Mark: Hi, it's Mark from TLR. I'm here with Dana Ranahan. She's a physiotherapist, the owner of Body Works Physiotherapy in North Vancouver, BC. They're an award-winning, many time award-winning physiotherapists clinic and Dana is one of the best physiotherapists in the world, frankly, in my opinion. And we're going to talk about healthy aging. How are you doing Dana?
Dana: Hi, Mark. Thanks so much for such a great introduction. I'm doing pretty well. Yeah. And I'm happy to be here at talking about healthy aging. It's National Physiotherapy Month this month in Canada. And so the main topic is healthy aging, and I think it brings us to the forefront because often we talk about addressing pain or injury rather than addressing our health.
And as we get older, it's more important. I think, to look at health and prevention, rather than just treating injury or pain.
Mark: Yeah, it's a weird thing that aging, somehow isn't considered a disease. It's just something that happens.
Dana: It's true, I mean, there's a normal aging process and we all have some wear and tear changes in our body, of course, associated with that. However, there can be like negative things that happen with aging where people start to get degenerative disc disease earlier, or hip arthritis at an earlier age or other things that start to develop. And so if we can sort of spearhead that from an earlier age, I think it will help us see our healthy aging years be better and more functional and more able to do activities that we want to do to stay healthy.
Mark: So I know you big part of your focus in your clinic is helping people be active, stay active, doing whatever it is that they want to do, whether that's their sport or whether that's just gardening in the backyard, walking, et cetera. How much does movement actually affect, restrictions on movement really, affect people in their ability to age gracefully.
Dana: Well, I think changes or restriction in how we move, definitely have a detrimental or can have a detrimental effect to our aging and our ability to continue being active. And this is where you see someone who, you know, as they're getting older, develops hip arthritis and has to have a hip replacement, and that does happen.
However, usually that's years in the making. And I would say, I work a lot with young athletes, as well as older people. Some of the young athletes, you see movement patterns that start developing through sport. So I work a lot with soccer and the young female soccer players who do a lot of cutting and turning and directional force on their body.
If they have asymmetry with that, and they're training at a higher level or staying active at a higher level, that pattern of movement becomes automatic for them. So then they learn to be asymmetrical and movement, which can wear things asymmetrically. And ultimately that's kind of the general picture of why things break down.
Mark: So when you're dealing with somebody like that, or if somebody just comes into the clinic and they've got, you know, Hey, I've got a sore hip or a sore ankle or whatever it is, how do you go about diagnosing it? And then what's the treatment protocol, I guess it depends on the injury of course, but what would be some more typical things that you could talk about?
Dana: Well, when people come in, definitely first off, we'll talk a little bit about why they're there and what's brought them in. And a lot of people is pain, so they wait until they're in pain when they come in and sometimes they'll have other people that say, you know, I'm a runner and I'm just, can't get my speed up. Or I'm playing a sport and I'm having trouble being, you know, skiing. I can't cut one direction as well as the other. So they're noticing asymmetry and maybe tightness, like you mentioned.
So the first question is figuring out what's happened. Have they had a traumatic injury where they fell and broke a limb or something which may change how they move because they offload it. Or is it something that's developed over time through sport or through work even you know, if you had an asymmetrical loading pattern, I don't know, labourer or something using your arm, then you may have a pattern that tied to work or sport.
So, you know, with our name as Body Works Sports Physiotherapy, I think people often think they need to be an athlete to come in. But it really, it can be anyone in any situation. So gardeners, could be a work-related issue, it could be a sport or even just day-to-day activities that you do at home that are making you move in certain ways that could be leading you to the tightness.
So I think it's important to break down the whole body and determine if your hip's tight, know is it coming from your hip or is it because you're sitting at your computer twisted all day and you know, maybe your upper body twist is making your hips twist to counter it. So there could be other factors at play.
And if we start to then address those pieces, well, for me, a lot of it is postural awareness. So how do you stand? How do you sit? When you go to those activities? How are you moving? And if someone has a significant joint restriction or, you know, arthritic change, of course there's limitations about how much we can improve it.
But if there's a lot of muscle or fascial or other tension, that's driving their movement patterns. So your brain has a program that says, move this way based on history. Then we can really work to change some of that by getting people to become aware of it and then stretching and strengthening different parts of the body that can contribute to better movement patterns. And then you see people being able to return to their activities with less problem. Either from that performance perspective or from a pain perspective, let's say.
Mark: So what else would be a common aging kind of related issue that you see in the clinic that you guys help a lot with?
Dana: Well, we do see a lot of challenges that happen as we age is that we tend to lose balance for example. And I mentioned the young soccer players where we may see the start in a young soccer player where I would see someone who tears a ligament, like an ACL ligament in their knee. And the question is, why did that happen? Was it from a trauma or the girl I have in mind is a patient of mine and she's tore it without having any trauma. She was just cut on the field and turned. And when you look at her balance, it's quite poor. So she can't stand on one leg without falling over at the age of 15-16.
So if you then extrapolate that down the life of that career, if she didn't have an injury and hadn't addressed this and had been aware of it, it only if it gets worse if you don't improve and work on your balance as we age. So that person in particular may end up leading into, maybe they have a knee arthritic change, or they fall and sprain their ankle, or she tore her knee ligament. Or there could be things that come from poor balance. And we do know that as we age, our balance becomes less resilient, let's say as we get older, and less we're challenging it.
So it's the same as any skill. If you don't use your balance reactions, then they become weaker. So I would see people from the young athletes to the middle-aged athlete whose now starting to have some breakdown happening where we can work on even balancing their body and training better control of movement in space, which is what we call proprioception or kind of our sense of our body position in space, which ties to balance.
And there can be visual inputs, our inner ear, or joints and muscles all contribute together. So it's quite a complex picture. So then we would help to address someone's, you know, whatever it is and the young soccer player, maybe it's a muscle issue. And the older person, maybe they are a bit weaker and they have some arthritic change. But if they can't improve balance, then people are at risk for falls. And we know that as you get into our senior years, and if you have a fall and maybe break a hip. Then there's higher mortality rates or our ability to function becomes much less.
So as we get older, these become more and more important, I think, to keep up. And it can be, you know, that you can do simple things for yourself, just practicing balancing on one leg, for example, or something and trying to control your position. So there's a little simple things that we can get people working on.
So I would see a range of people that need different balance cues and different balance exercises, but there's some still basic premises that, you know, can you stand on one leg and balance? And not fall over and not tip your body. And then can you close your eyes and do the same? And I'm careful if you're going to do that at home too, sometimes you will lose your balance.
So it'd be near a counter or something, but those are the things that are just a quick test for yourself. How do I do when I stand on one leg? And if I close my eyes and take my vision out of it. So my muscles know where I am and can my brain perceive that because if not, maybe at a higher risk of an injury down the line or falling as you get older.
Mark: So how much does muscle strength and sarcopenia, I think it's called, the wasting of muscle tissue as you get older, how much does that play into healthy aging?
Dana: I think that definitely plays a big role because we know that over the age of 35, I think it is, is that we start to have a decline in our muscle mass naturally as we age. And so if you can extrapolate that if at the age of 35-40, you don't start doing some strength work to try to maintain strength. Our strength does decline over time. And of course, if you don't have strength, then it's hard for the muscles to control a reaction. So the way that our brain has said is that if you go to balance. When you start to tip over the brain gets a signal sensing, Oop, straighten up. So your muscles pull you back again. But if your muscles don't have the strength, it can be harder to work on balance because you need a mix, right? You need a mix of strength and balance.
And so it depends on what we what we're seeing in the clinic, what we get people doing. But sometimes it's just simple, functional strength work that they need to ensure that the base muscles are staying strong. So even how do I get in and out of my chair? You know, you can do squats, simply like that to try to keep leg strength so that you're less at risk of falling or losing your balance let's say.
So I think it does play a role. Of course we can't change that. That happens naturally, but I think we can try to manage it. And often I would say, we start to see people in their fifties or sixties, maybe that are saying, wait, I'm not strong like I used to be. Where if they started a bit younger, even doing some base strength work I think it'll help to delay some of the functional noticing of this weakness, right? So as we get older, it becomes functionally weaker, unless we're always challenging it. So that's kind of a bonus for people who are trying to stay fit and active, you know, walking and stuff is good, but we need to also be doing some basic strengthening. Starting, you know, for sure in our thirties or forties at the latest, if you can, to try to help the later sarcopenia to be managed more easily.
Mark: But there's no real limit, like even in your nineties, you can double or triple your strength.
Dana: You can still increase strength. It's just, the rate of increase is usually less. And you might have to look at other sort of supplementation, high protein diets or whatnot, which starts to get a little out of my expertise, but definitely you can maintain strength by keeping active.
And I think that's what we see as people get older, you know, maybe they retire and they become a bit more sedentary if they're not an active person. The more sedentary you are and the less you do functional stuff, then it only will get worse and worse. So if you can keep that going, you can definitely keep it there and probably increase. Question's over time will you actually be able to fight the loss of muscle mass? It's hard to know exactly, but yeah, more active you are the better. And the more active you are, the more the joints stay lubricated. So it's kind of a, win-win all the way around and it doesn't mean you have to go to the gym and be pounding a bunch of weights.
There's some basic, simple things you can do at home without weights even. To try to just keep yourself moving. We do know that adding weights adds load and helps with maintaining muscle strength. So that is important. If you can manage it and you'll get a few weights at home. But you can do a lot of stuff without needing say weights or gym.
Mark: So anywhere from the toes to basically the neck and even into the head. Yeah. All structures of the body, you guys deal with all of that. You see all of it. You have a great deal of expertise on helping people get what they want out of, even their hands and their fingers right.
Dana: Exactly, yes that's true. I mean, that's the beauty in it, it's like a puzzle you're trying to piece together what pieces of the puzzle are missing for that person. And maybe there's a neck component. Maybe there's something else going on. So sometimes you can even have like multiple areas happening to help correct a hip alignment. So definitely we connect the whole body and I think that's really important rather than just addressing a sort of stiff area. It's looking at the whole chain.
And so then we do kind of look head to toe because you never know what you might find when you look and what's relevant. Sometimes things aren't as relevant. So we have to sort of suss out what's important to work on, but definitely we address all kinds of things.
Mark: If you're looking to healthy age, age healthily, how do I say that? I think actually, yeah, you did a good job. Age healthy, yeah. Bodyworks.ca you can call them. You can book online on the website. You have to book ahead. Dana's always booked up for months ahead, but it's worth it. She is a professional. Her team are experts at all this kind of stuff. Body-works.ca is the website, or you can call them in North Vancouver, (604) 983-6616. To book your appointment, ask your questions. They'll be happy to help you. Thanks, Dana.
Dana: Thanks so much for having me Mark and I look forward to seeing any of you out there who need help.