Transcript chapter - Human Kinetics

chapter
17
Age Considerations
in Therapeutic
Exercise
Table 17.1
Pediatric Growth and Development
• Prepuberty
– No difference between sexes for development of
secondary sexual characteristics
– Physical abilities equal
• Puberty and beyond
–
–
–
–
Girls begin and end process 2 years before boys
Size difference
Muscle bulk differences
Strength and power differences
Youth Bone Factors
• Physis is indication of maturity.
– Chondral material
– Can be damaged  may affect bone growth
– Damage: shear, compression, torsion
• Closure of physis = end of growth.
Youth Articular Cartilage Factors
• Articular cartilage (AC) also subject to damage
• Can be affected by stresses similar to those for
physis
• May be able to heal better in youth than in
adults
• Early diagnosis important to prevent lasting
injury effects
Youth Muscle Factors
• Not developed until puberty (testosterone and
other hormones)
• Strengthening exercises OK for preadolescent
children
– Follow guidelines from American Academy of
Pediatrics (AAP)
– Avoid shear forces
Youth Tendon Factors
• Bones grow faster than muscle.
• Tendon stress increases with growth spurt.
• Youth may develop tendon, apophyseal injuries
during growth spurts.
– Sever’s disease
– Osgood-Schlatter disease
– Little League elbow
Youth Neurological Factors
•
•
•
•
Muscle–nerve connections
Coordination
Accuracy
Recruitment patterns
Youth Thermoregulatory Factors
• Less sweating than in adults
• Higher convection rate
• More energy per body mass expended in heat
Youth Sport Injuries
• Will be first-time injuries for many
• Acute
– Sprains
– Contusions
• Chronic
– Tendinopathies
– Apophysitis
– Stress fractures
• Anterior cruciate ligament (ACL)
Table 17.2
ACL Reconstruction Choices
Depends on Maturity
• Prepubescent:
– Either no surgery (a functional brace instead) or a physealsparing and combined intra-articular and extra-articular
reconstruction using an autogenous iliotibial band graft.
• Adolescent with significant growth remaining:
– Surgery features a transphyseal ACL reconstruction using
autogenous hamstrings tendons with fixation away from the
physes.
• Older adolescent approaching skeletal maturity:
– Surgery is a conventional adult ACL reconstruction with
interference screw fixation using either autogenous central third
patellar tendon or autogenous hamstrings.
Rehabilitation Considerations for
Young Patients
• Assess for postural deviations.
• Avoid activities causing pain to growth plates.
• Strength exercises
– High repetitions, low weights
– Supervision required for proper execution
• Provide challenging exercises with successful patient
results.
• Patient’s face may get red.
• Give frequent breaks.
• Make exercises fun and varied.
Physical Changes As We Age
•
•
•
•
Gradual decline seen in all functions
May begin in 20s and 30s
Increases with age over 60
Connective tissue becomes stiffer
– Affects flexibility
– Increases injury risk
Aging Muscle Factors
• Sarcopenia = muscle mass decline secondary
to aging.
– Fewer functioning myosin heads  actin–myosin
bonds reduced
– Decreased muscle size
•
•
•
•
Speed of muscle contraction declines.
Point of peak output is delayed.
Muscle endurance decreases.
Exercise can improve muscle factors.
Aging Skeletal Factors
• Articular cartilage (AC) has less proteoglycan
aggregates  less water in AC.
• Articular cartilage becomes thinner, calcified.
• Osteopenia or osteoporosis occurs after
menopause.
• Bone density declines in both sexes.
• Exercise can reverse bone loss.
Aging Neural Factors
• Autonomic reflexes become less sensitive.
• Reaction time increases.
• Neural stimulation speed to muscles
decreases.
• Hearing and other senses decline.
• Memory declines.
• Other existing pathological conditions may add
to neural decline.
Rehabilitation Considerations for
Older Patients
• Gains will be made in rehabilitation but will be
slower than in younger patients.
• “Normal” flexibility, strength, endurance,
balance, and coordination will not be the
“normal” of younger patients.
• Speak more slowly and in a lower voice if
hearing is a problem.
• Use larger print for home exercise program
instruction sheets.
(continued)
Rehabilitation Considerations for
Older Patients (continued)
• Reduced vascular supply may slow healing for
these patients.
• Muscle and tendon tissue are weaker, so
overstretching should be avoided.
• Use lower weights and less aggressive
increments and rates of increase.
• Balance activity is necessary, but progress will
be slow.
• Use warm-up and cool-down.
Table 17.3