Do kids get bad backs?

Child with Bad posture

In general, we think that children are impervious to serious injuries, given their boundless energy and great flexibility. However, we cannot take their health for granted.

Such is the case with back health, allegedly an adults-only issue but in reality something that demands vigilance and intervention at all ages.

Sure kids bounce up quickly when they fall, but as their bodies mature they will be motivated to test their physical and athletic limits. Thus, they will become more susceptible to back injuries and putting their quality of life at risk. Therefore, parents and others (teachers, coaches, community leaders, etc.) all share an interest in promoting superior back health.

Here are some steps that you can take to help your children (ages 4-12 in particular) to prevent back injuries:

Provide children with correct footwear

Children’s back health literally starts at the bottom. Most recognized pediatric associations acknowledge that proper footwear encourages full movement and reduces the risk of back injury. This is especially true for kids involved in sports like gymnastics, basketball, and football.

Here are some easy tips to follow:

  • Make sure the shoes fit!
  • Shop in-person with your kids – don’t go online to make purchases.
  • Avoid novelty footwear like flip-flops and high heeled shoes.
  • If mass-marketed footwear does not work for your kids, consider special orthotics.

Once you outfit your children with the right footwear, don’t forget to teach them how to put them on. In particular, have them lace up while sitting on a chair with knees raised at a ninety degree angle. This will prevent overarching of the back, discourage stiffness and encourage proper posture. Strapless and Velcro-fastened footwear are less complicated but demand care.

At the same time, many experts encourage young children to walk in bare feet whenever possible. By having direct contact with smooth and uneven surfaces, young feet will develop strong muscles and ligaments, so critical for overall balance.

Speak with your physiotherapist if you have any concerns. We can help.

Be wary of heavy back packs

Increasingly, a “silent” and seemingly innocent childhood activity is drawing more attention as a cause of major back problems: carrying heavy school backpacks. Paediatricians cite backpacks that exceed 15% of body weight as a reason for increased back strain and other overuse injuries (neck, shoulders). The average 10 year-old weighs 31kg, so her/his total backpack should weigh no more than 4.5kg.

At the same time, improper use of backpacks (e.g. slinging it over the same shoulder all the time) can cause injury even when the weight is reasonable. Therefore, parents should encourage good carrying habits and other common sense tips:

  • Choose a quality canvas backpack with wide padded straps, back support, individual compartments, and weight redistribution features like wheels, hip straps and waist belts.
  • Show your kids the best way to distribute books and supplies in the backpack.
  • Consider using a separate bag for the child’s laptop or other heavier electronic items.
  • Teach them to be prudent with what to bring home from school, and what to take back.
  • Develop good lifting (e.g. use leg muscles) and walking habits with weight.
  • Child should not lean forward when walking; if this is necessary, the backpack is too heavy.
  • Proactively ask your child about back pain.

child carrying heavy backpack

Thankfully, with the advent of laptops, digital tablets and other consumer electronics, the need for carrying heavy hardcover books between home and school is decreasing. But these themselves can add considerable weight.

Encourage back-friendly posture

It’s important for kids to develop good posture habits while walking, sitting, running and taking part in any physical activity. Simply “standing up straight” is a good start, but consider offering your children an array of balance and flexibility exercises that are fun and easy to perform. We can design a program of body weight activities, as well as ideas that require small, inexpensive equipment. This can be vital for young athletes who put above average pressure on back muscles and their spines on a regular basis.

To avoid unnecessary surprises, consider a thorough spinal check for your child on an annual or biennial basis. A qualified physiotherapist can assess posture and general joint movement from head to toe. This is a safe way to identify any back problems and a first step to avoiding headaches, weak abdominal muscles and spinal curvature (rounded back).

Parent involvement with children’s lives is the best way to prevent serious back injuries. The world can be a rough place, so providing them with the best equipment and knowledge is their best defence. Use all the tools at your disposal, and be aware of any changes in your kid’s walk (i.e. gait) and overall physical performance. Speak with us, your local physiotherapist if you have any questions.



Health inspiration

“Living a healthy lifestyle will only deprive you of poor health, lethargy, and fat.”

~ Jill Johnson

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Facts about Holistic Personal Training

A holistic healing method incorporates treating the entire person rather than just focusing on one ailment.

Nowadays, it is more and more common that a Personal Training embraces the entire well-being of the individual, instead of addressing issues only to the physical body and dietary.

In 1h of session is possible to work on different areas of the body such as the respiratory system through breathing exercises, balance and coordination through Hydrotherapy and Ballet techniques, and strength through isometric exercises. As a result, the combination of all those techniques will increase body awareness and improve focus.

A Holistic healing method also takes place in the cultural and intellectual aspects of the individual, usually by recommendations of specific literature and documentaries about natural healing and the mystic law of cause and effect that permeates our reality.

pilates in the morning

Holistic Personal Training is present 24/7 in our lives, because once we start to look at the big picture, healthy habits will slowly take place and change our behavior and old tendencies.

Alternative therapies such as magic candles, incenses, chromotherapy, mantra recitation  and sound healing to name a few, are part of a holistic approach, creating a relaxing and tranquil atmosphere in some time of our day or week. Besides, those possibilites can turn into habits, changing our routines for the better.

Meeting your Personal Trainer to do outdoor activities is a great strategy to connect with nature and expand the surroundings. Some clients are so committed with a new and conscious lifestyle, that the Personal Trainer also plays the role of a personal assistant, organizing calendars and even grocery shopping with the client for a better and complete experience.

If you think about starting a Holistic Personal Training to improve your quality of life and increase discipline, please give us a call. Our services are private and offered by appointment.


Just one healthier choice a day!

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5 reasons to STOP pain medication and START Physical Therapy

As we age, our bodies develop pain that can be from several different causes. Taking pain medication daily can be harsh on our organs and eventually build up a tolerance making the medications less effective and possibly addictive. Physical therapy can be a wonderful way for seniors to keep their bodies moving and healthy, while working to keep the pain at bay.

For seniors recovering from an illness or chronic pain, physical therapy can help work to relieve pain and improve a variety of health-related aspects.

1. Decrease Pain

Chronic pain affects each person differently. Daily pain can increase chances of depression and anxiety, challenging the daily life of the elderly in a tiring way. One of the major contributing pain factors for seniors is arthritisimages

Physical therapy has been proven to play a vital role in helping manage the pain associated with the different types of arthritis that seniors endure. For seniors, physical therapists may recommend different treatment options, such as braces and splints to support joints, shoe inserts to relieve stress on the lower extremities, hydrotherapy, and hot and cold therapy to ease joint pain and stiffness.

2. Improve Cognitive Function

Becoming more physically active after midlife was shown to lower dementia risk. Physical therapy can allow seniors to work areas of their bodies that may not be particularly active and act as an effective preventative measure in decreasing one’s chance of developing Alzheimer’s or dementia, or making sure it doesn’t worsen with age over time. occupational_therapy

Reading, doing manual tasks, dual tasks, IQ tests, playing musical instruments, learning a new language, cooking, and writing are few examples of activities that an elderly can perform without supervision, and are certain to improve cognitive function.

3. Infection Prevention

Lack of movement can increase one’s chance to develop pneumonia and decrease the immune system.

Physical activity will accelerate the metabolism by creating new muscle fibers and regenerating tissues in the body.

Decreasing pain medication will diminish the liver’s workload, demanding less of this structure.


4. Help with Incontinence

Senior women in specific are more prone to urinary troubles, which can be helped with the use of physical therapy.

Physical therapy can target most areas of the body, and with urinary incontinence, there are a number of pelvic floor exercises that can be shown to patients in order to improve urinary functions. PELVCL.1

Most women who suffer from urinary incontinence aren’t aware of why it’s happening. Working with physical therapists can assist women in gaining the awareness they need of their bladder-supporting muscles (pubococcygeus and sphincter) and then learn how to strengthen them in order to control their bladder better.

5. Fall Prevention

Falling can be one of the most deadly challenges that seniors may face. Even healthy seniors can take an accidental tumble and have to deal with the repercussions that an aging body may not be up for. Slips and Falls 1

According to the National Council on Aging, one in three seniors fall each year. That statistic would be dramatically decreased if more seniors sought out physical therapy for overall strengthening of the body. Physical therapy can improve functionality and flexibility of aging joints and muscles. Especially after a hospital stay, which often leads to decreased strength and balance, seniors need physical therapy to protect against falls.

To start Physical Therapy ASAP, give us a call to schedule an assessment session.

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Study carried out on ninety-year-olds reveals the benefits of strength training as physical exercise

After doing specific training for 12 weeks, people over the age of 90 improved their strength, power and muscle mass

Results were reflected in the increase of walking speed, a greater capacity to get out of  chairs, improvement on balance, significant reduction of falls and significant improvement in muscle power and mass in the lower limbs.

These are some of the outcomes of the study recently published in the journal Age of the American Aging Association and which was led by Mikel Izquierdo-Redín, Professor of Physiotherapy at the NUP/UPNA-Public University of Navarre.

Twenty-four people between 91 and 96 years old participated in the research, 11 of them in the experimental group and 13 in the control group.

Twice a week over a 12-week period they did multicomponent training: a programme of various exercises designed specifically for them and which combined strength training and balance improving exercises. As Mikel Izquierdo explained, “the training raised their functional capacity, lowered the risk of falls, and improved muscle power. In addition to the significant increase in the physical capacity of frail elderly people, the study has shown that power training can be perfectly applied to the elderly with frailty.”

With aging, the functional capacity of the neuromuscular, cardiovascular and respiratory system progressively diminish, and it increases the risk of frailty. Physical inactivity is one of the fundamental factors that contributes to the loss of muscular mass and functional capacity.

The conclusions of the study are: b9f1839a5ac36dd485d1c9ab24f31e90

Implementing exercises for muscle power, balance and walking in the elderly routine can prevent the impact of aging and improve quality of life. 

To start a strengthen program of personalized physical training, contact us to schedule an assessment session.


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Real ‘superfoods’ you should be eating more of, according to science

Here are the top 25 healthy foods you should add to your diet , according to America’s leading public health institute.


The term “superfood” doesn’t actually mean anything , and most of the foods hiding behind such a label aren’t all that good for you. But there are dozens of real, nourishing foods that you should be eating more of right now.


Cabbage is a good source of calcium, iron, fiber, folate, and vitamins:

Cabbage and its cousin Chinese cabbage are rich in calcium, iron, fiber, folate, and Image result for cabbage cookedvitamins, and very low in calories — 22 for a cup of the regular variety served raw and just nine for a cup of the Chinese variety served raw.




Cauliflower packs in the fiber and folate:

Cauliflower is rich in fiber and folate, vitamins B6, C, K, and potassium. A cup of Image result for cauliflower cookedchopped, raw cauliflower has just 27 calories, 3 grams of fiber, and 2 grams of protein. Toss some in your next curry.




Kohlrabi is high in vitamins C, B6, and potassium:

Kohlrabi — an off-white veggie you’ve probably never heard of — is high in fiber, folate, Kohlrabi is high in vitamins C, B6, and potassium.vitamins C and B6, and potassium. A cup of it raw packs just 37 calories but a whopping 5 grams of fiber. Try it baked.





Scallions are flavorful sources of vitamins A and C:

Scallions, known for their crunchy texture and poignant flavor, are low in calories (just Image result for scallions cooked32 for a whole cup) but high in nutrients like vitamins A and C. Try chopping up a few and adding them to salads.




Brussels sprouts contain compounds also found in other leafy greens like broccoli that may help reduce the risk of certain cancers:

A member of the cabbage family, brussels sprouts contain compounds called glucosinolates and isothiocyanates that may help reduce the risk of certain cancers, according to a study published in the Journal of Food Science.


Brussels are also high in fiber, folate, vitamins A, C, K, and B6, iron, and potassium. A cup of them boiled has around 56 calories and packs some protein too.

A cup of pumpkin has more potassium than a banana:

The naturally deep orange hue of a pumpkin is a good indication of its richness in beta-Image result for pumpkin cookedcarotene or vitamin A, which plays a key role in preserving our vision, especially at night. Plus, they’re high in potassium (a cup of boiled, mashed pumpkin packs more than a banana), fiber, vitamins B6, C, E, and iron, and they can be baked into a yummy fall gratin.



Broccoli packs a mean folate punch:

Several studies suggest a link between crunchy veggies like broccoli and a reduced risk of certain cancers and other chronic diseases. Image result for broccoli cooked

Plus the miniature trees are high in vitamin C and folate, which is especially important for women who’d like to get pregnant one day. So try tossing a few stalks in your next stir-fry.



Zesty arugula may help improve digestion:

This spicy green is a delightful addition to a salad or pizza. Like its cousins broccoli and Image result for arugula fresh and cooked kale, arugula has many nutrients that have been linked to disease prevention and improved digestion. Plus, it’s a good source of zinc, calcium, and iron. Toss it on your next pizza.




Bell peppers provide 300% of your daily allowance of vitamin C:

A great source of vitamins A and C, bell peppers are a crunchy addition to salads and
stir-fry. A cup of raw bell pepper provides nearly 100% of your daily allowance of vitamin A and 300% of your daily allowance of vitamin C. They’re also a great source of vitamin B6.


Collard greens have your vitamins covered from A to Z, literally:

As great sources of fiber, folate, magnesium, vitamins A, B6, C, E, K, calcium, iron, Image result for collard greenpotassium, and zinc, collard greens have your nutrients covered from A to B.






A cup of kale gives you nearly 700% of your daily allowance of vitamin K:

Sure, it’s trendy now, but kale has been good for you since long before it was cool.Image result for kale

A cup of raw chopped kale gives you more than 200% of your daily allowance of vitamin A plus a whopping 684% of your allowance of vitamin K. It’s also high in vitamins C, B6, calcium, and potassium. Like broccoli, kale also contains high levels of glucosinolate plant compounds, which may be helpful in protecting against certain types of cancer.

Chives contain lots of fiber and vitamins:

Delicious on a baked potato, chives are rich in fiber, vitamins A, B6, C, and K, as well as Image result for chives on a baked potatofolate, calcium, iron, magnesium, and potassium.






Don’t dismiss lettuce:

Next time someone disparages a salad as “just lettuce,” remind them how good for you Image result for lettuceleaf lettuce is. With just five calories per cup, leaf lettuce also packs in vitamins A, B6, C, and K, as well as calcium, magnesium, fiber, iron, and potassium.




Parsley and chicory are good sources of fiber and vitamins:

Both parsley and chicory are great sources of vitamins, folate, and zinc. And they’re veryImage result for parsley on a dish low in calories — just 22 for a cup of raw parsley and seven for a cup of raw chicory greens.




Spinach may be a true power food:

Spinach contains several plant compounds, like kaempferol, which studies suggest plays Image result for spinach on a disha role in protecting against cancer and other chronic diseases. In fact, a 2011 study suggested that some of these components helped cyclists use less oxygen over the course of a ride. And a 2014 study found that another spinach compound called tyrosine helped to improve reflex speed.


Swiss chard is rich in iron and magnesium:

Rich in fiber, vitamins A, B6, C, E, K, calcium, iron, magnesium, and potassium, swiss Swiss chard is rich in iron and magnesium.chard is also low-calorie, with just seven calories per cup . Both its dark green leaves and juicy stalks are completely edible.





Watercress could help reduce your risk of diseases like diabetes:

Although often overlooked, watercress is a nutrient-dense alternative to plain old lettuce Image result for watercressthat can be eaten raw or cooked. Plus, a large review of five studies published in the European Journal of Nutrition suggested that watercress and other leafy greens were among the standout foods with the strongest links to reducing risk of type 2 diabetes.



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Is your smartphone trying to hurt you?

Repeating the same action at work endlessly can cause injury to the muscles and joints: This is known as RSI (repetitive stress injury). But what about while using your smartphone?

Sadly, incessant cell phone use has been linked to increased tension and numerous RSI, in up to 83% of users in some studies!

Image result for smartphone hurts

The first problem with smartphone use is “turtlenecking”- your head sags forward while looking at the small screen. This throws out the normal gentle forward curve of the neck, resulting in unnecessary pressure on the spine, pinching the nerves and squeezing the cushioning discs (“herniated disc”). It can lead to damaging the nearby spinal cord or large nerves. Result? Pain in your head, neck, shoulders and upper back. You may also feel nausea or dizziness.

“Texting thumb” comes from over-use of a smartphone’s tiny buttons. Your thumbs are simply not designed for rapid tapping motions. As the thumb tendons rub repeatedly against the sharp hard bone underneath, they start to swell and hurt.

“Text-claw” comes from clutching your smartphone for long hours. The small muscles in your hand tire quickly and go into spasm.

Image result for smartphone hurts

Image result for smartphone hurts

Since texting needs flexed wrists, they are under excessive constant tension and can swell up. These wrist tendons all pass through a tight hole under the wrist bones. Lacking space and under pressure, any swelling that occurs presses on the nearby nerves. The result? Pain, tingling and numbness in your fingers, carpal tunnel syndrome.

“Cell phone elbow” can come about holding the phone to your ear. The nerve under your funny bone is stretched too tight, too long.

And the iSlouch or the smartphone hunch? Caused by hours spent hunched over your smartphone, this posture affects more than your neck and shoulder muscles. Your chest cavity shrinks; you get up to 30% less oxygen. Your digestion slows as abdominal organs are crushed into less space. You even feel miserable! Your shoulder muscles become rigid, you hold your breath more, your heartbeat speeds up – unmistakable signs of a high tension state.

iGrinding is the teeth-grinding that is often seen when children get caught up in smartphone games.

If you have any of these symptoms, contact us ASAP. Physical Therapists will check your pain thoroughly to identify its cause. We use various means to relieve knots of pain. We’ll help restore good posture, pain-free joint mobility and prevent further phone-induced damage by teaching you how to use your phone right.

Other tips?

  • Limit texting time or use a computer.
  • Use an external keyboard.
  • Keep your wrists straight while playing with your phone.
  • Instead of cradling a phone between shoulder and ear and pulling muscles and bones out of line, use earpieces or head-phones.
  • Alternate the phone between both hands and ears.
  • Stretch regularly.
  • Drink lots of water, to keep your discs more efficient and durable.
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Remain positive: Win the recovery battle with the help of positive thoughts

Have you heard of or read Norman Vincent Peale’s ‘The Power of Positive Thinking’ (1952)? This self-improvement classic has inspired countless people over the years in a variety of fields. While Peale is often criticised for the religious overtones of ‘Positive Thinking’, there is no doubt that positive thoughts can influence daily living for the better.


Recovery from traumatic injury is one area where a positive attitude can make a big difference. Increasingly, physiotherapists are emphasising the mental and psychological aspects of their patients’ approach to rehabilitation in making a full recovery.

Acute and chronic back pain is but one example of where positive thinking can make a difference. As recently as October 2008, the U.K.’s Chartered Society of Physiotherapy (CSP) focused on the role of positive thoughts in long-term pain treatment and management during its ‘Back Care Awareness Week’. There are no magic bullets when it comes to the back, so it’s important to follow an integrated approach to healing that emphasizes both our thoughts and actions.

Mental barriers to physical recovery often become a self-fulfilling prophecy. A patient may be stressed or fearful of attempting certain activities, motions and skills and thus needlessly prolong her recovery.

What does this mean for long suffering patients? Hopefully, a future without addictive painkillers, unnecessary surgeries, or additional health issues. This is where family, support groups, and a responsible physiotherapists can all play vital roles. They are well-positioned to keep spirits high and encourage us during rough times.

A positive mental attitude is a prerequisite for achieving personal and professional goals. Conversely, negative thoughts are a roadblock to success and are sure to prevent you from:

  • Getting to physiotherapy appointments on time and meeting performance goals.
  • Carrying through on home exercises recommended by your physiotherapists.
  • Maintaining good post-treatment lifestyle habits (e.g. better posture and breathing habits).

During rehabilitation, it’s important to set manageable milestones and celebrate small wins as they occur. Do whatever it takes to remain hopeful, and be especially vigilant about avoiding negative people and pessimists. Keep body and mind working together.

Commencing physiotherapy treatment provides an excellent base for healing. However, staying positive and remaining hopeful throughout the recovery process is also very important. Regardless of your injury, regaining full use of an arm, leg or other body part is as much a mental exercise as it is brute physical effort.

Quick tip

Pull in your stomach muscles when you walk. This is a great, but simple way to help tighten those stomach muscles.


Running is one the best solutions to a clear mind.

~ Sasha Azevedo

Funny thought of the day

The sinking of the Titanic was a miracle for the lobsters in the kitchen.

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6 crucial ways to lower your stroke risk

A stroke can turn your world upside down. When you have a stroke, your brain is suddenly hit by an interruption in its blood supply. One could end up being crippled, a lifelong invalid or even dead.

So how can you lower your odds of being a stroke victim?

A stroke is caused by damage to an artery. The continuous pounding of blood at high pressure can do it. Or fatty deposits can cause a blood clot.

So what are the top six risk-busters for stroke?

1) Quit smoking

Just stop. No more tobacco smoke. Not your own, nor anybody else’s. Find something else that you love to do; something which you can’t do if you smoke. Chew gum. Kiss your partner. Play the harmonica. Go for a swim. Whatever it takes to stop the craving.

Call us; our therapists can help you on the path to quit. How about a massage, rather than a nicotine fix, to relieve stress?

Resultado de imagem para no smoking

2) Blood pressure control

Blood pumping against your arteries at too high a pressure is going to rupture them sooner or later. So get your blood pressure checked regularly. Especially if you have a family history or you’re overweight, stressed or diabetic.

If your blood pressure is too high, you’ve got to change to a healthy diet and/or lose weight.

You might need medications if your blood pressure remains high, or you have other risk factors. Get professional advice.

Resultado de imagem para blood pressure control

3) Dietary intake

Keeping your body fat within normal range is one of the best things you can do for your brain. Eat slowly, and no second helpings.

Reduce the daily meat and full-fat dairy products. Try baked beans, curried chickpeas, or stir-fried lentils with whole grain tortillas instead. Buy some fresh produce for your dinner.

Avoid processed foods: Too much sodium, too much sugar, trans-fats set the stage for all sorts of trouble. If it’s pre-packaged and has an “ingredients” label, it’s probably processed.

Have fatty fish like sardines, mackerel, herring or fresh tuna regularly. Switch to vegetable oils like flaxseed, safflower, sunflower and olive oil. Have a small handful of nuts as a treat.

Resultado de imagem para dietary control balance people preparing

4) Start moving

Aim to exercise for 20 minutes every day. Add some weights for strength and with stretching for flexibility. Work activity into your daily life – do some chores, walk the dog, take the stairs. And keep off that couch.

If you haven’t exercised in a while, speak with us first; we’ll get you started safely with an effective program.

Resultado de imagem para exercises

5) Diabetes management

Once you’ve come this far, you know how to eat and exercise to cut your diabetic risk. If you still can’t bring your blood sugar to within normal range, see your doctor.

6) Chronic atrial fibrillation

If you suffer from atrial fibrillation, ensure you take your medication regularly and get tested for control as well. Get professional advice!


These six steps will dramatically reduce down your chances of suffering a stroke. Speak with your doctor to get some tests done, so you know where you stand. Then call or visit us, your local physiotherapists. We’ll help you add years of enjoyment to your lifespan.


Good friends, longer life!

Yes, it’s true. The wisdom of the ages has been proved scientifically in the last century. Strong loving and long-term relationships help you live longer, healthier and happier. Since you are a whole person, mind, body and spirit, what heals one so beautifully heals all. On the other hand, living a closed life increases the risk of dementia, depression and more – too early!

Some of the prime benefits of having close relationships are:

  • Being part of a close network lowers stress and has been found to reduce the risk of heart disease, push up survival four times longer after cancer and so many more!
  • Your confidence and self-esteem improves, so your body relaxes. This means better immunity, better digestion, improved heart and blood pressure and lower blood sugar!
  • Close friends tend to produce safer and healthier lifestyle decisions.
  • A socially active network delays dementia.
  • You don’t flip your lid as much when faced with a crisis because you can rely on your friends to see you through.

To have a friend, of course, you need to be one. So be on the alert for people who are wise and mature, who can love you as you are but push you to be the best – and live a longer, happier life!


Quick tip

Don’t follow the crowd. Find an exercise routine that suits you and your lifestyle. If you love the outdoors try running rather than joining the gym where you will be shut in. You need to find something you enjoy to keep your motivation high.


A man’s health can be judged by which he takes two at a time – pills or stairs.

~ Joan Welsh

Funny thought of the day

In 1969, aliens invaded the moon.


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Assistive Device: Walkers

There are three major categories of ambulatory assistive devices: canes, crutches, and walkers. This post is the last of the series, and we will talk about walkers. Visit our previous posts about canes and crutches.

Assistive devices are prescribed for a variety of reasons, including problems of balance, pain, fatigue, weakness, joint instability, excessive skeletal loading, and cosmesis.  Another primary function of assistive devices is to eliminate weight bearing fully or partially from a lower limb. This unloading occurs by transmission of force from the upper limbs to the floor by downward pressure on the assistive device.


Walkers are used to improve balance and relieve weightbearing either fully or partially on a lower extremity. Of the three categories of ambulatory devices, walkers afford the greatest stability. They provide a wide base of support (BOS), improve anterior and lateral stability, and allow the upper extremities to transfer body weight to the floor.

Walkers are typically made of tubular aluminum with molded vinyl handgrips and rubber tips. They are adjustable in adult sizes from approximately 32 to 37 in., with children`s, youth, and tall sizes available. Several design variations and modifications to the standard design are available and are described below.


Glides are small, plastic attachments placed on the posterior legs of walkers typically in combination with wheels on the front legs. They promote a smooth forward progression without having to lift and place the walker with each step. They are typically made of high-density plastic in an inverted mushroom-shape. Other common glide designs include a 1-in. diameter “disk” with a central stem that slides into the tubular leg and is tightened into place with a screwdriver; and a fitted cap that is placed directly onto the walker leg (in the same manner the rubber tip is attached). Another style of glide incorporates a tennis ball within a fixed housing.

glide walker

glideball walker

Folding Mechanism

Folding walkers are particularly useful for patients who travel. These walkers can be easily collapsed to fit in an automobile or other storage space.

walker collapsed

Handgrips (Handles)

Enlarged and molded handgrips are available, and may be useful for some patients with arthritis. Some walkers offer a second set of handles to assist with sit-to-stand transitions.

handgrip walker

Platform Attachments

This adaptation is used when weight bearing is contraindicated through the wrist and hand (described in the crutch post).

Wheel Attachments

This adaptation to walkers (often called rollators or rolling walkers) includes the addition of wheels (either to the two front wheels only or to all four wheels). The addition of wheels frequently allows functional ambulation for patients who are unable to lift and to move a conventional walker (e.g., frail elderly). Swivel wheels turn freely in a complete circle. Fixed wheels rotate around a central axis. Wheels are generally available in 3-, 5-, and 6-in. diameters. Eight-inch diameter wheels are also available and can be used to add height for tall users.

Swivel wheels

Swivel wheels

fixed wheels

Fixed wheels

Braking Mechanism

A braking system is an essential feature of walkers designed with wheels. Walkers with four wheels frequently include handbrakes that lock the rear wheels. Posterior pressure brakes are effective when wheels are placed only on the front walker legs.

brakes walker

Tripod Rollators 

Three-wheel collators incorporate a tripod design. A major advantage of this device is ease of maneuverability and turning. Height adjustments are made at the handles; the unit folds for storage and travel.

Tripod Rollators wlaker


Sitting Surface

A variety of seat walker designs are available that fold out of the way when not in use. The structural design of many walkers also includes a contoured back support. Seats are an important consideration for individuals with limited endurance (i.e., post-polio syndrome) as well as for community ambulatory who require periodic rest intervals. Walker seats should be carefully examined for stability and safety with respect to individual patient needs. Patient practice in use the walker seat should be provided.

Sitting Surface walker

Reciprocal Walkers

These walkers are designed to allow unilateral forward progression of one side of the walker. A disadvantage of this design is that some inherent stability of the walker is lost. However, they are useful for patients incapable of lifting the walker with both hands and moving it forward (in situations in which a rolling walker might be contraindicated).

Advantages: Conventional walkers provide four points of floor contact with a wide BOS. They provide a high level of stability. They also provide a sense of security for patients fearful of ambulation. They are relatively lightweight and easily adjusted.

Disadvantages: Walkers tend to be cumbersome, are awkward in confined areas, and are difficult to maneuver through doorways and into cars. They eliminate normal arm swing and cannot be used safely on stairs.

reciprocal walker

Measuring Walkers

The height of a walker is measured in the same way as that of a cane. The handgrip or handle of the walker should come to approximately the greater trochanter and allow for 20 to 30 degrees of elbow flexion.

Gait Patterns: Conventional Walkers

Prior to initiating instruction in gait patterns using a conventional walker (4 points of floor contact without wheel attachments), several points related to use of the walker should be emphasized with the patient:

  • The walker should be picked up and placed down on all four legs simultaneously to achieve maximum stability. Rocking from the back to front legs should be avoided because it decreases the effectiveness and safety of the assistive device.
  • The patient should be encouraged to hold the head up and to maintain good postural alignment; forward flexion of the trunk, neck, and head should be avoided.
  • The patent should be cautioned not to step too close to the front crossbar. This will decrease the overall BOS and may result in a fall.

There are three types of gait patterns used with conventional walkers. These are the full, partial, and non-weightbearing gaits (rolling devices are not recommended for patients with altered weight bearing status). The sequence for each pattern follows.

Full Weightbearing Gait

  1. The walker is picked up and moved forward about an arm`s length.
  2. The first lower extremity is moved froward.
  3. The second lower extremity is moved forward past the first.
  4. The cycle is repeated.

Partial Wightbearing Gait

  1. The walker is picked up and moved forward about an arm`s length.
  2. The involved lower extremity is moved forward, and body weight is transferred partially onto this limb and partially through the upper extremities to the walker.
  3. The uninvolved lower extremity is moved forward past the involved limb.
  4. The cycle is repeated.

Non-Weightbearing Gait

  1. The walker is picked up and moved forward about an arm`s length.
  2. Weight is then transferred through the upper extremities to the walker. The involved limb is held anterior to the patient`s body but does not make contact with the floor.
  3. The uninvolved limb is moved forward.
  4. The cycle is repeated.

Note: Rolling walkers generally allow use of a reciprocal gait pattern as the walker can be rolled forward while walking. As the need to lift the walker forward following each step is eliminated, a smoother forward progression can be achieved.

Assuming Standing and Seated Positions with Walkers

Coming to Standing 

  • The patient moves forward in the chair.
  • The walker is positioned directly in front of the chair.
  • The patient leans forward and pushes down on armrests to come to standing.
  • Once in a standing position, the patient reaches for the walker, one hand at a time.

Return to Sitting 

  • As the patient approaches the chair, the patient turns in a small circle toward the strong side.
  • The patient backs up until the chair can be felt against the patient`s legs.
  • The patient then reaches for one armrest at a time.
  • The patient lowers to the chair in a controlled manner.

Source: Susan B. O`Sullivan, Thomas J. Schmitz. Physical Rehabilitation.

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Assistive Devices: Crutches

There are three major categories of ambulatory assistive devices: canes, crutches, and walkers. In this post, we will talk about crutches. Stay tuned for the next post about  walkers, and visit our previous post about canes.

Assistive devices are prescribed for a variety of reasons, including problems of balance, pain, fatigue, weakness, joint instability, excessive skeletal loading, and cosmesis.  Another primary function of assistive devices is to eliminate weight bearing fully or partially from a lower limb. This unloading occurs by transmission of force from the upper limbs to the floor by downward pressure on the assistive device.


Crutches are used most frequently to improve balance and to either relieve weight bearing fully or partially on a lower extremity. They are typically used bilaterally, and function to increase the base of support (BOS), to improve lateral stability, and to allow the upper extremities to transfer body weight to the floor. This transfer of weight through the upper extremities permits functional ambulation while maintaining a restricted weight bearing status. there are two basic designs of crutches in frequent clinical use: axillary and forearm crutches.

Axillary Crutches

These assistive devices also are referred to as regular or standard crutches. They are made of lightweight wood or aluminum. their design includes an axillary bar, a handpiece, and double uprights joined distally by a single leg covered with a rubber suction tip (which should have a diameter of 1.5 to 3 in.). the single leg allows for height variations. Height adjustments for wooden crutches are accomplished by altering the placement of screws and wing bolts in predrilled holes. The design of most aluminum crutches incorporates a push-button pin mechanism for height adjustment similar to those found on aluminum canes. Both the overall height of the crutches as well as the height of the handgrip typically adjust in 1-in. increments. Axillary crutches are generally adjustable in adult sizes from approximately 48 to 60 in., with children`s and extra-long sizes available.

Advantages: it improves balance and lateral stability, and provide for functional ambulation with restricted weight bearing. They are easily adjusted, inexpensive when made of wood, and can be used for stair climbing.

Disadvantages: Because of the tripod stance required to use crutches and the resultant large BOS, crutches are awkward in small areas. For the same reason, the safety of the user may be compromised when ambulating in crowded areas. Another disadvantage is the tendency of some patients to lean on the axillary bar. This causes pressure at the radial groove (spiral groove) of the humerus, creating a situation of potential damage to the radial nerve as well as to adjacent vascular structures in the axilla.


Several methods are available for measuring axillary crutches. The most common use a standing or a supine position. Measurement from standing is most accurate and is the preferred approach.

Standing: From a supported standing position, crutches should be measured from a point approximately 2 in. below the axilla. The width of two fingers is often used to approximate this distance. During measurement, the distal end of the crutch should be resting at a point 2 in. lateral and 6 in. anterior to the foot. A general estimate of crutch height can be obtained prior to standing by subtracting 16 in. from the patient`s height. With the shoulders relaxed, the handpick should be adjusted to provide 20 to 30 degrees of elbow flexion.

Supine: From this position the measurement is taken from the anterior axillary fold to a surface point (mat or treatment table) 6 to 8 in. from the lateral border of the heel.

Forearm Crutches

These assistive devices are also known as Lofstrand and Canadian crutches. They are constructed of aluminum. Their design includes a single upright, a forearm cuff, and a handgrip. This catch adjusts both proximally to alter position of the forearm cuff and distally to alter the height of the crutch. adjustments are made using a push-button mechanism. The available heights of forearm crutches are indicated from handgrip to floor and are generally adjustable in adult sizes from 29 to 35 in., with children`s and extra long sizes available as well. The distal end of the crutch is covered with a rubber suction tip. The forearm cuffs are available with either a medial or anterior opening. The cuffs are made of metal and can be obtained with a plastic coating.

Advantages: The forearm cuff allows use of hands without the crutches becoming disengaged. They are easily adjusted and allow functional stair climbing activities. Many patients feel they are more cosmetic and they fit more easily into an automobile owing to the overall decreased height. They are also the most functional type of crutch for stair climbing activities for individuals wearing bilateral knee-ankle-foot orthoses (KAFOs).

Disadvantages: Forearm crutches provide less lateral support owing to the absence of an axially bar. The cuffs may be difficult to remove.

Standing is the position of choice for measuring forearm crutches. From a supported standing position, the distal end of the crutch should be positioned at a point 2 in. lateral and 6 in. anterior to the foot. With the shoulders relaxed the height should then be adjusted to provide 20 to 30 degrees of elbow flexion. The forearm cuff is adjusted separately. Cuff placement should be on the proximal third of the forearm, approximately 1 to 1.5 in. below the elbow.

forearm crutches

Gait patterns for use of crutches

Gait patterns are selected on the basis of the patient`s balance, coordination, muscle function, and weight bearing status. The gait patterns differ significantly in their energy requirements, BOS, and the speed with which they can be executed.

Prior to initiating instruction in gait patterns, several important points should be emphasized to the patient:

  1. During axillary crutch use, body weight should always be borne on the hands and not on the axillary bar. This will prevent pressure on both the vascular and nervous structures located in the axillary region.
  2. Balance will be optimal by always maintaining a wide (tripod) BOS. Even when is a rest stance, the patient should be instructed to keep the crutches at least 4 in. to the front and to the side of each foot. The foot should not be allowed to achieve parallel alignment with the crutches. This will jeopardize anterior-posterior stability by decreasing the BOS.
  3. When using standard crutches, the axillary bars should be held close to the chest wall to provide improved lateral stability.
  4. The patient should also be cautioned about the importance of holding the head up and maintaining good postural alignment during ambulation.
  5. Turning should be accomplished by stepping in a small circle rather than pivoting.

Three-point gait

In this type of gait three points of support contact the floor. It is used when a non-weightbearing status is required on one lower extremity. Body weight is borne on the crutches instead of on the affected lower extremity.

Partial Weightbearing Gait

This gait is a modification of the three-point pattern. During forward progression of the involved extremity, weight is borne partially on both crutches and on the affected extremity. During instruction in the partial weight bearing gait, emphasis should be placed on use of a normal heel-toe progression on the affected extremity. Often the term partial weight bearing is interpreted by the patient as meaning that only the toes or ball of the foot should contact the floor. Use of this positioning over a period of days or weeks will lead to heel cord tightness.

Four-point gait

This pattern provides a slow, stable gait as three points of floor contact are maintained. Weight is borne on both lower extremities and typically is used with bilateral involvement due to poor balance, incoordination, or muscle weakness. In this gait pattern one crutch is advanced and then the opposite lower limb is advanced. For example, the left crutch is moved forward, then the right lower extremity, followed by the right crutch and then the left lower extremity.

Two-point gait

This gait pattern is similar to the four-point gait. However, it is less stable because only two points of floor contact are maintained. Thus, use of this gait requires better balance. The two-point pattern more closely simulates normal gait, inasmuch as the opposite lower and upper extremities move together.

Two additional, less commonly used crutch gaits are the swing-to and swing-through patterns. These gaits are often used when there is bilateral lower extremity involvement, such as in Spinal Cord Injury. The swing-to gait involves forward movement of both crutches simultaneously, and the lower extremities “swing to” the crutches. In the swing-through gait, the crutches are moved forward together, but the lower extremities are swung beyond the crutches.

Assuming Standing and Seated Positions with Crutches

Coming to Standing 

  • The patient moves forward in the chair.
  • Crutches are placed together in a vertical position on the affected side.
  • One hand is placed on the handpicks of the crutches; one on the armrest of the chair.
  • The patient leans forward and pushes to a standing position.
  • Once balance is gained, one crutch is cautiously placed under the axilla on the unaffected side.
  • The second crutch is then carefully placed under the axilla on the affected side.
  • A tripod stance is assumed.

Return to Sitting 

  • As the patient approaches the chair, the patient turns in a small circle toward the uninvolved side.
  • The patient backs up until the chair can be felt against the patient`s legs.
  • Both crutches are placed in a vertical position (out from under axilla) on the affected side.
  • One hand is placed on the handpicks of the crutches, one on the armrest of the chair.
  • The patient lowers to the chair in a controlled manner.

Stair-Climbing Techniques

Crutches: Three-Point Gait


  1. The patient is positioned close to the foot of the stairs. The involved lower extremity is held back to prevent “catching” on the lip of the stairs.
  2. The patient pushes down firmly on both handpicks of the crutches and leads up with the unaffected lower extremity.
  3. The crutches are brought up to the stair that the unaffected lower extremity is now on.


  1. The patient stands close to the edge of the stair so that the toes protrude slightly over the top. The involved lower extremity is held forward over the lower stair.
  2. Both crutches are moved down together to the front half of the next step.
  3. The patient pushes down firmly on both handpicks and lowers the unaffected lower extremity to the step that the crutches are now on.

Crutches: Partial Weightbearing Gait


  1. The patient is positioned close to the foot of the stairs.
  2. The patient pushes down on both handpicks of the crutches and distributes weight partially on the crutches and partially on the affected lower extremity while the unaffected lower extremity leads up.
  3. The involved lower extremity and crutches are then brought up together.


  1. The patient stands close to the edge of the stair so that the toes protrude slightly over the top of the stair.
  2. Both crutches are moved down together to the front half of the next step. The affected lower extremity is then lowered (depending on patient skill, these may be combined). Note: When crutches are not in floor contact, greater weight must be shifted to the uninvolved lower extremity to maintain a partial weight bearing status.
  3. The uninvolved lower extremity is lowered to the step the crutches are now on.

Crutches: Two- and Four-Point Gait 


  1. The patient is positioned close to the foot of the stairs.
  2. The right lower extremity is moved up and then the left lower extremity.
  3. The right crutch is moved up and then the left crutch is moved up (patients with adequate balance may find it easier to move the crutches up together).


  1. The patient stands close to the edge of the stair.
  2. The right crutch is moved down and then the left (may be combined).
  3. The right lower extremity is moved down  and then the left.

Source: Susan B. O`Sullivan, Thomas J. Schmitz. Physical Rehabilitation.


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