After many years of sliding into third, risking the black diamond slopes, driving the ball to the basket, powering through blood-pumping runs and trekking up and down the Grand Canyon more times than he can remember, William Stone, PhD, can honestly say he’s actively enjoyed the past few decades.

Stone, along with the masses of active Baby Boomers, grew up with sports and recreation. But as the graying of America takes place, Baby Boomers are starting to bear the burden of their active past. This alarming number of individuals suffering from serious aches, pains and injuries is stirring up several new therapeutic approaches, as well as a new approach to the therapy field as a whole.

High Impact, High Risks

Helene Pavlov, MD, chief of radiology and imaging at the New York City-based Hospital for Special Surgery (HSS), says a high impact non-contact sport like running causes repetitive cyclic loading injuries. Therefore, runners experience stress fractures not because the impact was so great – in the case of a contact sport like football – it’s because of the repetitive nature of the impact.

“When we teach this, we liken it to a paperclip,” explains Pavlov. “If you bend a paperclip, it’s not a problem. But if you bend it back and forth repeatedly, it will snap.”

Typically, with high impact sports like running, the body “snaps” and commonly results in stress injuries in the foot, tibia and occasionally in the hip, says Pavlov.

Yet, the body, unlike the paperclip, has reparative properties and snapping isn’t inevitable. Limbs of the body can be bent back and forth to make the bone and muscle stronger if given enough time to physiologically repair.

“But,” Pavlov says, “if the push is greater than the body’s ability to respond, that’s when you get injuries, that’s when you get stress fractures and that’s when you do damage to tendons and ligaments.”

Escaping Punishment

Last fall, Stone realized he could barely get out of his car because of the excruciating pain in his right hip. “I knew I had to get something done right away,” he recalls.

And he did. He talked to his doctor and soon thereafter underwent a complete hip replacement. He’s now working on building back his strength and range of motion with low impact activities.

“Baby Boomers started jogging in the ’60s and ’70s. You do that long enough and you begin to wear the joints down, like yours truly,” says Stone. “So, people begin to seek out less intense and less joint-punishing activities.”

Pavlov, also a sports medicine expert, says swimming is an excellent exercise in terms of protecting the joints. “Swimming is considered an absolute low impact sport,” she says. “But it doesn’t provide any gravity effect on the bones.”

Spinning, however, offers the perfect cocktail of benefits. Pavlov says spinning – which takes place on a stationery bike with a resistance knob – is superb to all other exercises because of the high intensity, low impact and gravitational effect on the bones.

A Happy, Healthy Fusion

Stone, chair of the department of exercise and wellness at the Mesa, Ariz.-based Arizona State University, says there’s considerable interest now in mind-body exercises. He says this tendency runs parallel to the growing number of Americans adopting alternative and complementary medical approaches.

“People are looking for alternative ways to keep themselves happy and combat stress,” Stone says. “They’ve found that some exercises like yoga are getting the results they’re looking for, as opposed to the traditional running, sweating, et cetera.”

As the popularity increases for this type of exercise, entrepreneurs like Sharon Colvill are heading up low impact-centric facilities to supply the demand.

Colvill and her husband own Fusion, a studio in Fort Thomas, Ky., that offers only yoga, spinning, Pilates and personalized strength training classes.

Because many of the facility’s members asked for a stress releasing activity, Colvill brought an ashtanga yoga instructor on board as this type of yoga heavily focuses on breathing and meditation.

While Pilates is one of Fusion’s most popular classes, spinning treads close behind. Colvill says several people in her spinning classes are actually runners recovering from an injury or preventing one.

She adds, “Runners are starting to see spinning as a great alternative that lets them heal and recover while still sticking to their training program.”

Lending an Ear to the Body

Pavlov says many running injuries occur when “the runner ‘runs through the pain.’ Yoga injuries occur when the body says, ‘No, no, no,’ and the person doesn’t listen.”

But people don’t always listen, and stress injuries happen. When they do, Pavlov says the only thing that can improve the situation is an early diagnosis. She says there is a window of opportunity when the stress injury is microscopic and not grossly imminent.

This microscopic fracture, or an edema pattern, can be seen on detailed plain radiographs or magnetic resonance. When the micro fractures become more consolidated, it’s easier to see on plain film. But it’s best to catch the fracture before it gets to that point.

Pavlov says, “The problem with a partial fracture is that if the person runs through it, it will propagate and become a complete fracture, usually requiring surgical intervention and an extended amount of downtime.”

A Higher Quality of Life

Fred Miller, author of Yoga for Common Aches and Pains (Penguin/Putnam, 2005), says yoga is physically beneficial for people because they are stretching, strengthening and bringing more oxygen their muscles; And it benefits people mentally because they gain a sense of wellbeing and accomplishment they can’t get with other exercises.

“People try a lot of different kinds of exercises and most of them don’t work and they get depressed over that. But yoga is about progressive accomplishments,” he explains. “Even in the case of chronic fatigue, [multiple sclerosis] and lupus, people can use yoga to build strength and improve their quality of life.”

This holds true for Michele Holland PT, ATC, CSCS, in private practice with her husband Jerry Holland PT, ATC, CSCS in Londonderry and Nashua, N.H. As clients are able to master a task and have a better understanding of their low impact activity program, Holland says she sees a new interest in continuing a long-term total strength and conditioning program with positive effect to their diet and attitude.

“If you could put positive attitude into a pill, you’d be a gazillionaire,” says Miller. “But in reality, you can do it with a few moving and breathing exercises.”

Sticking to It

Therapists aren’t the only ones saying a positive attitude and sense of accomplishment is leading to program continuation. Research is now saying it, too.

The American College of Sports Medicine (ACSM) recommends exercise for 30 minutes at 75 percent maximum heart rate. “Very few people could start exercising at such a high heart rate, and they certainly couldn’t endure 30 minutes of it,” Stone explains.

In fact, 50 percent of people drop out of a physical activity program – such as the one recommended by the ACSM – within six months. But Stone says he’s getting up to 75 percent adherence at nine months using a model based on the Surgeon General’s prescription: A basic recommendation saying one can get a health benefit by conducting moderate exercise for 30 minutes accumulated five to seven times a week.

“That prescription is effective, but it isn’t as rigorous and it fits the kinds of things you’re getting with yoga and Pilates. Plus, you get the added range of motion, whether you’re young or old,” says Stone. “So, we suggest adopting a lifestyle activity model.”

Making it Meaningful

Lifestyle activity is the basis for a new approach that’s bringing a lot of success to the Rehabilitation Institute of Chicago’s (RIC) Arthritis Center.

“From an OT perspective, we’re uniquely looking at physical activity in what we’re calling ‘lifestyle physical activity,’” says RIC’s Heidi Fischer, MS, OTR/L. “We have a client-centered approach where we include activities they are interested in, and we integrate formal and non-formal exercises into their program – all depending on their preferences. We’re helping them to re-engineer their lives and integrate new kinds of meaningful activity into their day.”

Due to recent advances in arthritis pharmacology, Fischer says there’s been a growing need to prevent future deterioration and to promote joint health through physical activity. This is a departure from the traditional techniques of symptom management that have been in place for the past 30 years.

After integrating meaningful activity into their lives and exercising more, Fischer says people are surprised at themselves. She adds, “We find that after people start our program, they say they feel better and more confident to take charge of their own body and their own life.”
 
While RIC’s program integrates non-formal activities – such as housework, gardening and playing with an animal – it also encourages patients to incorporate formal, low impact activities like Pilates and yoga.

Holland says this training is important because it focuses on proper postural positions, total body flexibility and trunk or "core" stability.

A person must have good proximal stability in the trunk before they can have good distal mobility and strength in their extremities, says Holland. And once patients get this stability, the improvements are quite apparent.

“I see a dramatic difference in patients’ awareness levels in how proper posture and core stabilization affect their injury,” says Holland. “It does not matter if I am treating them for a back injury or an extremity injury; with the knowledge of proper movement patterns, they can correct faulty biomechanics of their joints and prevent further injury.”

When Two Worlds Collide

While a sizable gap exists today between therapy and imaging fields, Pavlov says those two worlds will soon collide in the name of improved patient care. 

She says the divide between physical therapy and the imaging world is already diminishing at HSS. She says PTs attend conferences to better understand images and further integrate their group as part of what she calls the “HSS team.”

“The more informed that anyone is, the better,” Pavlov says. “I think if a therapist got exposed to different types of imaging and different injuries, it would be easier for them to provide the necessary therapy. It’s good for them to understand what happened, what type of surgery was done and where exactly those pins are so they are more knowledgeable and their therapy is more effective.”


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Amy Storer is the editor of TherapyTimes.com. Questions or comments can be directed to editorial@TherapyTimes.com.