Preventing Falls and Fractures in Older Adults: A Whole Person Approach
On a recent visit to see my elderly mother, I began to think about her risk of falling.  Falls and fractures are significant health concerns for older adults, particularly those with osteoporosis. I’m sure you have heard stories, as I have, about an otherwise fit and healthy elderly person falling, losing their independence, and never quite recovering again. One of my mentors once said that aging can be seen as a series of accidents or events, like torn muscles and fractures,  that reduce function and which is never gained back.  However, the right strategies can significantly reduce the risk of falls and subsequent fractures. Here, I discuss effective measures based on best practices in geriatric care.

Understanding the Risk

Osteoporosis is a major contributor to fractures among older adults. According to the Bone Health and Osteoporosis Foundation, about 10 million Americans have osteoporosis, and 44 million have low bone density. This makes bones more fragile and susceptible to fractures, even from minor falls. Women and men are both affected, with one in two women and one in four men experiencing an osteoporosis-related fracture in their lifetime. When someone finds out they have osteoporosis, they are usually told to exercise a little more with some resistance or weight and given medication.  Common medications include bisphosphonates and denosumab, but these have risks, which include bone fracture and bone death, which is not really what you want from a medication that is meant to make bones stronger. 

How about focusing on falls rather than bones?

I don’t know if my mother has osteoporosis, given her age (86). She probably does, but the NHS in the UK isn’t an easy system to navigate, and we will not find out anytime soon. However, balance is a trainable skill, and better balance can help prevent falls. How do we put that into practice?

Practical Steps to Prevent Falls and Fractures

1. Comprehensive Mobility Assessment: We start with a thorough assessment of an older adult’s mobility, including evaluating gait and balance. This is where allied health professionals such as osteopaths, physios, chiros, and PTs play a crucial role. We can assess, identify deficits, and prescribe simple balance and mobility exercises to help a person improve.  These can be as easy as repeatedly getting someone to step forward and backward with one leg.  This pivot-type movement involves strengthening and mobilizing the standing leg while challenging balance. One, this is easy for older adults. Different head or arm movements can be introduced to challenge more of the ‘kinetic chain’ and other proprioception. 2. Home Environment Modifications: Simple changes at home can prevent falls:
  • Install grab bars in bathrooms.
  • Remove loose rugs and other trip hazards.
  • Ensure adequate lighting in all rooms and stairways.
  • Use non-slip mats in the shower and bathtub.
3. Use of Assistive Devices: Encouraging the use of walking aids, such as canes or walkers, can significantly reduce fall risk and provide a quick visual cue for others to watch out for. Education is critical, as some older adults may initially resist using these aids, feeling they signify a loss of independence. However, understanding that these devices can prevent falls and maintain mobility is crucial, and using an aid in unfamiliar environments can be very beneficial. 4. Medication Management: Not only do we have to look critically at the medications for osteoporosis, but certain other medications can affect balance and coordination. It is essential to review all prescriptions, especially psychotropic drugs, with healthcare providers to adjust dosages or find alternatives that pose less risk. 5. Vision Care: Regular eye exams and proper vision correction can help prevent falls. Poor vision can lead to missteps and accidents, so it's critical to address any vision problems promptly. Lack of lighting and not wearing glasses can also be significant problems. 6. Addressing Medical Conditions: Conditions such as postural hypotension (a drop in blood pressure when standing up), heart rate irregularities, and other chronic illnesses should be managed carefully. These conditions can contribute to dizziness and falls, so regular check-ups and tailored treatments are necessary. 7. Education and Awareness: Educating older adults about fall risks and prevention strategies is vital. This includes understanding the unpredictability of falls and the importance of precautions like modifying environments, lighting, and the judicial use of aids.

Conclusion

Preventing falls and fractures in older adults requires a holistic approach that addresses physical, environmental, and medical factors. By following this simple framework and implementing practical measures such as mobility assessments, home modifications, and medication management, we can significantly reduce the risk of falls and enhance the quality of life for older adults. If you have elderly family members, make sure you work with them to keep them independent as they age.
Unlocking the Key to Thyroid Health: Beating Hashimoto’s and Thyroid Disorders
Dr Stone and I sat down to talk about everything thyroid.  You can watch the video here or listen to the podcast here This is what I learned: The thyroid is a small, butterfly-shaped gland at the neck's base. This gland plays a crucial role in our overall health and well-being. It produces hormones that regulate our energy levels, metabolism, and even our mood. When the thyroid functions properly, we feel energized, maintain a healthy weight, and experience a sense of emotional balance. However, when the thyroid is not working as it should, it can lead to troubling symptoms.

Hypothyroidism: When the Thyroid Underperforms

Hypothyroidism, or an underactive thyroid, is a common condition that affects millions of people, particularly women. When the thyroid gland doesn't produce enough of the essential hormones T4 and T3, it can result in a range of symptoms, including low energy, weight gain, anxiety, depression, constipation, and hair thinning. Traditionally, the medical approach to hypothyroidism has been to prescribe synthetic thyroid replacement medication, such as levothyroxine or Synthroid, to supplement the body's natural thyroid hormone production.

The Limitations of the Traditional Approach

While thyroid replacement medication can be helpful in some cases, it often fails to address the underlying causes of hypothyroidism. Many patients find that even after taking these medications, their symptoms persist or worsen over time. This is because the root of the problem may lie in an autoimmune condition called Hashimoto's thyroiditis, which is responsible for up to 98% of hypothyroidism cases.

Hashimoto's Thyroiditis: The Autoimmune Connection

Hashimoto's thyroiditis is an autoimmune disorder in which the body's immune system mistakenly attacks and damages the thyroid gland. This ongoing assault on the thyroid can lead to a gradual decline in its ability to produce sufficient hormones, resulting in hypothyroidism. Interestingly, Hashimoto's is often accompanied by other autoimmune conditions, such as lupus, Sjögren's syndrome, or rheumatoid arthritis.

Addressing the Root Causes

To effectively manage Hashimoto's and hypothyroidism, it's crucial to address the underlying factors that are driving the autoimmune response. This requires a more comprehensive, functional medicine approach that looks beyond just the thyroid and considers the whole body. Some of the key factors that can contribute to Hashimoto's and hypothyroidism include:
  • Insulin Resistance and Blood Sugar Imbalances:  this is because chronic high glucose and  insulin levels can trigger the immune system and exacerbate autoimmune conditions. (1)
  • Adrenal Dysfunction: Chronic stress and burnout can impair the adrenal glands, leading to hormonal imbalances that impact the thyroid. (2)
  • Gut Health Issues: Leaky gut, dysbiosis, and other gastrointestinal problems can contribute to developing autoimmune disorders. (3)
  • Environmental Toxins: Exposure to heavy metals, mold, and other toxins can trigger an autoimmune response and disrupt thyroid function. (4)
  • Food Sensitivities: Certain foods, such as gluten, dairy, or soy, can cause inflammation and further aggravate the immune system in those with Hashimoto's.(5)

A Personalized Approach to Thyroid Health

A personalized, holistic approach is essential to effectively managing Hashimoto's and hypothyroidism. This involves comprehensive testing to identify the underlying triggers, followed by a customized treatment plan that addresses each individual's unique needs. The plan may include dietary changes, targeted supplements, stress management techniques, and other lifestyle modifications to support the body's natural healing processes.

The Power of Lifestyle Interventions

While medication may play a role in managing thyroid dysfunction, the real key to long-term health and wellness lies in addressing the root causes through lifestyle interventions. This is a key piller of my philosophy by using "You Lifestyle As Your Medicine".  By optimizing factors like blood sugar levels, adrenal health, gut function, and environmental exposures, many individuals with Hashimoto's and hypothyroidism have been able to significantly improve their symptoms and even achieve remission of their autoimmune condition.

Embracing a Holistic Approach to Thyroid Health

The journey to optimal thyroid health is not a quick fix but a lifelong commitment to self-care and wellness. It will involve experimentation and persistence, but by understanding the complex interplay between the thyroid, the immune system, and the body's various systems, we can empower ourselves to take control of our health and find lasting solutions to even the most stubborn thyroid problems. With the proper support and guidance, it is possible to overcome the challenges of Hashimoto's and hypothyroidism and reclaim a vibrant, healthy life. I hope you found this information helpful. If you want my help to see if we can use specific exercises and lifestyle medicine to help you recover from pain, injury, or illness please reach out to me via ed@edpaget.com
  1. https://www.levelshealth.com/blog/the-connection-between-autoimmune-disease-and-metabolic-health#:~:text=Their%20studies%20are%20beginning%20to,diabetes%20than%20the%20general%20population
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430608/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9271567/
  4. https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2019.03094/full
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9101513/
What is The Role of Pelvic & Leg Imbalances in Scoliosis?
I've been helping people take a whole-body approach to their scoliosis for years.  One of the reasons for this is that we can't ignore the rest of the body when dealing with scoliosis. Dentists and researchers have long postulated imbalances in the teeth (1) may play a role in idiopathic scoliosis, and many other disciplines have good theories about what causes scoliosis. There is, currently, no 'smoking gun' when it comes to the cause of adolescent idiopathic scoliosis. However, it is worth looking at the rest of the body for anything that could contribute to scoliosis or prevent it from improving.  One area I'm particularly interested in is the pelvis. I view the pelvis as the foundation of the spine. If we drop a midline or 'plumb line' down the front of someone's body it would follow their spine and then dissect the pelvis in half. However, my scoliosis patients often have their pelvis rotated or shifted to one side. Often, this is an adaptation to scoliosis, but what if it's an adaptation to something with the feet or hips that is actually making the scoliosis worse?

Let's look at some common causes of pelvic imbalance and see what we can do about them. 

  • Apparent Leg Length Deficiency: This condition arises when postural muscle imbalances cause one side of the body to draw up the leg despite equal lengths. The solution is to find which muscles are tight and how they affect the joint. For example, tight hip external rotators will externally rotate the hip, making the hip a little longer. Tight hamstrings, popliteus, and calf muscles can flex the knee, causing the leg to appear shorter. Stretching and mobilizing the joints and muscles will help in these cases.
  • A collapsed arch on one foot pulls the hip down on the same side. Foot strengthening exercises and, in some cases, orthotics can help with this. 
  • True Leg Length Deficiency: There is an actual difference in bony length between the left and right sides. This is best corrected with a lift on the shorter side. 
However, sometimes, the anatomy of the scoliosis can also drive the pelvis into rotation and an oblique tilt. This has to do with the weight shift that happens when scoliosis isn't balanced. In an S-curve, this occurs when one curve is larger than the other, but it's also common in adult degenerative lumbar spine scoliosis. But this is then compounded by postural habits that tighten up muscles. Assessing the hips in all six cardinal directions is essential before starting any corrective-type exercise. In the Scoliosis Correction Protocol, we use 22 different body tests to build a picture of imbalances in our patients before we get them to do any specific scoliosis exercises. This allows the scoliosis exercises to be more effective as they are not 'fighting' against muscle imbalance elsewhere in the body that could be adding to their scoliosis.  Understanding the interconnectedness of pelvic and lower extremity imbalances with scoliosis progression underscores the holistic approach required for effective management. By addressing these contributing factors through tailored interventions, we can optimize postural alignment and mitigate the impact of scoliosis on overall spinal health. As healthcare practitioners, we must learn to recognize and address these intricate relationships to provide comprehensive care for individuals with scoliosis. I hope you found this information helpful. If you want my help to see if we can use specific exercises and lifestyle medicine to help you recover from pain, injury, or illness, please reach out to me via ed@edpaget.com
  1. https://www.researchgate.net/publication/7842106_The_Influence_of_an_Experimentally-Induced_Malocclusion_On_Vertebral_Alignment_in_Rats_A_Controlled_Pilot_Study
4 Top Exercises for Bulging or Herniated Disc Relief
Understanding Disc Bulges and Herniations Up to 85% of us will experience back pain at some point in our lives. For most, this pain is temporary and resolves within a few days. It is often caused by a pulled muscle or ligament. However, for some, the pain may be the result of a disc bulge or herniation. In a disc herniation, the gel-like liquid at the center of the disc, known as the nucleus pulposus, is squeezed out of the surrounding ring, much like jam being squeezed out of a doughnut. This "jam" can then push on the nearby nerves, causing inflammation, which leads to pain that radiates down the leg, a condition known as sciatica. Disc bulges and herniations are common when the joints of the lower spine are overused, such as in individuals who frequently bend forward or have tight hips, causing the lower back to compensate by moving more. While disc bulges are very common, they don't always cause pain. For example, up to 84% of people in their 80s have disc bulges without any pain, but they sometimes do cause pain.

Avoiding Surgery for Disc Issues

Some people may consider surgery for disc issues, but studies have shown that there is not much difference in long-term outcomes between those who undergo surgery (1) and those who do not. Dr. John Sarno, a renowned physician, believed that simply providing information and education could help many people overcome their back pain. (2) While information is valuable, it doesn't always relieve the pain. That's why we're going to explore four exercises that can help pump out inflammation, relax the muscles, and keep the spine strong and mobile.

Exercise 1: Somatic Flower

This exercise involves lying on your back and using your breath and movement to mobilize the spine. Start by taking a deep breath, feeling your belly expand. As you exhale, allow your back to arch slightly off the ground. As you do this, let your knees drop outward, relaxing the muscles in the front of your body. As you exhale, rotate your hands externally, pulling your shoulder blades together. Then, on the next inhale, rotate your hands inward. Repeat this sequence 5-8 times, moving slowly and in control to help pump out inflammation and improve mobility in the lower back and hips.

Exercise 2: Prone Extension and Leg Lift

For this exercise, you'll start by lying on your stomach, with your head turned to the side and your hand resting on the ground. Lift your head and chest off the ground using your upper back muscles rather than your lower back. This is important as it helps to avoid further straining the already irritated area. Next, lift the opposite leg off the ground, focusing on pushing the pelvis down into the ground to stabilize the lower back. Avoid arching your lower back as you lift your leg. The key to this exercise is to engage your upper back and your glute but not extend or move your lower back too much.  Repeat this movement 3-5 times on each side, then try lifting your whole arm off the ground as you lift your leg and head.

Exercise 3: Spinal Flexion and Extension Cogs

For this exercise, you'll need a chair. Sit up tall, with your hands dangling down by your sides. Begin by rotating your hands backward, which will gently arch your lower back. Imagine there's something on top of your head that you're trying to push up towards the ceiling. Next, rock to the back of your pelvis, flexing your spine and allowing your chin to come forward slightly. Avoid letting your ribs flare out. Repeat this sequence of arching and flexing your spine, breathing in and out 5-10 times. This exercise helps to mobilize the spine in both flexion and extension, complementing the previous lying-down exercises.

Exercise 4: Nerve Flossing

The final exercise is designed to help move or "floss" the nerves that may be irritated by the disc issue. Start by sitting up tall and extending one leg out in front of you, but don't push into any pain. Just as far as you can go before you feel a stretch. Look up as you do this. Next,  breathe out and slowly slide your leg back to a normal sitting position, allowing your chin to tuck towards your chest. Then, repeat, as you breathe in, use your back muscles to extend your spine, look up towards the ceiling, and slide the leg out in front of you again. Repeat this sequence of flexion and extension 10-15 times, focusing on keeping the movement smooth and controlled. You may feel some tension down the back of your leg, but the goal is to stay within a pain-free range of motion. Repeat on the other side. Remember, these exercises are designed to help pump out inflammation, relax the muscles, and improve mobility in the spine and surrounding areas. If you have any specific concerns or questions, don't hesitate to reach out to a healthcare professional for personalized guidance. I hope you found this information helpful. If you want my help to see if we can use specific exercises and lifestyle medicine to help you recover from pain, injury, or illness please reach out to me via ed@edpaget.com
  1. https://pubmed.ncbi.nlm.nih.gov/20949289/
  2. https://www.nytimes.com/2021/11/09/well/mind/john-sarno-chronic-pain-relief.html