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Injuries due to falling are a very common problem in the elderly. Hip fractures are the most common injury due to falling in the seniors. According to the American Academy of Orthopaedic Surgeons, each year more than 300,000 people are hospitalized for hip fractures in the United States. These fractures represent 72% of all fracture costs, totaling more than 12 billion dollars in 2005 and, not surprisingly, 90% occurred in those 65 and older. Most hip fracture patients who previously lived independently will require family assistance, home or long term care and 50% will require a cane or walker.

A recent study by the American Physical Therapy Association found that patients benefited from a physical therapy evaluation to determine their risk level for falling. If a high-risk level is found on a falls assessment, physical therapy interventions can be successfully employed to improve strength, balance, and coordination and falls prevention. Also, a well-balanced diet, exercise, Calcium with vitamin D supplements and medications can help prevent or retard osteoporosis and prevent hip fractures.

Exercises to Prevent Hip Fractures

***Always perform slowly, alternate right and left sides, limit other distractions and concentrate on the exercise to retrain the brain, 10-20 times each 2-3 times per day.

***Caution: Do not do standing exercises without assistance or supervision if needed

Standing Hip Hikes (photo 1)

Face a countertop and hold onto it with both hands. Hike your hip and knee up to 90 degrees as if you are marching. Hold the position for 3-5 seconds on one leg and lower slowly. Repeat this on the other leg and alternate 10 times.

Photo 1

Standing Hip Scissor Kicks (photo 2)

Face a countertop and hold onto it with both hands. Lift your leg up 30 degrees as if you are spreading your legs apart. Hold the position for 3-5 seconds on one leg and lower slowly to cross over the middle. Repeat this on the other leg and alternate 10 times.

Photo 2

Standing Squats (photo 3)

Face a countertop and hold onto it with both hands. Bend your hip and knee down to 45 degrees to a squatting position. Hold the position for 3-5 seconds on both legs and return to standing slowly. Repeat this 10 times. Once strong enough try on one leg at a time and alternate.

Photo 3

Chair Squats (photo 4)

Sit in a chair with arm rests. Get out of chair only using your legs. Hold the position for 3-5 seconds and return to sitting. If necessary, use 1 or 2 arms to assist. Repeat this 10 times. Focus on trunk core stabilization and leg strength. Use more leg muscles and less arm muscles as strength improves.

Photo 4

Line Walk (photo 5)

Place a straight line on the floor and practice “walking the line” with the right then left foot on the line.

Photo 5

Single Leg Stance (photo 6)

Hold onto a chair while bending one knee and shifting your weight to the other leg. Hold for 3-5 seconds and repeat with the other leg. Increase time 10 -15 -20 seconds as tolerated.

Photo 6

If you feel you or a loved one may be at risk for falling or a hip fracture, ask your family physician if a physical therapy consultation for a falls prevention program to prevent hip fractures may benefit you.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. 

For all of Dr. Mackarey's articles visit www.mackareyphysicaltherapy.com/forum

When an older loved one sustains a serious injury it is traumatic for the entire family and mine is no exception. My grandmother and father enjoyed 90 wonderfully active years; however, their independence was lost the same way more than one-third of a million people lose their independence each year… hip fractures! As a doctor of orthopedic physical therapy, I feel remise that I could not prevent this from happening. What most of us fail to realize is that his fracture, like many, was more than just an orthopedic problem …it involves age, gender, diet, exercise, vision, leg strength, medications, environmental risks, and vestibular problems (inner ear problems effecting balance).

Injuries due to falling are a very common problem in the elderly. Hip fractures are the most common injury due to falling in the seniors. According to the American Academy of Orthopaedic Surgeons, each year more than 300,000 people are hospitalized for hip fractures in the United States. These fractures represent 72% of all fracture costs, totaling more than 12 billion dollars in 2005 and, not surprisingly, 90% occurred in those 65 and older. Most hip fracture patients who previously lived independently will require family assistance, home or long term care and 50% will require a cane or walker.

Several risk factors for hip fractures have been identified. While some factors are somewhat controllable and may improve bone quality, (diet, exercise, smoking, alcohol) others are not.

Hip Fracture Risk Factors:

        Vestibular or inner ear problems

Preventing a fall can not only save your independence but also your life! Preventing injuries from falls reduces the need for nursing home placement.          

Tips to Prevent Falls/Fractures:

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  Hip Fractures - Part II of II

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.  

For all of Dr. Mackarey's Articles visit: www.mackareyphysicaltherapy.com/forum

Don’t Forget to Prehab!

Rehabilitation is defined as the process of restoring something that has been damaged to its former condition. Recovering from joint replacement surgery involves intensive rehabilitation to attain full recovery. In recent years, however, the concept of rehabilitation “before” surgery or “prehabilitation” has been encouraged by most physical therapists and other rehab professionals as an opportunity to expedite the post operative rehabilitation process.

A recent study revealed that strength training before a surgical procedure can counteract muscle wasting associated with bed rest and limited mobility after a procedure. Two systematic reviews revealed that “prehab” exercise decreased pain and complication after the surgery and improved rehabilitation following the procedure. The studies also noted that individuals rehabilitated and attained goals faster, saving time and money. Due to these findings it is our opinion that prehab is an essential part of a comprehensive rehabilitation program for total knee (TKR) or total hip replacement (THR) surgery.

Therefore, it is important to plan ahead and discuss the best “prehab” program for you with your orthopedic surgeon and physical therapist.

Pre-habilitation – Pre-Operative Exercise Program.

Performing two or three sets of 10, two times daily is recommended:

  • Long Arc Quad: Begin seated on an elevated chair or mattress. Squeeze your quad muscles and straighten your knee as far as you can. Hold for 3 seconds than slowly lower your knee back to the starting position.
  • Hip Adduction: Begin laying down, feet flat, knees bent, and pillow folded between your knees. Squeeze your legs together squishing the pillow. Hold for 5 seconds than slowly relax your legs without dropping the pillow
  • Hamstring Curls: Begin standing, facing a hard surface about waist height, like a counter. Have your hands on the surface for support, maintain a straight back and leg. Slowly bent your knee as far as you can. Hold for 3 seconds than slowly lower your knee back to the starting position
  • Standing Abduction: Begin standing, facing a hard surface about waist height, like a counter. Have your hands on the surface for support, maintain a straight back and leg. Lift your leg forward, like taking a step, hold for 3 seconds than slowly lower your leg back to the starting position
  • Standing Extension: Begin standing, facing a hard surface about waist height, like a counter. Have your hands on the surface for support, maintain a straight back and leg. Lift your leg backward, like beginning to kick a ball, hold for 3 seconds than slowly lower your leg back to the starting position
  • Static Squat - 30 degrees: Begin standing, facing a hard surface about waist height, like a counter. Have your hands on the surface for support and maintain a straight back. Slightly bend your knees, without your knees moving past your toes. Hold for 5 seconds than slowly straighten your knees back to the starting position.

“Prehabilitation” enables individuals preparing for a total joint replacement to maintain or improve range of motion, strength, and endurance prior to going for a surgical procedure. We recommend doing at least 4-6 of these exercises 2 times a day to help improve the conditioning of the body prior to surgery and the overall recovery and rehabilitation process following. When completing these exercises, it is important that the movements are symptom and pain free. Should you experience any pain or discomfort with an exercise, you should not continue to perform that exercise. The goal of “prehabilitation” is to prepare the body for your surgical procedure and improve the outcomes and success of the surgery, not further injure or hurt yourself in the process. Therefore, you may not be able to complete all the exercises listed, which is okay, just do your best and what you can! In conclusion, performing exercises prior to having a total joint replacement can enhance your recovery and post-op rehabilitation, so put your best foot forward and take the right steps toward a better total joint replacement with “prehabilitation!”

More Information: For a complete list of these exercises, visit our website at www.mackareyphysicaltherapy.com or call to see how Mackarey Physical Therapy can help you!

Guest Authors: Paul Mackarey, Jr, PT, DPT, clinic director at Mackarey & Mackarey Physical Therapy and Andrea Molitoris, PT, DPT, associate at Mackarey & Mackarey Physical Therapy.

Read Dr. Mackarey’s Health & Exercise Forum – Every Monday

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.