Powerful Basic Exercises For Older Adults. Part 1

00:00:00:02 – 00:00:21:01

If you are someone who’s getting older and you want to do the most impactful things that very skilled physical therapist do with a lot of people and get kind of special insight to be active and independent in your home and in the community as long as possible. Then this is for you. If you’re taking care of an aging parent and you want to give them very simple exercises that can be the most impactful for them, time This is for you.

00:00:21:04 – 00:00:54:00
Unknown
If you are a health care provider or a physical therapist or a chiropractor, and you want additional insights on kind of details, a lot of the key exercises for people as they’re getting older, the themes of the muscles and the strength that declines with age and the muscle imbalances that tend to happen with age that result in walking problems, strength problems, functional decline type problems that tend to land people in nursing homes and tend to cause falls and walking problems and hospitalizations and very common themes that we see on a regular basis because we work with people over the age of 85 all the time.

00:00:54:00 – 00:01:22:01
Unknown
80 to 95 is very normal for us. 70 is quite young, so we are used to seeing the type of decline that happens with people as they get older. So that’s why we’re going to cover these exercises today. These are the most common exercises and exercise progressions that we work with people on as rehab professionals. Hi, I’m Dr. Jeffrey Gill, physical therapist, and we empower people to be active and independent in their homes and in the community and get as much information to get out to people to help them move better as much as possible.

00:01:22:01 – 00:01:42:04
Unknown
So if you like information like this, subscribe to our channel and you’ll get more information like this. So that way you don’t miss anything. Most important for daily life to live, to not decline, to not end up in our support, to not fall, to not pass away. We need strength and power in our legs. These things are very important, very vital to our pure survival.

00:01:42:04 – 00:02:00:02
Unknown
And if we don’t have them, then that puts us at increased risk of decline. Increase what we call burden of care in rehab, the increased need for utilization of someone else to help us out, the likelihood that we’ll end up in a facility into the hospital and then an increased risk of death If our legs are not strong and powerful.

00:02:00:02 – 00:02:15:23
Unknown
All of these exercises will be basically on our YouTube channel and Facebook, and so you’ll be able to access those there. So if you want to get visuals and you want to go off of our podcast and go on our YouTube channel, you can get the actual visuals of these and you’ll be able to see me taking you through these exercises.

00:02:15:23 – 00:02:37:09
Unknown
So don’t miss out on that. Go to our YouTube channel or Facebook channel and you’ll be able to see these exercises being done there. And so you can get actual visuals out there. So you might be wondering why might these exercises is matter to you or someone that you care about. So these are the most common exercises that we tend to give people when we’re working with them over the age of 80, 85 years old, when we see them declining, they’re having problems of walking.

00:02:37:09 – 00:02:53:06
Unknown
They it’s had a fall or they’re about to have a fall. They end up in the hospital. And so they want to get back to doing the things that they want to be able to do. So these are the most common exercises and you might spot some of these things where maybe you have a parent or maybe you can notice that yourself or maybe your health care provider.

00:02:53:06 – 00:03:14:03
Unknown
You know, this with your patients is problems with walking from being able to stand up from a chair where everything is a lot more challenging than it used to be. And even just basic things start to become more problematic. Now there’s more alignment issues and things like this. It’s just moving seems to be a lot harder. And so these exercises will really help address a lot of these things.

00:03:14:09 – 00:03:29:07
Unknown
If you’re younger, let’s say if you’re in 65, 70, 75 years old and you want to get ahead of a lot of these things, we’re going to get a lot of progression with a lot of these things. Or you might find out some things about yourself that you didn’t know. You didn’t realize that you had some of these weakness problems.

00:03:29:11 – 00:03:58:15
Unknown
And here’s the dirty little secret. Some of these things are actually true for people who are younger. Some of these things we work with all the time, with the elite athletes, people who are 20, 25 years old, they have these sorts of similar problems as well. It just becomes more amplified as people get older. These are common weaknesses that people tend to develop and some of them do tend to happen more with age just because of lack of use, and then others are actually present when people are younger, just because of lack of use and daily life in general.

00:03:58:15 – 00:04:13:06
Unknown
And people just don’t tend to know about it because it doesn’t impact their daily life until later on because the muscle becomes so weak by that point and then it affects their daily lives. This affects the way they walk. It affects the way they stand up from a chair. It affects the way they move their ability to be able to stand upright.

00:04:13:11 – 00:04:41:06
Unknown
All these things then add up as people get older and then all of these things become more amplified. So understand that we give these exercises a lot because these problems are very common in our population, and so they apply to a lot of people. So broadly, all everybody should be doing something very similar to this. I do exercises for these things in particular as well, not at the level that I’m going to show you today, because we’re talking about exercise for people who are 70, 75, 80, 85 years old and above.

00:04:41:06 – 00:05:00:07
Unknown
And I’m going to talk about something kind of new today and I think is very vital and very important. The value is in the progression. It’s not just doing a certain exercise and then you’ve done it for three years repetitively, but also how do you progress that exercise? How do you take that very basic exercise? And then how do you increase the resistance?

00:05:00:07 – 00:05:26:20
Unknown
How do you increase the load? How do you increase the complexity? What’s the progression of the exercise that you’re doing? So then you’re actually getting stronger, more flexible, and then as you’re getting older, you’re actually improving and getting better than you were even maybe five years ago because you’re increasing the challenge to your body. It is very possible to actually become more youthful as people get older because if you address the right things, then you can actually solve a lot of these problems that people associate with age.

00:05:26:20 – 00:05:45:03
Unknown
But actually it’s not so much age is the fact that we’re just not stimulating our muscles in the right way. And so with time, those muscles tend to bend decline. It’s not that they tend to decline, they do decline. And if you put a 20 year old in a bed for seven days and look what happens to them, the term we use in the medical profession is called muscle wasting.

00:05:45:03 – 00:06:03:13
Unknown
And this is true of anybody of any age. So these exercises will be very helpful no matter who you are and it’ll be a nice progression and especially if you’re over the age of 70, 75 and above all the way up through 100 years old. These exercises will be impactful for you, whether it’s you, someone that you care about, an aging loved one, a parent, or to your health care provider.

00:06:03:13 – 00:06:35:19
Unknown
This will provide additional insights and tips. But we’re also going to cover today is the execution of these exercises how to do it again, the progression of it, keeping it simple and safe. And then that way you can actually execute on it and have a lot of success with it. And again, the value is in the progression. So we’re going to talk about a lot of progression today and we’re going to show you how to progress these very basic exercises to give you the most bang for your buck to build, to progress, to become stronger and better balance, improve posture and prevent the trajectory of decline as we get older and change that trajectory more

00:06:35:19 – 00:06:55:19
Unknown
upward. So then we’re talking more upwards instead of down. So a lot of people, as they get older, if we’re not using our body, if we’re not stimulating our body, then we tend to reject down. If we’re doing the right things and focusing in the right areas and stimulating our bodies in the correct way. We have a good shot of being able to change that trajectory to progressing upwards.

00:06:55:19 – 00:07:18:00
Unknown
So here we go. So the first group of exercises that we want to target are the side rear end muscles. They’re called medius and good minimus. And of course there’s some interaction there with the climax, our main rear end muscle. So why these muscles are so important? I find these muscles to be some of the most underused, most underappreciated muscles in the human body, because if you think about it, how often do we go side to side?

00:07:18:02 – 00:07:36:00
Unknown
Because we usually in life go front to back all the time. And whether we’re cycling, running, walking, lifting weights, most of what we do is front to back all the time. But if you think about your side rear end muscles, basically what did they do? They basically left our leg out to the side and that’s all well and good.

00:07:36:05 – 00:07:57:18
Unknown
Why does that matter? What they also do when our foot is on the ground, they stabilize is our pelvis, so our pelvis doesn’t slope downward when we’re standing on a single leg. And so the media is to minimize or we can think of them as a side rear end muscles or the abductors that have baby doctors, they stabilize the pelvis when we’re on a single leg so that we can walk without our pelvis dropping.

00:07:57:18 – 00:08:20:19
Unknown
So they create a torque on the hip that keeps the opposite side lifted up when the foot is on the ground. So this is very, very, very important. And what it also does is it provides a lot of stability, not only at the pelvis and hips and prevents back problems, especially aside joint issues are sacroiliac issues. A lot of what it does also is provide stability at the knee and the foot as well.

00:08:21:00 – 00:08:40:11
Unknown
So a lot of new problems come from a lack of strength and the good leads and minimize the side rear end muscles. So we want to keep these muscles activated and strong. Now, why the problem? Again, what we talk about first, the front back component of daily life. Most of what we do in our daily life is front to back instead of side to side.

00:08:40:16 – 00:08:58:02
Unknown
And we strengthen these muscles more when we go side to side. So that’s if you’re a hockey player or something along those lines, you’re probably not going side to side very often. Now, a good strength conditioning coach or personal trainer, Now we’ll take elite athletes and this is a lot more common in sports now where there is a lot more side to side movement.

00:08:58:02 – 00:09:27:00
Unknown
There is a lot more strengthening of these side rear end muscles. Of course, lots of esthetic reasons to strengthen these muscles. And there’s plenty of information out there on YouTube. And that’s great because whatever encourages you to strengthen these muscles because whether it’s for esthetics or daily life function so that our body works correctly, whatever motivates you. So these muscles need to be strengthened and everybody needs to focus on these, whether you’re an elite athlete or whether you’re 95 years old, because these muscles will cause problems if they’re not strong enough.

00:09:27:02 – 00:09:45:11
Unknown
And one of the most complex reasons why these muscles tend to be weak is we so easily compensate with other muscles instead of these. So, for instance, very commonly the hip flexors in the front of the leg, the muscles that lift our leg, those muscles tend to be very over dominant on a lot of people, or at least very tight on a lot of people.

00:09:45:11 – 00:10:02:10
Unknown
So especially if we’re sitting all day as a lot of times older people tend to do, the energy isn’t quite what it once was. They’re not out running around as much as they used to. They tend to enjoy a lot more sitting. You know, we work with people over the age of 80 all the time. It is what people tend to do as they get older, so they sit more.

00:10:02:16 – 00:10:32:12
Unknown
And so then the from the legs kind of remain more short or the front of their legs tend to shorten as we sit more and more, or if we’re working late at a desk, the front of the legs will shorten. So this entire hip flexor complex from basically the right below the knee all the way up to basically where our ribs basically the right to some rest the and the elbow so as complex all become very short as we’re sitting more or if we’re doing a lot of front to back motion type stuff if we’re walking a lot, if we’re cycling, if we’re running, we’re going front to back all the time.

00:10:32:12 – 00:10:53:17
Unknown
Then again, that whole hip flexor complex tightens up. So the muscles that lift up the leg tighten up. When those become tight and over dominant, they tend to shut down the activation of those side rear end muscles. That got me just my good manners. And so it’s harder for people to activate than those muscles and to even get to being able to utilize those muscles effectively.

00:10:53:17 – 00:11:13:21
Unknown
So then a lot of other muscles will then start to kick in instead of the side where I’m muscles to do things and the trunk can kick in. There’s all sorts of compensations that can occur when we’re trying to activate our side rear end muscles or the body needs to utilize them, but it really can’t any more. So then the body will use other muscles in order to stabilize everything.

00:11:13:21 – 00:11:33:16
Unknown
And so then this is kind of this negative feedback loop, this vicious cycle towards compensations, decline, weakness, postural problems, and not be able to utilize the muscle properly that we should be using. So where to start to address the side rear end muscles that good media smell good manners? So I like to start with the clam on most people.

00:11:33:17 – 00:11:51:00
Unknown
Yeah, if I’m sorry if I’m working with a client, let’s say if they’re 80, 85, 90 years old or so, they clam is a great place to start. But you can start someone who’s 70 years old or 65 and you might find that the clam is actually the most appropriate place to start, or even younger than that, because a lot of people compensate so much when they try to utilize these muscles.

00:11:51:00 – 00:12:10:01
Unknown
So starting with the clam, if you’re a health care provider especially, is a good place to start. Basically can be left up there, lay at a 45 degree angle and be able to utilize the correct muscles. So being able to utilize that called medius to make good minimus to be able to lift up the leg. And we’ll show more demonstrations on this, more in depth later on.

00:12:10:01 – 00:12:26:06
Unknown
But to be able to activate the media and the M.S., to lift up the leg in a way that is against gravity, but you’re not straightening out the leg all the way. And what you’ll often find is a of compensation when you go to, say, outpatient physical therapy, people are just kind of throwing their leg up to the side.

00:12:26:06 – 00:12:47:06
Unknown
The leg is kind of more forward rather than behind them behind the hip. That knee is back instead of straight. And all of these other compensations will be occurring. And so what is actually happening then is they’re actually more using their hip flexors or the trunk muscles to do the exercise rather than using the good me is good manners, which are the muscles we actually want to be activating.

00:12:47:06 – 00:13:10:01
Unknown
And this is very important and can be very difficult to do because it takes consistent work with someone who really knows what they’re doing to make sure that these compensations aren’t happening. The most common compensation is just rolling the hip outward to work up the leg. So it’s a mechanical compensation that tends to happen. So it can take a lot of focus, especially someone who is not as familiar with formal exercise as they might be.

00:13:10:01 – 00:13:31:21
Unknown
So it takes a lot of skill from a professional who can guide people in the right way. So utilizing the correct muscles, eliminating the compensations, and then that way we can get the most effective use of the muscles that we want to work. So basically from the clam, then we figure out, okay, can you do a clam at a very basic level against gravity, basically lifting up the leg once back at 45 degrees?

00:13:31:21 – 00:13:48:23
Unknown
Okay. Very, very well. Good. Now, let’s say if the person can’t even do that, they can’t lift up their leg when the knee is bent to 45 degrees. That’s a very basic thing. Both say they can’t do it either because of a prior surgery from a while back or from some other reason that their hip is really weak or to say that’s just the level that they’re at.

00:13:48:23 – 00:14:08:12
Unknown
So what you can also do then is lying on your back and then just basically bringing the leg out to the side and then back. So what, the knees bent and feet flat, lying in a bed or a massage table or wherever you’re at lying on your back. And then just bending the leg out to the side always, and then coming back in, bending out to the side and then coming back in.

00:14:08:12 – 00:14:28:17
Unknown
So we kind of eliminate gravity in this position and then we’re able to control how far we bring the leg out and then we bring it back in. Not only does this help the media, some do minimus become stronger. It also helps what pelvic stability overall help strengthen the hip joint itself, because we also need the inner thigh muscles to pull the leg back in.

00:14:28:17 – 00:14:47:20
Unknown
So very important. So if you can’t do a clam, then this might be an exercise that you do. So lying on your back, knees bent, feet flat, bringing the leg out to the side and then back in. Now, before I go back to the progression on the client, a very important component to the clam is not only can you lift the leg up, but then can you control the knee as it comes down.

00:14:47:20 – 00:15:03:16
Unknown
So then you don’t bring the knees together between repetitions, you actually stop right before that and then go back up. Now, if you can’t do that and you have to just let the legs come together and rest, but you can lift up, they go ahead and start though that’s perfectly fine. If you can’t control it on the way down and go back up.

00:15:03:16 – 00:15:30:23
Unknown
But you’re able to go from a resting position and then go up and then back down and rest. Then these together start there. And then once you’re able to do that ten or 20 times, then stop and don’t let the knees touch. The reason for this as a very important component to what the media and good many of us do is they control deceleration or they provide a certain amount of control when we’re moving, when we’re walking, when we’re being dynamic.

00:15:30:23 – 00:15:54:16
Unknown
So it’s this lowering contraction or the slowing down contraction. If you’re a fitness person, it’s the eccentric contraction that is very important to be strong. And we’ll talk more about this later on when we talk about the quadriceps and set the stands and things like that. But very important to also train that essential component, that lowering contraction. And don’t just let the leg just drop down on the other leg and then go back up and less if that’s where you’re at.

00:15:54:16 – 00:16:14:15
Unknown
But then progress to slowing and controlling and then don’t touch and then go back up as you go. And again, this is very important and this is where the details come in. That important part of the progression. Again, the value is in the progression. So start from being locked up the length and then controlling that essential contraction, that lowering contraction and then being able to lift back up.

00:16:14:16 – 00:16:28:23
Unknown
Okay, great. Now you can do a clamp and you can do it 20, 30 times and then be able to control the leg so that they don’t touch each other. So where do we go from here? We’ll talk about lengthening out the hip flexors later on, and that will be a very important component. And then how that relates to hip extension.

00:16:28:23 – 00:16:47:07
Unknown
So basically pushing your hips forward and all these exercises are going to start coming together. So you do need multiple of them. It’s not just one problem. Usually it’s multiple problems that feed into each other because that’s how the body works. But we’ll get to that in a bit. So how do you progress from there? Basically bringing the leg back behind you with the leg relatively straight?

00:16:47:07 – 00:17:05:08
Unknown
And again, we’ll talk about lengthening out the hip flexors later on because commonly if there is a good media scope minimus problem, there’s probably a hip flexor shortness problem. So we’ll assume then that you’re then able to bring the leg back behind you with the need relatively straight and then activating the Cyrene muscles to lift the leg off the ground just a little bit.

00:17:05:08 – 00:17:29:00
Unknown
That’s all you need at the beginning without compensation, without the trunk muscles kicking in, without the hip flexor muscles kicking. And you know that the hip flexor muscles are kicking in when the legs hold forward, when you’re letting the leg up to the side, then you know, the hip flexors are kicking in. So if you can’t do this exercise with the leg behind you, behind your hip, and then when you lift it up, the leg has to go forward and you can’t stop it from doing that.

00:17:29:00 – 00:17:52:06
Unknown
You know, you’re not ready yet. You’re not ready for this progression. So you need to keep strengthening at the basic climb level, which is perfectly fine. Just keep working on that strength and progress. And again, so you’ll be able to see these compensate. And so this is basically the side leg raised, just being able to lift the foot off the ground with the knee straight with the leg all the way behind the hip and without the foot turning now and without the trunk kicking in.

00:17:52:06 – 00:18:12:15
Unknown
And all of these compensations that tend to happen without the hips rotating out. And so if you’re able to do that now, you’re on your way to be able to do a side leg, Right. So anatomically, we call this hip abduction as an exercise. Sideline abduction would be a good and topical term for it. So or leg raises and sideline or sideline leg raises.

00:18:12:17 – 00:18:29:18
Unknown
And again, very commonly you’ll see people in outpatient physical therapy doing this wrong and they have to like forward and they’re working the leg up just again and again, again, just cranking away at it. And so then the hip flexor muscles are pulling the like forward and they’re just feeding into the problem over and over again. They’re not using their correct muscles.

00:18:29:18 – 00:18:46:22
Unknown
They’re using the hip flexors and they’re feeding into the problem when they’re doing that. And so it takes time, focus and intention to get people to do this properly. So from here, just being able to lift the foot off the ground. So then you just keep lifting the leg up farther and farther. So then being able to lift the foot up to about hip level, if that’s what you’re able to do, then great.

00:18:46:22 – 00:19:10:19
Unknown
And eventually you’re able to lift the leg all the way up about 45 degrees above hip level. And that’s a good amount From there, we don’t need to lift up any higher than that. The amount of motion in the hip is actually not very much, the reason being because we walk on our legs. So the pelvis, the heart muscle is basically very much restricted as far as motion is the same type of a joint as the shoulder joint.

00:19:10:19 – 00:19:33:02
Unknown
So the ball and socket joint at the shoulder has a ton of movement, but not a lot of stability. It’s the same type of joint, but the hip muscles have a lot of stability and less mobility, so they can’t move as much. So we need to move them a whole time. So being able to lift up just about 45 degrees, if you’re able to do that against gravity, that’s great here on a really good path from there.

00:19:33:07 – 00:20:01:09
Unknown
And then you’re able to keep progressing from there. Now, another higher level thing that you can do, and you can even do this a little bit even before, let’s say if you’re at the client level and your balance is good and you’re not worried about falling necessarily, that’s not necessarily a problem. Basically doing basically side walking with your feet apart and then just step and step, step, step key thing, keep the feet pointed forward because what most people will do is they’ll turn the foot out as they go or they’ll turn the feet out.

00:20:01:14 – 00:20:22:16
Unknown
They’ll allow the feet to come together. We want to keep the feet apart one step and then the another step, one step and then another step, keeping the feet and toes pointed forward. And that’s going to promote activation of the media and the minimus. So again, here a side to side motion at a very basic level. And if you’re a younger person, this may not be a whole lot to you.

00:20:22:16 – 00:20:37:20
Unknown
If you’re someone who’s 70, 80, 85 years old, just walking sideways in this way, you’ll feel the burn actually quite quickly. So when we do this with our clients and we can do this with a lot of our clients, especially if we’re with them, or we might have them do it along the counter and they can even be touching the counter.

00:20:37:22 – 00:20:55:17
Unknown
This is not fan furniture walking, but this is now financial walking. This is doing an exercise strategically and then just recognizing that there might be a balance problem. So you’re using the counter as you’re stepping sideways by the feet need to be point forward that hip muscles need to be activated and so someone can feel the burn with this very, very quickly.

00:20:55:17 – 00:21:12:00
Unknown
Now, if you’re a younger person and you’re able to do this really well and without compensations, again, compensations, that toe is turning out the hip, hiking up So you commonly you’ll see people’s hips is kind of lifting up as they step or they’ll step too far. You don’t need to step very far. You don’t need a whole ton of motion.

00:21:12:00 – 00:21:30:04
Unknown
With this. You can start adding in resistance bands of various types. If falling is a concern, you might want to avoid resistance bands or get proper guidance from a personal trainer or a physical therapist in order to progress this. So I like to do a lot of side walking with resistance bands. That’s how I like to activate these muscles most when I’m isolating them.

00:21:30:04 – 00:21:48:16
Unknown
It’s a very powerful way of doing ideal fuel to the burn. Very, very, very fast, especially if you really focus on form the correct muscle activation, the proper technique, then you’ll feel this very well. And if you do these on a regular basis, it will prevent a lot of problems. It doesn’t matter whether you’re 16 years old or 95 years old.

00:21:48:18 – 00:22:13:01
Unknown
These muscles are so important to stay strong, activated and engaged, and it helps prevent compensations from happening or the reverse of it. We need to address the compensations that tend to come with the weakening of these muscles. So we need to lengthen out the hip flexors. We do need to strengthen the max as well to promote more activation of the muscles that push the hips forward.

00:22:13:01 – 00:22:30:21
Unknown
And then that allows us to get more motion in the hips to build a push forward. So all of these things are very important and they all fit together and we’ll talk about that a little bit more later on. Now, the next muscle that tends to decline as people get older and this is more a product of age and lack of use, and you’ll see it more and more as people get older.

00:22:30:21 – 00:22:50:04
Unknown
You’re not going to see this usually younger populations. And with the younger populations you’ll see a lot more glute weakness, a lot more good media, good M.S. and good max weakness just because of the way we move in daily life. But the next one, we do tend to see more and older populations, which is quad weakness. So basically the front of the thigh muscle that its main job is to straighten out the knee.

00:22:50:04 – 00:23:06:06
Unknown
And you can spot this in older people as they’re walking with their knees bent. And when they stand up from a chair, they don’t straighten out their knees all the way. Maybe they push their legs into the chair to help lift themselves up mechanically, or they have to bend their knees back quite a bit to be able to lift themselves up.

00:23:06:06 – 00:23:25:11
Unknown
Or they have to lean forward quite a bit in order to stand up from a chair. Now, some of these compensations actually are very useful and we utilize them as rehab professionals and then some of them are not as useful and we do want to get rid of. And so the main thing is we want to strengthen the quad muscles because this is the main muscle that straightens out the knee.

00:23:25:13 – 00:23:46:14
Unknown
And so if we’re not straightening out our knee effectively, then it makes walking very difficult, standing up very difficult and then true. What we call in rehab functional decline is probably very present and ongoing at that point. And so we want to reverse that, what we call a functional decline. So basically a big fancy word for the person is declining physically and we need to intervene fast to reverse that decline.

00:23:46:14 – 00:24:05:15
Unknown
So the most simple way to do that is the quads. And we’re starting with a lot of very what we think of as cookie cutter exercises in rehab. Now, as I tell our clients all the time, sometimes cookie cutter exercises are good because there’s a reason they’re cookie cutter exercises. The key is in how they’re executed and how they’re thought out and the way that they’re coached.

00:24:05:15 – 00:24:26:10
Unknown
So for a quad set, it’s just basically keeping the leg straight and then utilizing the part of the quadriceps muscle, the front thigh muscle that’s close to the knee, and then pushing the knee down and straightening out the knee. Now, sometimes you can put like a towel roll or something under the ankle, and especially if the person has had surgery, then that can be helpful to help the knee straighten out more.

00:24:26:10 – 00:24:51:12
Unknown
Maybe the knee has problems straightening out already. Maybe there’s a lot of arthritis, so putting a towel roll or something under the ankle can be helpful to allow the motion to be able to straighten out the knee as a person is contracting their front thigh muscle, their quickest muscle, and pushing the knee down the gal really good stretch and to build to get more knee extension, which is oftentimes one of the main priorities that people need to do.

00:24:51:12 – 00:25:16:18
Unknown
Now, another thing that you can do if you’re just having problems activating the quad muscle, you can put just like a small town roll or a small shirt or anything. And then the focus is just pushing into the towel roll or the shirt. Now, once we get that contraction, we don’t want to stay there because we don’t want something underneath the knee because we want to promote the need to straighten out more, not to have something there that prevents the knee from straightening out all the way.

00:25:16:22 – 00:25:41:08
Unknown
But temporarily, it can be a very effective way of activating acquired muscle to be able to straighten out that. Again, the priority here is the part of the quad muscle that’s closest to the knee itself, what we call the distal part of the quadriceps. We don’t want to be using the hip flexor muscles or the good muscles, all the muscles up into the hip and the back again, compensations are very common with people.

00:25:41:14 – 00:26:09:03
Unknown
People will find any way to do these sorts of compensations. They’ll use our glue, still used their hip muscles, they’ll use their hip flexors somehow when they’re doing all these things. And especially if you have a former athlete who’s now 80, 85 years old, you’ll see a lot of compensations because athletes tend to be great compensatory. Their movements can be just absolutely horrible because they are able to do things or they did things at a very high level.

00:26:09:05 – 00:26:29:20
Unknown
And if they had injuries or they just found ways to do them, their body figured out how to how to do all sorts of amazing things and sometimes not in the correct way. So athletes tend to be great compensator. So if you run into someone who’s over the age of 70 or 80 and they were a former athlete or aren’t very athletic in general, you might find some very interesting compensations.

00:26:29:20 – 00:26:48:20
Unknown
You’ll find very interesting conversations with athletes in general, and it doesn’t really change as they get older. And we know this because we work with people over the age of 80 all the time. So we see some of these patterns. So very important. Activate the part of the quad that’s closer to the knee, pushing the knee down and then being a hold that for like five or 10 seconds and then relax.

00:26:49:01 – 00:27:09:23
Unknown
Here is a key component. It’s the relaxation that the key is in the relaxation. So being able to push that knee down and then just to be able to relaxed all the way so you can contract release, contract release, contract release the muscle and that’s the magic. Being able to turn that quad muscle on and off, on and off and to be able to put the mind to it and be able to do that.

00:27:09:23 – 00:27:26:16
Unknown
Because once you solve that problem, then what you’ll find is people are able to walk with their knees straighter. When they stand up from a chair, their knees tend to be able to straighten out more, or when they climb stairs they’re able to get that knee extension at the end of the ball to straighten out their knee at the end when they’re climbing stairs, when they’re standing up.

00:27:26:16 – 00:27:44:01
Unknown
And again, if they have weakness here at a very basic level, then they’ll tend to keep their knees bent. When they do those things, when they climb stairs, they’ll knees will kind of stay back, might stand up from a chair, their knee will be back. Now, some of this can be a weakness issue at the muscle itself. Some might get sick, a mind body connection type of thing.

00:27:44:06 – 00:28:08:16
Unknown
So basically, can the brain just connect to the quadriceps muscle and contract on and then relax off contract on blackspot? Can the brain do that? And sometimes it can just take a little bit of training and then you can get that person off to the races and they’re able to do amazing things. They just lack the mind body connection their bodies didn’t think to, okay, let’s contract the by the muscle is there, the strength is there.

00:28:08:16 – 00:28:30:18
Unknown
It’s a strength issue. It’s a mind body connection issue. Or in rehab, we call it a neuromuscular connection issue, but basically a mind body connection issue. If you’re not a rehab professional. So how does the brain connect to the quadriceps? Very, very, very important. So building up the connection and the quadriceps, and then that will also lead to greater strength, because if we’re connecting to the muscle properly, then we can add strength from there.

00:28:30:18 – 00:28:47:08
Unknown
But we cannot add proper strength if we’re not connecting to the muscle properly to begin with. Now, where we really want to get to with this type of progression, I’ll say if it’s someone who’s, you know, 85 years old and their quads have gotten weaker, if they’re able to do the quad set and we’re doing great with that, where to go from here?

00:28:47:08 – 00:29:04:11
Unknown
Where we really want to get to is what we call a straight leg race. So I like to do it by doing kind of a quad set first, so can track the quad, push down and then list the leg up. And you can start by just being able to lift the leg up just a little bit off the ground and then lowering it back down.

00:29:04:11 – 00:29:26:08
Unknown
And then the question is, can the person do this without the knee bending either on the way up or on the way down? If the knee bands, as they left the leg up or on the way down, then they’re not ready for a straight leg raise yet. So then that’s okay. We got something in between that. But again, what we tend to see in rehab is people be doing straight leg raises and they’re just cranking away and lifting the leg up and down and up and down.

00:29:26:08 – 00:29:46:07
Unknown
The knee might be bent. They might be using their hip flexors more than the actual quad. And so the person is lacking the true benefit of the exercise. And now that they’re feeding into the compensation. And so that creates a lot of problems later on. So later on board now they end up having tightness in their hip flexors and so that pulled their trunk forward and makes their walking worst posture worse.

00:29:46:07 – 00:30:07:03
Unknown
And actually their quadriceps muscles don’t strengthen because they’re over utilizing their hip flexors, which is a very, very common problem. So very important to do this exercise correctly. It’s a cookie cutter exercise, but it’s a cookie cutter exercise that needs to be done very correctly and with a lot of skill, focus and attention. So basically, contract in the quad, push down and then be able to lift the leg up.

00:30:07:09 – 00:30:24:19
Unknown
Now, once you’re able to do that and the knee doesn’t bend, then you lift the leg up about to the height of the opposite knee. So you’re lying on your back with the knees bent and feet flat. You’re letting the leg up to the level of the other knee and then that’s enough and then lower it back down at the top.

00:30:24:21 – 00:30:45:15
Unknown
Depending on how tight the person’s hamstrings are, the hamstring time this might get in the way. So you just simply don’t raise it up to that point. Why mess with that? Just let the leg up a little bit less high and that’s perfectly fine. Let’s not get too complicated into okay, now the hamstrings have to tie. Okay, now we have to address the hamstring tightness in order to get to that strength in the quads.

00:30:45:15 – 00:30:59:15
Unknown
Of course, that’s an important thing and they speed into each other. But let’s not have perfect be the enemy of the good. So letting the leg up, up to the level of the outset, knee, if you can’t quite get there because of tightness in the back of the leg, then just go a little bit less so that the tightness in the back of the leg doesn’t matter quite so much.

00:30:59:15 – 00:31:18:01
Unknown
The important thing here is the activation of the quad and the strengthening of the quadriceps, and we see a lot of progress with strength itself when the person gets to the straight leg raise. Okay, now let’s say you’re not able to do a straight leg race yet, but you’re able to crank away on your quad sets really well and you’re doing great with that.

00:31:18:01 – 00:31:39:07
Unknown
So what to do? So the in-between exercise would be putting something like a tolerable or a pillow or something underneath your knee to support it, a bolster, as we call it, in rehab, and then just basically straighten out the knee and then back down, activating the quadriceps to straighten out the leg all the way and then lower back down and give back to that eccentric control, that lowering contraction that we talked about with all these things.

00:31:39:07 – 00:31:56:11
Unknown
You want to control the leg on the way down. It’s not just lifting the leg up. It’s also controlling it as you go down because that is central control, that lowering contraction is so important when we’re working on standing up from a chair and then standing back down from a chair. So when we go to sit down from a chair, it prevents the plopping.

00:31:56:11 – 00:32:15:10
Unknown
So that’s what that lowering contraction does. If we have good strength with that lowering contraction, then we’re able to control ourselves on the way down. When we go to sit down, if we only have concentric contraction or the shortening contraction. So when we’re lifting up on a bicep curl that’s concentric, is that shortening contraction? If that’s all we have, then we might be able to stand up just fine.

00:32:15:12 – 00:32:41:03
Unknown
But then we can’t sit down as well because we don’t have that lowering contraction where basically if it’s a bicep curl, we’re letting up and slowly lowering down. That’s that you center contraction, that wavering contraction. We need that in order to lower ourselves down and have that control. So back to putting a bolster or a towel under our knee, straining it out, get the knee as straight as we can, utilizing the quadriceps and then slowly lowering back down.

00:32:41:08 – 00:33:02:02
Unknown
And again, the key here is activating the part of the quad that’s close to the knee itself. So we’re not using the part of the quad that’s more up towards of course, that will contract and that’s fine, but that shouldn’t be where our mind body connection is. That’s not where our focus area is, because then that quickly leads to other compensations, that glutes, the hip flexors, that other muscles basically kick them in.

00:33:02:03 – 00:33:23:09
Unknown
And so straightening out the leg, using the part of the quad that’s closest to the knee. And that’s what we want to be able to do, and then build a slowly lower that down. And that is a great progression to bend the straight leg, raise the straight leg raise then is really going to help us build a lot of strength because the straight leg rise is actually quite challenging for a lot of people over the age of 80.

00:33:23:09 – 00:33:40:09
Unknown
If they haven’t been utilizing those muscles well enough, then those muscles can go downhill and you do not want your quads to decline because these are the main muscles that straighten up and this is a big deal. Okay, so quick recap. So we’ve talked about the good medias and minimus, the side rear end muscles and how they stabilize the pelvis.

00:33:40:09 – 00:34:00:18
Unknown
And we’ve talked about the quadriceps muscle, the main muscle that straightens out the knee. All of these exercises will be basically on our YouTube channel and Facebook. And so you’ll be able to access those there. So if you want to get visuals and you want to go off of our podcast and go on our YouTube channel, you can get the actual visuals of these and you’ll be able to see me taking you through these exercises.

00:34:00:18 – 00:34:21:02
Unknown
So don’t miss out on that. Go to our YouTube channel or Facebook channel and you’ll be able to see these exercises being done there and so you can get actual visuals of that. Okay, So where to go from here? What’s another great exercise to build off of what we’ve already talked about? So of course this have to stand the ability to stand up from a chair and then the value is in the progression.

00:34:21:02 – 00:34:37:12
Unknown
And we’re going to talk about progression a lot with the center stand. And so if we’re working on strengthening our quadriceps and we’re working on our hip muscles, then this is a great segment to being able to stand up from a chair. So the progression from here is of course, being able to scoot forward to the front of the chair.

00:34:37:12 – 00:34:58:23
Unknown
That’s the first thing. And depending on where you’re at or where your walk on is at or where your patient is at, a lot of them will even miss out on that first step, which is scoot to the edge of the chair. And this is something that take for granted if we move normally, if we’re younger individuals or we’re physically active, we don’t have any of these decline type of problems.

00:34:59:03 – 00:35:16:17
Unknown
We take for granted that it’s actually we have to sit on the front of the chair and then lean forward and to be able to stand up. But this is something we don’t think about unless if you’re neuro professionals like me, then you don’t think about these sorts of things. When we stand up from a chair, we sit on the edge of a chair and then we lean forward to be able to stand up.

00:35:16:22 – 00:35:40:22
Unknown
We cannot physically stand up if we’re seated all the way back in the chair. And especially then if we don’t lean forward, if we try to stand straight up, we can’t physically stand up. It doesn’t how strong you are. There has to be certain mechanical realities that happen. When we go from sitting down to standing up. We have to lean forward in a certain way and we have to be able to be seated towards the front of the chair.

00:35:41:00 – 00:35:59:08
Unknown
Or if the more we’re sitting in the back of the chair, the more we’re going to have to lean forward in order to be able to stand up. And a lot of this, of course, depends on how much glue and strength that you had, the more the stronger your rear end muscle band, the stronger the front of your thigh muscles, then the more we’re able to provide, you know, muscular leverage to help lift us off.

00:35:59:11 – 00:36:16:05
Unknown
But still, it doesn’t matter how strong those muscles are, we still have to be sitting more forward and we still need to be able to be lean forward in some way in order to stand up from a chair. So step one, make sure that the person is sitting on the edge of the chair first, make sure that they’re not pressing their legs into the chair.

00:36:16:05 – 00:36:42:08
Unknown
That’s a very common compensation that older people will tend to do because they don’t have the strength of the lift themselves up by pushing their legs into the chair and then mechanically lifting themselves up that way. Another thing that they’ll tend to do is pull themselves up by pulling themselves up with their arms from the table. Common things that we tend to see all the time, and it can be very difficult to get people away from these compensations because sometimes they’ve been doing this for a very long time.

00:36:42:08 – 00:36:59:13
Unknown
So then if you’ve never stood up normally, if you’ve always pull yourself up from the table or you are pushing your legs into the chair and you’ve been doing that for months or years, then how strong are your quadriceps by this point? How strong are your leg muscles by point, or more importantly, how weak are they at this point?

00:36:59:13 – 00:37:19:05
Unknown
And so that’s the point of these exercises to intervene. And even if people are at that level, we can reverse that cycle, even at age 95, if they’ve been doing this for multiple years, we can still reverse that. And we know this because we do this with people all day, every day, and it’s a huge joy to do it.

00:37:19:05 – 00:37:35:18
Unknown
And it’s so much fun to watch people get stronger. So being able to sit down from a chair, scoot to the front and then make sure the feet are forward away from the chair so they’re not pushing their legs into the chair in order to stand up. The progression from here is pushing the hands into the chair and then leaning forward and standing up.

00:37:35:18 – 00:37:52:18
Unknown
I’m not concerned about the person having to lean forward a lot in order to stand up, because if the person is, let’s say 85, 99 years old, they have a lot of weakness, problems going on. They’re not going to be able to be standing more straight up as they go to stand up. In fact, oftentimes they’ll want to do that.

00:37:52:20 – 00:38:12:18
Unknown
The common compensation is they don’t want to lean forward if the person is experiencing decline, physical decline and falling is an issue, they’re probably more afraid to lean forward. And so they won’t allow their body to lean forward. And that is actually one of the big reasons why they can’t stand up properly is because they just don’t lean forward enough anymore.

00:38:12:22 – 00:38:30:00
Unknown
So being able to lean forward and then to be able to use the legs and to be able to lift themselves up. And it’s fine to start with pushing the hands on the seat of the chair, either the seat of the chair or the armrests. And so the type of chair that you choose is can be quite important.

00:38:30:05 – 00:38:45:01
Unknown
How high is the chair? How soft is the chair? Does it have armrests or do they have to use the seat? How wide is it? Can do they have the space to push their hands into the seat or do they not have the space for that? Do we need a chair that’s wider? Is the chair just too soft?

00:38:45:07 – 00:39:02:19
Unknown
So there’s all sorts of things. So we want a nice, firm, sturdy chair and if the legs are weaker, then we need the chair to be a little bit higher. Or maybe it’s the edge of a bed or a hospital bed or something. If we’re able lift the surface up a little bit. That can promote success for the person who’s trying to get their legs stronger.

00:39:02:19 – 00:39:29:16
Unknown
So starting with the hands on pushing into the chair, the next step from there is putting the hands on the legs and then standing up that way. Then the third level is standing up without the hands. In general, I like to have people go into, I call the prayer position. So putting their hands in front of them and kind of clasping their hands around them as if they’re praying or however you want to do it, and then having them keep that the hands together in front of them and standing up and setting down.

00:39:29:19 – 00:39:49:04
Unknown
What this also does is it provides a little bit of a counterbalance. So they’re actually able to stand up more easily because of that counterbalance or putting some weight more forward. If you’re on the strike fishing world, it’s basically similar to doing a front squat or a goblet squat with the kettlebell. And so that way it provides a little bit of a counterbalance and the person can be a little more up and down.

00:39:49:04 – 00:40:12:18
Unknown
It’s a better squat position, but that’s neither here nor there. Basically, the main reason to put the hands clasped in front is so that the person is clear that they’re standing up without using their hands. And that’s the big thing. And once able to get someone build a stand up without using their hands at all, that can be a huge win for them or being able to stand up from the chair at all, pushing their hands into the chair.

00:40:12:18 – 00:40:30:11
Unknown
What’s appropriate. A technique is huge, and so there’s the foundation. So then from there you just have them do that on a regular basis, you know, firmly every day, and then just keep increasing the repetitions. If they can stand up only two times pushing the hands into the chair and then standing up with correct technique, then that’s where they start.

00:40:30:13 – 00:40:49:01
Unknown
And then just go from two eventually becomes five, eventually becomes ten and then 20, and then eventually they’re able to stand up by pushing their hands into their knees to be able to stand up that way. Again, just keep increasing the repetitions from there over time. Again, the value is in the progression. That’s how we’re going to get stronger and get better.

00:40:49:05 – 00:41:07:22
Unknown
And you can have people who are in their nineties go from not being able to stand up from a chair appropriately at all, having to use all of these compensations, having to just walk themselves up with their arms or pushing their legs into the chair to mechanical lift themselves up, to being able to stand up from a low soft surface without using their hands.

00:41:07:22 – 00:41:26:08
Unknown
And you can do this within a few months. And I know this because we do this all the time. The challenge is in the execution, the consistency, and then of course, the person doing it. If the person does it, the strength will come and the value is in the progression. Now, from here, once a person is able to stand up without using their hands, then we can start adding in load.

00:41:26:08 – 00:41:43:00
Unknown
Now here we have to be a little more careful. And again, especially with a skilled rehab professional, it is very advantageous in these situations because we have to think about back issues and you know, how much are we really straining and everything else. But here’s the thing again, the value is in the progression, both for bone density, for strength, for power.

00:41:43:02 – 00:42:06:00
Unknown
Older people should be lifting heavy. Their muscles need intensity. We don’t want to just think, because they’re older, they need to just stay with light. The truth in that is we may not want to progress as fast as we would with someone who’s a little bit younger because just the soft tissue is not as pliable. There’s less collagen and there is more risk of injury if we go too much too fast.

00:42:06:00 – 00:42:27:15
Unknown
But that doesn’t mean that the progression should not be with the idea of we need to increase load. We want older joints and older muscles to experience load because that’s how we get more strength and power. Strength and power is most important for people who are older. I’ll say that again. Strength and power is most important for people who are older, not for the elite athlete.

00:42:27:18 – 00:42:47:05
Unknown
Of course, the elite athlete has to do it as well. Younger people have to have strength and power as well. But most important, for daily life to live, to not decline, to not end up in our support, to not fall, to not pass away, we need strength and power in our legs. These things are very important, very vital to our pure survival.

00:42:47:05 – 00:43:05:03
Unknown
And if we don’t have them, then that puts us at increased risk of decline. Increase what we call burden of care in rehab, the increased need for utilization of someone else to help us out, the likelihood that we’ll end up in a facility into the hospital and then increased risk of death if our legs are not strong and powerful.

00:43:05:03 – 00:43:24:17
Unknown
So these concepts are very, very, very important. And of course, I’m not exaggerating on this because we work with people every day. This is the world that we we work in. It is very fun and very excited to be able to work with this population because of the gains that people are able to experience. You don’t have to think just because I’m older now I’m going to get weaker.

00:43:24:18 – 00:43:50:20
Unknown
Not true is because of the lack of use of the muscles that the muscle get weaker, not because of age in and of itself. Now, of course, there’s some physiological changes that do occur. And even when you look at the power lifters, Olympic weightlifters, yes, of course, with age that there is certain level of decline. But relative to where the person is, where you’re going to find them in the general public is very unlikely that people are at the top level of strength training when you find out.

00:43:50:20 – 00:44:17:10
Unknown
So be able to do just very basic things like this to get these exercises started and get down the progression and build up progressed. These exercises on a regular basis, you can make a massive impact on people’s lives either for something that you care about or if you just want to get yourself better, stronger. You’re noticing these sorts of problems to start doing these simple things and go with the progression of these exercises and you give it a few weeks, two months, and you’ll be amazed what will happen.

00:44:17:10 – 00:44:43:18
Unknown
And like anything else in life that’s valuable, whether it’s compound interest, whether it’s relationships, whether it’s career passions for things that we love to do, skills that we develop. When we do things consistently over the long term, we get the most value from them. Quick fix and shiny objects are not as beneficial as things that we do consistently over time and slowly, slowly and solid and improve on these things.

00:44:43:18 – 00:45:07:14
Unknown
Again, compound interest, relationships, skills, whatever analogy you want to use progression over time, doing things consistently is going to result in improvement in those areas and strength is one of them. So again, special set the stand. So increasing road back to the idea of incorporating load, you can use a simple dumbbell and hold it underneath you. That might be a great way to even take pressure off the back.

00:45:07:16 – 00:45:27:15
Unknown
So holding a simple dumbbell, you can start with one or £2 and standing up and down from the chair and just incorporating a little bit of load. There can be usually beneficial experiencing the movement of holding a dumbbell below you, and that can be very beneficial. So if you’re a strong wrestling person, here’s a simple deadlift type of thing, right?

00:45:27:17 – 00:45:48:08
Unknown
Except we’re just standing up and down from the chair again back to the center contraction. We want to slowly lower ourselves down on the way down. What the two stands, we don’t want to just kind of plop down. We want to slowly lower ourselves down in order to stand up. But if we can’t slowly lower ourselves down but we can stand up, then that’s where we start.

00:45:48:08 – 00:46:15:02
Unknown
And that’s okay. So once we get the leg stronger, and especially for incorporating a lot of these different exercises that we’re going over today, then the legs become stronger overall. Then we are able to get to the point where we slowly lower ourselves down. So whether we’re using a load such as a dumbbell or a kettlebell to stand up and sit back down, or whether we’re pushing our hands into the chair, we want to stand up fast and then sit down slow.

00:46:15:03 – 00:46:32:00
Unknown
Why stand up fast? White power? It’s very, very important that we have a lot of power in our legs to be able to generate force or strength basically quickly, instead of just muscling it up. We want to be able to pop up from the chair as much as possible. US makes us a lot more youthful. Right. Okay, let’s let’s get real.

00:46:32:00 – 00:46:43:20
Unknown
We want to be able to pop up from a chair. We want to be able to get our children off our backs so that they’re not pestering me about my value. Not staying up from the chair like you used to. Or Mom, you look like you’re getting older. Okay, You go. You know what? Let’s just be real here.

00:46:44:01 – 00:46:54:22
Unknown
We want to get our children off our back so that they’re not pestering us all the time. So if we get pop up out of a chair really fast, that makes us look more youthful then that’s our children. Not for Max. It’s our spouse off our backs.

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