Strong Calves, Steady Bodies

by Julia Glick, PT

Whether we've tripped over an unexpected item in our home or over our own feet walking down the sidewalk, nearly all of us have taken a tumble - and those risks only increase for older adults. In fact, up to one third of people over 65 will have a fall each year (Sherrington et al. 2016), so balance and fall prevention is a huge part of what we look at in the clinic. Since there are already many resources that discuss the negative impacts of poor balance and falls - especially in the elderly - let's focus on balance and its relationship to calf strengthening.

But first, how do we define balance? According to a 2012 Cochrane review, balance is “the ability to stay upright and steady when stationary and during movement.” Let's break that down a little bit: if you are walking, sitting, standing, running, or even juggling balance is your ability to stay upright. If you start losing your balance or falling, balance also includes the ability to return to the upright position. It is thought that balance declines with age for a variety of reasons such as decreased strength, range of motion, reaction time, and awareness of where the body is in space (proprioception) (Howe et al. 2012).

Naturally, there are a number of interventions to help patients improve their balance. In a 2016 study by Maritz and Silbernagel, patients were given a general balance training program, but what was novel about it was that it incorporated calf strengthening. The researchers found that the group that incorporated single leg calf raises over 5 weeks into their program had greater improvements in balance than the group that did not. But why would doing calf raises make someone’s balance better?

A study conducted by Fujiwara et al. (2011) helps shed some light on why calf strengthening may help with balance. In this study, participants performed 100 calf raises daily for 2 months. They showed improved strength of the soleus (part of the calf) and improved reaction time with reaching activities. Fujiwara et al. suggested that calf strengthening promoted these improvements by promoting an "ankle strategy" with balance. Calf strengthening has the potential to improve someone’s ability to react quickly with small ankle movements and other postural muscles to prevent the need to take a big step if someone loses their balance. A smaller movement requires less energy and decreases the chances of someone stepping wrong and getting hurt. 

Single leg calf raises

Double leg calf raises

If you are already working on a balance program try adding double leg calf raises to your program and if those are too easy try single leg calf raises. If you are having difficulty with your balance or are having falls please contact a medical professional.

References: 

Fujiwara, K., Toyama, H., Asai, H., Yaguchi, C., Irei, M., Naka, M., & Kaida, C. (2011). Effects of Regular Heel-Raise Training Aimed at the Soleus Muscle on Dynamic Balance Associated With Arm Movement in Elderly Women. Journal of Strength and Conditioning Research, 25(9), 2605–2615. doi: 10.1519/jsc.0b013e3181fb4947

Howe TE, Rochester L, Neil F, Skelton DA, Ballinger C. Exercise for improving balance in older people. Cochrane Database of Systematic Reviews 2011, Issue 11. Art. No.: CD004963. DOI: 10.1002/14651858.CD004963.pub3

Maritz CA, Silbernagel KG. A prospective cohort study on the effect of a balance training program, including calf muscle strengthening, in community-dwelling older adults. Journal of Geriatric Physical Therapy 2016; 39:125-131.

Sherrington C, Tiedemann A, Fairhall NJ, Hopewell S, Michaleff ZA, Howard K, Clemson L, Lamb SE. Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD012424. DOI: 10.1002/14651858.CD012424

Getting Into a Pickle(ball)

by Sally Fansler, PT

Move over, tennis and golf – here comes pickleball! A new favorite pastime among Baby Boomers, this sport combines elements of badminton, tennis and ping-pong. In recent years, it has become popular with older adults because of the smaller court, lower net, and slower ball speed. The rules are fairly straightforward and easy to learn, so pickleball easily becomes a fun social activity. It can be played indoors or out, in singles or doubles.

Over the past decade, however, the pickleball craze is taking hold at all age levels. Teenagers often play it in their physical education classes, and it is showing up as an intramural sport on college campuses. According to the USA Pickleball Association (USAPA), the sport has seen a 650% increase in numbers over the past six years. On-site pickleball courts are now being built not only at many retirement communities, but also as part of community park districts. The equipment – wooden paddles and plastic, whiffle-type balls – is also affordable, making it accessible to be enjoyed by a wide range of people.

Here is the pickleball rule overview:

• The serve must be underhand and below the waist—and it must be made at least one foot behind the baseline, struck diagonally crosscourt.  Only one serve attempt is allowed.
• Only the team serving the ball is able to score points, which take place when the opposite side fails to return the ball or commits other faults, such as hitting the ball out of bounds. 
• When the ball is served, the receiving team must let it bounce before returning, and then the serving team must let it bounce before returning, thus two bounces.
• After the ball has bounced once in each team’s court, both teams may either volley the ball (hit the ball before it bounces) or play it off a bounce (ground stroke).
• The two-bounce rule eliminates the serve and volley advantage and extends rallies.
• With doubles, both players on the serving team have the opportunity to serve and score points until they commit a fault
• Games normally go to 11 points, with the leading team needing to be 2 points ahead to win

Lakeshore Sport & Fitness in Chicago is planning an intro to pickleball class on Sundays in the fall of 2019. Please contact LPRacquet@LakeshoreSF.com for more information. The Chicago Park District is also growing their program and information on additional places to play can be found here: https://www.chicagoparkdistrict.com/taxonomy/term/2210

References:

https://www.usapa.org/