Functional Strengthening
Standing Up
Photo taken by Loraine East of Sequim, Washington foggy valley.
Functional Strengthening
My favorite type of strengthening exercise to teach people is functional exercise. This means strengthening by doing something you are already doing anyway by moving your body the right way you turn it into strengthening.
By now you will ideally be working on functional strengthening sitting down doing a soft lunar landing to strengthen the hips and protect the arms preventing them from breaking down. Sitting down is an eccentric muscle contraction working with gravity which is more difficult because it requires more control. A concentric contraction of muscles is working against gravity which is the type of contraction used when standing up. Functional exercise is doing something that you have to do anyway moving the body and if you pay attention to how you do it you can build muscle during this activity. It is difficult to make it to the gym for many people so being able to exercise throughout the day is a great way to build strength.
Lift Chairs
I tell my patients that a lift chair will kill you faster than anything else. As people get older or weaker they start using taller toilets, chairs, and beds and frequently use lift chairs. By doing this you are choosing to make the hip and leg muscles weaker. It is easier to stand up from taller surfaces so you are using less muscle to do this activity. When people have a neurological degenerative disease process such as Multiple Sclerosis (MS), or Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s Disease, a lift chair is a life saver. Both my mother-in-law and father-in-law died from ALS. When it became obvious that my mother-in-law was getting weaker despite complying with a good strengthening program she went to see a physician who gave her the diagnosis of ALS. At that point, the first thing we did was to borrow a lift chair. I encouraged her to keep as many energy tokens as possible to be able to do as much for herself while she still can but let the chair do the work to raise her up to standing.
With ALS or MS there is a point at which people lose ability to do activities such as walking. I like to encourage them to save their energy tokens for things like feeding themselves and performing peri care when using the bathroom. I begged my mother-in-law to allow a nurse’s aid to help her get dressed and bathe. It was very difficult for her to give in to this recommendation, but I am so glad she did. In this situation using a lift chair is a really great way to save energy tokens to continue to be able to walk, for example.
There are also people who are so weak they do not have a choice but to use a lift chair. I suggest people at this point continue to use the lift chair to elevate them to standing but work with the chair to raise them up. Next, I have them lower the chair 50% before they walk away, so when they return they can work on strengthening their hips as they sit down. As they are able they stop the chair at 75% of the way up and try to use their legs to raise them the final 25% and gradually work on making the legs stronger. Then work on lowering the chair 100% of the way and sit down as slowly as possible.
30-year-old
I have watched over the past 25 years to see at what point people tend to use their hands to push their body into a standing position. I have seen people in their 30s using their hands to stand up. People do this but it increases the strain on the arms and eventually, the arm muscles can break down because the arms are not designed to be lifting and lowering our body weight. The arms are intended to manipulate the world around you and push things away and pull things toward you. As arms get overused they get to the point that doing common activities becomes difficult. As the breakdown continues you can get to the point where even lifting the hand to the mouth to feed yourself can become painful and eventually cannot do it. This is where I came up with the idea to write a book on nursing home prevention strategies. I recall a patient who continued to push herself saying “I have to water my plants” even though she was not able to bring her hand to her mouth. I helped her find a kind home for her plants so she could focus on keeping her energy tokens to be able to feed and dress.
Preventing Overuse
Every muscle has the ability to fire or contract a specific amount of times every day. However, no one knows how many times that is. The more conditioned the muscle is the more energy quarters are available or the more times it can fire. The weaker or more deconditioned the muscle the fewer energy tokens and the fewer times it can fire each day. I think it is best to consider that a weak muscle could probably fire 10 times a day. However, to be safe I think it is best to start with a smaller number than you think you have. When starting any new exercise it is best to start slow and build gradually. Overuse is difficult to treat, so it is best to prevent.
See previous information on overuse located in the Information page on this website.
Standing up from sitting down
To build strength when standing up, scoot to the front of the chair trying not to use your hands. If you must, use your hands to scoot forward. Spread feet so they are shoulder-width apart. Keep the toes pointed forward but pull the knees apart from each other to strengthen the gluteus medius. Fire the pelvic floor/inner core muscles to keep the pelvis and spine in alignment. Try not using your hands if possible. Use momentum to get your nose forward of your toes. Once you get your weight forward then push up with the legs to stand up.
Handout:
Start with two times a day. If you are unable to get up without using your hands, start by using your hands but take over using the legs as soon as possible. If you need to use the hands to get up then begin by focusing on sitting down slowly with the power of the legs. Once you have built more strength in your legs you will eventually be able to get up without your hands.