Musculoskeletal Changes Associated with Aging

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Musculoskeletal Changes Associated with Aging
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Muscular System

• Motor Unit There is a decrease in motor units
  with age
• The number of motorneurons dec with age
• Muscle fibers also dec with age
• Slow twitch Type I- there is a higher percentage
  of this type
• Fast Twitch Type II- are selectively lost to a
  greater degree

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Morphological and Functional Age related Changes

• Muscle mass From age 40 to age 80 there is a
  30-40 decrease in muscle mass. It is obvious by
  60.
• Antropometrically, there is a decrease in lean
  muscle mass and an increase in fat
• Muscle fiber size decreases with inactivity in
  both slow and fast twitch. Since there is no
  decrease in enzymes related to energy metabolism
  in skeletal muscle, aerobic and anaerobic
  metabolism does Not decline 2ary to aging

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Aging Joint mobility

• There is a decrease in extremes of joint ROM even
  without pathology
• PROM decreases with age
• Jt. Flexibility is inversely related to age.
  Women lose ROM at a slower rate than men. UE
  joints remain more flexible then LE
• PCT stiffness contributes to dec. ROM due to
  changes in collagen structure, dec. physical
  activity

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Arthrokinesiological Changes

• There is decreased angular velocity and
  displacement.
• Angular velocity
• Parallels decreased overall physical activity
• Other contributing factors are decreased m
  strength, meds, fear of falling

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Sensorimotor changes

• Dec. reaction times
• Inc. rate of loss of brain cells
• Altered neurotransmitter production
• Dec. perception of vibration, temp, touch,
  proprioception and pressure
• When these factors are put together, there is a
  dec. rate or magnitude of force generated by
  muscle

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Age Related joint mechanics Changes

• Arthrokinematics are affected by increased PCT
  stiffness when it interferes with natural
  translation of the joint.
• Gains can be made by stretching
• Sometimes these reductions produce enhanced
  safety

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Effects of exercise training on muscle performance

• When engaged in programs of 6-25 weeks of
  sufficient intensity, elders have shown
  significant increases in strength.
• 70-80 of 1 REM is considered high intensity.
• Lower intensities will also improve strength.
• Resistance exercises are better than walk/jog to
  increase general ex tolerance.
• There is a poor correlation between strengthening
  and function

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Skeletal Changes

• Bone mineral density declines with age
• After age 60, bone density declines at a rate of
  about 1/year for both sexes.
• By age 90, women lose 30 cortical bone, and men
  lose 20

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About Fractures

• About ½ of all hospital admissions for fractures
  is secondary to hip fractures.
• 90 of hip fractures result from falls
• 1/3 of all females gt 65 will have a vertebral
  fracture
• The forearm (radius) is the third most common
  fracture

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Factors contributing to bone loss

• Dec Ca in diet
• Dec Ca absorption
• Hormonal changes
• Lack of exercise
• Gender
• Caffeine
• Genetics
• alcohol
• cigarettes

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Effects of Exercise on the Skeletal system

• Dec. bone loss. However ex must be done for 9
  months to 1 year to increase bone density. It
  can be strengthening or aerobic

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Bone density

• Low bone density is defined as 1.0gm/cm2. This
  is also considered the fracture threshold.
• Ca supplementation will not be effective in
  reducing the loss occurring during the first 5
  post menopausal years.
• Bed rest has a more profound effect on loss of
  bone then the above

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CA role in bodily functions

• M contraction
• N conduction
• Cell membrane maintenance
• Blood clotting

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Regulating Ca

• PTH- prevents hypocalcaemia. PTH makes sure the
  kidney gets 9 gms of Ca/day for reabsorption at
  the nephron. Osteoclastic cells are sensitive to
  PTH. In the GI tract, PTH assists with Ca
  absorption
• Vitamin D Active Vitamin D is a hormone that is
  converted first in the liver then the kidneys.
  Active VitD assists in actively transporting Ca
  through the system

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Regulating Ca cont

• Calcitonin, excreted by the thyroid, assists in
  depositing Ca in the bone
• Estrogen until menopause, protects females from
  osteoporosis
• RDA Ca young adults 750-1000mg., premenopausal
  1000mg, preg/postmeno1500mg.
• Vitamin D 400IU hopefully ½ from sun, 1/2 from
  diet

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Remodeling

• Each day 15 of the skeleton is being remodeled.
• The osteoclast goes into the bone and excavates,
  this takes 1 month, then reintroduces Ca back
  to the circulation.
• The osteoblast however, needs three months to
  fill in that hole.
• Therefore you need enough Ca and have
  osteogenic stimulus provided by exercise to
  sustain bone mineral density
• Peak bone mass occurs at 35 years. Highest amt.
  Of Ca

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Posture

• Normally, external forces created by the body are
  favorable for energy conservation.
• In elders, when mobility becomes limited, forces
  acting on the joints produced by gravity are no
  longer efficacious .

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Whats different about the posture of an elder?

• Increased thoracic kyphosis
• Decreased lumbar lordosis
• Posterior pelvic tilt
• Forward head, rounded shoulders
• Flexed hips and knees
• Tight gastrocs/soleus

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REEDCO Posture Scoring

• Used to assess static posture. Score from 100
  (perfect) to 0 (poor)
• Allows scoring over 4 occasions.
• Provides a venue for quantifiable documentation
  of improvement.

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Osteoporosis

• Preventable
• Fantastic venue for promotion and wellness
  throughout the lifespan
• Children should be educated regarding intake,
  avoidance of risk factors, exercise
• Young women should be made aware during
  childbearing age of the successful management and
  prevention
• Peri/postmenopausal women

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What is available for prevention of Osteoporosis
today?

• HRT
• Nutritional Interventions
• Physical Activity
• Bone enhancing Need a mechanical load
• Must realize they have to continue

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Osteoporosis Education

• Optimal skeletal alignment
• Avoidance of postures and positions putting a
  bone at fracture risk
• Avoid spinal flexion exercises
• Generally stretching the anterior structures

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Examination

• Take an exercise inventory
• Type
• Frequency
• Duration
• Intensity

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Tests and Measures

• Special Attention to Posture
• Balance Functional Reach
• Gait
• Scapula m strength
• Body mechanics
• 6 minute walk test

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Acute Fracture Management

• Teach posture
• Body mechanics
• Make sure pt. Is up at least 10 minutes out of
  every waking hour and gradually increase
• Walking is important, rolling support if
  necessary
• Sit in a firm but comfortable chair

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Exercises During Recovery

• Isometric Trunk Extension
• Chin Tuck
• V exercise
• W exercise
• Money exercise

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Commonly used hip fixation devices
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Hip Fixes
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Risk Factors for Hip Fractures

• Female
• White
• Low weight
• Physical inactivity
• Cognitive impairment
• Old age
• Pyschotropic meds

• Estrogen deficiency
• High levels ETOH
• Caffeine
• Reduced m strength LE
• Impairment of postural control
• Neurological cond. CVA,PD

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Hip Fracture Sites

• Most common are intertrochanteric and femoral
  neck
• Intertrochanteric usually pt. Has osteoporosis
• Femoral neck circulation is a concern
• Subtrochanteric 10 of all fx. cm. Distal to
  lesser trocanter

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Outcomes?Rehab Hip FX

• Functional independence is achieved more in
• 1. Pts. lt 85 years
• 2.Had no post op complications
• 3.PT BID in acute care
• 4.I in bed mob., transfers, amb with walker

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One year post op

• 92 were amb if they were amb before
• Only 41 regained prefracture status

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Case Studies

• What practice pattern?
• Which TM
• What additional considerations?
• What are the goals of your interventions and
  treatment options?