Category: General

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

The Don’t of Weightlifting for Seniors

By: Brad Hankins

The trifecta of exercise is a movement practice (dance, yoga, pickle ball), a cardio practice (walking, swimming, biking), and a resistance practice (weightlifting, calisthenics, resistance bands).   All three, and especially the combination of the three, are vitally important in improving health, overall wellbeing and quality of life.  The questions for those of us a bit older is usually 1) how to safely begin 2) do I adapt exercise to fit me or the other way around and 3) how much of which type of exercise is enough. This month we are applying those questions specifically to weightlifting, and from the point of view of what we shouldn’t do when initiating a weight training program.

If you have followed this column, you know how pro-weightlifting I am for seniors. From my experience, weight training is a must for older adults.  Few exercise programs will do more to build strength, stamina and confidence, as well as improving safety and enjoyment of life. At the same time as older adults we must approach weight training with a high degree of respect.  If we do, weightlifting will become an enjoyable part of who we are, if we don’t, there is risk of frustration and injury – both of which we want to avoid.

Before we get to the don’ts let’s quickly run through the do’s. First, make an appointment with your health care provider to discuss beginning any exercise practice.  If you have a chronic health condition you will benefit from an exercise prescription from your provider which will determine heart rate limits, exercises to avoid due to orthopedic concerns and other safety parameters.  Second, make an appointment with an SSYMCA Personal Trainer for a health review (to include reviewing your exercise prescription), discuss goals and design an exercise plan that fits you and your current state of health.  Third, research which types of exercise interests you, what exercises will best help you reach your goals and how can exercise best fit into your day.   Fourth, consider a Personal Trainer at least for your first several weightlifting sessions to help set up the equipment to fit you, calculate beginning weight amounts, how to lift with proper form and how many repetitions and sets to do in the beginning.

Now the don’ts:

• At the top of list is don’t ego lift, in other words keep the weights low, use good form and keep your repetitions in the 10-12 range. How you lift the weight is more important than how much weight you lift, don’t let your ego convince you to lift more weight than is reasonable.
• Don’t rush through gym time, give yourself time to move through your exercises with adequate rest in between. Give yourself at least an hour and always start weightlifting sessions without feeling a need to rush.
• Don’t judge yourself against anyone else, you are on your personal fitness journey and the only yardstick is if you are meeting the goals you have set for yourself – don’t be intimidated by others.
• Don’t immediately start lifting dumbbells and barbells, instead begin on machines which are safer and allow you to work on form while increasing strength.
• Don’t begin power exercises (barbell bench, deadlifts – of any kind, barbell squats) without consulting a SSYMCA personal trainer. These are high risk exercises and though beneficial they can cause injury if not done properly.
• Don’t become frustrated with a particular machine or exercise. Often all it takes is a bit of adaption such as changing hand/foot position or moving to a different machine that will allow better compensation for shoulder or hip range of motion.
• Don’t think every day will be a strong day and give yourself grace on the days when you feel you have taken a step backwards.  The important thing is to still show up on the weaker days.  Give yourself more time, drop the weights a bit, cut the reps by two or three and purposefully move through the workout with energy you have that day.

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

Brad Hankins RN, CPT

Cardio For Seniors

By: Brad Hankins

Fall is here, the perfect time of year for cardio!  Cooler days make for great outdoor workouts or bumping up the duration and/or intensity of your current cardio work.  Inside or outside, cardio should be part of your fitness trifecta to include movement and weightlifting.

Cardio exercise is any form of movement that raises, and sustains, your heartrate for a set amount of time.  The exercise can be running, walking, swimming, biking, or any one of the numerous machines at your Y such as step machines, elliptical trainers, bikes (to include biking labs) and treadmills.  Yoga, Pilates and Tai Chi are also great forms of cardio exercise. Keeping in mind that the keys to a successful cardio workout plan are 1) focused on a goal – either by time or distance and 2) sustained – staying in motion until you reach your goal exercise time/distance.

The benefits of cardio exercise are numerous, regardless age or gender.  For those of us a bit older one of the biggest benefits is improved cardiovascular (CV) health https://pmc.ncbi.nlm.nih.gov/articles/PMC10068966/#ABS1 .  All 30 trillion (not a misprint-trillion) cells of your body are dependent on energy supply through arteries and waste disposal via veins. The heathier, meaning more pliable and non-restrictive, our arteries and veins are the better our cells function.  Better functioning cells means a slower aging process, decreased weight, better brain function and cognition as well as a decreased risk of CV related issues such as heart attack and stroke.

To help set your exercise goal first consider target heart rate.  To calculate target heart rate, subtract your age from 220 then multiply by 80%. For me this looks like 220-71=149. 149×0.8=119 beats per minute.  Target heart rate is as the name implies, the heart rate to sustain over your exercise period.  If you have a history of heart, vascular or lung disease, or any metabolic health conditions such as diabetes or high blood pressure please consult your medical provider for an exercise prescription before beginning or increasing cardio exercise.

Next to consider is breathing rate, which is measured by your ability to talk in complete sentences while exercising. Your target heart rate should equal the ability to talk in complete sentences without gasping or breaking sentences into two or three word bursts.  If you are exercising at your target heart rate and find it difficult to talk, please stop exercising until you consult your medical provider.

With your target heartrate known, next is to set an exercise goal.  This can be distance, say from your house to the third fire hydrant down the road and back, or a total exercise time with 15-20 minutes being a good first goal.  The object being sustaining your target heart rate over the exercise time, except for a two to three minute warm up when you begin exercising.

How much cardio exercise is enough?  The AMA, Cleveland Clinic    https://www.mayoclinic.org/healthy-lifestyle/fitness/expert-answers/exercise/faq-20057916 and others suggest 150 minutes of cardio per week with the larger goal being 300 minutes a week of total exercise.  If this seems daunting, start with a time/distance within your current ability.  If that is 10 minutes, or to the end of the block and back that is great! The most important thing is that you are out the door and on the way to improving your health.

One of the best things about cardio workouts is that you probably already have everything you need to get started. A membership at the South Sound YMCA gives you access to a wide variety of classes, equipment, and personal trainers who can help you plan and achieve your cardio goals. In fact, all you really need is a comfortable pair of shoes, some exercise shorts or pants, and a T-shirt. And let’s not forget, we live in the Pacific Northwest, which, in my opinion, offers the best outdoor cardio environment in the world.

Please let us at SSYMCA how we can help you begin a cardio program or support you in reaching new goals.

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

Brad Hankins RN, CPT