Sadly, many patients I see in physical therapy for shoulder, wrist, hip, and ankle fractures are people who have taken bad falls. During the course of physical therapy, we frequently discover an underlying problem such as ankle and lower leg weakness. This weakness contributes to poor balance that in all likelihood contributed to the original fall in the first place.

In my last posting, I discussed how lower leg flexibility is an important component of good balance. Today I want to emphasize how important ankle strength is for maintaining good balance as well.

Can you stand on one foot and “pump” your ankle up and down several times without holding on, as in the illustration to the right? If not, you have weakness in your lower leg and your balance is not as good as it should be.

If you have lower leg weakness, you can practice improving your lower leg strength by doing the exercise with both legs, as shown in the illustration below.

If you need to hold on to something for practice, that is fine. Soon you will be able to do it without holding on, and then you could try doing it with one leg. When you first try these exercises, stand near a support structure or you may fall. And remember, no exercise should cause pain.

Do this calf stretching exercise before and after, and to determine how many times you should do this exercise, use this exertion index for guidance.

Have you ever noticed how flexible children’s joints are? Flexibility diminishes as we age, and tight muscles and joints contribute to poor balance. I prescribe this simple calf stretching exercise for many patients with tight ankles.

You can improve and maintain the flexibility in your ankles by holding this gentle stretch position for 30 seconds and doing it 4 times daily. Exercise should never cause pain, and you should not try doing this without permission from your medical provider if you have problems with your feet or legs.

I have provided the dimensions for the wedge if you would like to build one for home use.

Karen Moore, PTA at Milpitas Physical Therapy Clinic, is a guest contributor for today’s posting.

Ergonomics is the science of understanding the interactions among humans and the principles, data, and methods for optimizing human well-being and overall system performance while working.

Your chair needs to have good lumbar support. It’s most helpful if this lumbar support is adjustable. Most ergonomic chairs do have an adjustable mechanism, but on many standard office chairs, the lumbar support is not adjustable.

Many people end up using conference room chairs because they’re more comfortable than their current chair; however, these chairs do not usually have adjustable arms, good lumbar back support, or the waterfall feature for the legs. Having adjustable arms is important—they will give you the option of keeping your arms low if you need to get closer to your work surface. You’ll also be able to adjust them so that your elbows, forearms, and wrists can be positioned at approximately 90°, parallel with the floor.

Your chair should have a waterfall feature and side contours in the seat. The waterfall feature of the chair will allow better blood flow through your legs. By increasing your blood flow, you will help reduce leg discomfort and tiredness.

Your feet should be supported. When your feet are hanging, tucked under your chair, or you’re sitting on them, they often fall asleep. This is bad for your general circulation and the blood supply to your feet. Using an adjustable footrest will not only give your feet support but also a little bit of exercise. Your feet do not have to always be on the footrest; they can be up against it as well, which will still help give you some support.

All of these points are important in selecting the correct ergonomic chair for you. Your chair should have a 5 pedestal or caster base, it should be height adjustable, it should have good lumbar support, an adjustable arm rest, and your seat should still feel comfortable after two hours. You should go out to an office supply store and check out all the different ergonomic office chairs to see which one feels best for you.

Loss of balance, strength, and overall function associated with advancing age are often met with anxiety, fear, and depression. Many of my patients express these feelings to me. It is often assumed advancing age is the problem. Be careful of making that assumption! In most cases it is incorrect.

Although it’s true that loss of muscle strength is associated with advancing age, it’s also true that the ability to restore and improve strength does not diminish with age. In fact, the older and weaker a person is when they begin a strengthening program, the faster they improve. This seems hard to believe, but amazingly it’s true.

Losses in function occur more from inactivity than age. Sadly, most exercisers are young people. It seems our performance-oriented culture views exercise as a competitive venture rather than a way of maintaining health and function. Strengthening exercises carried out properly by avoiding pain and excess fatigue do wonders for balance and overall function.

If you are interested in an in-depth discussion of this topic, check out this great article titled “Exercise and Physical Activity for Older Adults” in the journal Medicine & Science in Sports & Exercise, Volume 30, Number 6, June 1998. If you have trouble locating this article, please stop by my office and I will share a copy with you.

It’s a challenge to engage in all of the components of a Balanced Exercise Program. Lack of time is the main reason we don’t do what is necessary to improve our strength, endurance, balance, and flexibility.

One way to exercise more efficiently is to exercise outdoors instead of in the gym. Why? Because when we exercise outside, we do more than one type of exercise at a time. Without necessarily knowing it, when we exercise outside, we improve our balance along with our endurance and strength.

The reason is that exercises like walking on uneven ground, jogging on the sidewalk, riding a bike, and cross-country skiing improve balance more than riding a stationary bike or walking on a treadmill. Sitting while exercising on a weight machine improves strength, but it does nothing to improve balance. Hiking up and down hills improves both strength and balance.

My wife and I live in a condo where a lot of people exercise in a gym on cardio equipment. On sunny days, I am sometimes tempted to interrupt exercisers and suggest they go outside and enjoy the benefits of two types of exercise for the same amount of time, while enjoying some sunshine all the while.

Gyms are good when the weather is bad, but here in northern California, that is not often the case. Plus, exercise outside is more fun.

“If you are reading this sitting down, you might consider standing up.”

This is a quote from a Wall Street Journal article last week called “TV Linked to Higher Risk of Death.”

For years I have advised my patients to avoid prolonged sitting—especially sitting at a computer. Why? Because we know prolonged sitting causes spine problems. But now new research shows that prolonged sitting can also undo the good effects of regular exercise, and it can affect the body’s processing of fats. This can lead to an increased incidence of cardiovascular disease and possibly early death.

More reason to break up your sitting with periods of standing, even if for a few minutes each hour. I recommend setting a timer for one hour or less and stand up for five to 10 minutes whenever the timer rings. I also recommend breaking up your day with walking and, if possible, some other exercises. Not only will your spine be healthier, but your whole system will work better.

Last month I wrote a posting on willpower and new year’s resolutions. I discussed how our willpower is naturally limited by the limitations of our own brains, and how gradually building good exercise habits is the only way to sustain an exercise program over time. These good habits are important, but what if the exercises you are doing are not what your body needs the most. If the exercises you are doing result in joint pain, posture problems, excess fatigue, or other problems, you may be in the habit of doing the wrong types of exercises.

Often physical therapy is necessary for specific health problems, but physical problems occur because of poor exercise habits too. Habits like only doing aerobic exercises when muscle weakness is a problem, or only doing stretching exercises when you have a problem with balance are examples.

Generally speaking, to achieve optimal function, a balanced exercise program is recommended. The American College of Sports Medicine recommends a balanced program of four kinds of exercise. They include:

1. Aerobic exercise
2. Balance exercise
3. Flexibility exercise
4. Resistance exercise

As we age, engaging in a balanced exercise program becomes increasingly important if we are to achieve optimal physical function. I will discuss specific strategies to achieve better function through exercise in the coming weeks. Stay tuned.

The book of Ecclesiastes in the Bible begins the third chapter with: “To everything there is a season, a time for every purpose under heaven.” I think this is especially relevant for the month of January, because the holiday season is now past, and it’s time for many things to begin anew. For example, the pruning season of fruit trees that have been dormant for several months will soon begin. Baseball season starts in a few months, and many players will be restarting their training. And for most of us, it’s time to reorient ourselves away from holiday mode, and back to business as usual again.

What does the changing of seasons have to do with exercise? The answer: a lot. Our bodies need periodic rests to maintain optimal function. Studies show that even highly motivated people who start an exercise program seldom sustain it if they do not allow their bodies to rest. The February 2010 issue of Runners World Magazine contains an excellent article titled “The Slow Road.” The author discusses the importance of slowing down when engaging in exercise. I recommend a practice called Exercise Periodization to ensure the benefits of rest are incorporated into a fitness program.

When January hits, my body likes me to take it a little easier with my exercise program. I usually gain a pound or two during this time of year, and I am a little less active. As the days gets longer and the sun shines brighter (usually the second week of February), I am back to my full exercise program workouts again. I have discovered this period of less exercise makes sustaining my exercise program over time much easier.

The latest neuroscience research suggests that the act of exerting willpower is like exercising a very small muscle. The part of the brain that controls willpower is called the prefrontal cortex. It’s small and tires out very fast after just a little bit of exertion (exercise). That’s why exerting willpower when beginning or continuing an exercise program doesn’t work very well. Our brains get tired fast when we continuously exert willpower, especially if it’s been a while since we’ve done this sort of mental exertion.

This same small part of our brain (the prefrontal cortex) controls things like New Year’s resolutions or avoiding sweets and junk food. Based upon the experiences of most of us, it certainly makes sense that this is a small muscle!

Gradually developing moderate exercise habits over time is the only effective way to overcome the weak willpower we humans naturally posses. Weak willpower is not a character issue. It’s an issue of having a naturally small part of the brain that is only able to maintain a limited amount of willpower control.

This article in the Wall Street Journal has an excellent article about this if you are interested in a more in-depth discussion about willpower and human behavior.

So, if your willpower to exercise is weak, blame it on your brain.

Happy New Year!

Most of us have difficulty making time for our exercise program during the holidays in between parties, shopping, work, and family gatherings. Our commitment to exercise consistently is sometimes compromised during this time of year, and it is common to notice that our endurance has diminished and our muscles have become weaker. Sometimes this awareness can have a negative impact on our motivation to continue exercising after the holidays are over.

One easy way to maintain our motivation to exercise during the holidays and beyond is to view this as a time for exercise periodization, or for taking a short exercise break. This break time can have a positive impact on your program, and it allows more time for holiday cheer.

Enjoy yourself now and remember—it is okay to lose a little strength during this time. It will all come back once you start your normal exercise routine again.

Happy Holidays!