posted by Bill Neenan, P.T.

Caregiver Help

Nothing personal intended.  But know this: if you’re having problems running (injuries, pain, frustration, guilt) you’re not alone. So blindly follow the pack no more.   Prolonged running is unhealthy for most people, especially on concrete or asphalt.  It’s unnatural for the human body.  Running can, and often does, do more harm than good—that’s if you can keep on doing it.

I forget how many times I tried to run at least three times per week and gave up after a few weeks.  And now, as I’m speed walking around the park, another flushed face passes me by; sweaty, a huffing, puffing body-in-tow, bouncing off the toes, elbows cocked tight, arms swinging from side to side (bad form).  Unfortunately (or fortunately) many of the earnest souls I see pounding the asphalt path will vanish soon enough.

I managed to complete the New York City Marathon in 1987 in 4 hours, 9 minutes.   But frankly, that was an ordeal I never want to repeat. These days, I’ve been speed walking 2 to 3 miles 4 to 5 days per week for the last 7 months.  I do it after I get home from work, in the dark if I’m late, it doesn’t matter.  For the first time in my life, I’ve found a way to stay in shape that’s sustainable.

I feel good, sometimes great, and have lots of energy most of the time.   I love the feeling of walking as fast as I can (which can be quite challenging, believe me).  I especially appreciate the lack of pain in my knees and hips, and knowing that my blood is being saturated with oxygen for 20 to 30 minutes, nourishing my brain and muscles, removing toxins from my body,  keeping me strong and able to do the things I want to do.

Of course, there’s plenty of room for improvement.  But I feel comfortable knowing I don’t need to be strong enough to run another marathon…or some other big thing like that.  My point is, getting enough exercise doesn’t have to be a big deal, such a big challenge.  You can gain cardiovascular conditioning that’s more than adequate for your needs and enjoy yourself with much less chance of injury.  Moderate interest and  perhaps a little push out of your comfort zone is all you need to get off to a good start.

So here’s what I recommend, O caregiver who will benefit greatly from the strength and  energy that comes from regular exercise.   If you’ve recently started a running program and you’re enjoying it, keep it up; but make sure you practice correct stretching and warm-up techniques; and don’t ignore or suppress painful symptoms.   If you’re thinking about starting a running program (check with your doctor first), try speed walking instead.  If you’re running and it feels like you’re struggling, maybe about to quit, then quit, be glad you did, and try speed walking.

Here’s a brief definition of speed walking, sometimes called power walking.  For now, forget about the exaggerated arm pumping or heel striking you may have heard about.  Just walk at a moderate, natural, heel-to-toe gait pattern, then gradually escalate to a brisk pace.  Relax your arms and let them move in a natural reciprocal pattern with your legs.  Breathe deeply in a rhythmic pattern that feels comfortable.  Focus on your form, not allowing your arms to cross the mid-line of your body.  Music via ear plugs and talking on a cell phone are not recommended.  Get better at being present in the moment, at being with your self.

You may be thinking I’ve skipped over an important part of the story: how I’ve managed, finally, to stick with an exercise program for seven moths—while for the remainder of my life I’ve been a failure at exercising.   I’m saving that part for next time, along with details about speed walking and muscle strengthening and stretching exercises.  Meanwhile, let me know your thoughts, and tune in for the next issue.

Caregiver Help



posted by Bill Neenan, P.T.

Caregiver Help
By Dr. Alexander M. Zwick DPT, CSCS

(note: “her” and “she” will be used for simplicity of usage)

If you’re someone who’s been taking care of an elderly person, chances are you’ve witnessed the phenomenon of retropulsion, the tendency of a person to lean backwards, and/or to consistently lose balance backwardly, or the inability to walk forward because of an involuntary failure in muscle coordination to produce forward strides.

You may have observed this phenomenon when trying to get your client out of a chair, where she will appear stuck in place, unable to lean forward or to get up.  Despite telling the client what to do, she is not able to move her trunk forward enough to get her weight over her feet.  When walking, the client may be unable to initiate forward steps, and may fall backwards when standing.   Retropulsion will significantly affect your client’s safety and management will be more difficult.  Although in many cases the cause of retropulsion is unknown, the following causes have been identified:

Low blood pressure: the client’s blood pressure is below the appropriate level as recommended by her physician.

Ankle tightness: the muscles of calf are tight and/or the patient’s heels are unable to touch the ground when standing.  This is particularly common in persons who spend a lot of time in bed.

Neurological conditions: clients suffering from dementia, stroke, or Parkinson’s disease may exhibit retropulsion.

Prolonged bed rest:  this relates more to the client who spends as much as 24 hours a day in bed continuously.


Maintain good ankle flexibility: frequent stretching of  the ankle muscles, or basic, erect standing will help to maintain proper ankle mobility.

Reduce anxiety: the client may be afraid of falling out of her chair or falling forward. Make sure she feels safe.  Giving your client the proper assistance and reassurance that she isn’t going to fall can be helpful.

Have a properly sized assistive device (e.g., cane, walker): the device should be no higher than the patient’s wrist crease with the client standing erect.  An improperly fit assistive device, especially one that’s too high, can predispose your client to losing her balance backwards.

Practice standing: stand with your client as erect as possible at the kitchen counter, or with the client holding onto a sturdy chair.

Monitor blood pressure: Make sure it is within safe guidelines as recommended by her physician. An electronic blood pressure cuff is automatic, cheap and available at your local pharmacy or grocery.

Practice good body mechanics:  in order for your client to get out of a chair successfully, she must have her center of gravity over the base of support.  In layman’s terms, she must have her weight over her feet to minimize the tendency to fall backwards.  A useful saying is “keep your nose over your toes”.

Maximize independence: when helping your client up from a chair, your assistance should be directed at getting her to lean forward, and not just to lift her up.  In many cases, the patient has the strength to sit up, but body mechanics is faulty.  Lifting her might not be necessary.  A higher seat might also make getting her out of the chair easier.

Things to remember:

  • If the phenomenon of retropulsion happens for the first time, out of “nowhere”, it may be worth seeing a doctor
  • Work smarter, not harder.  Raise your client’s seat; give her verbal or tactile cues to assist her body mechanics; assist her in a way that also helps you.
  • Don’t get frustrated.  The client is usually very afraid of falling and has no control over her balance.  Patience and knowledge can go a long way.