National Physical Therapy Month Looks at 'Aging Well'
National Physical Therapy Month (NPTM) is hosted by the American Physical Therapy Association each October, and this year, the focus is on healthy aging.
At fisio Physical Therapy, 172 Mt Pleasant Road, physical therapist Karen LaBanca said that chronic neck and back pain are common issues for her older patients.
“Often, it’s from prolonged sitting, or spinal stenosis, a degenerative condition of the lower back or neck,” she said. The conditino results in pain when standing or walking.
“We teach ways to sleep more comfortably. For spine issues, we suggest side-lying with support for the neck curvature and a pillow between the legs,” said Ms LaBanca. If the neck and spine are not supported, disc and nerve issues can create pain, numbness, and weakness, she explained.
On the opposite side of the spectrum are the older patients who are so active that they experience injuries commonly seen in patients in their 30s or 40s, she said.
With time freed up by retirement, and with many having the resources available to do so, the older generation is traveling more and engaging in activities that may have been put on hold for a number of years.
“So many more people in the Baby Boomer generation are exercising. We’re seeing ankle injuries and ortho injuries. Exercise is good,” Ms LaBanca stressed, “but going from sedentary to active in retirement leads to some injuries,” she cautioned.
Some issues are not the fault of the patient, but simply ones that are common as the body ages.
“The spontaneous tear of the rotator cuff, is one,” she said. “[Older patients] come to us for therapy to strengthen the shoulder,” she said, after such an injury. Stretching and strengthening exercises can bring mobility back and prevent a frozen shoulder.
At fisio, they also see a demographic of older patients who are weak or deconditioned and have suffered a fall, and seek physical therapy to recover. Hip and knee issues are other conditions that bring older patients to fisio. Regional pain in those areas can indicate the need for a joint replacement, Ms LaBanca said. Physical therapy is recommended postsurgery, she said.
“Come to physical therapy sooner, rather than later, when experiencing aches and pains,” Ms LaBanca said.
Treatment does not differ greatly for older patients. Her office offers a great deal of hands-on therapy.
“Touch helps break up swelling, decreases pain, and improves mobility and motion,” she said. A gentler touch may be necessary on the aging patient, depending on the skin integrity or neuropathies, she said.
fisio also recommends exercises to stretch tight muscles and strengthen weak muscles. Patients with declining vision or hearing, or who have lost a loved one may be at risk for injuries, and Ms LaBanca is happy to advise patients of ways to address the environment to reduce risk of fall.
“We work with patients, too, on balance,” she said, which is an issue for many as they age.
Direct Access
What many people do not realize is that most insurance does not require a physician’s referral to receive physical therapy.
“It’s called direct access in Connecticut. The exceptions are those on Medicare and if an injury is sustained at work,” she said.
Following a thorough evaluation at the first visit, Ms LaBanca does fax the evaluation to the patient’s primary physician.
“I ask the physician to sign off on the plan of care, even though we don’t need it. It’s important,” she said, “to keep communication open.”
Creating a warm and fun environment for physical therapy is vital to helping people get better, Ms LaBanca said.
“We may not eliminate every dysfunction, but if we can allow somebody to be safe in his or her home, or return to an activity they love, that’s pretty cool.”
As director of physical, occupational, and speech therapy at Masonicare at Newtown, Brian Gallo sees patients mainly in the “65 to 102” age range.
“We really don’t worry about age so much, though,” said Mr Gallo. How healthy a patient was prior to seeing the physical therapist has much more bearing on the outcome. The body ages in relation to care, disease, and environment more than by yearly progression.
“It’s more about the diagnoses and prior level of function. Our goal is always to get the patient back to that level,” he said. Each new patient is evaluated by a physical therapist, occupational therapist, and/or the speech therapist at Masonicare, in order to determine the needs.
Physical therapy postsurgery often brings patients to the facility. Falls, often from clutter in the environment, or slipping on wet leaves in autumn, or snow and ice in winter, are very common among older patients, Mr Gallo said.
“We see a lot of people who have had strokes, or heart attacks,” he said, requiring physical and occupational therapy before they can safely go home.
Dementia patients are among the physical therapy patients he is likely to see and require a more repetitive education piece in order to make progress.
Anyone who experiences changes to the usual level of physical activity can seek physical therapy treatment, Mr Gallo said, but initially should schedule an appointment with his or her doctor to rule out any medical reason for the decline. Even if the doctor does not suggest it, any patient can request a referral.
Masonicare offers physical and occupational therapy to any community member, so long as insurance covers it. Physical therapists there work hand in hand with doctors to determine the best plan of care, he said.
It Takes Teamwork
In seeking a physical therapist that is experienced in working with older clients, Mr Gallo suggested setting up a brief interview.
“Have a conversation with the physical therapist to see if it is a good fit,” he recommended.
Regardless of what brings a person to physical therapy at Masonicare, “We always go back to what they did in the community. We don’t use traditional exercises all of the time,” said Mr Gallo. A carpenter, for example, might benefit from therapy that centers on an activity, like building a birdhouse. A gardener can go into the greenhouse there and pot plants — all the while actually working on balance and building up a tolerance to standing.
The therapists at Masonicare would rather not see patients have to return. Staying healthy can alleviate many of the issues that bring a person into physical therapy, he said.
Annual visits to the primary care physician, and getting appropriate vaccinations are important.
“I tell people, ‘Listen to your body,’” Mr Gallo said, particularly those with diabetes or other diseases that can lead to dizziness when not properly addressed. “If a person falls, it is important for him or her to immediately tell someone, even if they don’t think they’ve hurt themselves,” he said.
Exercise and continuing education are two of the best ways to head off injuries that lead to physical therapy, said Mr Gallo.
“A lot of falls happen because of leg or trunk weakness. Any kind of strengthening exercise is good, but especially exercise that improves core stability,” he said. Sit-ups, Pilates, squats, and chair yoga all strengthen the midsection.
“Go to community centers and senior citizen centers,” he urged. Educational programs keep a person alert, and it is a great way to make friends. And, he added, most senior centers offer a variety of exercise programs.
Silver Sneakers is a national fitness program geared toward the older population, and offers programs taught by instructors trained in senior fitness. At www.silversneakers.com, Snap Fitness in Bethel, Greenknoll YMCA in Brookfield, and Core Fitness in Newtown are all indicated as Silver Sneakers sites.
Newtown Senior Center, at 14 Riverside Road in Sandy Hook, offers a wide variety of exercise programs, said Senior Center Director Marilyn Place, and they are very popular. Members can choose from general exercise programs, yoga or chair yoga, stretch and meditation, qi gong, tai chi, dance, strength training, Zumba Gold, and activities such as ping-pong or pool. The center also offers numerous social activities, as well as noontime meals and special events. For information, call 203-270-4310.
Physical therapy is a vital part of returning a person to good health, but through attention to good health, many of those appointments can be avoided.
“It takes teamwork to return a patient to good health,” Mr Gallo said, and they always look forward to seeing former patients return — for a friendly visit, not as a readmittance.