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We need to learn to be kids again

I posted this video after I came across one of my favorite articles. Basically in this article, the authors found that people (51-80 yo) who could perform this movement (sit to rise) from the floor without losing balance or needing support tended to live longer (de Brito et al. 2012). Such a simple test!

When I see patients I am focused specifically on how they move in the clinic. I watch how they get on and off of the table, take their shoes on/off, etc. To me, these are fundamental and essential survival skills. I probably learned more from watching how my kids move compared to any book or journal. On the surface it looks very simple. First they need to be able to roll on their stomach. From there they build up strength in their neck and back muscles to get to their hands and knees. As they build up hip and shoulder muscles they start to crawl. Eventually they can stand and start moving their legs in a walking motion. Voila! That’s it! But is it that simple?

As a clinician and parent, my experiences taught me there is more than meets the eye. It’s very easy to appreciate the learning process in young children. What we fail to recognize is how we lose these skills as we age. And when I say age, I mean starting from grade school! More on this topic for a different blog post.

Falls in an aging adult become very serious and in some cases deadly. It’s a known fact that mortality increases dramatically after an adult suffers a fall related hip fracture. Estimates of death within the first year after hip fracture range between 14-58%. Then it dawned on me that the bigger issue is WHY did the person fall. Identifying risk factors is important for safety. However, it is unlikely that these fall risk factors resolve spontaneously upon discharge. You can not simply reverse engineer this problem.
Seeing a fall is a very late manifestation of a degrading sense of play that occurs slowly but continuously over decades. To understand why people fall you must breakdown what you need to stand.

These are factors that I think are most important when it comes to movement and getting off of the ground.

MOBILITY

Mobility or freedom of movement in all joints is important. I’m not talking just about your hips, knees, and spine. I’m talking even about your ankles, toes, wrist, and fingers. As young children, we are super flexible but as we age we get stiffer and it’s not because we are getting old. What is one of the first things that happens once babies start to walk? We put shoes on them! Shoes are not evil. They provide much need protection in a modern world. However, they do change how we move our feet. What’s next? When they get into 1st grade they begin sitting a lot more! As we enter into high school, physical activity starts to become less and less. As adults we end up stuck in front of cubicles for 8 hours a day. This is when the process of freezing up the knees, hips, and spine begins in my opinion.

SPATIAL PLANNING

I view the head, arms, and legs as tools your for your “core.” You use them to help you crawl, stand, walk, run, and climb. There is no “best” way to use these tools. Period. There are a multitude of ways to accomplish and create movement. Imagine crawling for the first time and using your arms mainly. It’s certainly possible to do this with just your arms. However, if you do it this way then your legs drag and increase resistance to your movement. Now if you flex your hips and knees to the side like frog when trying to advance your arms, you’ll notice that it’s not only easier but you are also moving faster. Watch carefully how the baby learns how to crawl and then walk. Here’s a great video that demonstrates a baby learning to use their tools. Similarly, if you are trying to stand for the first time and you put your feet too close together you will likely fall on your butt. The next time you look up, widen your stance, and put your hands in front of you to counter balance your weight. I think that you will learn that it’s easier to stand for a longer period of time! Tools when used with intention creates learning.

SENSE OF CENTER

I do not consider “sense of center” and balance as the same thing. Balance is a neurological balance of sensory input from the eyes, inner ears, and sensory nervous system to keep you from moving or falling. Having a sense of center the sense of where your “center of mass” or your core is located. It’s generally considered to be the “middle” of your torso. Knowing where your center is can help you immensely. It helps your efficiency of movement but it can also help you leverage and create force without using more muscle. There are a number of pictures on the Internet comparing how a child performs a squat compared to an adult. Children effortlessly get into this position and also get up without using their hands and with significantly less muscle mass. Plus, they are built super top heavy. Imagine balancing a big head on a wobbly body. That’s your baby trying to walk! Babies learn this skill. It’s their full-time job. As adults, finding our sense of center requires more intentional practice. We have less time and more money than we were babies. If there’s an app for that we are buying it in a heart beat. However, there is not app for maintaining movement skills.

COORDINATION

Coordination, like balance, is a complex interplay of the nervous system. It’s not about strength but control of movement. Imagine extending your arm and index finger in front of you and then touching your nose as fast as you can. There is an immense amount of control order to complete this task without poking yourself in the eye or doing it so hard that you give yourself a bloody nose. Now imagine trying to throw a baseball, run, or perform a squat. These movements are a summation of thousands of learned decisions. These decisions have to be practiced and refined which is why it can take time for kids to learn how to stand. Now imagine trying to get off of the ground right now versus 20 years from now. What does it look like? Is it effortless? Are you using your tools? Knowing how to get off the ground is more critical when you are 80 versus than when you are 20.

CREATIVITY

Last but probably the most important. I define creativity as the ability to assess a situation, understand what you need, taking what you have, and completing the task in a variety of ways. As I’ve said before, there is no perfect way to do things. Situations change in an athletic movement. You are running on a hard surface that becomes rocky. You jump in the air for a rebound when all of a sudden someone bumps you and now you have land only on one knee. What if you broke your hip and you had to get to the phone across the room? Having a routine practice helps build skill but not creativity. Changing things up keep you challenged, thinking, and ready to react. Creativity I believe is the single most important movement skill to have hands down.

It’s very easy to say that people might not perform well in the clinic because they are in pain. However, I am not only trying to assess their pain. I am also looking at their overall mobility and their creativity of movement because this is what I consider essential. Strength is often not the biggest issue in my opinion. People are creatures of habit which is a double edged sword when it comes to movement. We become dependent on what’s easy and what works. However, what happens if you have a stroke and can’t use your arm or your legs? What happens if there is pain? What happens if there is no “cure” or “fix?” These “efficiencies” or habits become traps as we age. Become more creative with your movement. Figure out more than one way to do what you need to do. Learning how to move again is a lifelong skill which comes in handy with injuries or disabilities come your way.

Now, go play!

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WORK HISTORY

April 2016 – Current

Director of Sports Medicine

EVMS MEDICAL GROUP, NORFOLK, VA

I currently work in the Department of Physical Medicine and Rehabilitation. I also serve as assistant professor at EVMS working with residents and medical students.


August 2012 – March 2016

CLinician and managing Partner

REBOUND ORTHOPEDICS & NEUROSURGERY, VANCOUVER, WA

I loved living in the Pacific Northwest! Aside from clinical care, I was involved in holding monthly spine conferences and helping develop a multidisciplinary spine center.


EDUCATION

2011 – 2012

Spine and Sports Medicine Fellowship

SPINE AND SPORTS PHYSIATRISTS, ELMHURST, IL

A year dedicated to diagnosing and managing a variety of musculoskeletal injuries. I also had the opportunity to give a variety of lectures to various residents in the Chicagoland area.


2008 – 2011

Physical Medicine & Rehabilitation Residency

NORTHWESTERN UNIVERSITY / REHABILITATION INSTITUTE OF CHICAGO, CHICAGO, IL

Outside of residency, I became very involved within the field at a national level serving as president of the Resident Physician Council for the American Academy of Physical Medicine & Rehabilitation. Helping develop the largest and longest running physiatric medical student programs in the country is one of my proudest achievements.


2003 – 2007

Doctor of Osteopathic Medicine

ARIZONA COLLEGE OF OSTEOPATHIC MEDICINE, GLENDALE, AZ

A challenging yet exciting part of my life. This is where I started to create my vision of musculoskeletal medicine. My skills as an osteopathic physician have truly complemented my sports medicine practice.


1997 – 2001

B.S. Biology

GEORGE MASON UNIVERSITY

Aside from studying, I became very involved in the Filipino-American community on campus. This is where I realized my passion for leadership and mentoring.

NAVIGATION