October Newsletter. Fit After Fifty. In This Issue: By: John Fiore, PT

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1 October Newsletter October,15, 2013 Volume 1, Number 10 In This Issue: Fit After Fifty Running in Your Fifties and Beyond Affordable Care Act Resource Patellafemoral Pain Syndrome Links to Our Favorite Sites: Related Sites: The Runners Edge: Missoula s hub for running gear, information, and races Missoula s choice for core strengthening and ski conditioning. From beginners to elite athletes, Momentum classes will increase your strength and reduce your injury risk. Run Wild Missoula membership promotes running, training, and racing in Missoula Find us on Facebook: Fit After Fifty By: John Fiore, PT October is National Physical Therapy Month! The American Physical Therapy Association (APTA) chooses a relevant topic each year as the theme for the month. The 2013 theme is Fit After Fifty. Those of us born between 1946 and 1964 are referred to as Baby Boomers. The post-world War II baby boomers represent 78 billion people in the United States. A huge group of people facing similar fitness challenges associated with age. Fitness after fifty has many faces. From the person who has just been told by their physician to lose weight and reduce their blood pressure to the 50 year-old athlete who resembles a 30 year old, fitness after fifty does not have to be elusive. Life experiences, life choices, environmental factors, genetics, and dedication to health and fitness all impact our fitness in the fifth decade of life. As a physical therapist, and athlete, and an individual who has been humbled and schooled by injuries, I offer myself as a resource. If you are interested in achieving fitness and health at any age (not just beyond 50), then read the following article. Call or me if you wish to discuss your individual health and fitness goals. Missoula, MT has some of the most accessible outdoor recreation in the United States. Year round access to trails, parks, National Parks, rivers, lakes, and mountain ranges in every direction make Missoula a perfect place to live a fit and healthy lifestyle. Make the commitment to fitness in the coming year and remember Sapphire Physical Therapy as a resource along your journey! For more information on the services provided by Sapphire Physical Therapy or to read more related articles, see our website or give us a call.

2 Sign up for the Sapphire PT enewsletter at sapphirept.com Contact Us: (406) Us: John Fiore, PT: Rachael Herynk, DPT: Jesse Dupre, DPT: Find Us: Sapphire Physical Therapy 1705 Bow Street * Missoula, MT Map: Our Services: Orthopedic injuries Back and neck pain Running overuse injury and prevention Running biomechanical gait analysis Cycling injuries & biomechanical bike fitting Work related injuries Work Hardening & Running in Your 50s and Beyond Health & Fitness Fundamentals By: John Fiore, PT I returned from cycling to my trail running roots six years ago. Twenty years of cycling had strengthened my quads and cardiovascular system, but my core was weak. It takes time, conditioning, and repetition to train your body to run as we naturally did as kids. The purpose of this article is to explain the components to consider when training and running well into your 50s and beyond. The 40 to 55 year old population represents the largest group of runners in the United States. Running is growing rapidly as a simple, efficient way to achieve health and fitness at any age. Many factors contribute to the success (ability to run without pain and to gradually improve performance) a runner may achieve as the decades of life advance. Running is often thought of as an activity reserved for the young. Runningrelated injuries have long been blamed on running itself rather than the multitude of predisposing factors. Recent research challenges the misconception that running is harmful to your knees (especially the knees of 50 year olds). The July 2013 study published in Medicine & Science in Sports & Exercise compared loads through the knee joint in separate samples of walkers and runners. Runners typically place loads of eight times their body weight through the knee joint, while

3 Functional Capacity Evaluations Pre and post-operative rehabilitation Core strengthening & conditioning programs Women s health All insurance accepted Cash payment discount walkers place two to three times their body weight through the knee joint. The key difference, however, lies in the duration and frequency of knee joint loading in runners versus walkers. Running, the study concluded, loads the knee joint for a shorter period of time. In addition, due to the increased speed of running compared to walking, fewer impact moments are experienced when running. The overall impact of running versus walking was concluded to be the same over a given distance. Walking has long been the exercise of choice for joint health. The research cited has shown that running may be at least as beneficial to health as walking. The main point to keep in mind is this: Fitness in general and running success specifically is not a mystery. It requires a realistic plan, commitment, guidance, and achievable rewards for your effort. I. Chronological versus physiological age: Genetics and lifestyle are the two main determinants of physical and mental health as we age. While it is true that age is just a number, certain physiological changes take place after 40 to 50 years of life. Muscle mass decreases, muscle force output decreases, and recovery rate decreases. Most studies which support the inevitable degenerative processes of aging do not include individuals who actively engage in physical exercise on a regular, structured basis. The use it or lose it philosophy definitely applies to all of us as we age. Physical conditioning generally decreases as we age due to a more sedentary lifestyle. External signs of aging represent only a fraction of what actually takes place as we approach 50 years and beyond. Aging, however, can be mitigated by lifestyle and physical exercises. Regular, structured strength training and aerobic conditioning can slow the aging process and greatly improve overall health and athletic performance. While chronological age is beyond our control, physiological age is greatly influenced by prior injury or trauma, lifestyle, sleep patterns, and conditioning over decades of life. A 50 year old body adapted to a life-long commitment to aerobic and conditioning training 5 days per week will move and function with the ease and efficiency of a much younger body. In contrast, a 50 year old body subjected to a life of smoking, alcohol consumption, and a sedentary lifestyle will move and function inefficiently and be prone to systemic diseases. Quality of life after 50 is determined by physical and mental health. It makes logical sense to me, therefore, to remain consistent with a physical conditioning and health program to maximize the decades of life beyond 50!

4 Past medical history and trauma also impacts running tolerance and performance in aging athletes as well. Osteoarthritis secondary to joint injury or surgery decreases the body s ability to absorb the impact of running. A discussion with your physician regarding your medical history is always a great place to start if you are a master-aged runner wishing to begin or increase your running. II. Muscle and connective tissue physiology and aging: Muscle and connective tissue provide the power to propel our body forward year after year. Muscle bulk decreases with age, but muscle force output does not decrease at the same rate. Strength training is widely accepted as a way to maintain bone density and muscle tone as we age. Functional strengthening done in weight bearing will increase your overall fitness, performance, and reduce your injury risk by challenging specific muscles in realistic movement patterns. The idea of training smart for running includes challenging key muscles in a manner which specifically relates to the activity of running. While it is true that a 20 year old may be a natural runner, training smart may give a 40 or 50 year old runner the competitive edge. Connective tissue (tendons, ligaments, fascia) are the site of most running injuries. Connective tissue becomes less elastic and less resilient with age. Good nutrition, a non-smoking lifestyle, regular weight exercise, and connective tissue release (rolling, active release, myofascial release massage, dry needling, and Gua Sha) techniques will decrease overuse injuries associated with age. III. Training and activity frequency: Consistency is the key for lasting fitness and health! It is easier on the body and the mind to stay fit throughout your life. Repeated attempts to get in shape followed by an off season of decreased fitness takes a huge toll on the body. Most runners are more serious about training and racing in the warmer months. Winter, however, is the most important time of the year to restore strength, connective tissue mobility, and cross train to build your baseline fitness level. Hard core training in the spring following a winter of inactivity often results in frustrating injuries and taxes the body. Be physically active all year and participate in a blend of aerobic and running specific strengthening 5 days a week if possible. IV. Training intensity: It may be somewhat surprising to see so many master runners in the top 10 results pages of marathons and ultra trail races. One benefit of aging is the fact that endurance increases! In physiological terms, fast twitch (sprinter) muscle fibers begin

5 to transform to slow twitch (endurance) muscle fibers with age. Long slow miles, however, are not the best way to train as a master runner. Training intensity must be high 3 days per week (if one runs 5 days per week) to preserve or even build speed and power as one ages. The long slow miles will come naturally. V. Recovery and rest: Sleep patterns are impacted by physical and mental stress. Physical training stresses our muscular, cardiovascular, endocrine, respiratory, and immune systems resulting in fatigue. Work and mental life stress tends to wake us up at night or keep us up late working and worrying. Rest and recovery, however, are the elusive keys to performing successfully as an aging runner. Chronic lack of sleep or lack of uninterrupted sleep may lead to serious health issues such as adrenal fatigue syndrome. If you get by with 6 hours of sleep, you should probably be getting 7 or 8. The extra hour of sleep may ad years to your life! If you wake up in the early morning hours and cannot get back to sleep, look at your stress level, diet, and pre-sleep ritual for clues to your restlessness. Allow your body to rest and recover, especially following a hard training or racing effort. At age 51, I estimate a 25% increase in recovery time relative to when I was in my 20s. VI. Nutrition and hydration: As we age it is easy to forget the importance of nutrition. After 51 years, I am use to eating certain foods as they have predictable results. My pre-race meal ritual of a peanut butter and jelly sandwich and a banana is not up for debate, but I have discovered Omega fatty acid-rich foods, quinoa, fresh vegetables, protein powder, and nutritional smoothies. Experiment, explore, and be open to whole food nutrition that fits into the amount of time, money, and energy you have to devote to your nutrition. Your body will thank you and you will fuel and replenish your running legs. Hydration is a huge factor in running success especially as we age. Kidney function is directly impacted by hydration. Dehydration is a fairly common side effect of distance running which can be reduced by regular hydration and electrolyte replacement. Frequent dehydration over the years is taxing on the kidneys which can lead to problems such as painful kidney stones or even kidney dysfunction. An annual physical which includes a measure of kidney function is necessary for master endurance athletes. Over-hydration during exercise may lead to an even more serious state known as hyponatremia. Overhydration may dilute the sodium level in the body and can be a serious medical condition. Avoid frequent dehydration and use the frequency and color of your urine as a hydration guide

6 while running. VII. Weighing fitness goals with health concerns: A November 2012 Wall Street Journal article created a stir with claims that endurance running health benefits declined rapidly in the master age group. The article challenged the health benefits and risks associated with high intensity and high mileage training and racing. Debate arose surrounding the demographics of the study. Were these seasoned, conditioned master athletes? Did the subjects of the study have underlying health risks which were present but undetected earlier in life? Irregardless of the answers to these questions, the take home message is to have an annual physical. Running and staying healthy for years to come begins with determining the health status of your cardiac, endocrine, respiratory, and immune systems. The key to fitness after 50 is to establish a realistic, enjoyable plan and remain consistent for the duration. Please call Sapphire Physical Therapy to set up an appointment to review your health and fitness goals for the present and the future. Our website ( is a resource for many articles on health and fitness. Affordable Care Act Resource By: Rachael Herynk, DPT Do you have questions regarding the Affordable Care Act? Monica Lindeen is the Montana Commissioner of Securities and Insurance, and I found her website to be helpful in gaining a better understanding of the Affordable Care Act. It is well organized for both consumers and healthcare providers. There are resources for better understanding the language of insurance, links to the companies providing coverage in Montana, and guidelines for purchasing and paying for insurance. Along with Monica s contact information, there is a function to ask individualized questions as well. The website is montanahealthanswers.com, and I encourage you to check it out. With the costs of healthcare discussed now more than ever, it s increasingly important to be satisfied with the quality of care received. Being active in your treatment improves outcomes. We at Sapphire Physical Therapy encourage you to take steps to ensure you are receiving the best care possible, whether from your physical therapist or primary care physician. We pride ourselves in providing treatment based on your expectations and goals, and we would love feedback on

7 how to continue to improve our care in the midst of healthcare changes. Please any feedback or suggestions to Patellafemoral Pain Syndrome I. What is it? (What, why, and how?) By: Jesse Dupre, DPT The knee is a common site for pain in people of all activity levels, ranging from sedentary to competitive athletes, and can occur in a number of different locations with a variety of sources. While pain in the front of the knee can have a number of different causes, one of the more common conditions is patellofemoral pain syndrome. When the patellofemoral joint is functioning optimally, the patella remains in the trochlear groove of the femur, tracking directly toward the hip as the quadriceps contract. With patellofemoral pain syndrome, the patella moves laterally as the quadriceps contract, rather than directly =244&h=188&c=7&rs=1&pid=1.7, following the thigh toward the hip. This causes increasing contact force and more friction between the patella and the trochlear groove of the femur, causing anterior knee pain. II. Causes: The knee itself is a relatively simple joint, but there can be a number of novel forces acting through the knee joint and patella. One reason for this is that the knee bridges the gap between the foot and hip which are both heavily involved in balance, stabilization, and accommodating to different terrain to keep us upright while standing, walking, running, and recreating. Two of the most common contributors to anterior knee pain are weakness and muscle imbalance. Ideally, the muscles of the thigh and pelvic girdle act to stabilize at the knee and control the direction of the patella as the quadriceps work when straightening and bending the knee. When the hip

8 muscles are weak, or when an imbalance exists, we lose the necessary stabilization through the leg and pelvis, which allows the knee to waver and changes the pressures on the patella. Similarly, weakness at the quadriceps can actually cause the patella to move to the side, rather than tracking directly toward the hip, increasing pressures and causing pain. While these are the most common contributors, improper patterns of muscle activation throughout the lower extremity, and muscle tightness can contribute to knee pain by making subtle changes to the position of the knee joint itself. III. Treatment: Strengthening, stretching, and rest: While rest has shown to be effective in some cases for reducing pain resulting from overuse in the short term, exercise, when performed correctly, is a more effective method of treatment. Directed and focused exercise aimed at increasing strength and resolving muscle imbalances in the quadriceps and throughout the hip musculature has proven to be one of the most effective treatments for anterior knee pain. Stretching for the tensor fascia lata, iliotibial band, hamstrings, and calf muscles have also shown to be effective, especially when combined with strengthening exercises. Taping, bracing and electrical stimulation: It s not always easy to exercise, stretch, and strengthen when you have knee pain. While it may be possible to push through the pain, it isn t always best, and there are ways to help treat anterior knee pain in the short term. When combined with a stretching and strengthening program, various taping techniques, bracing and electrical stimulation can be an effective way to control pain and help hold the patella in place. If you have anterior knee pain, and would like to work with a physical therapist, call Sapphire Physical Therapy romalacia-patella-(patellofemoral-pain-syndrome)- at to schedule an appointment with one of our physical therapists.

9 References: 1. Influence of the hip on patients with patellofemoral pain syndrome: a systematic review. Meira EP, Brumitt J.Sports Health Sep;3(5): The effects of movement pattern modification on lower extremity kinematics and pain in women with patellofemoral pain. Salsich GB, Graci V, Maxam DE. J Orthop Sports Phys Ther Dec;42(12): doi: /jospt Epub 2012 Sep Factors associated with patellofemoral pain syndrome: a systematic review. Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Br J Sports Med Mar;47(4): doi: /bjsports Epub 2012 Jul Prospective Predictors of Patellofemoral Pain Syndrome: A Systematic Review With Meta-analysis. Pappas E, Wong- Tom WM. Sports Health Mar;4(2): Isometric strength ratios of the hip musculature in females with patellofemoral pain: a comparison to pain-free controls. Magalhães E, Silva AP, Sacramento SN, Martin RL, Fukuda TY. J Strength Cond Res Aug;27(8): Closed Kinetic Chain exercises with or without additional hip strengthening exercises in management of Patellofemoral pain syndrome: a randomized controlled trial. Ismail MM, Gamaleldein MH, Hassa KA. Eur J Phys Rehabil Med Jul Hip posterolateral musculature strengthening in sedentary women with patellofemoral pain syndrome: a randomized controlled clinical trial with 1-year follow-up. Fukuda TY, Melo WP, Zaffalon BM, Rossetto FM, Magalhães E, Bryk FF, Martin RL. J Orthop Sports Phys Ther Oct;42(10): The Effects of Exercise on Decreasing Pain and Increasing Function in Patients With Patellofemoral Pain Syndrome. Kuru T, Yalıman A, Dereli EE. Acta Orthop Traumatol Turc. 2012;46(5): Effectiveness of different exercises and stretching physiotherapy on pain and movement in patellofemoral pain syndrome: a randomized controlled trial. Moyano FR, Valenza MC, Martin LM, Caballero YC, Gonzalez-Jimenez E, Demet GV. Clin Rehabil May;27(5):