chapter 17 Age Considerations in Therapeutic Exercise

Table 17.1

Pediatric Growth and Development Prepuberty –No difference between sexes for development of secondary sexual characteristics –Physical abilities equal Puberty and beyond –Girls begin and end process 2 years before boys –Size difference –Muscle bulk differences –Strength and power differences

Youth Bone Factors Physis is indication of maturity. –Chondral material –Can be damaged  may affect bone growth –Damage: shear, compression, torsion Closure of physis = end of growth.

Youth Articular Cartilage Factors Articular cartilage (AC) also subject to damage Can be affected by stresses similar to those for physis May be able to heal better in youth than in adults Early diagnosis important to prevent lasting injury effects

Youth Muscle Factors Not developed until puberty (testosterone and other hormones) Strengthening exercises OK for preadolescent children –Follow guidelines from American Academy of Pediatrics (AAP) –Avoid shear forces

Youth Tendon Factors Bones grow faster than muscle. Tendon stress increases with growth spurt. Youth may develop tendon, apophyseal injuries during growth spurts. –Sever’s disease –Osgood-Schlatter disease –Little League elbow

Youth Neurological Factors Muscle–nerve connections Coordination Accuracy Recruitment patterns

Youth Thermoregulatory Factors Less sweating than in adults Higher convection rate More energy per body mass expended in heat

Youth Sport Injuries Will be first-time injuries for many Acute –Sprains –Contusions Chronic –Tendinopathies –Apophysitis –Stress fractures Anterior cruciate ligament (ACL)

Table 17.2

ACL Reconstruction Choices Depends on Maturity Prepubescent: –Either no surgery (a functional brace instead) or a physeal- sparing and combined intra-articular and extra-articular reconstruction using an autogenous iliotibial band graft. Adolescent with significant growth remaining: –Surgery features a transphyseal ACL reconstruction using autogenous hamstrings tendons with fixation away from the physes. Older adolescent approaching skeletal maturity: –Surgery is a conventional adult ACL reconstruction with interference screw fixation using either autogenous central third patellar tendon or autogenous hamstrings.

Rehabilitation Considerations for Young Patients Assess for postural deviations. Avoid activities causing pain to growth plates. Strength exercises –High repetitions, low weights –Supervision required for proper execution Provide challenging exercises with successful patient results. Patient’s face may get red. Give frequent breaks. Make exercises fun and varied.

Physical Changes As We Age Gradual decline seen in all functions May begin in 20s and 30s Increases with age over 60 Connective tissue becomes stiffer –Affects flexibility –Increases injury risk

Aging Muscle Factors Sarcopenia = muscle mass decline secondary to aging. –Fewer functioning myosin heads  actin–myosin bonds reduced –Decreased muscle size Speed of muscle contraction declines. Point of peak output is delayed. Muscle endurance decreases. Exercise can improve muscle factors.

Aging Skeletal Factors Articular cartilage (AC) has less proteoglycan aggregates  less water in AC. Articular cartilage becomes thinner, calcified. Osteopenia or osteoporosis occurs after menopause. Bone density declines in both sexes. Exercise can reverse bone loss.

Aging Neural Factors Autonomic reflexes become less sensitive. Reaction time increases. Neural stimulation speed to muscles decreases. Hearing and other senses decline. Memory declines. Other existing pathological conditions may add to neural decline.

Rehabilitation Considerations for Older Patients Gains will be made in rehabilitation but will be slower than in younger patients. “Normal” flexibility, strength, endurance, balance, and coordination will not be the “normal” of younger patients. Speak more slowly and in a lower voice if hearing is a problem. Use larger print for home exercise program instruction sheets. (continued)

Rehabilitation Considerations for Older Patients (continued) Reduced vascular supply may slow healing for these patients. Muscle and tendon tissue are weaker, so overstretching should be avoided. Use lower weights and less aggressive increments and rates of increase. Balance activity is necessary, but progress will be slow. Use warm-up and cool-down.

Table 17.3