An article by Alberto García Martín,
Physiotherapist in (León).
The musculoskeletal diseases are one of the most common causes of disability in the elderly. A statistical study carried out in 2018 in Spain estimated that up to 40% of people over 65 years of age suffer from some type of disorder related to the locomotor system.
Among the most common diseases we find in the first place osteoarthritis, followed by osteoporosis, rheumatoid arthritis, sarcopenia, fractures, replacement arthroplasties and various pains depending on the location. It is well known that sport and physical activity help us to prevent and cure these diseases, but Why is it so important to lead an active life?. Not only is it necessary not to be sedentary throughout the development of our lives, but it is also necessary to achieve the best state of health the sum of intelligent sports training.
Diseases of the musculoskeletal system are one of the most common causes of disability in the elderly
From strength training to postural control classes such as the famous pilatescan help us avoid possible cervical and lumbar pain, or even prevent or delay the onset of the famous .
Science has shown us thatAxial loading and strength training are the best way to prevent osteoporosis and treat itin such a way that it is not only convenient to perform bipedalism in older people, but it is also advisable to perform strength and empowerment exercises.
We have to understand the body as a structure that adapts, understands and is intelligent; over the years it has been adapting to the needs and throughout a person’s life it adapts to the requirements that it gives them, therefore from physiotherapy we work by stimulating the body and sending it information, in this case the production and deposition of osteophytes (osteophyte: specialized cell of bone tissue) in the bones for the maintenance of a correct bone density.
And it is that, The widespread belief that hip fractures are the consequence of a previous fall is incorrect.. In the greatest number of cases the opposite happens; due to poor bone quality a hip fracture occurs, and immediately after, the fall occurs. In some cases, this episode is added to injuries actually produced by the effect of falling, such as fractures in the radius ulna, a colles fracture, head injuries…
Hip fractures are usually an easy challenge for the physical therapist, although some get complicated. One of the most common complications is the inhibition of the gluteus medius that causes the Trendelenburg gait.. This can be caused secondary to downtime or caused by the traumatic process during the intervention of the superior gluteal nerve. It is there when a good physiotherapy intervention becomes more important, restoring the function in case it is possible thanks to therapeutic exercise, manual therapy or electrotherapy, among others.
And what about osteoarthritis?
Osteoarthritis is known as joint wear, especially articular cartilage. However, studies of recent years suggest that, since cartilage is an avascular and aneural tissue and therefore not capable of producing pain, its origin comes from another place. These studies have verified that the wear of the articular cartilage (which exists) is not so important, but that the mechanism of reduction of this articular cartilage comes from within, so that the cartilage closest to the bone and the subchondral bone begin to ossify.
How can we avoid this process and take care of our cartilage? Although as we have said before, cartilage is avascular, so how does it manage to stay alive? Well, through the synovial fluid, although as it is such a hard and resistant tissue, it has a specific pressure frequency, which allows the exchange of synovial fluid that will provide it with the necessary nutrition; the frequencies are 1 Hz and 0.33 Hz, or what would be the same as walking taking one step every second and performing a static monopodal stay changing every 3 seconds. Thus, the synovial fluid manages to penetrate and prevents osteophytes from reaching the cartilage through the vascularization of the subchondral bone.
“Deyle et al”carried out in the year 2000 a study on the effects of manual therapy combined with therapeutic exercise. The results obtained finally concluded that manual therapy and exercise were found to be effective, achieving improvements in WOMAC scores and distance within 6 minutes. (WOMAC: Western Ontario University and McMaster Standardized Objectification Questionnaire for Osteoarthritis Index.)
What happens when osteoarthritis is very advanced?in this case we have the help of the traumatologywhere a replacement arthroplasty will be performed. Post-surgical physiotherapy management must be as early as possible.. Unlike in the past, it now prioritizes early mobilization and gaining full ROM early.
We must take into account the degrees of mobility that prostheses allow and tell us what model you have, they usually have from 0º to 110º. It is very important to achieve full extension, as a 5º flexion can create a functional limp. In addition to the knee we must pay attention to the hip and ankleafter a substitution surgery, since after a substitution surgery the planes and alignments that existed may be modified, which will give rise to possible stress in the adjacent joints and therefore they may generate pain.
The pre-surgical protocol followed in countries such as Canada, Japan or Russia, which consists of a exercise plan for 6 months achieves that up to 50% of knee replacement applicants end up refusing the appointment.
What is Rheumatoid arthritis?
This disease is known as in addition to the typical joint degeneration in osteoarthritis, the degeneration of the soft tissues adjacent to the joint, such as the joint capsule and the ligaments of each joint, commonly given in the carpal joints. In this case, physiotherapy can be the best tool for approach and rehabilitation, since we can do a good treatment on the soft tissues, giving them greater elasticity.
Exercise in this case of active mobility without loads will be of great help when it comes to improving their nutrition and their water content., since tissue dehydration is the main reason for loss of elasticity and appearance of rigidity. The application of other physical agents such as heat, cold or electric currents for pain control is also common.
What is sarcopenia and how can it affect?
Although we don’t normally hear about this musculoskeletal disorder It is more common than you think. Its abouta loss of muscle mass, strength and functionality that occurs more frequently in older people. It makes independence difficult for ADL (basic activities of daily living), and is a great indicator of disability. In some cases the loss of muscle mass and strength is so severe that some muscles lose their function and the person loses voluntary control of the muscle.
To prevent this pathology physical exercise and strength training They are our best friends, and more if they were accompanied by a adequate protein-rich nutrition.
How can physiotherapy help once the pathology is installed? physiotherapy can act to stop the loss of muscle fibers and even stimulate the creation of new fibers. Strength work is as important as voluntary activation control, so that in addition to doing strength work in the different degrees of the Danniels scale, we can work on voluntary and isolated activation control of a specific muscle with the help of the electromyography.
In case the sarcopenia is severe enough that the patient has lost activation control we will need electrotherapy, where we will use the TUT (therapeutic utility triangle), seeking to lower the intensity threshold for muscle activation and achieve reactivity at low intensities.
Numerous studies and literature reviews have been published on the benefits of sport and physical activity, as well as physical therapy over the years, so it’s no secret that the more you take care of your body, the better quality of life you will enjoy in your futureand if the presence of a physical activity professional is added to this equation, the results will be better, since poorly performed exercise can cause pathologies.
To finish and as a reflection, a phrase that I like very much, “If medicine is science, there are years of life left, Physiotherapy is the science that gives life to those years”.