Category: General

Hips – Part 2

By: Brad Hankins

Previously, we looked at hips, some possible hip injuries, as well as how to strengthen the hip and its surrounding muscles. This month, we will explore the various ways hips can be repaired and replaced, as well as what can be done both before and after hip surgery to shorten recovery time.

The members I am currently training are between 64 and 84 (except one youngster who is 51), and over half of them have had hip or knee replacements—and in two cases, both hip and knee replacements. Several others receive routine hip injections, and others are contemplating hip interventions in the near future. Unfortunately, hip issues are common as we age, with conditions ranging from being occasionally problematic to causing some degree of immobility. Let’s look at the various hip interventions and surgeries, and what can be done to improve the results.

I suggest considering prehabilitation for any planned orthopedic surgery. Prehabilitation involves exercise and dietary changes (within individual limits) that help improve surgical outcomes. First, consult your general healthcare provider and orthopedic surgeon for appropriate medical clearance and exercise and diet recommendations. Then, with those in hand, you can work with a SSYMCA Personal Trainer to help increase overall strength and stamina while strengthening the muscles surrounding the surgical joint. Decreasing body weight is another important part of prehabilitation, which will help with immediate post-operative recovery as well as long-term physical therapy and rehabilitation.

Non-surgical hip interventions can help decrease pain, improve joint stability, and enhance mobility. These approaches generally focus on strengthening the glutes, hips, and core muscles. Consult your general healthcare provider for appropriate exercises or a referral to a physical therapist. A SSYMCA Personal Trainer can also help you develop a hip-friendly exercise plan in line with your doctor’s recommendations.

Hip injections are usually the first intervention for escalating hip pain. Using ultrasound or X-ray guidance, a steroid and local anesthetic are injected directly into the hip joint. The procedure is often done in-clinic and typically takes 15 to 20 minutes. Ice and rest for 24–48 hours after the procedure are usually recommended. Results vary, but many people experience relief for several weeks to several months, which can allow them to defer surgery. Hip injections are often limited to two to three times per year, as steroids can weaken surrounding tissue.

Hip arthroscopy (https://my.clevelandclinic.org/health/treatments/22195-hip-arthroscopy) is a common, less invasive surgical procedure that uses scopes and small instruments to address hip alignment, repair labral (the cartilage surrounding the hip joint) tears, remove bone chips, and repair tendon injuries. Hip arthroscopy is performed in an outpatient surgical setting, with patients usually going home the same day. Rest and physical therapy typically follow.

Total hip replacement (https://my.clevelandclinic.org/health/treatments/17102-hip-replacement) involves the removal and replacement of the hip joint. These surgeries are now often done with patients going home the same day or occasionally requiring an overnight stay. Initial recovery is followed by several weeks of physical therapy as you regain strength and confidence. After being released from physical therapy, you can take your exercise list and meet with a SSYMCA Personal Trainer to discuss how best to continue your recovery.

I continue to be amazed at the short recovery times of members who have had hip surgeries, including total joint replacements. The common path includes staying committed to your recovery plan, becoming more active as your recovery allows, and incorporating overall exercise into your daily routine.

As always I would enjoy hearing your fitness journey, please feel free to email me at hankinsb@ssymca.net

Brad Hankins RN, CPT

Hips – Part 1

By: Brad Hankins

The past two months, we explored knees. This month, we will move up the body a bit and look at hips. Hips (https://my.clevelandclinic.org/health/body/24675-hip-joint) are ball-and-socket joints (as opposed to the knee’s hinge joints) that allow the bone of the upper leg (the femur) to move in multiple directions. These multi-directional movements allow each leg to bend, squat, push, and pull independently of the other leg. The hip muscles are the body’s largest, with the glutes (the three muscles of your buttocks), quadriceps in the front of your thighs, and hamstrings in the back of your thighs, along with numerous accessory muscles powering these complex movements.

As we age, many hip issues involve—or often begin with—the continuing loss of hip strength and flexibility. These losses can make us susceptible to muscle strain, tendon and ligament tears, worsening osteoarthritis, fractures, and even low back issues. In my opinion, the best prevention of major hip issues is building strength and flexibility in the muscles surrounding and powering the hips.

The single most common hip issue is osteoarthritis (OA). There are other types of arthritis that can affect the hip joint, with OA (usually caused by decades of wear and tear or joint trauma) typically affecting individuals over the age of 60 and a disproportionate number of women. The pain and decreased joint function often lead to disability and are the primary reasons for total hip replacement.

Osteoporosis is another common cause of hip issues. Osteoporosis is the weakening of bone, making it susceptible to fracture and/or misalignment. Unfortunately, osteoporosis itself usually does not cause symptoms. If you are over the age of 50 or have a family history of osteoporosis, please talk with your medical provider about bone density testing.

Hip trauma, including hip dislocations, is often caused by high-energy accidents such as falls and car crashes, though sports injuries, as well as slips and trips, can also be contributors. Hip dislocations can sometimes be reduced in emergency rooms, while in other cases, a trip to the operating room is necessary. Hip dislocations can reoccur if the muscles around the hip are not strengthened.

Hip fractures (https://my.clevelandclinic.org/health/diseases/17101-hip-fracture) involve the bone in your upper leg, the femur. The femur is the longest and strongest bone in the body; when it fractures, the narrowest part (the surgical neck) is typically the fracture point. The surgical neck is where the femur bends nearly 90 degrees and connects to the pelvis. Hip fractures are true medical emergencies and usually require some type of surgery, ranging from pinning (using small-diameter steel pins to hold the bone together as it heals) to total hip replacement. Next month, we will review the various types of surgical and non-surgical hip repairs.

Rehabilitating hip injuries, or reducing the worsening of them, is not only important but, if not done correctly, can make things worse instead of better. First, consult your medical provider and/or orthopedic provider for a list of exercises that would be helpful for you specifically. If you are currently in physical therapy, be sure to ask for a list of exercises you can do once you are released from care. Next, with your exercise list(s) in hand, meet with a SSYMCA Personal Trainer to see how these exercises can be incorporated into your overall exercise plan.

If you have healthy hips and want to decrease the risk of future injury, there are a myriad of exercises to consider. The focus should be on exercising all the muscles of the leg and hip. Leg machines, including leg extensions, leg curls, and leg presses, are all great. Hip machines are a must, as well as step-ups, lunges, hip thrusts, and leg crosses. Also, don’t forget the muscles of the lower leg—the calf muscles and the much smaller pretibial muscles in the front of the lower leg.

Squats are a very effective—but high-risk—leg and glute exercise that is not for everyone. A healthy and strong lower back and extremely strong core muscles are mandatory prerequisites to prevent injury. Strict form and 100% mental focus are not optional when squatting. Before adding squats to your exercise plan, please consult a SSYMCA Personal Trainer to help with developing a squat plan, weight selection, form, and mental awareness.

As always I would enjoy hearing your fitness journey, please feel free to email me at hankinsb@ssymca.net

Brad Hankins RN, CPT

Knees – Part 2

By: Brad Hankins

This month we are taking a further look at knees https://my.clevelandclinic.org/health/body/24777-knee-joint and the various interventional and surgical options available when knees become so worn that they negatively impact our day-to-day lives.  We will also explore what we can do to prepare for knee procedures and surgery.

The most common knee procedure is arthroscopy or knee scoping https://my.clevelandclinic.org/health/treatments/17153-knee-arthroscopy .  Knee scopes are typically done as day surgery and can be performed under a variety of anesthesia to include general anesthesia and spinal blocks as well as local anesthetic to help numb the surgical area.  Soft tissue injuries such a meniscus tears, torn tendons (ACL and MCL tears), bursitis and even minor fractures are some of the knee conditions that are routinely repaired with knee scopes.   The procedure itself involves several small incisions made in the knee so a camera (not the camera itself, an extremely small diameter lens at the end of a thin tube) and instruments can be inserted into the knee compartments.  Typically physical therapy follows knee scopes with most people returning to normal activity in weeks to months.

A relatively new surgical procedure is partial knee replacement or knee compartment replacement https://my.clevelandclinic.org/health/treatments/14599–partial-knee-replacement . In these procedures one of the three knee compartments is replaced leaving the others intact.  The knee has three compartments the medial (inside), lateral (outside) and patellofemoral (under the kneecap).  Though not as common as total knee replacement due to arthritis often affecting all three compartments simultaneously, there are still almost one million partial knee replacements per year.  People who have compartment replacements can eventually need total knee replacement, but total replacement can be delayed for several years.  This procedure is typically done as a day surgery with people recovering in six weeks to several months.

Total knee replacement https://my.clevelandclinic.org/health/treatments/8512-knee-replacement is a common surgical procedure that can be done as a day surgery with the procedure itself typically lasting one to two hours. The knee joint is replaced with a prosthetic made of titanium and plastic composites that is extremely durable with most lasting 15 to 20 years and 80-90% of current replacements often remain functional for more than 20 years.   Recovery can take months to a year depending on the age, overall health, activity level and, in my opinion, the presurgical preparedness of the patient.

Other options to increase the milage of worn knees include Platelet Rich Plasma Therapy (PRP) https://my.clevelandclinic.org/health/treatments/platelet-rich-plasma-prp-injection .  Platelet Rich Plasma Therapy is a process where components of your own blood are injected into the knee to decrease inflammation and stimulate growth of new tissue.  Please talk with your medical provider to explore PRP and other non-surgical options.

Preparing for any knee procedure is a vital step in ensuring a good result and quick recovery.  Often post procedure rehabilitation is prescribed after knee interventions but, again in my opinion, just as critical is prehabilitation before knee procedures.  What can be done before knee procedures to ensure the best outcome:

• First and foremost, lose weight. This seems counterintuitive as knee problems often lead to inactivity which leads to weight gain.  This is why prehabilitation should begin as soon, or preferably well before, the procedure is scheduled.  With help (please visit a SSSYMCA Personal Trainer) activity levels and exercise can be adapted to fit knee limitations.  Adaptive exercise combined with sustainable dietary changes can result in appreciable presurgical weight loss.
• Improve overall strength and stamina with a focus on core and leg muscles. Leg and glute muscles can strengthen, even if a (or both) knee restrict range of motion. Isometric exercises, the use of recumbent bikes and rowing machines are just some of the adaptive approaches.
• Improve your balance by using chairs and balance balls if your knee will not allow you to fully bear standing weight.   Standing balance exercises can be performed using the non-operative leg which will in turn improve overall balance.   Again, please visit with a SSYMCA Personal Trainer to help get started.
• In the days close to your procedure:

1. Schedule a dental exam and tooth cleaning to decrease the chance of bacteria entering your blood system.
2. Ensure you are well hydrated beginning 48 hours before your procedure and follow your medical providers instructions to stop drinking fluids before your procedure – usually 12 hours before your procedure start time.
3. Schedule a rest day, or two, immediately before your procedure.
4. Take your medications as prescribed and follow your medical providers pre-procedure medication orders.

As always I would enjoy hearing your fitness journey, please feel free to email me at hankinsb@ssymca.net

I would enjoy hearing about your fitness journey, please feel free to email me at hankinsb@ssymca.net.

Brad Hankins RN, CPT

Knees – Part 1

By: Brad Hankins

Our knees have carried us well through long work days, summer hikes, chasing children, and leg tiring sports.  However, wear and tear can bring joint pain, limited weight bearing and restricted knee movement which can in turn limit our enjoyment of life. These issues are common enough that in the older member population I work with finding someone with two well-functioning original equipment knees is somewhat rare.  Let’s take take a look at knees, some of the more common knee injuries and what can we do to improve our knee health.

The knee is the biggest joint in the body https://my.clevelandclinic.org/health/body/24777-knee-joint , made up of four bones, two cruciate ligaments, two collateral ligaments, two types of cartilage and a number of muscles, tendons and nerves. Having knees, you have no doubt noted the knee is a hinge joint with the ability to withstand a slight amount of side-to-side rotation.  A hinge joint is also a type of synovial joint meaning the joint has freedom to move, in this case like a door, and is self lubricating via the membranes lining the joint.

One of most common knee injuries is arthritis https://my.clevelandclinic.org/health/diseases/21978-arthritis-of-the-knee , which is inflammation in the joint caused from worn cartilage usually from years of routine use but can also be brought about by prior injury and autoimmune disease.  Osteoarthritis is usually caused by wear and tear while rheumatoid arthritis is an auto immune condition.  Arthritis can lead to knee joint replacement but pain and mobility issues from osteoarthritis can sometimes be lessened by weight loss and purposeful exercise.

Tears, or complete ruptures, of the anterior and/or posterior cruciate ligaments can severely limit knee range of motion and weight bearing.  These two ligaments (ligaments connect bone to bone) limit the forward (anterior) and backward (posterior) movement of the knee. In other words if either of these ligaments fail the knee will be able to freely slide from the front to back or back to front.  Unfortunately these injuries require surgery to repair, however after being repaired function is often near 100%.

Meniscus tears  https://my.clevelandclinic.org/health/diseases/17219-torn-meniscus   are often caused by injury such as a sudden stop/start or quick change of motion but can also be a wear and tear condition.  Mencius issues often lead to knee pain, swelling and limited range of motion. The meniscus (you have two per knee) are tough half-moon shaped pieces of cartilage that are your knee’s shock absorbers.  With time the meniscus can wear down or tear, letting the bones at the top of your knee contact the bone at the bottom and can cause misalignment of the joint.   Meniscus issues can sometimes improve with rest and therapy while other times surgery is required to repair or remove the meniscus.

These are just three examples of the more common knee issues, there are other conditions such as cysts, bursitis and collateral ligament injuries.  Please consult your medical provider for any lingering knee pain or issues limiting knee range of motion or the ability to bear weight.

Let’s explore how can we improve our knee health and help prevent future injuries.

• First and foremost lose weight, however this is often easier said than done. A circular issue can develop where knee pain limits activity and exercise, the decrease in activity causes weight gain, and the weight gain then worsens the knee pain. Your knees have carried your entire body weight for decades, the more you weigh the more stress there is on the cartilage, ligaments and lining of the joint.  A five or ten-pound weight loss can often help decrease knee pain.
• Exercising the muscles surrounding the knee can help improve stability, range of motion and weight bearing. Since knee pain often limits movement, isometric exercises are often the best starting point.  Isometric exercises involve contracting muscles around a joint without any joint movement.  Wall squats, or sits,  https://health.clevelandclinic.org/wall-sits are a good beginning.  A SSYMCA personal trainer is a great resource to help you get started.
• Movement, of any kind, will stimulate blood flow and help lubricate the joint. Gentle treadmill walking or using a rowing machine are possibilities.  If walking is too painful consider stationary biking.  Your Y has both upright and recumbent bikes that can be adjusted to accommodate most movement limitations.  Please see a SSYMCA personal trainer to help you select the type of bike and settings to best fit you.

As always I would enjoy hearing your fitness journey, please feel free to email me at hankinsb@ssymca.net

I would enjoy hearing about your fitness journey, please feel free to email me at hankinsb@ssymca.net.

Brad Hankins RN, CPT

The Six Things That Seem to Fix Everything

By: Brad Hankins

If you follow health and wellness articles, regularly research how to improve your physical and/or mental health, subscribe to a social media fitness influencer, or attentively listen to your medical provider on annual visits you typically hear the same six things (in one form or another) will improve your health and wellbeing.

1. Exercise regularly
2. Eat a diet orientated toward vegetables and heart healthy proteins and fats
3. Get adequate sleep
4. Manage stress
5. Stay hydrated
6. Increase socialization

Regardless of source, these same six suggestion are regularly at the top as the most important of all health improvement changes.  Seems simple enough.  However, not as simple as one would think.  What keeps us from fully embracing these six lifestyle changes?

It can be that we have not challenged ourselves physically and mentally enough to force a change.  In other words, most of us live somewhat comfortable lives and our health issues can sometimes be managed pharmacologically with little need to change our habits and lifestyles.  It is not until we run up against pharmacological limits, be those side effects or limited benefits, that we consider a different wellness path.

Sometimes after experiencing a health issue the recovery process will lead us to rethinking our life choices.  That may something as serious as a joint replacement or heart related event, but sometimes it could be recovering from minor fall or blood pressure numbers that are slowly creeping up can make one think about exploring alternative ways to improve overall health.

Of course, the best approach is to incorporate some of these six changes into your life before a health-related event forces a change.  If you are struggling to initiate a lifestyle change or can’t seem to sustain your efforts, consider building a change team.  This can be a buddy who is on a similar path to share support and successes or bringing a SSYMCA trainer onboard for coaching and training tips or share your goals and journey with friends and family members to build a support base.

Let’s look at ways we can adopt some of these six health improvement changes.

• First, pick one or two of the changes and once you can sustain them add one more at a time.
• Exercise is first about discipline, then about duration, then finally intensity. Set an initial goal of three hours of focused exercise per week.  This can be six half hour exercise sessions a week then slowly work your way toward full hour sessions.
• Changes to diet should be both maintainable and sustainable (not just for you but your family as well), single big dietary changes usually only work for days to weeks. First change the amount of food you eat, then slowly change the type of food you eat, looking toward the Mediterranean Diet as an example, https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801 .
• We discussed sleep in my August column, essentially the quality of sleep is as important as the amount of sleep. Seven to nine hours of sleep is optimum, and minor adjustments to bedtimes, diet and stress management can make big improvements in sleep quality (please see my previous column for details).
• Managing stress can become a full-time job, which in itself can then become quite stressful. Simply explore finding time for yourself over the course of a day.  It may be 15 minutes of reading or a half hour of alone time sitting outside.  Or consider other ways  https://www.ncoa.org/article/stress-and-how-to-reduce-it-a-guide-for-older-adults/ to mitigate the causes and effects of stress.
• As our bodies are approximately 50 to 60 percent fluid, maintaining and replacing fluid is extremely important. Most fluid counts toward your daily total, soup, tea, coffee (in reasonable amounts), even popsicles all contribute to daily fluid intake.  However, water, just plain water, should be your go to fluid for initial rehydration. For females 1.5 liters of fluid a day is the daily goal while males should be drinking 2.0 liters a day.
• Though every day we have more opportunities to communicate with others these same online venues can also serve to divide and isolate us. Instead we can explore sources of joy that are not directly connected to a screen https://www.michiganmedicine.org/health-lab/8-ways-older-adults-can-reduce-loneliness-and-social-isolation-0 , including volunteering and even going back to school or (part-time) work.

With winter approaching now is a great time to take a close look at these six things and see how they may fit into your daily life.

I would enjoy hearing about your fitness journey, please feel free to email me at hankinsb@ssymca.net.

Brad Hankins RN, CPT