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Geriatric Medicine

Stretches Can Keep Seniors Standing Tall

By: WILLIBALD NAGLER

Maintaining good posture is important for everyone, but especially older patients.

In general, flexor muscles are always stronger than extensor muscles. In the upper body, the muscles high in the chest become tight over time, which makes for a rounded back. The hip flexor muscles also become tighter over time. That is why many older people, especially those who are sedentary, have a tendency to pull the trunk forward and have rounded shoulders.

Maintaining good posture requires strengthening the upper back muscles, and a balance of strength between opposing muscle groups is essential.

Since sedentary patients are at risk for poor posture, it is important to encourage them to walk, which can also fend off osteoporosis.

A regular form of weight-bearing activity, such as walking, can be continued by many patients with regular stretching of the hip flexors and adductors.

The muscles lose elasticity with age, so help residents take care of them by having them stretch every day.

If residents can lift light weights without pain, I recommend simple weight-lifting exercises. Multiple repetitions with a light weight are more aerobic than fewer repetitions with a heavier weight. Multiple repetitions also allow time for the muscles to fill with blood, which happens more slowly with age. For older individuals, it is better to do something moderate nearly every day than to do something more intense only twice a week. You are likely to find that after a week of moderate daily exercise, residents are more likely to continue doing the exercises when they feel better.

Of course, a long-term care resident who is unsteady on his or her feet should be encouraged to use a cane for support. The important thing is to move comfortably, and if elderly residents build their strength, they may even get to a point where they don't need the cane.

Residents can use a cane with a single tip or four tips, (called a quad cane). The more tips, the more support for the user. However, quad canes also are heavier.

Regardless of the style of cane a resident chooses, he or she needs to use a cane that is the correct height. A cane that is too long or too short can cause back pain, add to bad posture, and make walking unsteady, which of course increases the risk for falls.

The tip of a cane should strike 6 inches in front of the foot and 6 inches to the side of the foot when the patient's elbow is bent at a 30-degree angle.

Exercises for Improving Posture in Seniors

Scapular adductor stretch, 90-degree angle. This exercise will help to strengthen the upper back. Have the resident lie on her stomach with a pillow under the abdomen. Extend the arms out to a T, at shoulder height. She should lift one hand at a time, hold for 5 seconds, then lower and relax. Start with 8 repetitions and work up to 12. When 12 repetitions become easy, add a 1-pound weight and start again with 8 repetitions.

Upper back extensor strengthening. Have the resident stand with her back touching a wall, using the shoulder muscles to brace her head and shoulders against the wall. This movement should bring the shoulder blades closer together. Hold for 5 seconds, and then relax for 2 seconds. Repeat 12 times.

Scapular adductor stretch, 45-degree angle. Have the resident lie on her stomach with a pillow under the abdomen and extend the arms at a 45-degree angle from the body. Lift one hand at a time, hold for 5 seconds, then lower and relax. Start with 8 repetitions and work up to 12. When 12 repetitions become easy, add a 1-pound weight, and start again with 8 repetitions.

Standing hip flexor stretch. The resident should start in a standing position, with the left hand holding a rail for support. Then, have the resident bend the right leg (with assistance if needed), and grasp the right foot with the right hand, and pull it toward the buttock to stretch the upper hip and thigh. This also can be done in a lying position. Have the resident tighten the stomach muscles while stretching, without arching the back. Hold for 5 seconds. Start with 3 repetitions and work up to 6 or 7. The resident can gradually increase the length of time to hold the stretch to 15 seconds.



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