Aging Frames: Baby Boomers Visit PTs with Musculoskeletal Complaints
Monday September 6, 2010
Print This- Select Text Size:
advertisement
Orthopedic surgeon Nicholas DiNubile, MD, couldn’t get through his own gym workouts without baby boomers asking his advice about their sports-induced aches and pains. In the early 1990s, he noticed more and more boomers (born between 1946 and 1964) becoming patients, complaining of overuse and other injuries.
“I call it a ‘mismatch’ between longevity and durability,” says DiNubile, who specializes in sports medicine and is clinical assistant professor, department of orthopedic surgery, Hospital of the University of Pennsylvania. “We’re living longer and looking better, but it’s our [musculoskeletal] frame that’s failing us. We need to ‘extend the warranty’ on our frames.”
DiNubile coined and trademarked the term “boomeritis” and wrote a series of “FrameWork” books aimed at keeping people’s musculoskeletal frames healthy throughout the aging process.
“Baby boomers are the first generation that is really trying to stay active on and challenge that aging frame in droves. In my parents’ generation, they just thought that, as they got older, they got more frail, and that was the normal aging process over which they had little or no control. Also, if they ever went out and did some activity, and were even a little sore the next day, they’d never do it again,” DiNubile says.
DiNubile says that boomers tend to push their aging frames into what he calls, “tendinitis, arthritis, bursitis and, most importantly, fix-me-itis.” The last of which is the boomers’ mindset that anything that goes wrong can be fixed, and boomers will go to any extent for the fix. “I tell my patients, ‘We can turn the clock back a little; we can certainly rewind it. But we can’t turn it back all the way,’” DiNubile says. “I think physical therapists can play an essential and dramatic role in how the aging frame can be better managed ... in finding the weak links that we all have [whether they’re symptomatic or not].”
Changing Mindset
PTs treating baby boomers need to look beyond the day of discharge, according to Marilyn Moffat, PT, DPT, PhD, FAPTA, CSCS, CEEAA, professor of physical therapy at New York University. “If somebody comes to me at the age of 55 for a rotator cuff tear ... I look at that individual not only as a person with a rotator cuff injury but rather as a 55-year-old individual probably wanting to be an athlete for as long as he or she can be,” Moffat says. “Therefore, my responsibility is not only to treat the rotator cuff, but also to give guidance and parameters for how patients can participate in their sports at levels they want, for as long as they can.”
Moffat says that by looking at five basic parameters she can identify a person’s physical weaknesses: posture, strength, flexibility, balance and endurance. She then can guide the patient in how to prevent future pathophysiological and physiological issues having to do with the aging process.
“We, as PTs, deal with these automatically in practice,” Moffat says.
Moffat says the examination might take an hour to run tests that include wall occiput and rib/pelvis tests for posture; static and moving balance tests; sit-to-stand test, bicep curls and grip dynamometry tests for strength; the back scratch test for arms; seated sit and reach for legs and low back for flexibility; and a two-minute step test or walk test for endurance.
Moffat, who is co-author of the book “Age-Defying Fitness: Making the Most of Your Body for the Rest of Your Life,” takes a little less time during appointments focusing on the specific injury and a little more on educating patients about self-preservation. For example, for patients who have arthritic knee changes, she will look at family history, the patient’s chosen sports, workouts and gear, such as running shoes. She will give advice, which might be for the aging athlete to switch to a less stressful option. “Giving exercise parameters is easy once you do the testing. You know where their weaknesses and needs are and can point them in the right direction.”
Fee-For-Service PT
Some PTs might think this means extra work for providers, but, in fact, it means more business, experts say.
“PTs have the knowledge base and can bridge that gap between the rehab world and the fitness world, which is a real big gap right now that needs to close,” DiNubile says. “In many gyms, more than 50% are over the age of 50, so they’re working with trainers who might not have this rehab background.”
Here is where PTs might be missing the boat.
“A lot of my patients come back and say, ‘Now what do I do in the gym?’ Some PTs are doing the fitness and transition programs, but I believe that you want to make that person really independent, so that no matter where they go, they know what they should and shouldn’t do. Many therapists are not venturing into that patient’s everyday world of workouts and fitness,” DiNubile says.
Wellness is an opportunity for PT practices. “I get a lot of patients and clients that come in just for an examination for a prevention program,” Moffat says.
Michael Weinper, PT, MPH, president of PTPN, a network of independent rehabilitation providers, says converting patients to clients is key to surviving dwindling insurance reimbursement. While patients in states that do not have direct access need a physician’s referral for PT treatment of an illness or injury, clients who seek wellness services pay out of pocket.
“Prevention and wellness are cash-based, non-insurance services,” Weinper says. Other types of providers are well into nurturing this part of business, he says. For example, dermatologists might offer clients cosmetic procedures and skin care products, and dentists sell toothbrushes and tooth whitening.
“The therapist should be a focal point for [baby boomers’] wellness, as well as their injuries,” Weinper says. “In physical therapy, there is a natural transition to wellness services.”
PTPN’s Physiquality initiative helps therapists transition insurance-covered patients into cash-paying clients through training in how to develop a “retail” wellness component in a practice, discounts on products and programs that can be offered to clients, and consumer marketing to drive boomers and other target audiences to member clinics.
“The market research we did in developing Physiquality very clearly told us that aging Americans, like baby boomers, are looking for more professional and supervised wellness and fitness services than they might get at a health club or gym,” Weinper says.
Wellness services might include periodic examinations and exercise advice, as well as marketing equipment, such as exercise bands and balls.
“Part of our training as physical therapists has always been to educate our patients about home exercise,” Weinper says. “I believe that a good therapist not only treats illness but also keeps a patient from coming back as a patient but, instead, as a client.” •
Lisette Hilton is a freelance writer.
“I call it a ‘mismatch’ between longevity and durability,” says DiNubile, who specializes in sports medicine and is clinical assistant professor, department of orthopedic surgery, Hospital of the University of Pennsylvania. “We’re living longer and looking better, but it’s our [musculoskeletal] frame that’s failing us. We need to ‘extend the warranty’ on our frames.”
DiNubile coined and trademarked the term “boomeritis” and wrote a series of “FrameWork” books aimed at keeping people’s musculoskeletal frames healthy throughout the aging process.
“Baby boomers are the first generation that is really trying to stay active on and challenge that aging frame in droves. In my parents’ generation, they just thought that, as they got older, they got more frail, and that was the normal aging process over which they had little or no control. Also, if they ever went out and did some activity, and were even a little sore the next day, they’d never do it again,” DiNubile says.
DiNubile says that boomers tend to push their aging frames into what he calls, “tendinitis, arthritis, bursitis and, most importantly, fix-me-itis.” The last of which is the boomers’ mindset that anything that goes wrong can be fixed, and boomers will go to any extent for the fix. “I tell my patients, ‘We can turn the clock back a little; we can certainly rewind it. But we can’t turn it back all the way,’” DiNubile says. “I think physical therapists can play an essential and dramatic role in how the aging frame can be better managed ... in finding the weak links that we all have [whether they’re symptomatic or not].”
Changing Mindset
PTs treating baby boomers need to look beyond the day of discharge, according to Marilyn Moffat, PT, DPT, PhD, FAPTA, CSCS, CEEAA, professor of physical therapy at New York University. “If somebody comes to me at the age of 55 for a rotator cuff tear ... I look at that individual not only as a person with a rotator cuff injury but rather as a 55-year-old individual probably wanting to be an athlete for as long as he or she can be,” Moffat says. “Therefore, my responsibility is not only to treat the rotator cuff, but also to give guidance and parameters for how patients can participate in their sports at levels they want, for as long as they can.”
Moffat says that by looking at five basic parameters she can identify a person’s physical weaknesses: posture, strength, flexibility, balance and endurance. She then can guide the patient in how to prevent future pathophysiological and physiological issues having to do with the aging process.
“We, as PTs, deal with these automatically in practice,” Moffat says.
Moffat says the examination might take an hour to run tests that include wall occiput and rib/pelvis tests for posture; static and moving balance tests; sit-to-stand test, bicep curls and grip dynamometry tests for strength; the back scratch test for arms; seated sit and reach for legs and low back for flexibility; and a two-minute step test or walk test for endurance.
Moffat, who is co-author of the book “Age-Defying Fitness: Making the Most of Your Body for the Rest of Your Life,” takes a little less time during appointments focusing on the specific injury and a little more on educating patients about self-preservation. For example, for patients who have arthritic knee changes, she will look at family history, the patient’s chosen sports, workouts and gear, such as running shoes. She will give advice, which might be for the aging athlete to switch to a less stressful option. “Giving exercise parameters is easy once you do the testing. You know where their weaknesses and needs are and can point them in the right direction.”
Fee-For-Service PT
Some PTs might think this means extra work for providers, but, in fact, it means more business, experts say.
“PTs have the knowledge base and can bridge that gap between the rehab world and the fitness world, which is a real big gap right now that needs to close,” DiNubile says. “In many gyms, more than 50% are over the age of 50, so they’re working with trainers who might not have this rehab background.”
Here is where PTs might be missing the boat.
“A lot of my patients come back and say, ‘Now what do I do in the gym?’ Some PTs are doing the fitness and transition programs, but I believe that you want to make that person really independent, so that no matter where they go, they know what they should and shouldn’t do. Many therapists are not venturing into that patient’s everyday world of workouts and fitness,” DiNubile says.
Wellness is an opportunity for PT practices. “I get a lot of patients and clients that come in just for an examination for a prevention program,” Moffat says.
Michael Weinper, PT, MPH, president of PTPN, a network of independent rehabilitation providers, says converting patients to clients is key to surviving dwindling insurance reimbursement. While patients in states that do not have direct access need a physician’s referral for PT treatment of an illness or injury, clients who seek wellness services pay out of pocket.
“Prevention and wellness are cash-based, non-insurance services,” Weinper says. Other types of providers are well into nurturing this part of business, he says. For example, dermatologists might offer clients cosmetic procedures and skin care products, and dentists sell toothbrushes and tooth whitening.
“The therapist should be a focal point for [baby boomers’] wellness, as well as their injuries,” Weinper says. “In physical therapy, there is a natural transition to wellness services.”
PTPN’s Physiquality initiative helps therapists transition insurance-covered patients into cash-paying clients through training in how to develop a “retail” wellness component in a practice, discounts on products and programs that can be offered to clients, and consumer marketing to drive boomers and other target audiences to member clinics.
“The market research we did in developing Physiquality very clearly told us that aging Americans, like baby boomers, are looking for more professional and supervised wellness and fitness services than they might get at a health club or gym,” Weinper says.
Wellness services might include periodic examinations and exercise advice, as well as marketing equipment, such as exercise bands and balls.
“Part of our training as physical therapists has always been to educate our patients about home exercise,” Weinper says. “I believe that a good therapist not only treats illness but also keeps a patient from coming back as a patient but, instead, as a client.” •
Lisette Hilton is a freelance writer.
To comment, e-mail pteditor@gannetthg.com.
Monday September 6, 2010