The ice and snow has hit Manitoba and patients are visiting our office with injuries from slipping and falling.  According to Public Health Canada, falls are the number one cause of hospital injury in older adults and account for 2 billion dollars in health care costs annually in Canada.  Seniors will spend 10 days longer in hospital after a fall over any other cause and 1/3 of them will end up in a long term care facility after a fall. Falls are the cause of 95% of hip fractures.  Schnell and Friedman published in the Journal of Geriatric Orthopeadic Surgery and Rehabilitation that seniors have a 21% to 29% chance of death in the first year after a hip fracture!
It is important for everyone, at all ages, to be aware of the risks of falling, and to be proactive about avoiding it.  Here are some tips and thoughts on fall prevention:

Make Some Changes at Home
Half of all falls causing hospitalization happen at home.  This is the most important area you can change in order to lessen the odds of an injury.  Common areas of the home to fall in are the bathroom and kitchen. Spills and slippery surfaces should always be cleaned up immediately. Non-slip mats, hand rails, and a raised toilet seat are a must in the bathroom. Place kitchen items that you use the most in easy-to-reach areas and have heavy items in your lower cupboards. Avoid using a stepping stool, but if needed, have a solid one with a hand rail. 
Take a look at the rest of your home for fall hazards such as loose mats, transition zones from carpet to laminate or hardwood, electrical/phone cords, and various types of debris.  Proper lighting at night is also essential, especially from the bedroom to the bathroom. 
Other tips include: having a spot to sit when putting on footwear, don't rush around the house, always use a handrail on the steps, get up slowly from sitting to avoid dizziness, and keep walkways clear of snow or ice.

Medications
Make sure you talk to your pharmacist or doctor about your medications and their side affects. This is more important when you start a new medication, as it might cause dizziness when combined with your current medications. If your medications cause sleepiness or dizziness, plan to take them when you are not active, and be cautious when combining alcohol and medications. 

Get Active!
You will be getting tired of me preaching this, but is so important! I feel it is the number one thing a person can do to age well and prevent falls.  We loose strength naturally with age but can slow this process with regular exercise and strength training. Exercising 15 minutes a day, or a minimum of 2 hours a week, with resistance exercises using body weight focusing on balance is a must. Exercises will depend on an individual's abilities, and you should never put yourself at risk. Doing wall squats, stair step-ups, step-out lunges, push ups (modified if needed), walking, and stair climbing are simple ways to maintain your strength.
​The other important benefit from exercise is balance. There is a direct correlation between how good your balance is and your risk of death.  Activities such as yoga and Tai Chi are excellent for balance. In fact, Tai Chi is one of the only activities studied and found to reduce fractures, and is recommended by Osteoporosis Canada.  You can also work on balance at home if you don't have access to these activities. Stand facing a corner with your hands against the wall for support, stand on one leg with your eyes open, then switch legs.  Try not to use the wall and balance as long as possible. This activity can also be repeated with your eyes closed, or with eyes open and moving your non-weight-bearing leg around to make it more challenging. 

Use Safety Aids
Don't be embarrassed to have to use trekking poles, a cane, or a walker. Check your pride at the door, because it will be a lot worse when you need to phone someone to come help you off the floor.  Consult your health care provider to ensure you are fitted properly to these mobility aides, and make sure you remove clutter so that you can use a walker or cane at home. When it is icy, purchase anti-skid soles for your shoes and add a spike to the end of your cane. 

Falls have a huge impact on our population and the majority of fall can be prevented.  It is not only seniors that are at risk, and everyone should take a look at their home for fall hazards.  Everyone should also get active and work on balance and strength.  

​Activity Fact: Single-leg stance test, getting up from a chair without the use of your arms, scissor squat test, and the "get up and go test" are a few balance tests that can be directly related to your chance of death! So it's important to be able move and maintain balance!

When some of us hear the words "strength training," we envision huge sweaty muscular guys grunting in the gym while lifting ridiculous amounts of weight. These days are long gone! 
In the last 20 years, there has been an astronomical amount of research done on human performance and the benefits of strength training. This research has been done across all demographics - from professional athletes, to seniors in personal care homes. It includes patients with various diseases, such as obesity, multiple sclerosis, dementia, diabetes, depression, and much more. 
Strength training is safe and effective for almost anyone and should be incorporated into your weekly exercise routine. Here are the reasons why: 

1. Stop the shrinking!
After our mid to late twenties, we all start to lose muscle mass and muscle strength. This is called sarcopenia. Strength training can slow this process down by helping to maintain good muscle mass and muscle metabolism. Sarcopenia has negative health affects for seniors with 30% being affected at the age of 65 and 50% being affected at 85.  This contributes to higher risks of falls, hospitalization, diabetes, weight gain, and osteoporosis.

2. Weight loss
Muscles are furnaces for burning calories!  Muscle tissue burns up to three times more calories than fat tissue. Studies show that you can increase your resting metabolic rate with increased muscle mass.  Many studies show that strength training  is more efficient in loosing fat compared to aerobic exercise. 
It doesn't end after you leave the gym. Your body is still burning calories for the next 24 to 48 hours as it works to repair stressed muscle tissues. That's known as "the afterburn effect," another name for excess post-exercise oxygen consumption (EPOC). The more oxygen you use, both during and after a workout, the greater the EPOC.  Studies show strength training is one of the best ways to achieve this.
Lifting heavy loads in short bursts causes the body to make type II muscle fibers. These is the muscle type that requires the most calories.  Strength training also gets the body producing metabolism-enhancing hormones that cause fat burning and aid in the production of muscle tissue.  

3. Increase your endurance and strength
Strength training has repeatedly been shown to help muscle endurance in high performance athletes and the general population.  When your muscles are stronger, they work more efficiently and therefore can work longer.  Increased muscle mass helps with the efficiency of the body's ability to transport oxygen and maintain an optimal metabolism.  This is important for everyone from the recreational hockey player, the seasonal pickle ball player, or the senior that wants to climb that flight of stairs.  

4. It helps to prevent broken bones
When you put force onto a bone, you lay down more bone tissue. Strength training, even with minimal weights, has been shown to do this. You can decrease risk of hip fractures and all other fractures, as a senior, by strength training. Strength training also helps to reinforce the central nervous system to help muscles react faster causing better balance and force to the ground. A strong neuromuscular connection is a primary indicator for longevity and well- being for all ages. 

5. Overall health improvement
Strength training has physical and mental benefits like all exercise.  As mentioned, weight loss is easier to achieve with strength training than aerobic exercise.  With this comes a decrease risk in all metabolic disease including: diabetes, cancers, chronic inflammation, cardiovascular diseases, and dementia. Strength training later in life has been shown to decrease overall mortality by improving balance, mobility, and therefore fall risks.  It's the old adage: "Use it or loose it!"
​

Call to Action
Strength training is essential to maintain good health.  Do not feel that it is a lot of work or that you don't have the right tools at home to do it.  Research shows that three workouts per week with 30 minutes per session is the minimum ideal frequency to gain benefits.
The best starting point is to do exercises that involve body weight resistance such as: push ups, squats, lunges, dips, climbing steps, box jumps, back extensions, and pull ups. All of these exercises can be done at home without any equipment. Progression to using weights and/or a gym ball will give you more challenge and thus more resistance.  Most senior living centers have exercise classes that involve strength work using body weight resistance. Get out and move!
Lastly, move onto lifting some weight.  Starting with large movements such as loaded squats, dead lifts, lunges, and rows.  Find someone that knows about strength training once you start to lift heavier weight.  This will help prevent injury. Visit your local gym to get instructions on how to perform these exercises to ensure you don't get injured.

Activity Fact: The most weight lifted in a dead lift (lifting a bar with weights on it off the floor to waist height) is 500 kg or 1102 lbs!!!

Carpal Tunnel Syndrome is a condition where the Median nerve gets compressed at the wrist causing decreased nerve flow to the hand. Symptoms include numbness into the thumb and the next two fingers, weakness in these fingers, and decrease sensation.  It is mainly caused by irritation at the wrist from jobs that require a lot of repetitive work with the hands, but can also be caused by pregnancy, trauma, or swelling. Symptoms often occur during certain activities and subsides with rest.  It is very common to have symptoms when sleeping, driving, or typing. 

Severe chronic carpal tunnel compression often requires surgery to decompress the nerve at the wrist and fix the problem.  However, there are many things you can try first to help eliminate this annoying problem:

1. Brace That Wrist
Short term use of carpal tunnel braces have been proven to help decrease symptoms and are effective for use at work and/or at night.  Often at night people flex their wrists, but carpal tunnel braces are designed to keep the wrist in a neutral position and therefore open the carpal tunnel.  They are proven to significantly decrease symptoms of numbness and pain at night.  They help relieve the aggravation on the nerve and therefore help the condition overall.  Carpal tunnel braces can be purchased at most pharmacies and medical stores and  they are an inexpensive method to help the problem.

2. Get Your Neck Checked
The nerve that travels through the carpal tunnel, the median nerve, originates from the nerve roots in the neck.  Hand symptoms often occur when there is pressure on the nerve root due to arthritis, joint irritation, bone spurs or bulging discs and can sometimes mimic carpal tunnel syndrome.  Often if the hand symptoms are associated with arm pain or numbness as well as a more constant pain, the problem is originating in the neck.  Another test is to see if you can reproduce the hand symptoms with changing the position of your head.  If you can do this, your symptoms might be originating from the neck, not the wrist. 
Your health care provider will perform various provocative tests to see if the symptoms can be reproduces at the wrist or at the neck, but in some cases a nerve conduction study is needed to help determine the origin of the nerve compression. ​

3. Change the Way you Work
There is an undisputed correlation with carpal tunnel syndrome and jobs that require repetitive use of the wrist and hands. Simple changes can be made to help take the stress off of your wrist.  Try to do the job with your wrist/hand in a neutral position.  An example is to purchase a keyboard pad to help elevate the wrist area to line up with the fingers.  This can also be done with jobs such as using a knife. You can move the product up or down, or closer to you to better achieve a neutral wrist position. 
You can also look for ways to decrease vibration when using tools, lessen the weight of objects you must lift, find ways so you don't have to hang onto items, and wear warm gloves/mitts that cover your wrist. ​

4. Talk to Your Doctor
Talk to your Medical Doctor when you have chronic numbness in your hands. Although rare, some conditions present with symptoms that mimic Carpal Tunnel Syndrome. Your doctor can order various blood tests to determine if there is a systemic problem causing your hand symptoms. ​

5. Time to Strengthen Up
There is an old saying that states "everything starts at the core".  This is also true with carpal tunnel syndrome.  When you have a repetitive job that is physically demanding, sometimes the extremities get injured because of weak shoulders or mid back.  When you compensate for a weak core, extra stress is applied to the wrists. A good assessment from your health care provider will tell you where your weakness lies and how to strengthen ​it.

6. Carpal Tunnel Exercises
There aren't a lot of good studies showing that specific exercises help Carpal Tunnel Syndrome however, there are a lot of case studies that show they help when combined with other proactive changes.  Start out with doing 3 sets of 10 of each exercise and never exercise or stretch into pain and always listen to your body.  Here are some exercises:
a) Fist to Fan- make a fist and hold for 5 seconds and then fan your fingers out and hold again
b) Shake it out- gently shake your hand, keeping the wrist and fingers loose
c) Fist to Stop sign- make a fist and hold for 5 seconds, then extend your wrist to the stop position
d) Swirl- take a half full glass of water and rotate clock-wise and counter clock-wise for a count of 10 each way. 
e) stretch it out- with palm down, gently pull down your hand towards the floor with the other hand and hold for 10 seconds, repeat with your palm up 
f) Squeeze it-  use a sponge or a soft ball to squeeze ​

7. Manage Inflammation
It is important to avoid chronic irritation of the wrist.  Applying ice after heavy use of the wrist can help decrease swelling and irritation and therefore decrease symptoms.  Ice should be applied for 15 minute intervals and never put directly on the skin. Sometimes anti-inflammatory medications can also help decrease symptoms at the wrist.  Treatments from your chiropractor can also help decrease inflammation with the use of ultrasound, massage, wrist mobilizations/adjustments, and strength therapy.

Carpal Tunnel Syndrome can be a very annoying condition.  If you suspect you have Carpal Tunnel Syndrome, make some changes in your work and personal life and try these simple tips.
Activity Fact: Carpal Tunnel Syndrome can be a common presentation in the third trimester of Pregnancy as women tend to retain more fluid.  The extra fluid causes pressure at the wrist and symptoms often subside after pregnancy.   

According to the World Health Organization, osteoarthritis (OA) is the most common arthritic disorder facing the westernized world, and is the single most common cause of disability in older adults. Up to 10% of people over age 55 suffer from osteoarthritis.  Of that, the knee is one of the primary joints affected by osteoarthritis.   

What exactly is osteoarthritis? This is a condition when the cartilage in a joint breaks down, and the body starts to lay down extra bone and tissue in order to stabilize the joint.  OA can be diagnosed by a good physical exam or by x-ray. However, the presence of osteoarthritis on a radiograph does not correlate directly to pain. It is possible to have extensive pain and very little degeneration observed on x-ray, but also possible to have very little pain but extensive x-ray findings. Knee OA can cause pain, stiffness and impaired movement. It accounts for more difficulty climbing stairs and walking than any other disease. Knee OA has a very large impact on quality of life as people age. 

There are some preventable risk factors that can mitigate your chances of developing knee OA, or manage early OA, to have a better quality of life as you age: 
1. Obesity
People who are overweight have a high prevalence of knee OA. If there is any sort of misalignment in the knee, or imbalance in how the muscles are acting around the knee, then the increase in body mass, or obesity, will increase the progression of knee OA. (https://onlinelibrary.wiley.com/doi/abs/10.1002/art.20726).
2. Footwear 
Ensuring that you are wearing proper footwear, or even custom-made foot insoles, will help to support the forces going through the knee joint and minimize the impact that obesity plays on OA of the knee.
3. De-conditioning
Lack of exercise, or maintaining a sedentary lifestyle, will predispose you to developing knee OA. This obviously correlates with being overweight but also helps to prevent injury, decreases your chance of osteoporosis and overall injury. 

Some risk factors pertaining to knee OA that are beyond your control are:
1. Gender
Women are more likely to suffer from knee OA then men. This increase becomes apparent in older women, leading to thinking that estrogen deficiency may play a role in the disease.
2. Genetics
When you have a family history of knee OA, you are more likely to suffer from it too. 
3. Bone Density
As bone density decreases, such as in osteoporosis, OA increases. This can be a genetic issue or, again, due to a sedentary lifestyle.
4. Injury
 When an injury is sustained in the knee, such as damage to the soft tissue structures, meniscus and ligaments, this will increase likelihood of developing OA in the joint.

How to Help Your Knee Arthritis
If you have been diagnosed with OA of the knee, there are a few things that you can do to help your prognosis:
1. Home-based exercise programs will decrease pain experienced by those diagnosed with knee OA. Both aerobic and resistance exercise improve measures of disability in older adults. Many exercises can easily be performed at home, and even simply walking can help your pain. Exercise in the water is beneficial as the force of gravity is removed, and you are better able to go through the full range of motion. Consult a healthcare provider for specific exercises to help determine the exercises that are best for you.
2. Glucosamine and chondroitin sulfate can be helpful. One study suggests the use of 1500mg of glucosamine sulfate daily for 3 years decreased the progression of degenerative changes of the joint cartilage. Consult your medical provider or pharmacist if this is something you are considering.
3. Lifestyle changes such as introducing exercise, decreasing weight, and using proper footwear in the early stages of OA make a bigger impact then seeking out passive treatment from a health care provider.  When the OA becomes symptomatic, specific exercise instruction from a qualified health care provider will be beneficial to decrease pain, and improve functional capacity.
4. Modalities such as TENS (Trans Electrical Neural Stimulation), acupuncture, massage, ultrasound, and heat therapy can help temporarily relieve symptoms.  Consult a health care professional that specializes in muscles and joints to receive these kind of treatments. 
5. Bracing has also been shown to be beneficial in relieving OA pain in the knee. A well-fitted brace can help combat the instability caused in OA due to cartilage breakdown. Custom fitted bracing is often successful in people with advanced knee OA. 
Sometimes OA can progress to a point that requires more invasive interventions, which would need to be managed by your medical provider. OA of the knee is the most common cause of total knee replacement. Specific medications or other medical procedures may be required, such as a scope or knee replacement.  

By maintaining an active lifestyle and maintaining good muscle mass, good body biomechanics, and good health habits, you can reduce your chances of developing knee OA, and prevent knee OA from making a big impact on your quality of life.

Activity fact: One would expect that runners have a higher chance of getting knee OA.  It's actually the opposite! Studies show a lower occurrence and less knee OA pain overall in people who run regularly.