This post is a continuation in a series on establishing a maintenance and prevention strategy, and may be best understood by reading prior related posts.
I remember sitting on the couch with my husband watching the 2018 Olympics. An ad came on as often is the case during a major broadcast, and I got up to do something else as is often the case during ads. But my attention was riveted back to the TV as I heard these words in a Toyota ad: “When we’re free to move, anything’s possible.” Ironically, I couldn’t move from the TV. It struck me as incredibly profound and brilliantly simple. While I wasn’t compelled to rush out and buy a Toyota, that phrase has stayed with me over the years. I even toyed with using it in our practice tag line, but decided Toyota might not like that. Evens so it epitomizes all we do in our physical therapy practice as we persistently work to maximize pain-free mobility and function. Our professional association acknowledges the importance of movement and cites it as the cornerstone of our vision statement and, beyond that, our profession.
So what does movement look like, and what defines normal versus abnormal? That’s a million dollar question that has been the topic of research and debate for years. Normal movement can be defined as the most efficient and economical movement or performance of a given task and is specific to the individual. This can be very difficult to describe, especially when it varies from one person to another. Perhaps this is why this post has taken me so long to complete: movement is complicated! For that reason I’m dedicating two posts to the topic.
There’s a Brazilian study published in 2014 in the European Journal of Preventive Cardiology that I find pretty interesting. The researchers tested the mobility of 2002 men and women ages 51-80 by using a simple test they call the Sitting-Rising or Longevity test and specifically noted which subjects needed to use their hands and knees (kneeling, pushing on legs with hands) as props to get up and down. They then tracked these subjects for an average of 6.3 years and made some startling discoveries. Those who needed to use both hands and knees to get up and down were were almost seven times more likely to die within 6 years, regardless of their age at the time of the test, than those who could spring up and down without support. Now before you rush to select your tombstone, please appreciate that these are likelihood statistics and not absolutes. If it was a 100% guarantee then I would have been a widow years ago, as my husband Bill has not been able to do this for ages (probably because he doesn’t take supplements – see my prior post).
For those unable to perform the Sitting-Rising Test, a less challenging global test of movement is the Timed Up and Go test, known as the TUG. It basically assesses the ability of the subject to stand up from a chair, walk 10 feet, turn around, and return to the chair. Longer time needed to accomplish the task signals an individual who is not only struggling with movement but also more likely to fall.
The ability to perform daily activities can also tell a lot about a movement system that is struggling. Consider these activities of daily living and how easy or difficult they may be for you:
- Walking – cadence (speed) tells a lot in that with walking (or any activity for that matter) the speed with which it is performed can be indicative of the level of difficulty associated with it (such is the basis for the above noted TUG test). Step length is another parameter to assess. A shortened step length may be a reflection of loss of mobility, as well as fear of falling. Feet placed far apart from side to side, as well as feet that are turned out, signal a system that is challenged to stay upright and trying to stabilize.
- Stairs – ascending or descending, doing them reciprocally (stepping past and not to the same step like a child), keeping the toes pointed ahead and not turned out, not using the arms to help pull yourself up the steps.
- Transfers – can you get up from sitting without much difficulty or having to use your arms to push up? Ideally you should also be able to lower yourself to sitting without using your arms or sitting down hard. Difficulty getting in and out of the car on either side can also signal a movement system that is losing ground.
- Reaching – up into a cabinet, behind your back to wash, into the back seat of the car from the front (NOT while driving!) are all examples of daily activities that test the movement system.
- Squatting – I love using squatting (when appropriate) as a global movement test for the lower half of the body. It gives me a lot of information about the hips, knees, and ankles and the connective tissue network that moves these joints. I also like to check any difference between squatting with the heels up versus down. Many people can go further with the heels off the ground, which typically signals a movement problem in the calf and /or foot. In the US we don’t squat much, and seem to accept that it’s one of those activities that disappears with age. Yet other countries and cultures belie this as their elders squat fully.
In my next post I plan to share a video I’ve made reviewing movement tests you can perform on yourself to check the status of your movement system. Until then….
Wishing you health and joy!