Exercise answers for active adults over 50

A couple of random thoughts on balance for me, especially in geriatric populations, is we have to consider the considerations of sensory organs. So your balance is, your body's awareness of where it's at is predominantly created or body mapping, spatial awareness is created by your senses. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host, Dr. Sebastian Gonzales. Hey guys, it's Dr. Sebastian's also again with the Restoring Human Movement podcast. Thanks for being part of the movement.

Now, I want to thank you again in the beginning here. Make sure everyone knows how grateful I feel that you actually spend time listening to me about an hour a week, because you can be listening to a lot of other people, and there's a lot of the great podcasts out there. So thanks for spending some time with me. Now, this one today was actually a topic that I never thought I would be doing, but I guess at some point we could have hit it, but it was emailed to me. So the topic is, I'll read the subject matter that a guy named Jack emailed me. He wrote the subject line, Old Farts. So I was like, hmm, this is interesting.

Let's see what this guy has to say. And he basically went down and said, hey, he's retired. He's 70 plus. He has a lot of friends who are active just like him. He was a past track coach. He's a past D1 college runner. And they want to stay active. They want to be able to get rid of as many injuries and aches and pains as they can, because they're just annoying. And he said, do you plan on doing any topics to kind of go over this with older people like that, like us? And I was like, I didn't really think about it. But yeah, let's see what you have to say. So I asked him, say, hey, can you ask me, ask me, what do you guys want to hear about?

Just give me some subject lines and we'll see what we can get with this. So, but for the most part, if you're listening to this and you're an older, I'm going to say, I always like be careful about age because people don't like, I guess older is very relative. But let's just say if you're 50 plus, because I think there's a lot of things occur after 50 where even mental mindset of thinking, oh, this is just age related. It's not going to get better. Or I don't know what I can do. It's just age related, things like that. So I think if you're older like that, you're probably going to get stuff from this.

If you're a clinician, a strength coach, a PT, DC, ATC, so on, maybe this will just give you some light into how it is to working with these populations. Now, to be completely honest, I don't have a lot of people who are 65 plus or 75 plus. I usually have people who are kind of, I mean, they're below that. I get a range, but I don't think it's really too different. There's a big mindset change in my opinion with it. And I know there's a certain, I want to say it was probably 85 plus, I guess now, the ones that I've interacted with that they just, a lot of them didn't exercise. It just wasn't a, it wasn't their come from, it wasn't their belief system when they were growing up.

So to trying to change like a habit or getting someone to eat, like say they didn't believe in any fish and you want to be fish, you know, and so it's a little bit of an upward battle. So I always got people who were a little bit more responsive to that. So I'll keep that in mind as you start to work with people of older age. Now, before I go into this, actually, I guess I should frame it. So the questions we're going to go to just roughly, or roughly is there was a question about feet, there was balance, flexibility, strength, knees, necks, dietary supplements, exercise modification. So there's a lot of stuff that we're going to cover through today and I'll get to as much as I possibly can, but there's obviously things that I will not be able to answer.

Now, before we get into that as well, I want to make sure that I'm sharing as much as I can about myself and I figure a couple minute section in the middle here in the beginning is going to be the best I can do. And the other reason for this is because it's not about like, hey, just look at me, look at, look, look at my life. It's like, I'm trying to share so that you guys get to know me better because I know that with, uh, I think about the host of nighttime TV shows or variety shows. It's like David Letterman versus Conan. It's like, which one do you watch? You, you watch the one you like better and it's not always the person that's interviewed, but I, I want to make sure that you guys get an insight into me.

So that's why I share these things. So I hope you're enjoying them. If you're not, I guess tell me that too. Lastly, before we actually go into that part too, is that make sure you do review this as well and share with a friend who is in need of this subject matter, because I mean, I would love to say that the reviews are all for me, but realistically, if you like this content, it does not get shared unless you share it further because these things have ranking factors. So if you can, if you can go onto iTunes or Google play, I would love if you, if you give me a review, it'd help me and our movement out a ton.

So let's get into that story. Then we'll get straight into the topics. So this right here is the story about how I inherited a boat, but the day that I inherited a boat. So me and my dad have, or family have had this boat for a very long time. The engine's probably, I want to say it's back in like the six, early sixties. It's a very old engine. I mean, it's definitely older than me. So it's, and it's attached to this boat, which really isn't worth that much money either. I bet the entire unit as a whole is probably like, you know, two grand or something like that, but it runs well. It goes faster than many boats on the lake, but oftentimes it's very temperamental.

So usually before each trip, we'd like to take it out for a little test run and we do it in the Harbor over here in Huntington Harbor. So just enough to where we can see if we keep starting the engine up and so on. So my dad takes this thing out with me and we have a secondary engine because the first engine typically craps out a little bit, especially at high altitude. I mean, I remember this one time on Convict Lake where we almost didn't get back to the other side and the wind was blowing us progressively across the lake and the engine kept cutting out. So, and it was, it was a windy and it was very like, it was almost like white capping.

So there was like water coming over. I thought we were going to like actually get swamped, but either way. So we like test this boat out. So my dad's like, let's go out in the Huntington Harbor. Let's go test this thing out. Cool. Great. So the second engine, usually we have to take this thing. We store it inside of the actual boat. We pick it up. We hand it to the person. We attach it on the back onto a rack system and then we test it to make sure it's good. We start the engines, make sure it runs, put it in the water, and then we start going. So we'll run the first engine, the big engine, the primary one for a while just to see if it's, if it's going to work, shut it down, start it on and so on.

But also too, we like to test the second engine. So that's why we have the whole thing in the water right there. So my dad though, he likes to really test this primary engine a lot to see if it can get some oomph. So he'll hit the gas and we'll slow it down. Hit the gas and slow it down. So the first time he did that this time, the small engine was, if you guys have had a boat, you can prop the engine up or put it down in the water. So it was down into the water. The prop was in the water. So I was in the front of the boat. He was in the driver's seat. So he hits the gas and he pulls back. And I'm looking at him and I see the back of the boat and I see the small engine just jump right off the boat and sink down on the harbor.

So we circle back around and we see all these little bubbles just coming out. And I actually hit a little Google pinned there to see that's where that engine, the seahorse, the seahorse was resting in peace nicely down there. And there's no point in pulling it back up because it's just going to be eroded and full of salt water. So when we eventually got back to the dock, we brought it back out. And like my dad, my dad was like standing like kind of like by the side of the boat and like looking out at the harbor. He's like, I think you can, you can have this, this boat's officially yours. So I think the loss of the seahorse and realizing that was the day he decided he doesn't want anything more to do primarily with the boat.

So that's the day I inherited a boat. Okay, so the first question that Jack hit here was about feet. And I guess I should disclaimer this entire thing is that I'm not trying to give medical information in regards to you don't need a medical exam. These are all things that need to be examined for sure. There's no way I can give anyone treatment plans or recommendations without actually seeing them that is medical law according to across the U.S. I don't know how it is in different countries, but for the most part, I'm just kind of spitballing of what I kind of hear here. So the first one is feet.

He mentioned about like chronic pain or dysfunctionality. And let's go into first about single-sided versus double-sided foot pain. And I think the major thing why I want to attack that first is because when you're active, you, it's, it's merited that you could have some foot pain or two feet pain, but it shouldn't last for a very long time, no matter what age. And I think a lot of these injuries of activity or aches and boo-boos and nuances, I think a lot of them do come from, uh, not, not programming well or not having a graded exposure to something. Meaning if I was going to try to get you to run five miles, I might not start you out as a 70 year old person to run five miles.

I might start you out with 200 meters at a slow, slow jog, or maybe we start walking, you know, cause we don't have the starting point and eventually get up to five miles over the course of, let's just say a couple months. You know, there's a lot less breakage that way. And I, I know a lot of people have goals they have in mind or race goals or activity goals, or for some reason they say like, you know what, this is the first day of the new year and I'm going to mash myself. So those are all issues with the, uh, lack of graded exposure. And again, we have a lot more, uh, safety net when we do it that way.

When it comes to feet, obviously there's a lot of muscles, tendons, ligaments, the feet, there's bones, there's, uh, there's a lot of things in there, but I think the first thing to consider, and I think I've gone through a lot of this in the past when I've talked about hamstrings, hips and so on, but it can extend all the way to feet is number one is how do we know that we're dealing with a structure of the ankle or foot, or are we looking at neurology because I've actually found quite a few of people who come in with like ankle turns that there was no bruising, no swelling, right? And you'd think with a large tear of like a ligament that there would be some bruising, tearing, and swelling, but they can't bear weight on this thing, you know?

And what we find is that sometimes there's nervous system contributions. And just to qualify that even further, and this is not going to be the only example, let's just say I turn my ankle, there's a lot of structures on the side of the ankle, including attend, uh, the tendons, muscles, ligaments, but let's just say all those are intact and they're good. Why is there still a shooting, stinging, stabbing pain in the, in the foot, maybe the top of the foot? Well, there's also nerves, there's vessels, uh, arteries and veins, lymph and skin fascia. They're on that side too. And they're a little bit harder to identify, I think for people because they're, it's kind of like when you look at your hand, you can tell that there's skin on it and you can feel the bones, but then you can't feel all the other stuff.

So it's a little bit more unreal, I think, to people. But I like to think of as some of those strains that people will get that just don't resolve, but all the tissues have been considered normal on imaging, MRIs and whatnot. I like to think that some of them are, uh, if you've played football, you probably know what a stinger is. And I think the last few times I've said this to patients, they're like, I don't know what a stinger is. And obviously I don't work in football players. So, uh, stingers are when they impact the shoulder pads onto the body of the other player and then it tractions the shoulder away from the spine and it basically tractions and stretches the nerve plexus into the shoulder area so much to where it makes like your arm kind of dead.

And so there's tension or, or, uh, stretching injuries that you can have on muscles and tendons and nerves. So in this case, we're looking at the possibility of a nerve area. I like to clean it up very simply to people and say, you've stretched a nerve past the point where it wants to be stretched. Let's consider it a foot stinger. And I don't know if it's a technical term that's going to carry over, but for the most part, that is a possible contribution there. And when we're talking into single foot pain, obviously there's, there's a single sided loading issues we have to, we have to consider too.

So you've done the same amount of mileage and activity on both feet while I was one screaming out in pain. Is that age related or not age related? Did you have a passenger there or not? So I think there's a lot of different contributing factors in even single leg stuff versus, or single foot ankle stuff versus double. Now double, double is an important one. I think it's more, it's going to be probably really common in this population set of 65 plus because they have a lot of things going on. And whenever someone has two sided foot, ankle, toe, calf, thigh, hamstring, hip tightness, then I think we have to consider the possibility that it's same.

It's both sides. It's fairly symmetrical, maybe same intensity. And they start out at the same time. Meaning that if you start walking, they start. If you sit down, they go away. If you lay down on your back, they go away. If you stand up, they come back. So these are, these are things where I would consider what is the intersecting point. And I go down a lot through this in a 105 podcast, 105 with Cody Dimak, as we talk about the intersecting points of, of, of syndromes, piriformis, IT band, hip impingement. What's the intersecting point? Why do these syndromes occur on people? When it comes to foot stuff, let's now we have to tangent back a little bit and consider the possibility that it's not really a foot problem anymore.

It's not an ankle problem. It's not a ligament, not a, not a muscle problem. It's not a plantar fascia problem. It's probably an issue with where those points come together and probably the easiest ones are vascular or neuro-based. And there's a condition called neurogenic, neurogenic claudication. There's stenosis of the lumbar spine. There's, uh, I guess I don't want to call it sciatica, but let's just say sciatica because it's a common term that you guys would probably understand. But for the most part, there's either, there could be a vessel or, or a nerve impinged. And these aren't always going to be painful up at the section into the low back.

Sometimes it's just like a grumpy back or it's a tightness that you thought was always going to be there or, Hey, my dad had back pain. So this is like normal for me. And I always find it interesting when people say, Oh, that's just, that's normal for me. I'm like, well, what is normal for you? And they say, well, I have headaches every day. And I'm like, how was that? That's normal for you when that start? Oh, it started a year ago. And it's, it's, those things aren't normal. Those, there are your, there are things that can contribute chronically to cause those things. So the a lot, oftentimes it can be reduced.

So we're talking about foot pain, bilateral, symmetrical, same intensity, same style. It just seems like they're, they're mirrors of each other. Then we have to consider that intersecting point. And at that point, if you're looking at, well, crap, that's me. Then number one, you have to get imaged up there to make sure that there's nothing serious up there because there is a possibility of oddball things. And I've only found two, but they're over, over the course of 10 years. But oddball things can be malignancies. It could be non-malignant tumors. There could be vessel things. So I always like to start with bilateral symmetrical things is if there's red flags or if someone's over 65, I like to, I like to image them at least bare bones.

Look for an x-ray first, then go the progression of MRI if we, if we can, uh, by the way, if your insurance company quote unquote won't allow an MRI, it really comes down to cash is king. If you want the image, you get it costs like what under $500 probably. I think for some, some imaging centers, some of them a little bit more depend upon your location. But for, for things like that, it's like, do you want to know the answer or not? Because we start, if you keep going on the route of like, Hey, I, I did ankle stretches. It didn't work. I strengthened my foot. I didn't work and so on. Then you're missing the boat.

So I think we need to consider up there. And if you're wondering about like how possible is this to go away? Well, if it's a mechanical based problem, by the way, I do have a section in my, uh, in my, in my website that is all about low bar, uh, lumbar spine or low back. If you go through the patient section and you check out back pain, there's a longer article than you ever want to, going to want to read. And there's also a lot of videos in there and suggestions. And, uh, there's also a podcast I did with Dr. Stuart McGill, who's the world leader in spine biomechanics. So those are all things that you can check out.

And I do have a course too, that is, uh, for back and nerve based pain. So those are all free things that you guys can check out. If you're thinking, I don't, I don't know what I can possibly do, but definitely go check out your, uh, talk to your healthcare provider because they're going to know your history and everything better than some random website will. So go talk to them first and say, here's my concerns. And I heard this podcast and here's questions I have. Write a list and just check them off. Make sure he's addressing your questions. So that is the first thing with foot ankle. If it actually is a muscle tendon thing of the foot ankle, a lot of times we have to consider the areas above it and below it.

And obviously with the foot, there's nothing below it on the ground, but it is important about ground contact. So if the ankle, we have to check the foot, we have to check the knee, we have to check the hip, we have to check the torso. So there's a lot of contributions in there for foot ankle things that I've, uh, and actually I didn't realize I, this is a great question because I do have a free course on foot ankle stuff too. And that's for running populations. So go through there on courses on my site and you'll see a bunch of stuff that you can check out, but, uh, it, it really does come down to the entire limb, usually with foot ankle tendon muscle conditions, or even plantar fascia.

It's the end of a whip. You have to control the handle a lot of times and control the, uh, the, I guess if you're going down this analogy, then if you're going to get a crack out of the whip, you got to hit something hard. You can't hit sand or air as much. So that's what I mean. I guess you can hit air. That's a bad analogy, but either way. So it's top and bottom. You should check on that stuff. Second is that we go into balance. The question was just balance period. Now I didn't know exactly where I should be going in this one, but just a couple of random thoughts on balance for me, especially, especially in geriatric populations is we have to consider the considerations of sensory organs.

So your balance is your body's awareness of where it's at is predominantly created or body mapping spatial awareness is created by your senses. So we have the ear, inner ear, inner ear, or a vestibular system. We have the eyes, which is visual. And then we have, um, I know skin is a big one too, because it's tactile sensation. Let's just say if you have a diabetic neuropathy and your feet don't feel anything, how are you expected to balance? Cause your, your brain doesn't know where the heck it's at. So building the senses is important and things with inner ear, if you've experienced things like vertigo and they say you have, uh, the little rocks and stones in your ear, if that's becoming symptomatic, then it's going to be really hard to have balance because it feels like the room is spinning, right?

So consider your, consider your senses first without even having to work on balanced stuff. The eyes, I like to have people to sit outside and go birdwatching even, you know, birdwatching, there's head turns, there's eye tracking, there's chasing, there's things like that. And this is actually why with, with younger people or into their like thirties to forties or so I like to have them keep doing things like reactionary sports, not just weightlifting, not just doing things where the, they're not chasing something, but softball, baseball, tennis, pickleball. These things are great things to do for just, uh, responsiveness because, and also we do side to side rotational movement, which is a lot of times an issue when it comes to balance as well.

Now exposure, graded exposure again is a thing because sometimes when people turn their head, they end up having a problem with balance in their room spins. Or if they're moving their eyes too much, sometimes your eyes get tired, right? Or exposure to, let's just say dancing because dancing is something I have some people do when they have balance issues and I just kind of dance with them side to side, turn and turn, hand off the football, you know, things like that. Like simple, like movements on the dance floor that you would think that this person does not know how to dance with, they're just learning.

Those are the same things. So it's a slow exposure to that because if you went dancing for like an hour or just like turn, turn, side, side, like bound back and forth, then, then you might have some issues with, with a soreness the next day. So there's other contributing factors too. The dancing thing I think is really easy for me and just thinking about pivoting about things or making athletic movements. A lot of times when people dance, I remember I looked this up one time that this is ridiculous and I went on to YouTube and I thought, Hey, I'm, I'm going to be impressive on the dance floor today at this wedding.

I'm going to look up cool dance moves for guys. And I did. And it's this guy, he was, I think it was on eHow or something like that. So a lot of people had watched it. So it popped up first. So this guy's like, okay, here's what you're going to do. You're going to lean left. You're going to lean right. And then put your elbows up. Yeah, that's nice. Right. I was like, this, this is it. This is it. And it panned down. It's like, so his feet are in the exact same position, but just showing how to move the upper body without moving the feet. And then the advanced moves was like, okay, I'm going to want you to step when you're leaning and step the other way.

Yeah, that's nice. Right. And then finally he added a finger snap. But actually when it comes to balance or issues where you're trying to develop balance, I think these, these footstep movements or even upper body stuff is, it's actually not bad because it changes your, it changes where your weight is stacking above your basis of support or your feet. So it challenges your body to adapt to that. Because if you think about it in real life, if you're trying to balance or prevent a fall, usually it's when you've gone past your base of support. And this isn't always a bad thing to expose people slowly to this.

It's considered like an anti-venom. They have to be exposed safely to it so they actually don't fall because if they fall, then they might break something or break a hip and then that's not going to be good. But they have to be able to control those ranges. And a lot of times when they have walkers and things are used in balance with their hands, they're not being exposed to that range that they've in the past been able to control. So sometimes I'll have people do this against the wall and so they put their hands against the wall and they'll be like mirroring against it almost like a mime and I'll be behind them just in case I have to catch them.

So I do it with the safety net of that. But eventually moving the feet and turning at the feet is important because people who have guarded walking or let's just imagine you're walking down a hallway in a dark place or a dark house that you don't live in. You do a shuffling gate and it's because the uncertainty of this of what the floor is like. It's not knowing where the ottomans are or the walls. So when you start to build that confidence and get the brain to realize where the body's at, balance will tend to improve. So that's why major parts in balance and I know that for people who are getting older, balance, if it's not an issue for you, if it's not a top of your concern list, I think it really should be because balance is a huge thing that I think the stats are that if you fall, then your quality of life goes down severely.

And I consider people who are getting up there in age, I call them sharks. If they don't move, they're going down. So you need to make sure you're continually moving when possible, build a greater exposure and eventually you should be able to become self-sufficient longer. And obviously if your doc's telling you about different things and they're saying, look, you know, different parts of your body or your ankle or your heart cannot tolerate these things and obviously those are bigger, bigger issues. So again, disclaimer, go talk to your doc before starting any exercise program or mobility or balance program.

So these are just talking points. The third is flexibility. So we had a question just how do I basically, how do we keep flexible? And I, I'm still of the thought that like when we talk about static stretching or stretching where you basically go and hold, I'm not a big fan of them. Like I'll have people do it every once in a while, not before they do anything active. Because it tends to slow them down and makes their muscles a little bit less responsive. But I like to have them do things that are more quote unquote mobility based where they have to have some type of strength to control the, the joint and keep it contained or keeping it safe.

And if we say we're talking about hamstring flexibility, by the way, first thing is that hamstring flexibility can be a change of tone that is protective of other issues. So stretching away, stretching away areas of contracture or tightness is not always a good thing because you're stretching away your, your protection layers. A lot of times once the threat reduces, then we're going to improve our mobility. So one thing I like to have people do who have issues with the flexibility at a certain age is that probably one of the scariest things for them to do is get on and off the ground. They don't want to do floor work, which when it comes to what I like to start them with for shoulders, hips, back stuff, foot stuff, I like to start them with the, check their torso strength or sorry, the torso stiffness and robustness or endurance.

Actually, strength is not really an important thing here. So when we check their endurance of their torso, can they keep position? Do they have any tone in there? Do they have any, any intra-abdominal pressure? Do they have any strength of the abdominal walls, actually endurance of the abdominal walls? I got to stop doing that. Those are things I like to start people sometimes on the floor just because gravity is not as, as much of a variable or we do on the wall, but I prefer the floor, but it's a hindrance for them to get down on the floor because they're like, how am I going to get back up?

I'm like, that's a great question. So why don't we practice getting it on and off the ground? Because gravity is your nemesis in that point. If you can control yourself to get responsibly and pain-free and well off the floor anytime you want to, then I think we're better. I mean, like, forget it, flexibility. You can get on off the floor. You're way better than someone who's flexible like Gumby, but can't get off the floor. So I think flexibility is a little bit overrated because I think the flexibility at that age is a possible protective mechanism. So I would rather just go on and off the floor a couple times a day.

And I think Dan John came up with this concept is that he said the best way to get someone to get off the floor better is to get them on the floor and make them practice getting off the floor. And there's very different ways to do it. And I don't think there's a necessarily completely wrong way because the variation is going to accumulate. As long as you don't do the same way every single time, I think you're going to be better off. There's nothing wrong with grabbing a chair. There's nothing wrong with having a little assistance. There's nothing wrong with using one foot predominantly over another as long as we start to balance them out.

So I think flexibility is probably the most important part or getting off the ground or having mobility is more important than flexibility in that. And that kind of brings us into the fourth question, which is functional strength. And he said his personal theory is that declining strength contributes to a lot of joint pain. I would say there's a big part in that. But I think the concept of functional strength, that terminology there is a little bit skewed in most people's understanding. So when they think strength, I think a lot of times they think lifting weights. And I don't necessarily think that strength will necessarily combat all joint strength.

And if you remember me correcting myself a couple minutes ago with torso, the torso, there's really not a big concern I have with building strength in the person's torso. But it's more endurance-based. Can they hold a certain torso or pelvic position to get the other parts of the body to work and move efficiently? And you know, that might seem like I'm saying the same, I'm kind of saying the same thing as strength, but it's not. And it's a translational thing I think people have an issue with, and even a lot of health care providers or rehab people have an issue with, is that we forget they kind of mean different things.

And I like to think of them kind of like down the route of if I'm saying copy machine and you're saying Xerox machine, we think we're saying the same thing. But really, I'm telling you it's a copy machine. It doesn't have to be Xerox brand, but I want a copy machine. You're like, whoa, a Xerox machine. Well, I'm saying, no, I want a copy machine. And strength is just the ability to basically move. But actually, endurance is the ability to hold a position or to be able to keep a position. And they have different physiological properties, really. And for most people with joint pain, let's just talk about knee stuff, we're looking at can we control internal femoral rotation or just think about knock knees.

When they squat or sit down, can we keep their knees stacked over their feet and under their hips or not? Do they almost hit them together? And in that case, I don't think that's necessarily a strength issue. I think we have a cascade of things occurring. And if you do listen back to that 105, we talk about syndromes and patellofemoral syndrome is one of them on there. And some of the research, I think it was pretty convincing. They did a dynamic MRI, which is standing as well. And they saw that the knee was really affected into the mechanism of, I'd say, degrade, where we have the femur internally rotating.

And that usually comes from the hip not keeping itself accidentally rotated or resisting the internal rotation, rather, meaning it kind of caves in or gives way. And that's still a reflection of not necessarily raw strength with it because we'd see really strong people. We see Olympic weightlifters. We see CrossFitters. We see strong-ass people still having knee pain and still having issues with keeping proper position. And maybe it's a learned position. Maybe it's a learned posture or a learned way of doing something. Who knows? Maybe it's just they have an isolated strength issue. God, I keep saying strength issue.

Let's just say isolated issue in that area where that muscle is just not doing its job. And maybe we have to ask why that muscle is not doing its job. So then we can build another cascaded pathway. And I think it usually starts with, does that muscle or does that hip have a fixed point to move from? Whatever is more stable is not going to move. The other part will move. So can we control the hip via torso stiffness? So when you say functional strength, I think really starting from can you get it on and off the floor I think is a big part in that. And being strong, yeah, I do think that strength is an important thing.

But I don't think strength should be focused on without first addressing endurance concerns or being able to hold positions. Like my major thought is that if you can't walk, you can't run. If you can't hold a single leg stance without having, say, knee pain, why am I having you sprint, right? You clearly can't do it without, I mean, you're not even exerting yourself too much. You don't have respiratory concerns. You don't have the gait mechanism or the gait mechanics creating other things that could go wrong. We're just simply putting you in the position. But if you can't hold that position, how do you expect to do it when there's more stuff going on?

So I think endurance is a precursor to that functional strength. And I'm not talking about endurance cardiovascular. I'm talking about can your body hold a certain position when needed? Now, what types of joint pain can actually be affected by issues of endurance and then further strength? I'd say for this population set, hips, knees, ankles, feet, shoulders, spine. I think there's a lot of things that can be addressed by building first endurance via torso strength, torso endurance. I swear that's going to get real old. Torso endurance and then building strength of the ball and socket joints upon that.

But I don't think it has to be as absurd as I don't think it has to be a lot. I don't think it has to be a lot of weight. And I think there's a certain point of diminishing return for people where, and if you've known someone who's done this, they go start at the gym in the beginning of the year. And they say, I'm just going to start pounding these weights or running these miles. And they come back broken or they feel broken and they don't want to address it again. And so I think scaring people away from actually doing the thing that their body is asking for is a big concern. And I would rather have them have a slow gridded exposure to it.

And I did an interview with Dr. Tom Michonne, I think it was like around 92 maybe, where we talked about foot and ankle stuff as well as running populations, as well as just overall strength in that older age group. And he was saying that, and he's done a lot of research on things, so I trusted judgment on it. I did the research myself, but he was saying about a 30% max, one hour max is all we need, or about 20 reps, I think, are roughly what it was of each thing. And you do it slow and controlled, and over the course of the week or so, you've built a lot of volume. So I'm of the thought where I kind of follow the, I'd say 50% to 60%, or just roughly say, if you did five reps, you should feel fresh at the end.

Fresh enough to feel where you could have done probably five to eight more. And I don't do this because I'm trying to be lazy. I do this because I realize that I want to feel good throughout the remainder of the day. And I know that I have the other days in the week, four to five days in the week, to build that volume. And building the volume, I think, is a safer way to go about it, because I actually have a rule in my office. I don't let people do anything heavier than a three rep max, because I don't think, we can calculate it. And I'm not building Olympic weightlifters, so I don't need to expose them to that.

I'm building athletic, weekend warrior, people who just want to age well, feel well. So I don't think there's a need to do it. We can push a little bit onto that fourth rep, but I don't think we need to go balls of wall to the point where we might injure something into great form with those heavier weights. And I guess, you know, after talking about this for a little bit, I realized looking through this email that I should probably kind of address some helpful tips on each ground. So balance, we talked about dancing, flexibility, I said just get on and off the ground, functional strength. I like getting on and off the ground, too.

But if you are going to the actual gym and you're starting to do some weightlifting, I tend to think do single arm, single leg stuff when possible, but do it fairly light. And I think a lot of people can't control their, of that age group, they can't control their own body weight anyways. So you might as well just do, just kind of even shift weight off of one side and use the other foot as balance. Or do a single arm, not necessarily push-up, but let's say you do a push-up position and you remove one arm. Can you hold that tabletop position? Or same thing when you're doing, like, say, a TRX row or a single arm dumbo row.

Just maybe do one arm stuff, lighten the weight a little bit, and make sure that you're holding position. And that just go down that route of torso stiffness or torso endurance that I was talking about. I think that we can definitely do two-legged, two-arm stuff, but it doesn't necessarily challenge the torso as much as single arm stuff because now we have a rotational component we're controlling. So I would prefer that people do, usually of that age group, slower things. Don't focus on the weight. Focus on exertion. So I usually keep them to about 50% or less of perceived exertion because I want them to do things responsibly.

I want them to do them well. If they've been coached, that's great. I want them to be coached and cued through proper movements because none of these movements should be painful, really. If they are painful, then maybe we have other things that we can do to substitute that exercise or maybe there's something that needs to be addressed in the clinic. The worst thing we could possibly do is scare them away and becoming too sore. And I'd rather just build up a good habit over time rather than try to make such a short-term gain. So I like to have people go ideally more towards free weight stuff. If it's lighter, that's fine.

I'd rather them do lighter stuff, free weights, get them to learn how to navigate the weight room. Also, too, getting them out of the area where they are accustomed to being I think is a big thing as long as they don't have some type of mental response. And the reason I bring this up is because my grandfather, he started to develop some dementia. And where he was at in the assisted living home, as soon as he left that place, like he went to a familiar place. It was fine. But then he went somewhere else. All of a sudden, dementia became a bigger issue for him. And we took him to the hospital a couple times for some procedures.

And he just almost lost it, just, you know, didn't know who people were. He knew who I was. We thought we lived at the hospital. So there's, I think, I kind of think getting people to, I don't know how to say this. I think giving them some variety in different places or they're going, or I think this is why retirement homes do like a ride share daily thing is to get them outside of their own four walls or the things they're familiar with. Because I think that provides a better mental response personally, at least based upon my observation. So I would rather, and it sounds like, it sounds like Jack's already doing a lot of this, is that they're outside a lot.

It sounds like they're biking, they're walking, they're on ellipticos, they're doing stuff like that. So I think those are important. And I would just go to different places because I think we get stuck in ruts a lot of times. And getting to the gym, I think, is one thing. It's just one more place where they have to pay attention to their surroundings and they're not quite as comfortable. So I think from a mental standpoint, I think that'll be good. Now, number five, the question was, what do you do at the gym fitness center? Machines are conventional but lack a lot. Also, or along with that, that no training partners create a challenge.

Ooh, okay. Along with that, that no training partners creates a challenge. Oh, so he wants to train with somebody. You know, I know that a lot of people try to do their own programming and I know they try to go to the gym themselves. But I would rather everybody go with a partner. And I think that ideally, you want to have a trainer, a strength coach, or someone who knows what they're doing. And I don't want to say that every trainer, strength coach, PT, chiropractor, ATC, or even MD knows what they're doing. Because some of them don't. I mean, they know what they're doing with certain things, but other things they don't.

So, and I don't know everything either. So, I would suggest that you find someone who can make it easy for you to succeed. The last thing you want is people to be hurt doing something which could have been easily mitigated and easily corrected at a gym. And I, on to that question about the machines, they do lack a lot. And I think, I mean, there's definitely a historical reason why the machines are in there. I personally don't use any machines. I use free weights. I use a lot of floor work. I use my own body as tension. I slow movements down so gravity is the load. And I even use the wall in some instances to wedge myself in.

And just to consider that and just to frame it well is that if you take your hand and you start to crush like you're breaking a walnut, all of a sudden your wrist gets, your wrist starts working, your bicep starts working, your tricep starts working, even the lat, shoulder blade, even belly start to work. So I think creating tension, smashing weights, pushing into walls, even though the wall's not moving, there's still work being done. So I think things like that that are more of an everyday encounter is going to be better. Because I think I mentioned this earlier, but I think I talked about an anti-venom.

So an exposure to something which is something you're going to be doing every day or even a risky movement like venom or a risky substance like venom, the anti-venom is a slow-gridded exposure so we can get antibodies. And that's the thought with the immune system and sickness is that you want to get antibodies. And if you don't develop antibodies, then you're susceptible for a big infection or sickness. So in the gym with these machines, like I don't, I mean, I think there's a time and place for machines. But at the same time, if we're trying to get these people, like if the overall goal of these older populations is just to get them to be able to sit down on the couch, get off the couch, roll over in bed, pick up objects, and I know this is, I don't want to sound demeaning, but like activities of daily living are a lot of times our primary goals.

And now we have other types of geriatric populations that are, they're very active. They're able to do that stuff and now that's what's, we've got to figure out what's their individual goals. Is it biking? Is biking the end-all goal? Is that the reason for existence or is it just a tool to accomplish another goal? Is biking even correct for this person? So for all we know, this person wants to be able to run with their grandkids or chase their grandkids around a park. In that case then, they might want to, we might want to expose them a little bit to changes of direction or leaning into walls because the kid's not going to run a straight line.

Perhaps they catch the kid and they're on the ground. Can you get down on the ground? Can you get off the ground? In that case, we might want to expose you more towards getting on and off the ground types of exercises and these are not going to be machine-based because the machine, it provides a stable platform. It supports the spine and it makes it really easy to push a lot of weight. But when you take that support system away, you have to develop that support system on your own to do the same amount of work or move that same way. So I think the machines should be used sparingly unless we're starting people out because I'm not really concerned with most people about muscle size.

I'm not concerned about looking jacked. I'm not concerned about these people looking as they did when they were 20 or regaining their youth physical or physical, what do they call it when people, physique. I'm not looking for the physique. I'm looking for functionality. The fact of the matter is if we teach that person to get on and off a toilet without weight even, we don't need to put weight in their hands, the more we expose them to that and doing it in a better way, the better they're going to get at it. So whatever the end-all goal is, that's important to write down and figure out the movements which break that down.

And once you're able to accomplish that task, then perhaps we go into what is the next goal, right? I think physique should be really the last on the list. And obviously, system health or systemic health is important. Cardiovascular or cardiopulmonary is really important. Or heart, lung, and organs, it's important. So I think there's, I think we need to just address goals here. And the training part, and going back to that again, is I would contact one of your, contact your kids or someone who's out and about amongst a gym. And contact someone who is, that you would consider as, I guess, your health go-to person.

Do they know, they might know more people in the health community, the healthcare community, or the training community. Because I know quite a few people who would be able to help people around here. And for all we know, that person who would be able to help you is cheaper than you ever thought. Or maybe they have a group class. Or, you know, maybe they can do it virtually. So these are all considerations that, I mean, I think a lot of people don't realize. And they think they can do better or do okay training on their own. And most people can't. And it's not just the physical nature of it or the programming.

Because it's the coaching of it and the accountability. It's are they doing things right? Are they doing things more right than wrong? And I've seen a lot of people over the years who have hurt themselves in a gym, hurt themselves while sitting, while running. It's just because they could have been doing something a little bit more appropriate for their goals. Or perhaps they were moving just a little bit inefficiently for that area they irritated at the time. So I think there's a lot of risks that can be mitigated. Now, number six is neck pain and mobility. Let me, let's see, scaring, it can be scary when riding in traffic and trying to make turns.

Ooh, that's a tough one. Here's the thing with spine, or actually, I don't want to say just spine. With joints of people who are older, number one is that, first off, let's start, let's cover this in the beginning. Osteoarthritis or old age arthritis, they say, is not always painful. It can be painful, but it's actually, like, we're really starting to reconsider here. And I don't know what the research is showing, but I'm pretty sure it's leaning towards what I'm going to say, is that osteoarthritis is not necessarily an old age arthritis. Not everyone gets it. Sometimes there can be hereditary components, but also, too, there's mechanical components.

Did you have a past injury of the neck? Did you have a past injury of the knee, which created that arthritis to occur? And we've seen this with the American College of Sports Medicine, and one of their position statements is about ACL injuries or knee injuries with high school or college-level girls in certain sports. And they found that over, I think it's 95% of them within five years have early-onset arthritis in that knee when they've had a past knee injury. Why is that? Is that old age? No, that's trauma-based. That's changes of movement quality. And my thought with arthritis is that it is an adaptive response to a situation.

And this is where I feel this way about a lot of different conditions of the body. And the older you get, the more time the body has had to adapt into the response of that situation that it's in. Let me clean that up. So if the knee in the girl feels unstable, the brain and body say, hmm, I bet I can make that better. So it starts to build some bony response around it to stabilize it because it doesn't want to be unstable. So how about the same thing with necks? If you've been moving in an altered way or have had pain for a long time, the arthritis is a response to that challenge that it had. It's an adaptation.

Now, at a certain point, actually, bony arthritis is not anything we can really reverse that I'm familiar with. Sometimes it will surgically intervene if it really is creating changes of range of motion, and it will at some point. But in the early stages or the mid-stages, it doesn't, and it's not always painful. But that bony response really won't change because you built something there out of, say, concrete, and it's just not going to change after that. But it doesn't always mean that it's the thing that is creating the problem that you're trying to solve. So neck pain and neck mobility. How do we know that it's not from something else?

And I think a proper exam can really tell. I found a lot of people with neck pain and issues with mobility of the neck can actually be reduced by improving stacking of the neck area. And people who have had a lot of upper trap tightness or neck tightness or headaches, sometimes it's just because there's a closure of the holes in the back of the neck via arthritis maybe, via stacking mechanics, via disc herniation or disc change of height. There's a lot of reasons why it can occur, but either way, it can create a light compression on a nerve root, which then tells the muscles to freak out and get tight and be protective.

So sometimes when you can reduce that, we can improve neck motion very quickly. I don't really have a good remedy for this on air because it's very individualistic. And I think necks are a little bit more unique to the person, more so than, say, like low backs are. Low backs are definitely unique, but I think there's a little bit more that could be recommended very quickly in a template platform and 75% of the people would say, hey, that really worked well for me. But necks aren't really like that. But one thing I do know with people who ride or cycling is that if you, a lot of people who cycle, I think they've kind of adapted this already because they realize they can't do it the other way.

And when I treat people with neck conditions, I kind of prompt them into this if they've been cyclists, is that I say, hey, if you're checking traffic, can you put your chin onto your shoulder and then look at traffic kind of through over your sunglasses versus under your sunglasses, which require you to look up towards the sky and then you kind of look under the sunglasses to check the traffic that's just behind you to your right or, sorry, to your left. So a lot of times when people can, when they tuck their chin, they open the holes of the backside, which allow the nerve roots to uncompress for a period of time.

And so when people are just doing every day-to-day movements, they might fare better with it because they're not in a hunched-over position. They're walking. They can move a little bit more simply or easily. When you're locked into a bike, you're in that rounded position. It's a little bit harder to check and turn. But I would say checking with a chin-on-shoulder type of thing is going to be a little bit easier. And also, two, how do we know that the neck is not being triggered throughout the entire ride? A lot of times when people jut their chin out or when they're riding their bike, I've noticed they're in a very aggressive position with the stem being low.

And they're down into like an arrow position or down into the, I forget what they're called, but the hoops. They get real low because they're trying to get away from the wind. And then their neck is arched or extended in relationship to that, and this can narrow those holes again. So in that case, maybe we raise the stem. Maybe we change the bike fit. Talking to the bike shop might be a critical point in this, and it might improve the way you feel dramatically. So I think thinking outside the box with that one is that when you're doing a certain type of activity and you're locked into a device that is not a normal human movement or a normal human position, like I am sure cavemen didn't ride bikes.

So they probably walked and ran, so it was a little bit easier to move their appendages and their necks, their hips, and so on. So I would make sure that your ergonomics of that are good because if not, then it's going to just keep triggering the same thing. Now the next question, number seven, is knees and hips slash glutes. At 70, my boys and I suffer, possibly look into linkage amongst foot, knee, hip, neck, and shoulder. Ooh, that's big. That's a big range. Why don't I narrow that down a little bit? We'll stick to the lower half. So knees, hips, and glutes. Okay, let's start with hips and glutes.

I think looking at the possibility of why and what the symptoms of the hips and glutes are, because if it's front side of the hip, then we are looking at maybe a hip impingement thing. Maybe it's arthritic based because it's pinching into a certain range of motion that the hip can't tolerate anymore. For whatever reason, there's that bony response that occurred via arthritis to stabilize the hip because of past injury. Who knows? So the hips and glutes, technically, I guess they're different symptom patterns, and we look at a little bit different things. With the actual groin-based things is, number one, is that usually the more narrow you get, if you're cycling, the closer your knees get to the center rung, the more pinching it becomes.

But also, too, when people kind of arch back or they create a rounded back, usually this will reduce their hip symptoms slightly. But is that a good thing for the back? Who knows? Now, another thing they can possibly try, too, is when they're riding the bike, rather than grabbing the bike and leaning on the bike, which creates a little bit of hip impingement, they can press almost like they're trying to push their handlebars via their palms straight through the forks. And this creates some torso stiffness or belly stiffness on the front side wall, which a lot of times allows the hip to have a little bit more range of motion.

Now, how do we lock that in with a training program? Well, would machines do it? Not necessarily. Floor-based stuff probably will. It's an easy way. And I've gone through quite a bit of this stuff. And there's actually a groin course that I have on my site. So go through the groin pain course or anterior hip pain course. And it goes through some of the stuff that I have people do with this. And a lot of it is floor-based. It's building the torso endurance to be able to create some pelvic positional changes that are favorable for the hip to respond well. So that's something which is you go through that free course right there.

It's going to prompt you to buy something. It's a $7 best money you ever spent thing. So I just go through there first. You can find a lot of stuff I have on YouTube as well, but it's going to be harder to find. I organize it well for people in there. But the dead bug is a great one. The bird dog, the side planks, those are good ones to do. Now with the glutes, a lot of times we find the glutes are a symptom of a different problem. And I've found people with piriformis syndrome, quote-unquote, but realistically I'd say well over nine times out of ten, I find that their glute pain is a result of a nerve-based thing coming from the spine somehow.

Now how it's coming from the spine is a whole different thing. Are they arching too much? Are they rounding too much? Is it from a disc? Is it from their stenosis? Who knows? But, and this go down, I know this, I don't want, I don't want it to seem like I'm promoting these courses too much, but realistically I get these questions a lot. So I've made a step-by-step process to this. And if you went through, there's a hamstring one. The hamstring one technically, I call it a neurogenic tightness of the hamstrings, which is a nerve-based tightness in the hamstrings, which is very close to the nerves which create glute tension, which then feels like an ache, deep pain to these people.

So I would make sure they clear the neurology out first, and I've given a step-by-step process in that we even have a video-based curriculum on that too, because it's, I'd say 75% of the people that just do the steps in that usually get better or significantly reduce their symptoms. Other people, there's a, there's a, there's a fine nuances we have to do with them in person, and then they usually improve significantly. But, yeah, there are, there are cases where the glutes can be, quote-unquote, scar tissue, adhesion, trigger points, and need soft tissue work in there as well as the primary thing.

Now, let me, let me backtrack a little bit with that, because over the past few episodes, it sounds like I'm a bachelor of tissue work, and I'm not. So my, my background was that I was trained in active release. I did a ton of tissue work, probably the first five to seven years of practice, and even well before that, I was in a, I was in a tissue-based clinic. We mainly did tissue work or manual therapies or help people passively through. We did the work. We passively took them through and, quote-unquote, fixed them, I guess. But realistically, I think that's only about, you know, 15 to 10% of the pie.

And I think a lot of times if we improve the way these people are moving via those courses on there, then we're going to find that there's a good response. And then after that, we kind of pick it away with a manual therapy. But considering this, too, is that certain population sets can't handle a lot of manual therapy, and I've, I've really worked with a lot of my geriatric people this way, is that some are on blood thinners and they bruise. Is it really beneficial to me to do a lot of tissue work on them if they're just going to get sore and guarded there? So I think not. I usually, I usually default more to a corrective exercise approach and an activity approach or quality of movement approach.

Can I adjust them? Yeah, but how do we know they're not osteoporotic, too? So there's a lot of other considerations that I have in there as well. So I tend to think that the hips, glutes, and knees, first I would start again with torso stiffness. Can your torso and pelvis hold position enough to allow your hips to control the knees and also to support the neurological structures of the spine, which then is the electrical impulse, which then tells the muscles to be tight or relaxed. It will tell the joints what to feel. It will tell the skin receptors how to respond. So there's a lot of considerations in there that I know that I was having this conversation with a friend recently.

He's like, I don't see how the spine is correlated to the knee. And I said, dude, like the entire thing is electrical system with, like, we have this, we have a circuit breaker box, right? And we're trying to address a light bulb. Say the knee is a light bulb. We can keep changing that light bulb out and tinkering with the fixtures and stuff. But if there's no electricity going there, or if the electricity going there is altered in some way, we're going to be just troubleshooting. We're already patchworking the hell out of that thing. You know, it's just not going to work. So why don't we decide to look at the electrical system first, and then if it bears no fruit, then we go on to the thing that would have the next bang for the buck.

So I think knees, hips, and glutes are like that. By the way, if you have not already gone through my site, just look up running tips or runner tips, and there's an entire huge article that I think you'll get a lot from. They go over knees, hips, IT band, a lot of the conditions that runners plague, or that plague runners, and I think that will cover a lot of the missing parts that I have in this, because this is a huge topic. I can do an entire podcast just on this. So there's definitely a linkage correlation there. Now, is there a possibility there's a structure which is damaged in there, which then is the pain generator?

Yes, there is. And I like to consider the possibility of correlating the imaging to the symptom pattern. If I saw arthritis in the knee, but then you had a finger problem, I'm guessing they're not related. But if you have arthritis in the knee and you have knee pain, is that still specific enough to say that the arthritis is the cause? Well, maybe there is an infection there. Well, maybe we need to deal with the infection first, because the symptoms were hot, swollen, and you've been sick. So I would not always lean on imaging, but there is a possibility that when you have a positive image that looks fresh and looks correlated to the condition, then, yeah, we need to deal with that first a lot of times.

And then in that case, looking at the nerve-based stuff and the areas above and below are a little bit more, I don't want to say indirect because there's still an important part with it. But I think from working with patients who have a definite structural thing in the knee or in the ankle or in the hip, I find that there's a better response from them when I address that part specifically in a microscope form versus a larger picture form because they came in for a specific reason and I want them to feel that I'm addressing that concern. And then the things that I think that will help them further that might not affect them directly at that one point in time with a walkout feeling like I paid attention to their exact concern.

I'll drop in a little bit later or when I feel like I've gained the person's trust because it's a little bit hard to get them to do the things that I want them to do if they don't trust me in the first place. Now, another question, there is one that I can't answer about AFib. He asked about AFib, by the way, so then if you guys have not been checked for heart stuff, you definitely need to be if you're going to be doing exercise. I think exercise is really important, so checking your heart and making sure that you go to a heart doctor who is well-versed about the research surrounding strength conditioning and cardiovascular fitness is important because they might just not pay you the time of day and say, oh, well, maybe we just lay in bed.

You know, whatever the recommendations might be that might not coincide with your goals. An example of that for me is that I had a knee issue. I went to a doc who was very sports-minded, and I said just straightaway, like, look, my knee hurts. I am going to be squatting. I'm going to be running. Tell me what I need to do or what I can't do. And he said, okay, I don't want you to squat past 45 degrees. You can run but do it in intermittent burst when in the same, probably the same condition with someone with different goals. He might have just said, oh, just rest it. So, I think you need to be direct about your goals with your cardiologist in that.

Next question was diet and supplementation. Many older guys eat poorly and too much. Hmm. Okay. I'm definitely not nutritionally coach, but I can tell you this much, is that if you think you're going to refine stuff in your diet via supplementation and you're eating poorly, I'd say just eat well first. And leafy greens, eat more vegetables, drink a lot of water. A lot of people are dehydrated. I'm not even going to go down the route of lean meats and so on. I just think a lot of geriatrics that I've seen is they just eat a bunch of sugar. And I know that my grandpa was like this where he just wouldn't eat much and he was starting to lose weight.

And people would just feed him anything to get calories in and they weren't quality. He didn't have probably enough vitamins and minerals in him for all we know. So, I think there's other things that we could be, other easy life hacks that we could be focusing on or other things, other habit forming things that we can focus on first rather than life hacks about, oh, add selenium or add zinc. You know, like I think that we really need to get people to just start eating well. Eating some things that they, I don't want to say like the, like, it's kind of like people turn into children with it. You know, like they, I would just force them to eat it.

And I know it's probably not going to be correct or trick them into eating things that you need them to eat. I know some people grind things up in a shake for people, which is fine. Some people hide vitamins in applesauce, which is fine. You know, but I think there's probably a bigger issue here is that eat things that will supply your body with the vitamins and minerals that it needs because those are really important with physiological pathways. So, we can expect the body to improve muscular system or the bone system or the cardiovascular system if we expose it to the right things via exercise.

But realistically, we are what we eat. If you don't eat well, you're not going to repair well and you're going to degrade. So, I would say that first. But if you have more questions on that part, just email me. I can direct you to some people who are much better at nutrition than me. And there was a podcast in the past with Benjamin Brown, which we did address some of these things. And I think he said malabsorption was an issue with elderly that he found that no matter if they ate well, they just didn't seem to absorb the stuff. So, I think that is probably going to be a better one for you guys.

And that podcast from Benjamin Brown is session number 80, actually. Now, let's go down to the last question here. So, exercise modification. Since many of the above mentioned topics limit execution, what are exercises older guys and gals can do correctly? Hmm. Okay. So, I would think of the things. Well, I guess we should qualify this first as exercise. That I think movement overall is just exercise. And I think the land shark is a good way with this. If you move, you're going to keep going well. So, once you start seeing stagnant, you're going to have issues. So, if paralysis by paralysis is a thing for you, if you're like, I don't know what exercise to do, I don't know what's going to say for me, then just start walking.

You know, walking is probably one of the easiest things. And I joke with some of the patients that come in here that are looking for very complex answers to their problems. And I tell them, like, look, like, I don't make much money, right? And so, I'm not saying this from, like, hey, bragging, how much money do you make? Because I don't make much money. And I tell them, do you know what percentage of my income is probably from teaching people to walk better and getting some torso stiffness? Because I know you've heard me mention that multiple times. And I'd say easily 75%. You'd be surprised the amount of the conditions or pain that people have when they have poor torso stiffness, which then leads to weak extremity joints, knees, hips, shoulders, all that kind of stuff.

They just can't push off the ground and transfer their energy. And walking, surprisingly, is, I mean, it's a very quick, dirty way to get some torso stiffness and just do it with a large arm swing. And we can talk about even how that correlates to neurological movement or nerve sliding. So, motion is lotion with this. Movement is medicine. And walking is one that we're going to be doing anyways, so we just might as well be really good at it. It gets muscles moving. It gets tendons moving. It gets joints moving. Movement of joints lubricates them. Improving slide of nerves helps out with decreasing things like sciatica and, like, kind of ambient tension within, like we talked about, glutes as being possibly neurological-based.

So, there's a lot of things that just walking can help with. And that's the first starting point I'd have for people. And if they can't walk for very long, then you take a little break and you build a greater exposure to it. I think that I would prefer people to get up to 30 minutes to an hour of duration if they can, all in a row. But if they can't, then they can break it up. Other exercise modifications are a guy came in recently. He had an excellent idea. He's like, hey, I can't walk because he had some balance issues. He's like, I can't walk. So, what do I do? Should I go to the gym? I said, yeah, sure.

You can go to the gym. He's already doing gym stuff. He's like, well, there's a swim pool there. Can I walk in the swim pool? I'm like, you know what? That's an excellent idea. Because even if he falls, it's fine. And I said, you know what? Put your hands out really wide and act like your hands are paddles. And can you make sure that you're always about elbow deep in the water and just walk with gusto. And when he has his paddles down, then he now has water as resistance with it. And he's getting better torso stiffness work and better joint stacking. And he has a lot of support of the muscles or the joints around him via the water.

Also, too, from a sympathetic recovery standpoint, fight or flight versus recovery. And I think that I'm basing this upon some research that I saw last year, is that people who are in the water, I think there's a lot of sensory chilling. It chills the sensory organs out. So if they're stressed out a lot, they go in the water and they feel chill, you know. And that helps out with recovery and all of the hormonal response that comes from the fight or flight mechanism or the state of being. So I think being in the water is actually a really good way to exercise older guys and gals versus getting them to do stuff that they might be afraid of doing.

But also, too, the exercise modifications for activities of daily living, I think we just start to range them into the depth that we feel that is the optimal depth for them to be able to do the activity we're trying to do. I heard, I think it was Dan John, that said that the barrier between having assisted living versus living on your own was, can you get on and off a toilet? And I don't know where he got that, but I think it's great. And I think also to correlate that with can you open a door, can you feed yourself, you know, can you walk your dog? And I think actually this is why people with dogs tend to be active longer is that they have to get up because they're getting up for the purpose of another living form.

They're not doing it for themselves, so there's a little bit more of a selflessness to that. But they stay active. They keep moving. So when you have your exercise partners or your trainer or your coach, you're getting up because there's some accountability with that. So exercise modification is probably the biggest one for me is just can you squat to a high chair? Can you squat to a chair? And don't think of it like an exercise. Think of it like a movement first. And if you can't get all the way down to a chair or to a toilet, then you start from something higher. Put cushions on it. Put books on it, you know, and just make sure you hit the target behind you because if you don't, you're going to fall.

You know, there's something called a shortstop squat where you just slide your hands down into your knees and you're like a shortstop and you push your butt towards a wall. Just do it against the wall. So these are things that I would probably have people start with, older guys and gals, because there's a lot of benefit that comes from those just from a musculoskeletal standpoint. But for the most part, we need to keep them moving. We need to keep them being able to do their activities well. And if they don't have their hips moving and they don't have some torso stiffness, they're not going to be able to get up, roll out of bed.

If you can't get up and roll out of bed, practice rolling out of bed more times than you think and then build a great exposure to it. If you don't have movement of a shoulder because of a past injury or it just doesn't work for whatever reason, then you're going to have to use a stool to get up on things, right? Perhaps then part of your training with your coach or your trainer is going to be practicing stepping up a stool and not having to think about falling, not worrying about falling. So I think training for the things that you continue to need to do, because I think your goals are, obviously your goals are individualistic, but I think the realistic ones are, can you do the stuff that you have to do safely?

And if not, we need to train it. The avoidance of it is not a good idea, I think, for most people. I tend to think a lot of the body is in a constant state of adaptation. We can continue to make it do what it needs to do in most cases, and via doing that same movement over time, eventually the body gets stronger at it. It gets more efficient at it. The brain says, I've done this a million times. I'm not worried about it, and I think when people learn to, say, golf or swim or dance at a young age, they don't necessarily lose all that stuff. There's still something in the memory bank about it. So the more you start to do the thing that you are looking to do, the better you get at it.

But if you do it with spikes and valleys in your volume, then you might get hurt from a musculoskeletal standpoint with it. So tomorrow's the end of the day, just start adding more in and check in with your body every once in a while and just see how it feels. Being able to listen to your body and knowing when to panic, when not to panic, and when to go see a healthcare provider or a trainer or your medical doctor or your cardiologist is going to be important. And also, too, lasting with it, and there's no scare tactic in this. This is just the reality of it is that as we start to get older, too, there's a possibility of malignancies.

So just because something is achy or something burns or you've had something in the past that you thought was that, if sleeping doesn't necessarily make it better or if you're starting to lose weight or you've had cancer in the past or you've had a family history of cancer, you need to check that out. And that's just the thing of being able to do your due diligence and kind of getting out of your comfort zone and just asking for help because the people that don't ask for the help are the ones that end up suffering. So you need to make sure that you have someone managing you from that point because if you're going to have problems, that is the biggest problem to have.

Let's just not get you there and make sure that you have your A-plus expert checking you for that consistently and then mitigating risk if it comes about. So that's all I kind of have to say about all that stuff. Jack, thanks for sending all this stuff in. I will definitely do more in the future for geriatric populations or people who are, I'd say, over 60 or so. But, you know, it's a little hard to say because people age differently too. I've seen people who are 75 who are more active than a 60-year-old. So I think it's definitely how you age and not necessarily your actual age, but it's your body's relative age.

Now, I'll probably have on the next time we talk about it, I'll probably have some type of expert or someone who works with those population sets for a certain type of condition or a certain subject to make sure that we have another talking point. Because, again, just to make sure that you guys all understand that I don't work a ton with these populations, but I have had a lot of exposure on and off throughout the years. And these are just the things that I've learned through the active older individuals that I've experienced because I've definitely had them through my office. So if you guys have questions on this stuff, if you're looking for the show notes, go on to p2sportscare.com.

You can look up session number. This is going to be 109. Or you can just look up, what is the topic? I'm going to put old farts in the topic, I think. So you probably look up old farts, you're going to see it. Or if you look up the term geriatric, I'm sure the show notes will be so dense with the term geriatric, you're going to be able to find it there too. So any of the links I talked about are going to be on that, including courses. Go through my website and check out courses. That is where I put all of the free information that is going to be better than the information that you actually paid people for, I think, in most regards.

So there's a ton of value in that stuff. And there's options to buy things in there if you want. There are, I don't want to say template programs, but they're the stuff that I usually start people with on those certain different types of conditions. And I'm not going to apologize for having people pay for stuff because I've got to make a living. And my goal at some point here is to be able to podcast full-time, write more content for people online, making it free. But at the same time, I can't do it if I'm doing patient care all the time. I'll probably just narrow down my patient care hours, and then I'll start to do a little bit more online content, e-books, e-courses, and so on.

I would love to do that. It's something I really am passionate about. I look forward to working with patients and working with them one-on-one. But I think from like an overall grand goal of mine is I want to be able to affect more people. And it's really hard to affect people one-on-one. I do recognize there's a big value of working with people one-on-one, and that's why I still do it. So, but probably the easiest way to get to the goal that I have in mind is to be able to do more things online, video, podcast, and text or copy or e-book based. So, if you guys want to support that, go through and check out my courses.

I'm hoping that you find a lot of value from that. And lastly, go review the podcast. Tell them what you think. Leave people better than how you found them. Have your granddaughter date an Eagle Scout. Talk to you later.