ASK THE THERAPIST By Carol Pietromonaco PTMBA

Question: My mother is an active 77-year-old woman. Lately I’ve noticed she’s been loosing her balance while walking around her house or reaching for something in her kitchen. I am fearful of her falling. My doctor told me about aquatic physical therapy and thought this might help. Does pool therapy really work to improve balance?

Concerned son, in Taunton.

Facts

More than one third of adults 65 years old and older fall each year. The following factors contribute to maintaining good balance. These include strength, flexibility, vision, vestibular & sensory feedback, cognitive factors, medication and medical conditions. As a person ages these factors become impaired due to immobility, pain and various medical conditions. Some factors can however be altered. These include strength, flexibility, and balance reaction time.

Your doctor is correct. Exercise and particularly aquatic exercise, or aquatic physical therapy can be very helpful in preventing falls.

You can’t argue with science?

Two principles of physics can be used to help explain why aquatic exercise is beneficial.

Buoyancy in water diminishes joint loading by reducing the effect of gravity. This reduces the force on the joints of the body and makes movement in the water easier and less painful.

Turbulence occurs when an unstreamlined object, such as a body part, moves through water or when the speed of movement increases. The faster one attempts to move in water, the greater the resistance.¹

Buoyancy and turbulence help explain why flexibility and mobility exercises are easier, more effective, and less painful in water. Turbulence in water helps explain why muscles can be strengthened through aquatic exercise, and balance challenged.

How our body rights itself?

It might be helpful to understand the steps your body takes to stay balanced.

For example, imagine you are standing and someone pushes you with a backwards force by placing their hands on your shoulders. Your center of gravity is now shifted backwards and immediately your muscles (proprioception) send a message to your brain and tell it you are now leaning backwards. Your brain senses that there is now pressure on your heels (sensation). Your brain says, “you can’t lean backwards you’ll fall, and tells your toes and ankles to adjust so that your weight shifts from your heels to your toes (strength and flexibility in your lower body are required).

Many common elder medical conditions such as osteoporosis (arthritis), diabetes and stroke alter the above physical factors. Aquatic Physical therapy helps restore them.

Why believe me?

A series of aquatic exercise studies were conducted to ascertain the effectiveness of aquatic exercise on lower limbs affected by arthritis and to determine its ultimate contribution to improving balance. In all studies the Arthritis Foundation Aquatic Program (AFAP) exercise protocol was used.² The 69 exercises of this program are designed to promote strength, range of motion, and stability.²

In 1997, researchers Suomi and Lindauer found that patients had an increase in strength and range of motion in the lower limbs affected with arthritis following aquatic exercise. If balance is affected by the inability of the lower extremity to work to perform proper postural control strategies due to decreased strength and/or range of motion, then the exercise mode chosen for intervention must be effective in alleviating these deficits.

In a second study, Suomi and Koceja (2000)³ examined the postural sway characteristics of 14 women with lower extremity arthritis before and after a six-week aquatic exercise intervention. The aquatic exercise subjects significantly reduced lateral sway.

For an exercise intervention program to have value for the participants it should demonstrate benefits in functional, day-to-day activities that require balance.

In this study 10 men and women with lower extremity arthritis demonstrated significant improvements in strength and self-reported significant improvement in their perceived ability to perform specific tasks of daily living and a significant reduction in pain while doing so.

Call you local physical therapist to set up an appointment for your mother. Most insurances pay for aquatic therapy. A doctor’s prescription is usually required for your insurance to reimburse.

Thank you for your question. I hope this helped.

Resources:

1. Ferrell KM. Aquatics for people with arthritis. Lippincott’s Prim Care Pract 1996;2(1):102-104.

2.National Arthritis Foundation. Aquatic Program Instructor’s Manual. Atlanta: Arthritis Foundation National Office, 1997 (138).

3. Suomi R, Koceja DM. Postural sway characteristics in women with lower extremity arthritis before and after an aquatic exercise intervention. Arch Phys Med Rehabil 2000;81(6):780-785. 4.http://www.biomech.com/db_area/archives/2001/0109.aquatic.ger.bio.shtml

About the Author:

Carol Pietromonaco graduated from McGill University, Montreal, Canada, in 1996 with a degree in Physical Therapy. She has been practicing in Massachusetts for 11 years. She has experience in a variety of settings from acute care to outpatient orthopedics. She received her MBA from Babson College in 2005. She is currently the primary treating therapist & Clinic Manager at N.E. Physical Therapy Plus Inc.’s Quincy location. N.E. Physical Therapy Plus Inc. has seven locations in the greater Boston area. Carol is happy to answer any health, injury or Physical Therapy related questions you may have. Please email Carol your questions at contact@neptplus.com or cpietromonaco@neptplus.com

For further information call 800.428.2224 or find other articles written by Carol and more about her education and experience, online at www.neptplus.com

The Need

Exercise is a core element of any diabetes treatment plan.Yet most people with diabetes lack the skilled assistance of therapists trained to understand the needs of the disease and equipped with medical exercise guidelines and regimens designed to address their condition.

N.E. PHYSICAL THERAPY PLUS is now a certified provider of the Joslin Diabetic Exercise Program. The Joslin DiabetesCenter is the world’s largest diabetes research center and an affiliate of Harvard Medical School. The Joslin Diabetic Exercise Program was developed and tested at the Joslin Clinic at Harvard University.

Practice Guidelines Issued for Screening, Diagnosing, Treating Diabetes

American Physical Therapy Association of Massachussetts

The APTA has issued new guidelines for Diabetes management. Of specific relevance to physical therapy is this recommendation:

"People with diabetes should perform at least 150 minutes per week of moderate-intensity aerobic physical activity (50% - 70% of maximum heart rate), and unless there are contraindications, those with type 2 diabetes should perform resistance training 3 times per week." Jen Baird, PT, MS, Amherst, MA

We are now offering this program

at

N.E. Physical Therapy Plus

A certified Joslin Exercise Site

380 Pleasant Street, Route 60, Malden MA, 02148

Fax referral to 781.321.5329

or call 781.321.7012

for information