifically between ages 40 and 60), but is also more likely to occur in someone who is overweight or constantly on their feet. It is very common in runners. Activities that are known for high rates of plantar fasciitis include ballet, dance, long-distance running, and ballistic jumping. There are a few other contributing factors which include wearing shoes that are worn out and have thin soles or wearing high-heels. The mechanics of how you walk (your stride) involves your foot position. If you have flat feet or a tight Achilles, the body will compensate for these dysfunctions which can lead to injury of the fascia.

Pain

Pain starts to occur near the heel towards the bottom of the foot. Most people feel the pain in the morning right when they get out of bed. This is known as “first-step pain”. This can also occur if you have been sitting for a long period of time and then stand up. The plantar fascia acts like an absorbing shock spring in our foot. Repetitive stretching and tearing of this area results in a stabbing pain.

Treatment

If pain persists, seeing a doctor can help detect this condition. He or she will check the tender areas of the foot. The good news is that plantar fasciitis does normally go away on its own. There are several treatment options. A doctor might prescribe anti-inflammatory medication or a steroid injection. Physical therapy and massage can help as well as shock wave therapy to stimulate blood flow. A Tenex procedure can remove scar tissue in the area or surgery can be done to remove the plantar fascia off of the heel bone. Wearing the right shoes or using shoe inserts oftentimes does the trick, so be sure to try these simple fixes first. Ice and soaking the heel can also help alleviate pain .

A good home remedy is freezing a foam cup of water then rubbing the top of the cup on the heel for 10 or so minutes. Stretching the calves and Achilles tendon can help over time and there are ways to tape the area of the foot to position the heel correctly with each step. Night splints worn to hold the foot at a 90 degree angle help when stretching the fascia.

There’s no doubt that we use and abuse our feet, bearing vast amounts of weight on them while performing all of our daily functions. As we walk from point A to point B, getting those 10,000 steps in, we must practice self-care from head to toe to heel. Sometimes foregoing that cute pair of shoes even at the gym is worth the fashion sacrifice to walk without pain.


Megan Johnson McCullough, owner of Every BODY’s Fit in Oceanside CA, is a NASM Master Trainer, AFAA group exercise instructor, and specializes in Fitness Nutrition, Weight Management, Senior Fitness, Corrective Exercise, and Drug and Alcohol Recovery. She’s also a Wellness Coach, holds an M.A. Physical Education & Health, and is a current doctoral candidate in Health and Human Performance. She is a professional natural bodybuilder, fitness model, and published author.

 

References

https://journals.lww.com/jaapa/Fulltext/2018/01000/Plantar_fasciitis__A_review_of_treatments.4.aspx
https://journals.sagepub.com/doi/full/10.1177/2473011419896763
https://academic.oup.com/occmed/article/65/2/97/1488760

Pregnant-woman-at-gym

Building Strength is an Important Component in a Prenatal Fitness Routine

You may have heard people warn that pregnant women shouldn’t raise anything over their heads or lift objects that are heavier than ten pounds when pregnant. These are warnings that still make the fitness trainer rounds when working with pregnant clients, yet these warnings aren’t based on science.  In fact, there’s no evidence for warning pregnant women to avoid lifting over their head unless it causes discomfort or balance issues, and the ten-pound limit is even more questionable, as ten pounds would be too heavy for some women and as easy as a feather for others.

It’s important to always remember that each pregnant woman has a specific fitness level and ability, so setting arbitrary limits is an ineffective way to provide guidelines for this population. In addition, when confronted with statements such as these, always review the research that supports the claim before implementing the information into your training guidelines.

Many women choose to continue their pre-pregnancy strength training program while they are pregnant, and most women may safely start strength training during their pregnancy as long as they are cleared for exercise by their healthcare provider. When developing a pregnant woman’s fitness program, you should take into account her current level of fitness and strength and pay close attention to how she feels during and after exercise. The key to maintaining a safe and effective routine is through consistent modification of the exercises for comfort as pregnancy progresses.

Strength training is an essential prenatal fitness component, providing the muscle power needed to compensate for posture adjustments and weight gain that occurs with pregnancy. Women who continue or even start a strength training routine during pregnancy can help prepare her body for all the lifting done with a new baby and reduce the risk of low back pain. Strength training has not been shown to pose any harm to either the fetus or the mother as long as these general guidelines are followed:

  • A gradual reduction in weight loads from pre-pregnancy will likely occur as the pregnancy progresses.
  • Women may continue their pre-pregnancy strength training routine (wt/reps/set) as long as they modify the exercises for comfort as pregnancy progresses.
  • If training causes muscle soreness during the pregnancy, it is recommended that overload be progressed by increasing the number of repetitions versus the resistance/wt.
  • Monitor exercise techniques carefully by mirror observation or supervision in order to correct for progressive postural changes that occur with advancing pregnancy. Improper lifting techniques may aggravate back problems and increase soft tissue injuries.
  • Avoid maximal static lifts. They may cause a sudden increase in cardiac output and blood pressure and employ the Valsalva maneuver. During the Valsalva maneuver, there is a significant diversion of blood from the internal organs (such as the uterus) to the working muscles.
  • Maximal lifts may also place extreme stress on the lumbar spine and other joint areas. Never overload an unstable or weakened joint.
  • Modify supine positions after the first trimester of pregnancy by using an incline board or wedge.
  • A strength-training workout involving all the major muscle groups should be performed three times per week, with a rest day between each muscle group training bout.
  • Machines, free weights, resistance bands, and body weight
  • are all options for building a strength training routine.
  • Remind client that she should exhale with the lift and avoid holding her breath or bearing down and straining as she lifts.
  • If a particular exercise continues to produces pain or discomfort are modification, it should be discontinued. If pain persists, the client should consult with her healthcare provider.

As always, all pregnant women should check with her healthcare provider before starting or continuing an exercise program during pregnancy.


Catherine Cram, MS started her company, Prenatal and Postpartum Fitness Consulting, in order to provide current, evidence- based guidelines maternal fitness guidelines to health and fitness professionals. She was a contributing author for the textbook, “Women’s Health in Physical Therapy” and co-authored the revision of “Exercising Through Your Pregnancy” with Dr. James Clapp.  Her company offers the certification course, “Prenatal and Postpartum Exercise Design” which provides continuing education credits for over 30 health and fitness organization, including ACSM, ACE, ICEA, and Lamaze.

walking mindful

Can Mindfulness Improve your Balance?

Short answer: Absolutely.

Focused attention has the power to improve your health, mood and cognition. When it comes to moving steadier, research shows that practicing mindfulness while walking can improve balance in older adults. This is a simple practice that anyone can do to move more freely and live more fully with more confidence.

What is Mindfulness?

Being mindful means to simply focus on the present moment. Its roots stem from ancient eastern and Buddhist philosophy. It includes being aware of your thoughts, feelings, sensations and the surrounding environment through a gentle, nurturing lens. This way you can tune into what you are sensing in the present moment rather than living in and rehashing the past or projecting into the future. 

Mindfulness Elevates Health

Do a PubMed search on “mindfulness and health” and 14,955 studies pop up in the National Library of Medicine! These research studies show there are numerous well-being benefits that can help people of any age with any health condition including:

  • Reducing stress and pain
  • Improving physical health and chronic conditions like arthritis, diabetes and cancer
  • Promoting cognitive function, attention and memory
  • Elevating emotional well-being and mood
  • Healthier aging and resilience
  • Improving balance!

One foundational way that mindfulness and meditation improve health is by calming your nervous system. Moving out of the sympathetic stress response and into the parasympathetic relaxation response is where health happens. It’s where the body can rest, digest, heal and repair itself. 

Constantly living in “stress mode” where you always feel overwhelmed, fearful or tense puts your body into a chronic state of inflammation that damages cells, tissues and organs. This damage accumulates and can lead to impaired bodily systems from your nervous system, respiratory, cardiovascular, musculoskeletal, and immune system. This can result in inflammaging where the body is under constant stress and strain and breaks down more than it can repair itself. It is a major reason for the age-related decline in physical and cognitive function that makes it more difficult to move and think smoothly and easily. 

Mindfulness for Better Balance

It’s well-accepted that practicing Tai Chi improves ankle proprioception and balance. Now studies are showing that walking meditation can do the same for elderly women and older adults with history of falling (1, 2). Walking meditation has even been shown to improve ankle proprioception and balance performance in people with chronic ankle instability! (3)

Walking meditation is a mindfulness practice where you walk slowly while focusing your attention on your leg and foot movements (2). Researchers saw improved ankle proprioception and balance improvements with older adults being able to stand on one leg for a longer time as well as increased neuromuscular control. When focusing your attention on your movement, researchers think that this improves the brain processes related to body awareness and balance adjustments (1). 

Stronger neural and muscular connections mean you can be faster to sense and respond to your everyday environment, as well as recover from the loss of balance to effectively prevent a life changing injury or fall.  

Practice Mindful Movement

For the happiest, healthiest and safest holiday season, before engaging in activity, focus on “BEAM” to relieve stress, boost mood, build a sharper brain, taller posture and better balance. BEAM is an acronym that stands for Breathe, Elongate, Align and Move Mindfully. 

You can imagine being as long, strong and sturdy as a “beam.” Another meaning of “beam” is to be happy, smiling and radiating a line of bright light or energy. Visualizations can enhance physical and emotional well-being and help bring your attention into the present moment.

BEAM for Better Brain, Body and Balance

Breathe: take 3-4 deep breaths into the front, back and sides of your belly, up into your ribs and then chest; exhale in the opposite direction from your chest, ribs and then squeeze your belly button towards your spine. 

Elongate: lengthen your spine on each inhalation lifting from the crown of your head

Align your body: feel light with body parts lined up; ears over shoulders, shoulders over hips, hips over knees and ankles. Practice standing with feet hip distance apart, toes pointing forward and knees softly bending over your second and third toes; pelvis is in neutral, your sternum lifts up and out with ribs aligned over pelvis, shoulders are back and down away from the ears, line up ears over shoulders that are over hips, knees and ankles. 

Move Mindfully: think about where you are and what you are about to do; whether you are cooking, cleaning, going up or down stairs or walking inside or outside focus on your leg and foot movements

Practice BEAMing throughout your day so you can move mindfully and enjoy feeling sharper, steadier, lighter and more confident with each step you take throughout the holiday season.  

Fit Pros: Guide Older Clients as a Geriatric Fitness and Lifestyle Specialist

Millions of people over age 65 looking for guidance from fitness professionals who are knowledgeable in exercise, nutrition and lifestyle principles that can help them improve functional mobility, while also preventing and managing chronic conditions to live their highest quality of life. The Geriatric Fitness and Lifestyle Specialist online certificate course will give you insights, strategies and tools to be a successful professional in this rapidly growing market. Learn how to be a valued part of clients’ continuum of care, working with the medical team to improve functional outcomes and positively impact people’s lives.


Cate Reade, MS, RD is a Registered Dietitian and Exercise Physiologist 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.

References

  1. https://pubmed.ncbi.nlm.nih.gov/31563384/. Walking meditation promotes ankle proprioception and balance performance among elderly women.” Jour Bodywork & Movement Therapies 2019
  2. https://pubmed.ncbi.nlm.nih.gov/34931904/. “Walking meditation versus balance training for improving balance abilities among older adults with history of fall: A randomized controlled trial.” Clin Rehabil. 2022 
  3. https://europepmc.org/article/med/35093512. Comparative effect of walking meditation and rubber-band exercise on ankle proprioception and balance performance among persons with chronic ankle instability: A randomized controlled trial. Europe PMC 2022
senior fit yoga

Chronic Disease Wellness: Disparities Among African American Active Agers

Are you one of the 50% of people in the United States that suffers from chronic pain due to an illness or injury? Or are you the 1 in 4 adults with at least one form of arthritis or experience inflammation due to an autoimmune disease? Maybe you are a part of the 45% of people who have been diagnosed with type 2 Diabetes or the 12% that have at least 5 chronic illnesses?

According to the Center for Disease Control, an increasing proportion of Americans are dealing with multiple chronic illnesses and are living in chronic pain. However, the good news is that our medical and fitness industry has been making some headway when it comes to promoting and educating the public on the power of exercise to prevent and reduce the onset of chronic diseases. With the growing number of specializations and medical fitness certifications, the number of fitness professionals that are highly trained to work with this demographic is quickly growing due to the help of the most recent research that promotes exercise as way to prevent various diseases.

“You could really benefit from starting an exercise program.”

Do you have a doctor who understands the power of exercise? If so, that is a great start! Regular exercise such as: repetitive and exaggerated movements will activate and build muscle, which is valuable in restoring function, prolonging effects of diseases, and improving neural pathways, muscle memory & Neuroplasticity!

Exercise has been proven to help reduce pain, decrease the dependency on medication, and prevent diseases such as:

  • Heart Disease
  • Diabetes/Obesity
  • Metabolic Syndrome
  • Chronic Obstructive Pulmonary Disease
  • Stroke
  • Some Cancers

The benefits are seemingly endless, however, what about the people in the United States who lack the knowledge, time, money, or opportunity to implement and execute a fitness and wellness routine?  What if YOU are a part of the active aging African American community who faces significant disadvantages when it comes to health and fitness due to a combination of systemic, socioeconomic, and cultural factors?

What Do You Know About Cultural Disparities?

Historically, African Americans have had limited access to quality healthcare and fitness resources, which has led to a higher prevalence of chronic diseases such as hypertension, diabetes, and obesity. Additionally, socioeconomic barriers such as lower income and education levels often result in reduced access to healthy foods, safe exercise environments, and preventive healthcare services. These disparities are compounded by cultural factors, including mistrust of the healthcare system due to historical injustices and a lack of representation in health and fitness professionals, which can discourage engagement in health-promoting behaviors.

  • Access to Healthcare and Fitness Resources: African Americans often have less access to quality healthcare and fitness facilities in neighborhoods where they reside. In addition, they have little to no access to parks, sidewalks, and in some cases, transportation. 
  • Socioeconomic Barriers: Lower income and, in certain instances, education levels limit access to healthy foods, safe exercise environments, and preventive care.
  • Cultural Factors: Historical injustices and lack of representation in health and fitness professions contribute to mistrust and lower engagement. As a result, African Americans are disproportionately exposed to measurable physiological and psychological stress compared to those not of African American origin.  

Some statistics are quite startling: 

  1. African Americans are 1.7 times more likely to have diabetes compared to their white counterparts (American Diabetes Association).
  2. Only 23% of African American adults meet the federal physical activity guidelines, compared to 33% of white adults (CDC).
  3. African Americans have a 50% higher prevalence of hypertension than their white counterparts (American Heart Association).
  4. African Americans are more likely to die at an earlier age due to earlier prevalence of chronic conditions or diseases such as: diabetes, heart disease, cancer, stroke, asthma, HIV/AIDS.  (CDC & The Office of Mental Health, part of the Department for Health and Human Services.  

Addressing Disparities in Health and Fitness

Health and fitness coaches can play a crucial role in addressing these disparities by implementing culturally sensitive and accessible programs. Firstly, coaches can provide education on the importance of regular exercise and balanced nutrition, tailored to the specific needs and preferences of African American Active Agers. This can include offering workshops in community centers, churches, and other familiar settings, making it easier for individuals to participate. Secondly, coaches should advocate for and facilitate access to affordable fitness options, such as sliding scale gym memberships or community exercise programs. Ensuring that these programs are welcoming and inclusive can help reduce the intimidation or alienation that many African Americans may feel in traditional fitness environments.

  • Culturally Sensitive Education: Tailored workshops and programs in familiar community settings.
  • Affordable Fitness Options: Sliding scale memberships and community exercise programs.
  • Inclusive and Welcoming Environments: Reducing feelings of intimidation or alienation in fitness settings.
  • Provision of Resources:  Having a database of resources to help clients with areas outside our scope of work/care/expertise.  

Additionally, health and fitness coaches can foster partnerships with local healthcare providers to create a holistic approach to wellness that addresses both physical and medical needs. They can also serve as advocates for policy changes that improve access to health and fitness resources in underserved communities. By building trust and providing consistent support, coaches can empower African American Active Agers to take charge of their health and improve their overall quality of life. This multi-faceted approach not only addresses immediate fitness needs but also contributes to long-term health improvements and reduced disparities.


Nicole Gordon is a seasoned women’s fitness and health coach with over a decade of experience, specializes in empowering busy women to achieve holistic wellness. As a certified personal trainer, group exercise instructor, and integrative nutrition health coach, Nicole advocates for balanced relationships, meaningful movement, creativity, and spiritual well-being. Her coaching philosophy, centered on “staying in your lane” while striving for progress, helps clients attain improved mobility, flexibility, strength, and energy for a balanced life.

Christine M. Conti, BA, M.Ed, is an international fitness educator and presenter. She currently sits on the MedFit Education Advisory Board and has been nominated to be the 2020 MedFit Network Professional of the Year. She is currently writing the MedFit Network Arthritis Fitness Specialist Course and is the CEO and founder of ContiFit.com and Let’s FACE It Together™ Facial Fitness & Rehabilitation. Christine is also the co-host of Two Fit Crazies & A Microphone Podcast and the co-owner of TFC Podcast Production Co.

parkinsons-word-cloud

Parkinson’s Bone Health: Camptocormia

Welcome back fighters, care-partners and fitness professionals! At Bridges For Parkinson’s, posture/vertical stability is a big concern and one we address in every class. Why? Because a strong, vertical spine means reduced falls, better gait, less back pain, increased lung capacity, ability to enjoy activities and live independently. However, fitness professionals observe some folks living with Parkinson’s disease having a severe forward lean at a 45-90 degree angle.

What is this? What causes it? And, is there a solution?

This forward lean is called “Camptocormia”, derived from two Greek words: Kampto- (To bend) and Kormos (trunk). Camptocormia was first documented in the 17th century by the Spanish painter Francisco de Zurbaran. In the 19th century, Brodie wrote about it. Later the term was coined by Rosanoff and Saloff who described the abnormality in World War 1 soldiers traumatized by shell shocks.

Camptocormia is defined as bent spine syndrome (BSS), an abnormal flexion of the trunk, appearing in standing position, increasing during walking and abating in supine position.

According to Srivanitchapoom and Hallett, approximately 3%-17% of the Parkinson’s population suffers from Camptocormia. See below examples of Camptocormia syndrome.

What Causes “Camptocormia”?

From a muscular perspective, the paraspinal, hip and glute muscles are in a weakened state making it difficult for the body to “fight back” against the neurological side of Camptocormia which we will discuss later in this article.

The paraspinal muscles are located on the left and right side of your spine and are made up of three groups.

  • Iliocostalis
  • Longissimus
  • Spinalis

Paraspinal muscles

The job of the paraspinal muscles is to extend your spine and to bend it over to the same side on which the contracting paraspinal muscle is located. For example: bending to the side to pick something off the floor.

The four main hip and glute muscles include:

  • The gluteal group (butt muscles) – responsible for stabilizing the upper body and pelvis, aid in locomotion and extend the hip. Example: when your leg travels behind you before kicking a ball.
  • The adductor group – responsible for pulling the thighs together and rotating the upper leg inward and stabilizing the hip. Example: When the leg moves to the center of the body after stepping out for a half-jumping jack..
  • The lateral rotator group – responsible for rotating the hip joint laterally. Additionally this group will aid in extension and adduction of the hip. Example: Piriformis stretch also known as the “figure 4 stretch”
  • The iliopsoas – this is the primary hip flexor and assists with external rotation of the hip joint. It plays an important role in correct posture for standing/sitting lumbar position and walking/running.

These muscle groups play a vital part in your activities of daily living! Bridges For Parkinson’s addresses these muscles groups with exercises such as:

  • Sit to stands
  • Squats
  • Bridges/Bird dog/Seated Back Extension (with tubes)
  • Clamshells
  • ½ Warrior step
  • Deadlifts
  • Lunges (forward, reverse, lateral and diagonally)
  • Rows
  • T’s

And we progress the exercise to a higher level of difficulty by:

  • Standing on one leg
  • Adding repetitions or length of time
  • Standing on the BOSU/Pad

Now, let’s discuss the neurological aspect of Camptocormia. Much like “Pisa Syndrome”, the root cause is multifactorial and largely unknown.

Camptocormia is largely considered a neurological disorder due to its comorbidity with other neurodegenerative and movement disorders such as ALS, dementia with Lewy Bodies, Alzheimer’s, and Parkinson’s (Srivanitchapoom & Hallett, 2016). As mentioned, although the presentation of this disorder is largely based on the forward lean, with a tendency to worsen throughout the day due to muscle fatigue, the causes are up for debate in research. For now, the best guess we can take is that the association with PD and other dystonias translates to a faulty cascade of events in the major movement centers of the brain, and the brain-body connection as consequence (Margraf et al., 2016).

Typically, you will find Camptocormia in the more advanced stages of PD, such as those living with Parkinson’s for 7 or more years, those with previous spinal issues, and those who indicate lower motor function on neurological exams (Srivanitchapoom & Hallett, 2016). However, even if you meet any/all of these criteria you won’t necessarily develop this disorder.

The onset of Camptocormia can be mitigated with proper preventative care such as exercise and physical/occupational therapy. Additionally, for individuals with this syndrome, botox and surgery (DBS) can alleviate the severe forward lean.

Botox may be used as a treatment that “freezes” the muscles affected in this disorder, allowing the muscles to lengthen, in turn helping to improve posture. However, this is neither a permanent nor strong solution, although it is seemingly effective in smaller studies assessing the benefits of this treatment (Bertram et al., 2015; Todo et al., 2018; Anandan et al., 2021) . There are also long term drawbacks, the biggest one being muscle weakness that can cause overall worsening of the disorder. There are other, more permanent ways of managing this as well, but are much more invasive. Spinal surgery and Deep Brain Stimulation are two of the more “common” options, although to be considered for these the symptoms must be severe (Margraf et al., 2016). The best ways to manage this disorder are to continue taking your prescribed medication, and exercise to strengthen the muscles involved with keeping your posture upright.

How Does Camptocormia Affect Activities of Daily Living?

Similar to Pisa syndrome, Camptocormia is a non-fixed flexion of the trunk, which can lead to significant deficits in posture, balance, safety, and ability to perform daily activities. Posture is one of the pivotal components for ALL ADLs. So, from an occupational therapy scope, restoration of posture and maintenance of current occupational performance is key.

ADL training: due to posture changes when standing, patients may experience difficulty maintaining routine activities with dressing, bathing. ADL retraining helps to maintain independence and current level of occupational performance.

Seating and positioning: in order to promote improved posture, position hips in an anterior angle, which can allow for increased participation in ADL’s such as feeding or grooming. This can also help with visual ability and increase social participation. Positioning during sleep is another potential area to examine as we do not want to encourage further postural deformity.

Visual strategies: due to the posture changes while standing, camptocormia can lead to difficulty interacting with our environment as we typically would, especially visually. Implementing visual cues or compensatory strategies can help promote improved posture and allow for safe interaction within their home or social environment.

Examples of Cues

1. Sit/stand with shoulders down and shoulder blades pinched together as if you are royalty. Automatically, people position their head over the shoulders and sit/stand taller.

2. Walk with eyes lifted and looking in the distance. When people look down they tend to bend over and slump their shoulders. Looking in the distance prepares them for what is ahead and trains them to use peripheral vision for what is right in front of them.

Home Modifications: modifying home and using assistive devices such as installing grab bars, removing trip hazards (rugs), training with reacher will ensure safety and promote ADL participation.

Energy conservation: as the day continues and the patient feels more fatigued, posture will be more difficult to maintain. Learning and implementing energy conservation techniques could help to promote improved posture throughout the day.

Supine exercises: Supine exercises (on your back) will help to maintain muscle strength and endurance while maintaining proper posture throughout range of motion. These exercises eliminate gravitational pull and forward flexion due to Camptocormia.

In closing, Camptocormia is unique in that it develops over time in conjunction with a movement disorder. The strength of your physical structure depends on having the knowledge to identify possible bone issues such as Camptocormia, properly addressing the issue with corrective exercises and a team that provides support and encouragement.

Bridges For Parkinson’s focuses on helping our fighters and care-partners develop a sense of awareness, provide corrective exercise therapy for those dealing with Camptocormia or preventative exercises to support a strong, vertical spine!

Fit Pros: You Can Improve the Lives of Those Living with Parkinson’s

Enroll in Colleen’s 12-hour online course, Parkinson’s Disease Fitness Specialist. The course brings the research, medical and fitness fields together so that fitness professionals gain a comprehensive understanding of Parkinson’s disease, and learn how to work with those who have it.


Originally printed on bridgesforparkinsons.com. Reprinted with permission.

Written by:

  • Colleen Bridges, M.Ed., NSCA-CPT, Parkinson’s Disease Fitness Specialist
  • Renee Rouleau, PhD candidate, Jacobs School of Biomedical Sciences, University at Buffalo
  • Betsy Lerner, ISSA-CPT, MA English and African American Lit, Parkinson’s Disease Specialist and Rock Steady Boxing Certified
  • Cindy Nyquist, LPTA, ATC, Rock Steady Boxing Certified

References

  • Anandan, C., & Jankovic, J. (2021). Botulinum Toxin in Movement Disorders: An Update. Toxins, 13(1), 42. MDPI AG. Retrieved from http://dx.doi.org/10.3390/toxins13010042
  • Djaldetti R, Mosberg-Galili R, Sroka H, et al. Camptocormia (bent spine) in patients with Parkinson’s disease-characterization and possible pathogenesis of an unusual phenomenon. Mov Disord. 1999;14:443–7.
  • Margraf NG, Wrede A, Deuschl G, Schulz-Schaeffer WJ. Pathophysiological Concepts and Treatment of Camptocormia. J Parkinsons Dis. 2016 Jun 16;6(3):485-501. doi: 10.3233/JPD-160836. PMID: 27314757; PMCID: PMC5008234.
  • Schäbitz WR, Glatz K, Schuhan C, et al. Severe forward flexion of the trunk in Parkinson’s disease: focal myopathy of the paraspinal muscles mimickingcamptocormia. Mov Disord. 2003;18:408–14.
  • Srivanitchapoom P, Hallett M. Camptocormia in Parkinson’s disease: definition, epidemiology, pathogenesis and treatment modalities. J Neurol Neurosurg Psychiatry. 2016 Jan;87(1):75-85. doi: 10.1136/jnnp-2014-310049. Epub 2015 Apr 20. PMID: 25896683; PMCID: PMC5582594.
  • Todo, H., Yamasaki, H., Ogawa, G. et al. Injection of Onabotulinum Toxin A into the Bilateral External Oblique Muscle Attenuated Camptocormia: A Prospective Open-Label Study in Six Patients with Parkinson’s Disease. Neurol Ther 7, 365–371 (2018). https://doi.org/10.1007/s40120-018-0108-x
  • Wartenberg R. Camptocormia. Arch Neurol Psychiatry. 1946;56:327.
change clouds

What Motivates Us to Change?

Humans are neurobiologically wired to seek out safety, convenience, and familiarity in our day to day choices.  The repetition of these choices create our behavioral patterns.  

Behaviors serve two purposes; first, to get something. Second, to avoid something.

Our behaviors cannot change until we become consciously aware of what environment and/or triggers are creating them.