Making Your Yearly Physical Truly 'Physical'

The yearly check-up.  Since childhood, every year we have gone to see our doctor to check up on our overall health.  The nurse and doctor work together to evaluate our vision, hearing, height, weight, blood pressure, heart rate, breathing, and screen for pathological findings that might indicate systemic or more serious pathology.  They are experts at keeping you up to date on the internal workings of your body.  The annual check-up with your primary care doctor is vital to your health. 

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We are so familiar with the check-up procedure that we automatically sit on the crinkly table cover and remain sitting while we are examined and questioned by our doctor.  Sitting allows more ease for taking blood pressure, checking vision and hearing, and performing auscultation to the lungs.  After the thorough and well executed examination we walk to the front and schedule next year’s check-up (maybe after giving some blood). Is there something missing in the examination?

MOVEMENT!

In any given day we are moving approximately 16 hours out of the day.  Some of us even move in our sleep!  Movement is a vital part of our everyday lives and we often take it for granted.  We assume we will wake up each day and be able to walk, run, squat, lift, do our hair, use the bathroom, and drive without pain or limitation.  For those of you who have been injured and your movement has been limited, you understand all too well the burden lack of movement or pain with movement is on your daily life. When we look at the impairments associated with altered or painful movement it is easy to see why so many people have a fear of losing their independence.

Your Car Gets An Alignment Check...

It is now customary to get the alignment in your car checked along with your oil change.  This is just as routine as the yearly physical at doctor’s office.  It is easy for us to understand that when the wheels of our car are out of alignment then the car breaks down or driving becomes unsafe.  According to Bridestone Tires:

“Tire balancing is essential for proper tire care for the same reason as wheel alignment: prevention of premature tread wear. Having tires aligned and balanced every 5,000 to 6,000 miles can help maximize their lifespan and overall performance.” (italics added)

Let’s change this quote and apply it to humans.

Controlling your posture and using proper movement is essential for the care of your body to prevent premature tissue break down.  Having your body evaluated every 6 months to 1 year can help maximize your tissues lifespan and improve movement performance.”

Every moving object is subject to the forces of gravity, shear, and torsion.  Every object has mechanical load and responds negatively to overuse, poor alignment, and improper maintenance.  Without a proper assessment it is difficult to discern the health of your movement system. 

Physical Therapists: The Movement Experts

When it comes to assessing and evaluating movement there is no better professional than a doctor of physical therapy.  According to the American Physical Therapy Association:

“Physical therapists provide services that help restore function, improve mobility, relieve pain, and prevent or limit permanent disabilities in patients with injury or disease.  They restore, maintain, and promote overall fitness and health.”

Unfortunately to date, physical therapist have not marketed themselves as professionals who prevent disabilities or maintain overall fitness and health.  Their educational background in pathology, anatomy, physiology, kinesiology, exercise physiology, orthopedics, neurology, and psychology make them ideally suited to perform a yearly physical to assess movement and health.  

As time passes medicine becomes more and more specialized.  For instance, if you have a foot problem you see the podiatrist, who realizes you have a heart problem and sends you to the cardiologist, who realizes you have lumbar nerve compression, who sends you the neurosurgeon, who finally realizes you need to see the physical therapist.  

When you see a physical therapist, their diverse knowledge and education allows them to assess orthopedic issues anywhere in the body, neurological conditions, vascular compromise, and movement dysfunction within the same evaluation.  Although they are unable to fully diagnose or treat pathology outside of the physical therapy scope of practice, they are skilled at recognizing issues and getting patients to the right doctors.  Therefore, by performing a yearly movement and wellness physical, therapists could recognize patterns of dysfunction or pathology before they become larger issues saving patients time, money, and loss of quality of life.

What Movement is Tested in the Yearly Physical

Posture

To be able to test the ability to move you first have to test the ability to maintain a stable static position.  Testing sitting and standing posture gives a snapshot of a person’s overall health.  An elderly female who is kyphotic through the thoracic spine may indicate changes in bone associated with osteopenia or osteoporosis.  A patient leaning over on their elbows and lifting their shoulders may indicate poor gas exchange indicative of COPD or lung disease.  While in static standing, a patient may sway side to side or adopt an unnaturally wide base of support indicating a potential balance issue.

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As you can see posture is a very simple but very telling test to record and track over time.  Taking a picture of sitting and standing posture to compare year after year should be a standard part of the assessment.

The Sixth Vital Sign: Gait Speed

Gait speed is largely considered the sixth vital sign.  The typical vital signs temperature, heart rate, respiration rate, and blood pressure we are all familiar with.  These have proven the test of time as valid tests for determining homeostasis of the body.  The fifth vital sign is typically considered to be pain but could also be pulse oximetry for determining oxygen saturation.

Gait speed, after substantial research, has even academic backing to be in the running as the sixth vital sign.  Research has proven gait speed to be reliable, valid, sensitive, specific, and correlates with functional ability and balance confidence. (Fitz et al.)  For those of you not familiar with the above terms, it is rare for a specific test to have all those characteristics.  In a nutshell, it means that the test is consistent, repeatable, is better than chance, and yields data that means something. The typical walking speed of adults is 1.2-1.4 m/sec.  In order to calculate a meaningful change in gait speed the change has to be more than .05 m/sec.  A decrease in walking speed by .1 m/sec has been linked to poorer health status, increased disability, longer hospital stays, and increased medical costs (Fitz et. Al).

Gait Speed and Survival http://jama.jamanetwork.com/article.aspx?articleid=644554 By assessing walking gait speed using a 20 meter walk test, you can obtain an excellent measure of overall health which can easily be compared from year to year.  It also happens to be easy to administer and extremely cost effective.  

Aerobic Capacity

When we think of aerobic capacity we think of distance runners, triathletes, and cyclists.  We think of being in a lab with a breathing apparatus coming from our mouth to a machine that is testing our VO2max.  We also think of walking on a heavily inclined treadmill with cardiac sensors on our chest during stress tests.

It turns out there are simple ways to gain valuable data on cardiorespiratory fitness without a cardiac lab or exercise physiology center.

3 Minute Bench Test

This test is designed to test how quickly your heart rate recovers after doing 3 minutes of submaximal steady exercise.  It is a cost effective and less elaborate measure to obtain an estimate of VO2max.  There are multiple versions of the test including the Harvard Step Test and the YMCA Step Test.  Check out the links for normative data and testing protocols.

6 Minute Walk Test

This test is designed to evaluate the global response of your cardiorespiratory system during exercise including systemic circulation, peripheral circulation, blood, neuromuscular units, and muscle metabolism.  Like the 3 minute bench test, the six minute walk test can be used to evaluate quality of life and peak oxygen uptake. (thoracic.org)

Balance Screen

A key component of normal function is a stable base of support.  Without proper balance, walking, stairs, squatting, and transfers would become challenging and pose a threat for falling and injury.  In my career practicing physical therapy, I have found patients often don’t even realize they have impaired balance until they have been tested.  Our bodies naturally avoid situations that challenge our proprioception and dynamic stability when poor balance is internally perceived.

Falls and Injury

  • 1 out of 5 falls results in a serious injury (broken bones or head trauma)
  • 2.5 million older adults are treated in the ER for fall injuries
  • 250,000 older adults are hospitalized yearly for hip fractures
  • 95% of hip fractures are caused by falling sideways
  • Falls are the most common cause of traumatic brain injuries (TBI)

Risk Factors For Falls

  • Lower body weakness
  • Altered walking and balance
  • Use of 4 or more medications (antidepressants, sedatives)
  • Vision problems
  • Poor footwear or foot pathology
  • Environmental hazards (throw rugs, clutter, poor lighting)

The consequences of poor balance and falls are high.  It is important, especially if you are over the age of 60, to have your balance checked on a yearly basis.

Balance Tests

There are an array of balance tests that help to determine risk factors for falling.  I have listed a few of them here (not an exhaustive list)

Strength and Flexibility Testing

The final part of the yearly movement physical to consider is strength and flexibility.  As you have read in previous sections, strength is a vital component to overall health.  Strength in our legs helps with walking, balance, stair climbing, and squatting for sitting and lifting. Strength in our arms helps with reaching, lifting, driving, and throwing. Strength in our core helps with avoiding lower back pain, with bracing for safe lifting, and for upright sitting. 

Traditionally, strength testing is done with isokinetic dynamometry; however, this testing is typically reserved for athletes and specialized populations.  There are valid tests that can be performed at your local physical therapy clinic with excellent predictive value.

Strength Testing

Flexibility

Proper flexibility is also a key component in maintaining proper functioning of your body’s movement system.  As the aging process occurs, physiological changes take place that decrease the movability and stretching capacity of muscles and tendons.  It is important to keep up with proper mobility to allow ease of movement with everyday activities.

For athletes, it is essential to keep proper tissue mobility to allow full range of movement to produce maximum power.  Keeping up with flexibility exercises decreases the likelihood that a tissue will be strained performing or practicing.

Flexibility Tests

  • Functional Movement Screen
  • Deep Squat
  • Hurdle Step Test
  • Appley’s Reach Test
  • Sit and Reach Test (YMCA)

Move to Improve Your Health

It takes a lot of courage to release the familiar and seemingly secure, to embrace the new. But there is no real security in what is no longer meaningful. There is more security in the adventurous and exciting, for in movement there is life, and in change there is power.

 Alan Cohen

Having your health checked annually by your primary care doctor is essential.  Having your movement checked by a physical therapist is also essential.  Be sure you keep your body working in top condition to live an active and full life. If you live in the Bay Area and want more information about a yearly movement physical please call 408-784-7167 to speak with a physical therapist.  You can also email using the address Kevin@compedgept.com

Written by:
Kevin Vandi DPT, OCS, CSCS
Physical Therapist in San Jose-Los Gatos-Campbell-Almaden