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Shaking Off The Rust Intro 1: Smart talk on aging smartly. It's another episode of Shaking Off the Rust Here's Carl.

Carl Maronich (Host): So Bryan, what we want to be talking about is how folks can stay active so they're staying healthy. That's the big thing, right? We want to make sure people have in mind what they can do, and how activity is going to reinforce their health. So, let's jump into that conversation. Maybe I'll start by asking—as folks get 50 plus, their body starts changing, or at least they perceive it's changing or they're noticing things, what would you tell a 50-plus-year-old about staying active?

Bryan Hack, PT, DPT, EMT-B: Yeah. I believe, you know, activity is different for everybody. The way our bodies are, the way we react to activity, the way we react to stress, those types of things. So, activity looks different for everybody. And that means there's a starting point and endpoint everybody. If you're not doing anything, we start with something, right? If you are doing things and your activity is pretty high and you're still seeing some issues, then we get a little bit more in depth about maybe—are you doing the right activity? Are you doing the wrong activity? What else can be done? So, there's a lot of conversation that can be had.

But at the basics of it, as we age, our bodies begin to what people call deteriorate, we just need to stay active, we need to stay moving. And that gets difficult as we age, right? Things start to hurt. Things don't move like they used to, or we get really comfortable with the television or we have long car rides, we sit in the office, activity becomes more difficult, as we get into those things like that.

And so at the end of the day, what we got to do is look at ourselves and what we're doing now, and we got to move more. The simple thing is move more and that looks different for everybody. Again, if you're at the very beginning of it, you're not moving at all, start with walking. If walking's somewhat of an issue because of joint pain, those type of things, start with swimming. Get in the pool, just move. If you're fairly active already and you still want to continue on that path, then what else can you do at home? Can you lightly run? Can you jog? Can we up your swimming? Can you get with a personal trainer? Can we start strength training? Those are the things that you need to look at is the body is made to move. The body is not made to sit still. When that begins to happen, we start to break down, right? And then, I'm talking more muscular breakdown, but even prolonged inactivity, metabolic issues, right, neuro issues can happen. So at the end of the day, we got to keep ourselves moving.

Host: Keep moving. That makes me think, Bryan, that we should have done this podcast as we were walking. You mentioned we sit a lot. We all do, unfortunately, probably. So, we should have done this walking next time we're together. We're going to do it in motion.

But, you know, you mentioned aches and and pains and that's, you know, a natural part of getting older, a natural part of life at any stage, really. But there can be a difference between, you know, an ache or pain that's just, you know, "I got to get up and move a little bit. It's going to go away," or something that's a little more serious and might need professional attention. What's your advice to folks about kind of gauging kind of pain they're having, and what they should be doing about it?

Bryan Hack, PT, DPT, EMT-B: Yeah. Again, pain is a complicated topic as well, right? You know, as we get older, and when I'm working with patients of the older generation, morning stiffness is fairly common. That kind of a normal process, things that, as we rest, our muscles get stiff as we age. And so, morning stiffness is typically normal, that kind of ache and soreness should go away as you begin to move a little bit more throughout the day. And I encourage, you know, my patients who are complaining of this is get some morning activity, and that soreness, that achiness is going to go away faster and potentially you get rid of it if you start moving more in the morning. You're going to get mild soreness with activity, right? If you do some strength training or you do something that you haven't done in a long time, you're probably going to have some soreness. Soreness is okay. Soreness will go away. That's the body just producing elements for itself to build more muscle. And that's how our body responds. If that doesn't go away, that's another issue. But if it goes away, that's an okay thing to have.

And occasional joint pain is okay as well. You know, let's say you had your grandkids over and you spent some time on the floor, you're getting up and down, you know, you might have some knee soreness, you might have some muscle soreness from that. I wouldn't say that's necessarily a rush to the emergency room or rush to the doctor. You know, if things are starting to simmer down, most likely okay.

Now, where I tell folks to help my patients, when that pain begins to be more limiting, right? You're not able to perform the things that you want to perform, right? You're having more aches and and pains. That's when you need to get a little bit more cautious about seeing a doctor, seeing a physical therapist, so we can kind of discuss what's going on. Because at the end of the day, we should not be having aches and and pains. There's usually reason for those that we can minimize.

Host: And in that example you used, you know, the grandkids you're playing, you get and down on the floor, and then you know, they go home. Later that night or the next day, you're, "Oh man, I'm stiff, I'm sore." That, I would think is an indication you need to be doing something when the grandkids aren't over to get your body ready for that kind of activity. And we're not talking about running a marathon, but just get ready for basic activities of life or some of those advanced activities that you still want to make sure that you can do and have fun with and not have to rest the next day because you were playing with the grandkids.

Bryan Hack, PT, DPT, EMT-B: Exactly. I mean, that's one of the more common things that I get in therapy practice, is "I'm here because either I want to be able to participate with my grandkids or, you know, I lifted them or I played with them and now I got a sore back or I got a sore knee." That's a common conversation that I have most often with my patients who are over 50, 60 years old. They still want to be part of their day. They still want to participate like they were when they were 30 and 40, right? And typically, that is running around with grandkids, picking them up, just keeping up with them, right? That is a real goal to have, and I would encourage everybody to have that type of goal, because that's what keeps us young. Not only do the grandkids keep us young, but preparing to keep up with them is going to keep us young.

Host: Absolutely. And again, I would guess, and I won't put words in your mouth, but the activities that we're talking about, as I said a minute ago, not necessarily training for a marathon, although that's great if that's what you're able and want to do. But, you know, even just again, playing with the grandkids, gardening or maybe trying to play pickup basketball at the Y a couple days a week, or start playing pickleball or tennis or something to keep active. But I think some of us, when we go down that road, suddenly, you know, we've got to train for five hours every day and we kind of get carried away with it. So, what advice would you give folks for kind of keeping it real a bit?

Bryan Hack, PT, DPT, EMT-B: Yeah. Keeping it real is entirely start low and start slow. Again, you're not trying to beat any world records, right? You're not trying to run any marathons at this point. You're just trying to maintain, right? And the number one anti-aging activity in a sense outside of just normal keeping up with movement and walking is strength training, the musculature is going to preserve our body mostly. The latest research out there is we should all be strength training at some level to help reverse the aging process. It's starting to help. We're seeing it help metabolic health, neuro health, those type of things is. So, we really got to look at how strong are we and where can I fit in strength training into my day.

And when I say strength training, I'm not saying going to the weight room and lifting dumbbells around, right? Strength training can be as simple as walking. Strength training can be as simple as sitting up and down from a chair 10 times. Strength training can be simple, and it can be done effectively at the house. It can be done effectively outside, most definitely be effectively done in a gym, but you don't have to go and be an Olympic lifter at this point. We just need to maintain our strength and continue to build the muscle as we get older.

Host: Kind of to that point, again, starting slow, building up, having realistic expectations, I guess is kind of what it comes down to that are not just doing something that gets your body moving. I think of resistance as opposed to weightlifting. And maybe, you know, those terms are interchangeable or they're slightly different. But body weight kind of exercises as opposed to—and that's what you were just saying, getting up and down in a chair—as opposed to thinking about you have to buy a rack of barbells or join the Y and go to the weight room with all the big muscle guys and do that. And that would probably be overdoing it.

Bryan Hack, PT, DPT, EMT-B: Certainly, that's going to benefit you more if you're able to work to that level, right? And get to muscle building at that point. But again, that's not necessarily what it takes. Again, we need to preserve what we have, do not let it decline, and build just low and slow as we age, right? And again, that's as simple as body weight exercises. Walking a half mile, walking a mile, right? Getting up and down a chair. Resistance training could be as simple as some band work, right? Again, I wouldn't suggest going right into band work without a little bit of communication with a physician or a physical therapist.

But easy way to get some activity at home is band resistance training. You hook it on the door, you hook it somewhere simple, and you'll automatically have a gym in your house and you can do all kinds of sort of exercise.

Host: People that are hearing this and they're going to decide, "Yeah, I need to start doing something," and maybe they're going to go to the internet and look up, "What resistance should I do? What should I be doing as a 50, 60-year-old, whatever?" And there has to be caution with that, I would guess. You want to make sure you're getting good information. How would you advise folks if they want to try kind of get the information on their own before seeking out a trainer or something? Is there something you'd recommend in that regard?

Bryan Hack, PT, DPT, EMT-B: That's a tough one. The Google doctor, you know, it's tricky. You can find anything and everything on the internet, especially these days. you know, if you don't have much background or understanding on the science of, you know, muscle training, understanding what that is, seek out some advice, whether that be talk to your physician, talk to your local therapist. You can overdo it. A lot of folks get eager, "I'm ready to do this. It's time," and you overdo it, you potentially injure yourself, then you're set back, and/or you're doing it incorrectly. And then, you have these joint issues and that stuff down the road.

There is some basic things that you can find on the internet that are not going to hurt you. But if you're struggling to find what might work, what might not work, as simple as talking to your local therapist or your primary care provider, at least where to start so you don't cause any more issue.

I always recommend you're not going to do that, start very low, start very slow. Again, don't go from the couch to running a 5K in a day. Take that quarter mile approach, that mile approach, that mile and a half approach before you get up to the 5K. And you most likely would be fine progressing yourself.

Host: Bryan, I want to get to injuries and some of the common injuries that you might see and what folks could do in advance to prevent that. But before we get into that, I want to talk a little bit about your background or ask you to talk a little bit about your background as a physical therapist and some of the other training and things that you do.

Bryan Hack, PT, DPT, EMT-B: Yeah. So, I've been a physical therapist by background for 12 years. I grew up in central Illinois area. I went to school at the University of Illinois. Quickly realized then that physical therapy was a degree that I wanted to pursue. I spent some time in therapy myself, following up with a sports injury. That's where my interest started to spark with the therapy profession. Then, I went up down to St. Louis at Washington University. I obtained my physical therapy degree there. I spent some time in private practice after that in the Nashville market. quickly realized, you know, as I met my wife and we were beginning to have a family, we needed to get closer to home, her homes this way as well, which landed us more so in the central Illinois area.

And this point, since being at Riverside, I'm more on the leadership side. I'm on the hospital administration side. But I oversee all physical, occupational speech therapy operations that our hospital offers. So, I still get to interact with patients. I still get to create programs for our patients who are seeking out, you know, at this point, injury prevention or injury recovery. But it is been a great career up to this point, because this is a passion of mine. I love these topics. I love having these conversations. I love bringing it forth. So, our patients and our community understand what's out there for them and how to safely do this.

I mean, Carl, we're not going to get any better as a society at current state. Current society, we're obese, we're not as active as we should be. We need to change the course of action, so we can continue to live healthier lives so we can begin to live longer. So, we are there for our grandkids, so we're there for our great grandkids, those type of things. It is going to take the healthcare profession to kind of help change that pattern.

Host: So, you're director of physical therapy at Riverside Healthcare in Kankakee, Illinois where you're based with a great extensive background. And as I said, leading into that question—injuries. What kind of injuries are common that you see in the 50 plus crowd? And again, we want to make sure folks are doing before they get too active to hopefully prevent those injuries.

Bryan Hack, PT, DPT, EMT-B: Yeah. I mean, it goes the whole spectrum. We see it all. I would say we see a good amount of back soreness, back injury in the age of 50 plus. A lot of shoulder discomfort, shoulder injury, lifting your arm. I'm having shoulder pain. At that age, we're beginning to see balance issues as well. Patients are coming to us saying, "Hey, I just don't have the balance that I used to." And that is an aging change, right? Fifty plus, we're beginning to see those aches and those pains that weren't there before. We're seeing injuries from, "Hey, I tried to be active like I was and I hurt myself," whether it be low back, knee. And we're beginning to see those joint discomforts. You're starting to have those conversations around what does a total knee look like in my future? What does a total hip look like in my future? We're beginning to see those at the 50 plus age.

It's a whole spectrum though. Every patient, individual, it comes in a little bit different. But that's what's great about physical therapy. We're trained to treat them all. I would say that's a very global message there. But a physical therapist is trained to look at the body from a musculoskeletal standpoint and help the musculoskeletal system is our knowledge base. We utilize that as our treatment method to helping you get on the right path.

Host: You mentioned balance. And I know that's important and continues increasingly important, as you age. Maybe you could talk a little bit about that and what should the average person be doing around the idea of balance before it becomes an issue that they have to seek help for?

Bryan Hack, PT, DPT, EMT-B: There is some physiological changes that just occur with aging that affect balance being vision. There's things in our ear that help us balance and understand where our head is in space. Those things begin to physiologically change as well. That don't work as well.

But at the end of the day, two strength. Strength is a big one when it comes to balance. So, if we're losing strength in our core, our belly and our back muscles, if we're losing strength in our hips, we're going to see that transition of balance become a little bit more difficult. You'll find yourself turning and not catching yourself as good as you used to, or stepping off that curb and not catching yourself as much as you should, just because the strength and the hips and the core are not there like they used to be. And the good news about the strength versus kind of the eyes and the ears is we can reverse the strength, we have the power to at least slow the decline and/or reverse strength issues.

Host: And that's interesting. Because you said, I think when people think about balance and get concerned about balance, they think of their feet. And it's really not just in your feet. It's really the whole body, and there's a lot of elements that come into play when it comes to balance.

Bryan Hack, PT, DPT, EMT-B: That's a good point too, Carl. There's proprioceptors in our whole body, but mostly our feet when it comes to balance that we lose from a physiological standpoint as well. And again, those are just things that happen as we age. Not necessarily things that we can change. But again, strength is going to be a core component to that as well. So, when you take a step, your brain knows where your foot is from the muscle pole and the muscle relaxation. And so, as you continue to train that, your brain's going to pick that up still. Though we can't change some of those other items, we certainly can change the strength to keep that part of the body.

Host: Yeah. You know, you mentioned, we talked earlier about playing with the grandkids and getting an ache or pain from that. But what are some of the other things you may be seeing people come in with injury, if they're going to physical therapy because of an injury? And I have to believe getting near the top of that list is pickleball. Because lot of people are now playing that and they've heard about it and maybe they didn't get in the kind of shape maybe they should have before they started running around on the court. What's the deal with pickleball in the physical therapy world these days?

Bryan Hack, PT, DPT, EMT-B: Yeah. You know, I would say the injuries that we see from, I would say golf is up there as well. Pickleball obviously being the one that's come more often. Typically, I would say the injuries that we see, you know, acute injuries, things that just popped up, is "I just wasn't trained for that," right? "I went out and played pickleball for two hours and now all of a sudden I can't lift my arms, my legs are sore. You know, I got this hip pinching now." That's just from being inactive, going to a heavy activity without a lot of training in between.

So, I would say low and slow, right? If you're going to pick up pickleball, don't go play the two-hour game against the guy who's been playing for the last six years, you got to train yourself. You know, we just watched the Olympics. You know, those are the top-tier athletes. But man, those are folks who are training 24/7 to be able to compete at that level, right? Again, we're not to that point, but we got to train to the activity level that we're trying, right? We can't just pick it up and go.

So, we do see a lot of injuries, I would say, just because of inactivity going straight to activity. You know, anytime that you pick up a sport I won't say that's a heavy load or that's a huge physical activity, but you're going to start stressing things that you probably haven't stressed in a long time. We get shoulder injuries from pickleball just because, you know, you haven't done a lot of overhead swinging or even side swinging in quite some time. So, you got muscle imbalances that's causing the shoulder joint not to necessarily work like it should. And now, you're taxing it much more, causing irritation. So, we have to really look at what's your muscular component of your shoulder so we can get that swing moving in a direction that it should. That way, the joint's working properly. You're not pulling on things that shouldn't be pulled on.

Host: And also, stretching just prior to an activity. That's another thing that people generally, and I myself included, don't put enough emphasis on or don't think enough about, or do it all wrong and put yourself at greater risk from the stretching than from the actual activity.

Bryan Hack, PT, DPT, EMT-B: Yeah. Stretching is probably one of the most important tasks to activity that gets missed probably most of the time, right? But being one of the most important and it is very difficult to understand what should I stretch? Where do I stretch it? How long do I stretch? Is that even the right stretch? That's a lot of questions that we get. And what I tell people who are getting new into activity or trying to build activity back up is, as you start an activity or let's call it the warmup, it should be dynamic. It should be moving. You know, you think of the hamstring stretch, right? You stick your leg out and you bend over and you stretch. That is what we call a static stretch. Those stretches are left for after activity, after your muscles are warm, after they've been through some activity and things are moving appropriately.

When you're warming up, so you're coming from, waking up or from sitting in a chair all day, you want to do a dynamic stretch. And that is this kind of slow, consistent movement, getting those muscles kind of used to getting stretched, getting relaxed, getting moved, getting the blood flow to them. That's the appropriate warmup for getting into an activity versus a static stretch right away. You're going to stretch it, but it's probably not going to help you perform that activity better, or at least get long-term change versus that dynamic stretch at the beginning.

Host: Yeah. Talking about the hamstring stretch. And you very closely described mine. It's put the leg out, stretch it, and then scream in pain because it wasn't warmed up at all before I tried to stretch it. Warming up, that's probably the better word to use. Warming up as opposed to stretching.

Bryan Hack, PT, DPT, EMT-B: Again, dynamic is key. I would say a simple walk is more of a stretch warmup than a static hamstring stretch, right? And so, getting things mobilized, getting things moving, getting blood flow to the areas is key before you start an activity just to make sure the muscles have everything that they need to perform.

Host: In most places, Bryan, if somebody has an issue, they've been some activity, now they have an issue, should they go right to a physical therapist or they go to their primary care provider first, or what's the best path for them to take?

Bryan Hack, PT, DPT, EMT-B: Yeah. You know, that's the burning question that everybody has. And it's difficult to probably understand like, what do I do at this particular moment. I always say it's a safe bet to go to your primary care. They're going to have the best knowledge of you from a general practice standpoint, from a general health standpoint, to assess you in full and understand where you're at with your current injury.

But I will say most states in the United States, you can walk into a physical therapy office and ask to be evaluated,. And they will and they should. I would say, you know, if you're having this acute minor ache, soreness, pain, you know, you play with the grandkids, now your back is sore, most appropriate to walk into a PT office. You walk into my office and I assess you, I'm going to say, "Hey, I think I can help you here. I saw some things here that we can progress. Let's do this," or I might say, "You know what? I'm going to have you go see your primary care. Something's just not quite adding up with my assessment. I'm going to have you go to the primary care." They might ask for x-rays, MRIs, those type of things, just to make sure we're not in a position that's significant, right?

I think either one is appropriate. Again, if you have a great relationship with a physical therapist already, you've been treated before by that physical therapist for that same injury, most definitely—and your state allows it, go for it again. If you haven't been in that before and you have a relationship with a primary care, go ahead and go to your primary care first. They're going to put you on the right path either way.

You know, a system like ours here at Riverside and Kankakee, we work heavily with our physicians. So, you might call me and say, "Hey, I got this leg issue." And I'm going to say, "Come see me. I'll call your doctor in the meantime and we'll get this kind of sorted out," I'll give them a heads up, right? And so, there are markets out there that work like that too, where the therapist and the physician are in tune with each other, and they kind of help get that patient in as soon as possible.

Host: Good advice there. If someone is going to be going to a physical therapist, are there physical therapists who—I don't want to say specialize maybe—but if an older adult needs a physical therapist, are there things they should be looking for in that physical therapist that may help an older adult as opposed to somebody younger, if that makes sense?

Bryan Hack, PT, DPT, EMT-B: Yeah. There is specialization out there. As the general training of a physical therapist, we're able to treat any and all musculoskeletal diagnosis in a sense. But if there are some out there that are doing it better than others and who are able to diagnose a little bit stronger than others, yes, there is those just based on peer experience for one, or having the right equipment in that particular facility for that particular diagnosis or treatment.

So if you're seeking out physical therapy, orthopedic for example, musculoskeletal knee pain, shoulder pain, you probably want to find those therapists who have an orthopedic musculoskeletal background, versus those that might have more of a neurological background who might be treating neurological diagnosis versus the musculoskeletal diagnosis. It's very hard to find that maybe on a website or a Google search. But there are therapists out there who have specialization in orthopedics or in sports or in neuro that can all be researched and looked.

The other option you have is to call the local offices and just ask: what therapist is good at treating low back? What therapist has great experience with shoulder injuries? They'll likely tell you who to go see. Talk to your friends, talk to your colleagues. Most likely, they've seen a therapist too. and they're going to maybe be able to refer you. Really good therapists have great relationship physicians as well. So, physicians should be able to point patients in the direction of, "Hey, go see this person for this particular injury" or illness, because they've already created that relationship.

Host: Bryan, as we wrap up, and again back to the theme of this, stay active, the key to staying healthy, what takeaway do you want to make sure people leave with when it comes to staying active so you can stay healthy?

Bryan Hack, PT, DPT, EMT-B: Yeah. I think the key takeaway of today's conversation is skeletal muscle. Keeping skeletal muscle going, keeping strength training going so you can maintain activity in the long run. Again, look at where you are from a base and increase it. So if your base is, I've been sitting for 14 hours today, let's start with gentle walking around the house, right? If you already are walking or those type of things, let's elevate it to the next level.

Low and slow is key. Do not overdo it, especially at age of 50 or older. You're not trying to win any events by any means. Low, slow, consistency, right? You can't do it for three days and then be done for a month and then try it for three days again. If you can find something that you can do every day, every other day, consistency is going to be your best friend.

Host: Very good. Bryan Hack, Director of Rehabilitation Services, Riverside Healthcare in Kankakee, Illinois, helping people stay active so you can stay healthy. And as I said, if we, if and when, I hope we do talk again Bryan, because you had a lot of great information, a lot of things to share, that we should do it—and if it's got to be on Zoom, then on each of us on a treadmill, or we get out in the world and go for a walk while we're talking. Your treadmill can go a lot faster than mine, I'm sure, being a young, healthy guy. But this has been a great conversation. Very helpful and appreciate your time.

Bryan Hack, PT, DPT, EMT-B: Yeah. Thank you, Carl. I appreciate the opportunity to share some of this, because I truly believe it's what's going to change our world, right? It's going to change our habits, and how we become a healthier society in the end.

Host: Very good, Bryan Hack. Thanks so much.

Bryan Hack, PT, DPT, EMT-B: Thank you, Carl. Appreciate it.

Carl Maronich: Hope today's show helped you shake off the rust. We'd love to hear from you. Drop us a note and let us know what you'd like to hear about. Thanks for listening.