Whether you see yourself striving to stay fit marking your 10,000 steps a day or you are among the super-agers aiming for the athletic outer limits, we can all find ourselves trapped in a sequential process of normal muscle soreness that can evolve into chronic pain and eventually lead to injury. Many overuse injuries are just that: if you don’t allow yourself adequate time to recover from strenuous activity, the micro-trauma from workouts can build up to injury.
Repeated overuse of healthy tissues and ongoing damage of injured ones can perpetuate the cycle of new pains and worsening strain that can go on for years. All the while, slow and insidious changes occur in our body mechanics, ultimately leading to weakness and muscle imbalances. We are hardly aware of any of this as the years pass, until the “sudden” moment we can no longer ignore a pain or perform an exercise with ease.
Physical therapists are thought of as the go-to specialists following an injury (bone fractures, tendon and cartilage tears, severe sprains, strokes, and other mobility diseases), and many adults have never been to a physical therapist unless for these reasons. Yet, they are the best resource to use if our goal is lifelong agility and mobility. The mobility checkup, performed by a certified physical therapist, isn’t a standard tool in our self-care armamentarium tool kit, but it should be.
Here are few reasons why we should be getting yearly physical therapy (PT) mobility and balance evaluations:
The aging process of connective tissues predisposes us to injury, and more than 50% of adults over 65 have been diagnosed with some degree of arthritis. Some degree of pain/discomfort becomes synonymous with older adults and mobility. Consider your own body mechanics and fitness for a moment.
- Do you know where you stand in terms of your range of mobility, muscle strength, chronic areas of weakness?
- Do you know if any imbalances with areas of atrophy exist?
- Do you have joint pain with exertion that you ignore?
- Do you have full range of motion?
- Do your current exercises suit your needs?
- Are you compensating for injured or weak muscles?
- How good is your balance?
Physical performance measures, like walking speed, identify and predict preclinical mobility disability but are rarely used in routine medical care. Yet mobility is considered a crucial aspect in order to maintain healthy aging with a good quality of life. Research data supports mobility is linked to longevity. The model Mobility Checkup is being designed by researchers to reduce mobility disability in older adults, but it is not yet standardized.
The Older/Senior Athlete
It is very easy to misinterpret weakness or pain as post-workout soreness. It is easier still to resign oneself to the belief that slowing down, adapting, is a natural process we are expected to accept with aging. Many older athletes often use the same skills from prior sport coaches without updates and accept their plateau or decline in their strength or agility as inevitable. The take-home message is: while you might have the right training concepts, you might not be performing up to task and actually ignoring the subtle, gradual decline in physical performance from correctable imbalances. Many use gym personal trainers, exercise class teachers, and health coaches as their mentors, but one size does not fit all, and these trainers come with varied expertise. For these reasons, the annual PT mobility checkup with a medically trained expert in body mechanics is the ideal and safest way to assess for areas of imbalance and weakness and offer corrective steps, restore muscle tone and muscle synergy, and limit or prevent future injury.
My Own Story
In my own case, 66 years old and very active despite prior sports-related injuries and surgeries for bilateral knee meniscal tears and a hip cartilage tear, along with bad kneecap alignment genetics and years of zealous Ashtanga yoga and a long youth of formal dance and ballet training, I knew I had knee/hip challenges. However, I failed to understand I was losing ground when I ignored muscle weakness (atrophy), more frequent episodes of tendinitis, and more frequent post-workout pain. Recently, following a ski trip, I had significant knee swelling and felt greater weakness and pain in my right hip. It seemed “new” to me, but it turned out this acute pain was from chronic overuse syndrome, made worse from my own poorly calibrated workout training fueling my growing functional deficiencies. A trip to an orthopedic doctor on my return gave me the answers with MRI imaging and a nonsurgical approach for my mild arthritis and a knee brace for patellar stability, but the goldmine came in a physical therapy evaluation. My therapist, Daniela Jubis Saca PT, DPT, CSCS was about to change my life.
Misled by what I felt was my activity in numerous sports (cycling, modified barre class, home yoga, mountain hiking, downhill ski runs, horseback riding, SUP and swimming, even tennis clinics), I believed my participation in these activities was the metric to define mobility, yet failed to interpret the actual decline in my quality of mobility.
Further fueling my dilemma of staying fit and active in an aging body was the persistent echo: ‘no pain, no gain.’ When my muscle pain was not improving and was hindering my full range of mobility, I didn’t think to get an evaluation by a PT specialist. Instead, I perpetuated my injuries and worsened my weakness using my same exercise routines, needing longer rest periods with pain, unaware I had severe muscle weakness and imbalances that were not being addressed at all. The reformer Pilates classes, yoga, and one-size-fits-all exercise classes were no longer for me since most of them put emphasis on the knees, so I began to avoid doing things that hurt without considering the underlying reasons. It wasn’t until my PT evaluation that I was diagnosed with very specific needs, and got started on corrective leg and hip strengthening routines that protected my damaged areas and reduced the overuse strain. I began to feel changes, less frequent pain, made progress, could see new muscle growth, and had greater stability.
Daniela Jubis Saca PT, DPT, CSCS diagnosed as our challenges my bilateral lower extremity weakness and hip and knee pain from muscle imbalances overlapping the few chronic issues/obstacles from prior injuries. We had to work around my specific obstacles (severe patellofemoral syndrome in my left knee, and right hip tendinitis and scar from prior surgery) and work on bilateral hip flexor weakness, right quadricep strain with right hip tendinitis, and build up a weaker left leg.
We got to work using the PT equipment that isolates muscle groups so we could address the imbalance; eliminate favoring my right leg and work on building up each muscle in both legs, strengthening the left while avoiding putting strain on the left knee and overloading the right leg.
How long did it take before we saw improvements?
I’m coming to the end of three months of biweekly sessions. I am moving in a corrective direction with steady improvement each month. We increased load and increased difficulty of exercises working towards the full range of motion. I was given exercises with home resistance bands and floor-mat exercises to work on my range of motion. Typically, PT insurance coverage with a medical diagnosis covers two to three one-hour sessions a week in a 90-day period.
In hindsight, I learned in the first sessions how I had missed the opportunity for earlier improvement when I first began to experience subtle, gradual decline in my physical performance, saw I had given up my full range of motion, and had a harder time with certain mobility exercises that I should have been doing comfortably. I understood I lost out again when I gave up on the physical challenges I once loved, instead of getting evaluated then. I gave up doing the things that hurt and chalked up the decrease in muscle tone and full range of motion to part of aging.
The lesson here is: getting an evaluation by a PT professional is the game changer. Pain is not gain, and a decline in function and decreases in range of motion are not markers for aging.
Let’s Ask the Professional!
Daniela Jubis Saca PT, DPT, CSCS, my PT therapist working for Fyzical Therapy and Balance Centers in Miami Beach, answered a few of my questions that might help encourage and inspire you to seek a PT mobility evaluation for yourself:
Daniela, why should we be getting annual physical therapy and balance evaluations?
An annual physical therapy checkup focuses on one’s ability to move freely and independently. My job as a physical therapist is to ensure the musculoskeletal system – collection of bones, muscles, joints, and tissues – is working optimally so limitations like strength, balance, flexibility and pain don’t stand in the way of a person’s quality of life. An annual physical therapy checkup is crucial to effective long-term wellness and preventative care. We can address issues that can cause pain and decrease overall quality of life.
What can the PT checkup offer?
Based on the results of a physical therapy checkup, a physical therapist will establish individualized treatment plans and/or programs meant to help correct issues and prevent future movement-limiting issues. Physical therapy can not only decrease pain, but also avoid potential injuries by addressing limitations before they lead to degenerative changes or more severe injuries.
What does the checkup consist of?
At an annual examination, we perform an in-depth evaluation of the neuromuscular and musculoskeletal system. We gather the patient’s health history and perform a series of tests and measures to address any limitations to a person’s quality of life and function. We perform strength and balance testing, assess posture and biomechanics, observe performance of functional activities such as gait, reaching, and bending, and determine risk of degenerative changes and injury in muscles, joints and ligaments.
During a preventative checkup, we evaluate your movement and injury history, balance, aerobic capacity, functional strength, flexibility, and quality of movement (ie, gait, reach, bending). In addition, we address any personal limitations, weaknesses, pain, or other impairments that may be holding you back from reaching lifestyle and movement goals.
Keep doing what you love and don’t hesitate to get help to achieve your best form.
Zoë A Lewis, MD, FACP