What is Creatine and should I be taking it?

I am back and ready to dig into creatine today.

You may have heard of it, as it has gotten a lot of attention lately. First, I want to make sure you don't confuse it with collagen, which is completely different. I have written about collagen both here and here.​

Back to creatine.

This is a new supplement for me. I am not a big fan of taking supplements. But anything with real science behind it is always a possibility. I'm open to new things

What is it?​
Creatine is a non-protein amino acid. Your body can synthesize about half of what you need, and the rest you get from your diet, specifically red meat and seafood. The supplement I decided to try, from Momentous, states that it is vegan. It looks like it is produced in a lab. My husband and son are taking a creatine supplement from BulkSupplements.com. It also states it is vegan.

Why am I trying it?​
The benefits of creatine include increased muscle strength, improved muscle recovery after exercise, and improved mood, and while the research is still in its infancy, combined with resistance training, it may improve bone density. There are no real risks to taking it in small doses either if you are healthy.

It is well known that women post-menopause (like me), have a decreased ability to absorb and digest the protein we eat. We also start to lose lean muscle mass. This means that even when we are eating the same amount of protein we have always eaten, and our workouts are the same, we still seem to lose strength, and bone, and have a tendency to get injured and need longer to recover after exercise. Depression is also more common, as well as sleep issues

Adding a creatine supplement to my routine can help with most of these things. I am willing to give it a try.

What I have noticed so far:​
Thirst! I immediately found that I was more thirsty than normal the first week I added creatine to my post-workout water. That seems to have tapered off a bit now.
A bit less brain fog.
Less pain. I have been struggling with hip pain, a tendonitis, for about 4 months. It has subsided substantially.

I want to note that in addition to creatine, I have also added prescription strength Vitamin D to my weekly routine. The combination of these two things has made a difference I was not expecting. I will be writing about Vitamin D next week. This change was made in consultation with my primary care physician after I had bloodwork done - I always recommend discussing supplements with your doctor and not self-prescribing!

Creatine has a few medications it interacts with, particularly diuretics, NSAIDs, kidney medications, and more. Please check in with your PCP if you want to try it. You can use the following articles to support your reasons for giving it a try in a very low dose (5 g or less).

That’s all for today, time to get active,

​Andrea Trombley PT, DPT

PS - If you are looking for ways to work with me, I am all online. Here is the link to my current passes.

References:

Kreider, R. B., Kalman, D. S., Antonio, J., Ziegenfuss, T. N., Wildman, R., Collins, R., Candow, D. G., Kleiner, S. M., Almada, A. L., & Lopez, H. L. (2017). International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Journal of the International Society of Sports Nutrition, 14, 18. https://doi.org/10.1186/s12970-017-0173-z

Smith-Ryan, A. E., Cabre, H. E., Eckerson, J. M., & Candow, D. G. (2021). Creatine Supplementation in Women's Health: A Lifespan Perspective. Nutrients, 13(3), 877. https://doi.org/10.3390/nu13030877

Smith-Ryan, A. E., Cabre, H. E., & Moore, S. R. (2022). Active Women Across the Lifespan: Nutritional Ingredients to Support Health and Wellness. Sports medicine (Auckland, N.Z.), 52(Suppl 1), 101–117. https://doi.org/10.1007/s40279-022-01755-3

I have osteoporosis, can I still exercise in the water, or am I wasting my time?

Have you heard that your favorite water exercise does next to nothing to help your osteoporosis or osteopenia?

The latest systematic review and meta-analysis has something to say about this.

Published in March, 2023, The effect of aquatic exercise on bone mineral density in older adults. A systematic review and meta-analysis took 11 studies and pooled the data to come up with some interesting conclusions.

Let's first say, land-based weight training is superior. But what if you, or someone you know, has difficulty with land-based exercise?

This latest review found significant improvement in the bone status of both the lumbar spine and femur after at least 6 months of regular water exercise. As with all systematic reviews, the exercise protocols in the studies were all quite different, making it hard to say exactly what aquatic exercise is best.

Here are some general conclusions and recommendations for water exercise to build bone:

• The studies followed post-menopausal women doing water-based exercises for at least 6 months - so you need to stick with this for a while to get a benefit.

• Only one of the 11 studies included involved swimming.

• 10 studies used exercises in the water involving jumping, running in place, ski movements, using resistance equipment and bands, vertical jumping or squats.

• Two study’s participants were taking Alendronate (a bisphosphonate, brand name Fosamax).

• Almost all of the participants were overweight.

What should we do with this information?

Breathe a sigh of relief if you have been doing water exercises and enjoy them. Keep it up.

If you have been incorporating high-intensity jump-based exercises in the water, even better.

If you swim laps, you may want to add high-intensity jump-based exercises to your pool time.

That's all for today. Here in Vermont, the summer heat and humidity sure makes the pool an inviting place to be. I may do a bit of water exercise today as well.
​

Stay strong and retire active,

Andrea Trombley PT. DPT

Reference:
Schinzel, E., Kast, S., Kohl, M., von Stengel, S., Jakob, F., Kerschan-Schindl, K., Kladny, B., Lange, U., Peters, S., Thomasius, F., Clausen, J., Uder, M., & Kemmler, W. (2023). The effect of aquatic exercise on bone mineral density in older adults. A systematic review and meta-analysis. Frontiers in physiology, 14, 1135663. https://doi.org/10.3389/fphys.2023.1135663

PS - If you are looking for ways to work with me, I am all online. Here is the link to all of my recorded content.

Pickleball Injuries - Is the Potential for Injury Greater than the Fun?

I played pickleball in the rain yesterday.

It was probably not the smartest idea I have ever had, but my son wanted to play, and I take advantage of every opportunity to do something fun with him. The constant downpour of rain had ceased, and I hadn't gotten much exercise. We found an open pickleball court that was more dry than wet and practiced our short game. We did play one game but decided the wet court was potentially too slick for more, so we returned to the practice drills.

The players on the next court (who were in an older age group than me) were playing and competing.

It got me thinking about pickleball injuries. And you know me, I wanted to know what the research had to say.

I found this article, from 2021 "Non-fatal senior pickleball and tennis-related injuries treated in United States emergency departments, 2010–2019".

Here is what the cross-sectional descriptive study of pickleball players from 2010-2019 revealed:

⭐Most pickleball injuries happened in the 60-79-year-old age group.

⭐Sprains and strains were the most common injuries.

⭐Fractures were the second most common injury

⭐Contusions (bruises) were the third most common

⭐Men were 3.5 times more likely to suffer a sprain or strain than women, usually to the lower leg.

⭐Women were more than 3.5 times more likely than men to sustain a fracture, and 9 times more likely to fracture a wrist.

⭐Eye injuries were rare.

What can we learn from this?

Sprains and strains are common. How we react to them is key.

If we treat them for what they are, a common athletic injury that all athletes get, there is really nothing to be afraid of. When anyone plays a competitive sport, including professional athletes, injuries happen.

With appropriate rest, good nutrition, protection of the joint for a short amount of time, and a gradual return to activity, there is no reason to throw the baby out with the bathwater and give up the sport. Older athletes are just that, older. Treat the injury and return to your sport!

​
Next, women in the over-55 age group appear to be much more prone to wrist fractures than men. There are so many things to research based on this, but I will jump ahead and conclude that upper body weight bearing is needed to help women strengthen their forearms and wrist bones. We already know that bone loss, osteopenia and osteoporosis, is a problem for women post-menopause and that many women are not doing enough to keep the bone they do have.

What kinds of exercises should women do to strengthen their wrists and forearms?
Push-ups
Planks
Chest press
Cat and Cow pose
Bird Dog
Downward Facing Dog
Overhead press
Biceps curls

and so many more. (Most of these can be found on my YouTube channel if you want to see how to do them.)

I think we can conclude that this upcoming generation of retirement-aged people (myself included) is going to be very different than previous generations. Exercise, competition, and the expectation of being active for a good long time are evident. This sport is growing, and so are others.

Ageism can show up everywhere. When someone says that a sport is dangerous, or not good for you, what are they really suggesting? And why?

The benefits of pickleball go beyond the physical. This systematic review, Pickleball and mental health in adults: A systematic review, came out in February 2023. The author’s conclusion was this, pickleball was good for adults over 50. They were less depressed, more fulfilled, and happier with their lives.

I took up pickleball at 54. I play with people 30 years younger than me, and people 30 years older. The lady with the knee brace and at least 10 years my senior kicked my butt last weekend.

I loved every minute of it.

I will continue to work on strength, flexibility, agility, and endurance, so I minimize the chance of injury, just like I would do for any sport, no matter my age.
​

If you would like to join me in staying strong and haven't been doing all you can, join my next Strong Women, Strong Bones program. Subscribe to my email list and be the first to know when the program opens again.​

Until next time,

Andrea Trombley PT, DPT

References:

Cerezuela, J. L., Lirola, M. J., & Cangas, A. J. (2023). Pickleball and mental health in adults: A systematic review. Frontiers in psychology, 14, 1137047. https://doi.org/10.3389/fpsyg.2023.1137047

Sarafrazi N, Wambogo EA, Shepherd JA. Osteoporosis or low bone mass in older adults: United States, 2017–2018. NCHS Data Brief, no 405. Hyattsville, MD: National Center for Health Statistics. 2021. DOI: https://dx.doi.org/10.15620/cdc:103477.

Weiss H, Dougherty J, DiMaggio C. Non-fatal senior pickleball and tennis-related injuries treated in United States emergency departments, 2010-2019. Inj Epidemiol. 2021 May 3;8(1):34. doi: 10.1186/s40621-021-00327-9. PMID: 33934725; PMCID: PMC8091689.

Non-dairy sources of Calcium for Women with Osteoporosis and Osteopenia

If you have been diagnosed with osteoporosis or osteopenia, you probably want to maximize your diet to increase your chances of building bone. Calcium is one essential component of strong bone.

But what if dairy isn’t for you?

What are good sources of non-dairy calcium?

Is spinach a good source? Should it be cooked?

These are a few of the questions that came up in my free Facebook group, Osteoporosis, and Osteopenia Exercise Support. It started when I asked everyone what their favorite non-dairy calcium-rich food was.

The general guideline for women over 50 is to consume 1200 mg of calcium/per day.

There were a lot of great responses and good ideas.

Here are a few of them (in no particular order):
Broccoli
Almonds
Arugula
Collard greens and Kale
Chia seeds
Soy milk
Bok Choy
Flax seed
Almond milk
Figs
Seeds, like sunflower or sesame seeds
Orange juice - fortified

The one that caused a bit of confusion was spinach.

I listed it as a good source but was quickly questioned about whether it was better in a cooked state, or if it was a good source at all.

Here's what I found out (remember, I am not a registered dietician).

Spinach has a high level of oxalates, which are known to interfere with calcium absorption. This makes the bioavailability of calcium in spinach quite low. When you eat spinach, it is estimated that between 5-25% of it is actually absorbed.

What happens when you cook it? The oxalates are broken down. This results in better absorption. But when you do cook it, other nutrients are broken down (like folate and Vitamin C). So maybe eat it both raw and cooked for the best overall nutrition. I like my spinach raw!

The easiest way to determine the bioavailability of any food is to read the label. When you see the RDA (recommended daily allowance), the bioavailability of the food has been considered.

But why are you calculating your calcium? Here is more food for thought:

Observational data from a randomized controlled study from The Journal of Clinical Endocrinology & Metabolism (August 2019), questioned how much calcium consumption contributed to their bone mineral content. After comparing two groups of women over the age of 65 with hip T-scores between -1 and -2.5 (osteopenia and osteoporosis), they concluded that there was no relationship between calcium intake and bone mineral content. The women in the study were followed for six years. During that time, there was no difference in bone loss between the women who consumed the most calcium and those who consumed the least.

The author's conclusion:

Postmenopausal bone loss is unrelated to dietary calcium intake. This suggests that strategies to increase calcium intake are unlikely to impact the prevalence of and morbidity from postmenopausal osteoporosis.

Similar results were also found in a study of premenopausal women who took calcium or Vitamin D supplements. A Cochrane Database Systematic Review from Jan. 2023, concluded the following: Our results do not support the isolated or combined use of calcium and vitamin D supplementation in healthy premenopausal women as a public health intervention to improve BMD in the total hip or lumbar spine, and therefore it is unlikely to have a benefit for the prevention of fractures (vertebral and non-vertebral).

What does all this mean for you and me?

There is more to bone health than calcium and Vitamin D levels, and supplementing may not be enough for you to get the bone changes you need. Getting well-rounded nutrition is going to be your best bet, as nutrients in food are always going to be absorbed better than a pill.

Bone and muscle building take place when two things are present:

1.) sufficient building blocks (all the nutrients from food) and 2.) the stimulus from exercise.

We are learning more about bone health every week. Don't throw the baby out with the bathwater. If you have been prescribed supplements, don't throw them away - have a conversation with your physician. Remember, these studies do not always take into account things like pre-existing conditions, other medications, or your personal activity level. And if you are self-supplementing, again, have a conversation with your physician. Supplements can interact with your medications. Just because you can buy supplements without a prescription does not mean they are benign.

Stay strong and retire active,

Andrea Trombley PT, DPT

References:

Bristow, S. M., Horne, A. M., Gamble, G. D., Mihov, B., Stewart, A., & Reid, I. R. (2019). Dietary Calcium Intake and Bone Loss Over 6 Years in Osteopenic Postmenopausal Women. The Journal of clinical endocrinology and metabolism, 104(8), 3576–3584. https://doi.org/10.1210/jc.2019-00111

Harvard School of Public Health. The Nutrition Source. Calcium.  https://www.hsph.harvard.edu/nutritionsource/calcium/#:~:text=*Bioavailability%20of%20calcium&text=The%20amount%20of%20calcium%20listed,is%20called%20%E2%80%9Ccalcium%20bioavailablity.%E2%80%9D 

Méndez-Sánchez, L., Clark, P., Winzenberg, T. M., Tugwell, P., Correa-Burrows, P., & Costello, R. (2023). Calcium and vitamin D for increasing bone mineral density in premenopausal women. The Cochrane Database of systematic reviews, 1(1), CD012664. https://doi.org/10.1002/14651858.CD012664.pub2

Exercise Tip: Are you strong enough for Boat Pose?

This week I would like to talk about boat pose, not a pose I do regularly, but one I get asked about pretty often.

It's not that I don't like it or think it is ineffective, it is just a hard one to do correctly. It is an intermediate to advanced pose. It is easy to cheat, or I should probably describe it as compensate (because it is not that you try and cheat). And for anyone who has pelvic floor weakness, it can put a lot of pressure on the very muscles you are trying to strengthen.

First, the most important thing to do with this pose is EXHALE and not hold your breath. The big cheat/compensation here is to take a big breath in and hold it. If you need to do this to get into the pose, you are not strong enough to do the variation you are attempting.

You should be able to breath while you do this, just like any exercise you are doing.

Follow along below with my modifications to see if you are able to hold this pose while breathing and not compensating.

Second, don't rock back on your sacrum, the bones on either side of your tailbone. If you need to rock back, again, this means you are not quite strong enough to get into the pose. Put a foot down or hold onto your legs.

Honestly, I do not do this pose in my class very often. Maybe I should start, all my consistent members are getting stronger. I do not teach this in my Jumpstart, as I am careful to help my students develop good habits, use modifications, and be self-aware. I am here to help you get strong for the long-term.

Let me know if you have any questions about this. If you are new to yoga or exercise in general, I would skip this one for now. It is not a beginner pose.

Thanks for tuning in once again. This video, and many more, are on my YouTube channel. Subscribe and follow along.

Start today, no matter what level you are, and take that first step,

Andrea Trombley PT, DPT

Pomegranates, blueberries and Stress Reduction

Let's talk about muscle soreness, pomegranates, and blueberries.

Like many women, I wanted to get 2023 started off on a positive health note. I have been increasing my weight training and with the increase in weights, I was getting a little sore.

While I accept a small amount of soreness 24 hours after my weight training, 48 hours of post-workout soreness means I overdid it. I do, however, want to do all I can to build muscle and avoid injury. So I looked in to what I could eat, or drink, post workout.

My new go-to post-weight training drink is pomegranate juice. It has been shown to reduce oxidative stress, which is basically reducing inflammation. And it is tasty. If you don't like pomegranate juice, an alternative would be to eat blueberries. Blueberries and pomegranates are both superfruits. The benefits of these fruits are extensive, including lowering blood lipid levels and decreasing the risk of cardiovascular disease.

Anti-inflammatory foods are always better than anti-inflammatory medications. 

And right along these lines, let's talk about reducing stress, which also contributes to chronic disease and increases oxidative stress.

I recently came across this 60-second meditation tool to help ease your mind: 
easy-to-use stress-reducing tool. 
It is from a website called Pixel Thoughts. Put your stressful thought in the circle and watch your thought shrink into the universe. Give it a try and let me know what you think. Of course, it is not for everyone, but with some of life's smaller annoyances, it can help put your thoughts in perspective.

Thank you to all who have been sending me articles. The NY Times has really had my back recently with this article, You're Never Too Old for Yoga, and The Guardian as well, with Six lifestyle choices to slow memory decline named in 10-year study The takeaways:  a healthy diet; regular exercise; active social contact; cognitive activity; non-smoking; and not drinking alcohol are key to living well. None of this should surprise any of you in the Strong Women community.

Keep the good stuff coming!

Andrea Trombley PT, DPT

PS - If you already completed a Strong Women program and want to get back to a regular routine, reply to this email me and I will send you the membership link. 


Reference
Canals-Garzón, C., Guisado-Barrilao, R., Martínez-García, D., Chirosa-Ríos, I. J., Jerez-Mayorga, D., & Guisado-Requena, I. M. (2022). Effect of Antioxidant Supplementation on Markers of Oxidative Stress and Muscle Damage after Strength Exercise: A Systematic Review. International journal of environmental research and public health, 19(3), 1803. https://doi.org/10.3390/ijerph19031803

What you should know about your psoas muscle

I had a question about the psoas muscle this week, so I thought I would write a post about it for all of you.

I love talking about the psoas muscle. It is a large, deep muscle that can show up in mysterious ways.

Back pain? Might be the psoas.
Groin pain? Might be the psoas.
Pain with walking or running? Might be the psoas.

Let's demystify it.

It can be hard to describe where this muscle is without a picture. Look at the image below and notice where the psoas begins (don't worry about the minor or major). It starts on the inside of the lumbar spine, attaching to the transverse processes. It even attaches to the intervertebral discs themselves. It cannot be touched from your back, it is too deep.

Follow the muscle down, through the pelvis, and see how it attaches to the inside of the femur bone (the thigh bone). The part of the femur it connects to is called the lesser trochanter. You can try to feel this on the inside of your thigh, but it is pretty deep in there.

​If you have ever had your psoas muscle palpated, it was from the front, through your abdomen. It is not always a pleasant sensation. And if it was tender, you knew when it was touched!

The job of the psoas muscle is flexion. In standing, to lift your right leg, your psoas muscle needs to shorten. As it shortens, your hip flexes.

If you are flat on your back and you want to pull your right leg up toward your body, your psoas will shorten and bring your leg up.

If you are flat on your back and you want to sit straight up, your psoas will help pull your body up into the sitting position. This is why a full sit-up doesn't work just your abdominals.

Now let's talk about stretching your psoas muscle. After a prolonged day of sitting, with your psoas in a shortened position, try this psoas stretch with a chair.

Can you picture how the muscle is lengthened in this video?

I hope you now know a bit more about your psoas muscle. I am a big anatomy nerd, and sharing anatomy bits with you is fun. I hope you find some fun in knowing all about your body as well.

RICE Or Peace And Love

Imagine this scenario: You injure yourself, but not to the level of needing to go to your physician or the emergency department. You want to treat yourself.

For years, the advice I handed out for these types of sprains and strains came with this handy acronym: 

RICE - Rest, Ice, Compress and Elevate.

And it worked pretty well. RICE has gotten me through many injuries over the years. 

But in 2019, the British Journal of Sports Medicine published a rebuttal to RICE and the authors proposed a new way of thinking about acute injuries. Taking into account the latest research about what happens at the cellular level in regard to tissue repair, their proposed new acronym has been making its way into the rehab world. 

And I want to share it with you:

Peace and Love.

Let's start with PEACE.

In the first 1- 3 days after an injury, 

P - Protect. Imagine you have sprained your ankle or strained your shoulder. Go ahead and wear an ankle brace or sling for a day or two. Don't force your tissues into painful motions, protect them.

E - Elevate. This works well for the ankle, knee, and even the elbow and hand, but your shoulder or back can be trickier. But in general, let gravity help drain the swelling by getting your injury above the level of your heart.

A - Avoid anti-inflammatories and ice. This one can be hard. If you can, resist the inclination to start self-medicating with anti-inflammatories and ice, ice, ice. Allow the inflammation to happen, as it is the way tissues begin to heal. Taking anti-inflammatories and using ice may cause a delay in actual healing, interfering with how collagen is formed, disrupting revascularization and macrophage infiltration (they clean up the mess). 

C - Compress. Taping or using some sort of bandage can reduce swelling and possibly help you be more functional.

E - Educate. This is where your physiotherapist comes in. We help determine the damage and make a plan on how to best get you back to your life as quickly as possible without long-term problems.

After the first few days, your tissues now need LOVE.

L - Load. Too often, injuries are left in the protection phase for too long. We now know that we heal best when a load is added, small at first, but steadily increasing, for full recovery to happen. You want your tissues to heal strong, not vulnerable. In order for your tissues, including tendons, ligaments, muscle, and even bone, to heal optimally, we need to load them.

O- Optimism. Don't let your brain get in the way of healing. Fear, depression, and catastrophizing are all barriers to fully healing. This is another spot in the process where your physiotherapist can really help move you along. Don't wait 8 weeks and then seek help. If you are not making steady, daily progress, get into PT and get support, encouragement, and a plan.

V - Vascularization. Get your blood moving with exercise! Pain-free cardio work is going to help bring the good nutrients to the injured area and flush out the bad stuff. It is also good for reducing pain.

E - Exercise. Get yourself moving with weights, balance exercises, and mobility. You need to activate your tissues and stimulate repair, resting for too long impedes full recovery.


Let me know, how does this resonate with you? Have you been practicing PEACE & LOVE with your injuries? Does it feel hard to avoid ice and anti-inflammatories?

 

 In Peace and health,

Dr. Andrea PT

Reference
Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British journal of sports medicine, 54(2), 72–73. https://doi.org/10.1136/bjsports-2019-101253

NSAIDs or Exercise, Which Serves You Best?

This week, let's talk about pain, NSAIDs (non-steroidal anti-inflammatory drugs), and acetaminophen (brand name Tylenol, known as paracetamol in Europe).

First, what are NSAIDS? The most common NSAIDs include ibuprofen, naproxen, and Celebrex. There are a few others as well.

Many of us have taken these medications from time to time, usually for pain. But they do have side effects, with stomach problems being the most well-known.

What if you could treat your pain just as effectively without the possible stomach side effects of these drugs?

You can. According to this meta-analysis, which just came out in the British Journal of Medicine, exercise was found to be just as effective at treating knee and hip osteoarthritis as any of these medications.

The authors conclude: Exercise IS medicine. And exercise should probably be the CORE recommendation for treating both hip and knee arthritis. Exercise reduces pain and increases function, without the side effects of the drugs.

Good news, right?

With that recommendation, I want to remind you about my 4-Week Strong Women, Strong Bones Jumpstart. I run one a quarter, make sure to email me to get on the waitlist for the next one.

I am here to help, let's do this,

Dr. Andrea Trombley PT, DPT


Reference
Weng, Q., Goh, S. L., Wu, J., Persson, M. S. M., Wei, J., Sarmanova, A., Li, X., Hall, M., Doherty, M., Jiang, T., Zeng, C., Lei, G., & Zhang, W. (2023). Comparative efficacy of exercise therapy and oral non-steroidal anti-inflammatory drugs and paracetamol for knee or hip osteoarthritis: a network meta-analysis of randomized controlled trials. British journal of sports medicine, bjsports-2022-105898. Advance online publication. https://doi.org/10.1136/bjsports-2022-105898

Build Bone with Mineral Water and Eating for Exercise Motivation

Are you ready for another cutting-edge aging update? I stay on top of the current research so you don't have to.

This week, let's talk a bit more about hydration. Last week, I shared this study,  which pointed out the importance of staying hydrated to combat chronic disease and premature aging. The conclusion: 

Stay well hydrated.

What if you could better hydrate AND work on your bone health, specifically calcium absorption, as well? Mineral water may be what you need.

According to this study, mineral water had calcium absorption equal to milk and a calcium supplement in healthy test subjects. That's right, drinking mineral water produced the same increase in blood calcium levels as taking a supplement or drinking milk. 

What I found interesting about the study was the Vitamin D levels. Before the study was performed, all participants were given a Vitamin D supplement for 4 weeks to make sure calcium was absorbed. All the participants had adequate Vitamin D levels on the day of the experiment.

Takeaway: Mineral water may be a good way to get more Calcium and stay more hydrated. And without adequate Vitamin D, it won't be absorbed - get those Vitamin D levels checked and supplement if needed.

Now on to the motivation to exercise. Maybe what you eat has more impact than you thought.

This study just came out in Dec. 2022, in the journal Nature. The authors found a gut-brain connection in mice that seemed to help motivate some mice, labeled the active mice, to run and run, while other mice, labeled the lazy mice, did not. When the running mice were given antibiotics that changed their gut microbiome, the running mice became lazy mice. When the lazy mice were given gut microbiomes from the active mice, they became active. Crazy cool. It may be that the antibiotics destroyed some of the dopamine receptors that helped with that exercise high. Restoring the microbiome then increased the exercise pleasure.

Takeaway: Get your healthy gut microbiome in order. This can be done with foods like yogurt, probiotics, Kefir, Kombucha, and fermented foods such as sauerkraut, and pickles.

Thanks for being here,

Andrea Trombley PT, DPT

References:

Dmitrieva, N. I., Gagarin, A., Liu, D., Wu, C. O., & Boehm, M. (2023). Middle-age high normal serum sodium as a risk factor for accelerated biological aging, chronic diseases, and premature mortality. EBioMedicine, 87, 104404. https://doi.org/10.1016/j.ebiom.2022.104404

Dohnalová, L., Lundgren, P., Carty, J. R. E., Goldstein, N., Wenski, S. L., Nanudorn, P., Thiengmag, S., Huang, K. P., Litichevskiy, L., Descamps, H. C., Chellappa, K., Glassman, A., Kessler, S., Kim, J., Cox, T. O., Dmitrieva-Posocco, O., Wong, A. C., Allman, E. L., Ghosh, S., Sharma, N., … Thaiss, C. A. (2022). A microbiome-dependent gut-brain pathway regulates motivation for exercise. Nature, 612(7941), 739–747. https://doi.org/10.1038/s41586-022-05525-z

Greupner, T., Schneider, I., & Hahn, A. (2017). Calcium Bioavailability from Mineral Waters with Different Mineralization in Comparison to Milk and a Supplement. Journal of the American College of Nutrition, 36(5), 386–390. https://doi.org/10.1080/07315724.2017.1299651

Don’t Assume Your Bone Density is OK, and Collagen for Bone Health

Do you have osteopenia or osteoporosis? 

If you think that osteopenia and osteoporosis are exclusively the concern of post-menopausal women, this reveiw from 2019 might surprise you.

The researchers looked at a healthy group of both men and women between 35-50 years of age. They found that 28% of the men, and 26% of the women already had osteopenia at the femoral neck (the vulnerable hip fracture site). Osteoporosis was found in the lumbar spine of 6% of the men and 2% of the women. Remember, this was a healthy group of people, not an at-risk group. The participants were excluded if they were postmenopausal or if they took medications that we know reduce BMD (antidepressants, glucocorticoids, proton pump inhibitors).

The participants, 173 people, all had DEXA scans to evaluate their bone mineral density (BMD). One interesting finding in this study was that the participants were actually more active exercisers than the national average. One could argue that this group may have actually had better BMD than a sample that reflected an average exercise level.

Takeaway - Bone loss is more prevalent than you think, in both men and women, and earlier.  Take steps now to prevent any more bone loss. If you have risk factors, or take one of the medications listed above, you may want to push for that DEXA scan before age 65, the current recommended age.

Do you use a collagen supplement?

Maybe you should.

A group of scientists out of Germany conducted a randomized controlled study including 131 post-menopausal women with low bone mineral density (BMD) at either their femoral neck or spine. Half of the women dissolved 5g of collagen peptides in water before breakfast for 12 months, and the control group got a placebo to dissolve in water before breakfast. 

At 12 months, repeat DEXA scans found that the collagen supplement group had increased their BMD by almost 3.0% in the spine and 6.7% in the femoral neck. For the control group, BMD decreased by −1.3% for the spine and −1.0% in the femoral neck. 

Takeaway - Collagen supplements may be worth considering if you have low bone mineral density. 

Want to know more about collagen supplements? You can purchase the recorded masterclass here.
>>>Masterclass: Collagen, What's All the Hype? <<<

I presented this 36-minute masterclass to my Strong Women Strong Bones Members in October 2022 and the response was overwhelmingly positive. Save yourself both time and money by getting all the facts before buying your collagen supplement.

In health,

Andrea Trombley PT, DPT

References:
Bass MA, Sharma A, Nahar VK, Chelf S, Zeller B, Pham L, Allison Ford M. Bone Mineral Density Among Men and Women Aged 35 to 50 Years. J Am Osteopath Assoc. 2019 Jun 1;119(6):357-363. doi: 10.7556/jaoa.2019.064. PMID: 31135863.

König, D., Oesser, S., Scharla, S., Zdzieblik, D., & Gollhofer, A. (2018). Specific Collagen Peptides Improve Bone Mineral Density and Bone Markers in Postmenopausal Women -A Randomized Controlled Study. Nutrients, 10(1), 97. https://doi.org/10.3390/nu10010097

Four Reasons Women Lose Strength After 50

Did you know that muscle strength and bone strength are intricately related?

Kettlebells and dumbbells are essential components of muscle and bone building

How much easier would life be for you if you were just a little bit stronger?

Most of us got weak by accident. We didn’t intentionally lose strength.

We usually figure it out once we find ourselves in a situation we didn't see coming. We realize what was once easy to do, without much thought, has now become difficult.

What happened? And what can you do to prevent this from getting any worse, right now?

Here are my top four big reasons you may be at risk of losing muscle strength after 50, or post-menopause.

#1. You have slowly stopped lifting heavy things and regularly allow other people to do the heavy lifting for you.

This has happened to me, and I have to be careful. Very kind people ask me if I need help bringing my groceries to the car, getting my luggage at the airport, picking up compost bags at the garden center, or offering to bring my pet food to my car. These little kindnesses add up to me not doing all of the strengthening I could be doing throughout the week.

#2. You are an avid walker and count this as your exercise.

I love walking, and I encourage everyone to get out and walk. But walking does NOT count as a strengthening exercise. If this is the only exercise you are doing, you WILL lose muscle mass. This is especially true for your upper body/arm strength.

#3. You are eating a healthy diet, but not getting enough protein.

Your protein needs increase after menopause. Your muscle strength can only be maintained and built if you eat enough protein. As women post-menopause, you have a decreased ability to digest protein the way you did before menopause (anabolic resistance), so you need to eat additional protein to make sure the building blocks of muscle are present.

#4. Aches and pains prevent you from doing what you need to do.

It can be frustrating to feel pain in your joints. I know the base of my thumb and my left hip can act up and make me feel like I have done something wrong. But what we know about exercise and aging is this: the more active we are, the less pain and less disease we will have.

The number one intervention recommendation for knee pain due to arthritis? Muscle strengthening.

Time and again, we see the strengthening of your muscles as the best and most proven intervention for the reduction of pain, increase in activity, and general all-cause mortality.

How is your strength training going?

Can I help you get on the right path?

My Strong Women, Strong Bones is the 4-week solution I have developed to help you get on the right path for building both strength and flexibility going forward. Check for upcoming programs and get on the waitlist.

I look forward to growing this community of Strong Women, I hope you join me.

Andrea Trombley PT, DPT

Reference:

Wang, H., Ma, B., Wang, G., Wang, P., Long, H., Niu, S., Dong, C., Zhang, H., Zhao, Z., Ma, Q., Hsu, C. W., Yang, Y., & Wei, J. (2023). Dose-Response Relationships of Resistance Training in Adults With Knee Osteoarthritis: A Systematic Review and Meta-analysis. Journal of geriatric physical therapy (2001), 10.1519/JPT.0000000000000394. Advance online publication. https://doi.org/10.1519/JPT.0000000000000394

How To Drive Long-Distances Without Back Pain

One of my biggest worries about driving across the country was how I would do it without back pain. I would be the sole driver as I made my way from Vermont to New Mexico with my son. In the past, even in my 20’s, when I drove across the country from Arizona to Vermont, my back hurt.

I bought Advil and Tylenol. I steeled myself for the possibility of pain. I have a known history of bulging discs that was confirmed by an MRI in the early 2000s. I know how to keep ahead of my back issues, but 2300 miles just might be more than I could stay ahead of.

But it didn’t happen. My 52-year-old body made it all the way to Las Cruces, NM, my new home, and my back felt great! Even with sleeping in a different bed with different pillows every night, I made it to New Mexico back pain-free! (Insert big sigh of relief here.)

How did I do it? I followed my own best PT advice, advice I give out regularly. Here is what I did to get myself 2300 miles without back pain:

1. I never drove for more than 2 hours without getting out of the car. I would stop for gas, I would go into a Starbucks for an iced chai tea, or a convenience store for a snack (Boom Chicka Pop Kettle Corn was my go-to snack on this trip). I physically got out of the car and moved; no drive-thrus. I randomly stopped at Welcome Centers to look around and check things out for a few minutes. I also dragged my son on a few excursions to see a few things that were on our way, like the Gateway Arch in St. Loius.

2. I limited my drive to under 550 miles a day. By limiting my mileage, I had time to stretch both in the morning and the evening. It also assured me that I had time to have a good dinner and breakfast (lunch was not always so good).

3. I walked on a treadmill every morning for a minimum of 30 minutes, then stretched and did weights (specifics below). I was with a 19-year-old who was happy to sleep in while I did this.

That’s it. I drove the entire distance, packed and unpacked the car, and arrived ready to take on all of the physical and mental exertions that come with moving and settling in. Stress is a big predictor of back pain, so in order to minimize the chance of it happening, I took control of the things I could control.

Honestly, I get a lot of resistance when I tell people to get out of the car every 2 hours when traveling, and this is for people without back pain. If you start a journey with back pain, reduce the time to every 1 hour. And importantly, get out and move BEFORE you have pain. Once the pain has kicked in, you have been sitting too long. If back pain kicks in, go ahead and stop for the day and get walking and to the weight room, or even the pool. Don’t drink alcohol and watch TV, that will not help.

Here is my routine:

Standing back extensions

Treadmill X 30 minutes at 3.8 mph and 3% incline

Clean off a mat in the weight room, then get on all 4’s for cat and cow

Bird Dog 2X on each side, very slowly

Table position calf stretch one leg at a time

Child’s pose (brief) into upward dog (or sphinx)

Locust pose

On belly quad stretch

Flip over for hamstring stretch and ankle circles and pumps

Weights:

Overhead presses

Goblet squats

Bent-over row on a bench

Standing Quad stretch

Sitting in a car for long drives increases your risk for blood clots. This is another big reason I don’t sit for more than 2 hours, and I walk briskly on a treadmill at the end of each day. I spent a good long time with my feet up in the air doing my ankle pumps and circles to make sure my blood was flowing out of my feet and calves. Be sure you know if any medications you take make you more prone to blood clots (birth control pills, hormone replacement therapy, tamoxifen, thalidomide, erythropoietin, and others). Be sure to check in with your prescribing physician to double-check your risk.

That’s it. Successful long-distance driving. Go ahead and plan your trip without fear of pain.

Can You Do Yoga With Thumb Pain?

Have you had pain at the base of your thumb? This is the most common area to have pain in your hand, and if you practice yoga and regularly place your hand flat on your mat for table pose or downward facing dog, it can be quite a problem. I know it well, I have had pain in my left thumb joint for over a year. 

The joint at the base of the thumb is called the carpometacarpal (CMC) joint. For some of us, it becomes painful, the motion becomes limited, and you may notice a loss of strength. You may suspect you have thumb arthritis. Arthritis develops when the cartilage, which is found where the two bones come together, breaks down and extra bone grows. This is a slow process that happens over many years. Why some people develop it and others do not is not fully understood. It is possible that some sort of injury, possibly long ago and not remembered, made you more prone to it. Some other risk factors include being a woman, being over 40, and doing jobs that repetitively strain the CMC joint. Hand intensive jobs, like being a physical therapist, massage therapist, landscaper or nursery worker, childcare provider or fitness instructor, nursing, and many others, all require hand strength and repetitive motions.

Just because you have arthritis does not mean you will always be in pain or that you need to give up your most enjoyable activities. There may be times when it is more bothersome than others, and you may find there are times when it doesn’t hurt at all. Trying interventions such as ice, splints, or ibuprofen may be helpful. Identifying what activities aggravate the joint is also important. For instance, you may not be able to knit for hours on end without taking breaks and purposefully stretching your hands and strengthening your shoulders.

It is extremely important to keep your hands moving through their full range so that your motion doesn’t become limited. Limited motion and poor strength can creep up on you if you let it go. You may notice it is hard to do things like open jars, or hold tightly to things that are slippery.

Can you still do yoga when your thumb hurts? Of course you can. Should you push through the pain and ignore it? Well, no, but that doesn’t mean you should stop doing everything yoga-related. Unless you have had a fall onto your hand and suspect you may have broken it, continuing to use your hand and thumb is recommended. You also want to make sure you continue to strengthen your upper back and shoulders to help keep your arms strong so that you don’t overuse your hands. Modifying your practice may be necessary to avoid too much pain or discomfort, and the style of yoga you practice may change or evolve.

For me, I practice a much slower style of yoga than I did when I was in my 20’s and 30’s. I do fewer downward-facing dogs, I use blocks and blankets much more, and I make sure that my practice serves my goals and not my ego. I take time to set up my hand and shoulder positions, and allow myself to be playful in my practice rather than strict and judgmental.

The Best Shoes for Walking and Hiking and Protecting Your Joints

I have two pairs of walking/running shoes. I bought them both a little over a year ago, and I have put enough mileage on them to know it is time to replace them. I know they look fine from above, but it is what is happening on the bottom and on the inside that matters, not the top.

Have you had your walking shoes for over a year? Time to replace them.

The Hoka’s are my go-to shoes when I know I will be walking or running on the road or concrete, or if I have any knee, hip or back discomfort going on. The Hoka’s have serious cushion, and I also gain an inch of height when I have them on (which has no effect on my movement, it is just fun to stand next to my really tall son when I have them on). I recommend Hoka’s to many of my clients, and most who try them really like them. Not everyone, but most. The Hoka’s I bought last year do tend to push me into more pronation than I like, so I am not sure if they changed their shoe or if it is just this particular pair. They have several models, and when I go back to get my next pair, I will be sure to check this more than I did before.

My Hoka’s are no good for trail walking or hiking, although they do have models that work for this. When I head off into the woods or know I will be on dirt, I go with my Brooks Ghost. These also have serious cushion and support, but the lower profile makes me more confident so I don’t worry about rolling my ankle on uneven terrain. I can also easily slip my Yak Tracks over these if it is slippery.

Yes, both are expensive, but a better way to think of this money is as an investment. It is an investment in your joints. If you are able to get out and walk, run, and hike more comfortably because your foot, knee, hip or back are cushioned, then you are not going to need that trip to the orthopedic surgeon to talk about surgery or injections. You won’t need pain killers, or high blood pressure medication. You will keep your weight off more easily if you are moving more. The benefits and savings that go with more exercise, and outdoor exercise in particular, are tremendous.

There are so many reasons to spend your money on your feet, because when your feet feel good, you move more. And when you move more, you feel better. So think of your feet as an investment in your health, and skip something else. Like expensive, fully sugared coffee drinks, or the gym membership you aren’t using, or the extra movie subscription service that sucks you in.

If you want to learn more about your feet and how they work, join me on March 13th for a 2-hour workshop on anatomy and the foot, and do some yoga-based poses to strengthen and release tension in your feet. Once the workshop is over, you will be able to purchase it online to learn as well.

Now go get those awesome joint-saving new shoes!

A Solid Night of Sleep and Menopause

Sometime around the age of 47, I noticed profound changes in my sleep rhythm. Previously, I had never had trouble falling asleep, and if I woke up in the night, I was able to fall back to sleep pretty easily. That sure has changed! Although I have always been an early riser, 4:30 am seemed to be my new normal. And then the 2 am wake-ups stretched on to 4:30 am, on a regular basis. Many mornings, I would give up and get up for the day. I made that work for a while by joining a 6 am exercise class. These intense early morning workouts did help, but then COVID began and the gym closed.

In addition to the random wake-ups and difficulty falling back to sleep, my hot flashes intensified. Not only was I waking up, but I was hot, uncomfortable, and wide-awake. This would happen several times a night, and I found myself looking forward to crawling into bed around 6:30 pm, exhausted. I was drinking a glass or two of red wine, which further increased my drowsiness, but seemed to be contributing to my night-time hot flashes. My morning coffee became 2 cups, and worst of all, my middle started to get a bit thicker.

I am now 52 and have completely transitioned to post-menopause. It has been 13 months since my last menstrual period. My natural estrogen is gone. What I have been experiencing for the past 5 years is perimenopause, followed by the transition, during COVID. My hormones have been changing, and all of the tissues in my body have been adjusting to the new normal. And I am still adjusting. It has been hard!

I have changed many things to improve my sleep, and although I don’t have all of the answers, I have figured out a few things that might help you.

One. Cool down your bedroom. I sleep much better now that I keep my summer sheets and summer comforter on my bed year-round. I keep the window open and wear earplugs. I also sleep in a tank top, not heavy pajamas, even when it is sub-zero. Your partner may need a blanket on their side of the bed, but keep your body from overheating and triggering the vasomotor response we call a hot flash. This will help you decrease the number of times you wake up from too much heat.

Two. Stop the alcohol. I know. But do it. Alcohol messes with your body’s temperature, insulin, and is known to be a depressant. Right now, none of us need anything in our lives that is a known depressant. Imbibe on special occasions only, but not on a nightly basis and definitely not as a sleep aid. It does the opposite. It may cause initial drowsiness, but it is well-documented that it decreases REM (Rapid Eye Movement) sleep, which we need in order to feel rested. It also disrupts our circadian rhythm, which we are struggling with anyway, so stop. (Inkelis, 2020).

Three. Get exercise outside, during the day, with sunlight. Our circadian rhythm is thrown off during this menopausal transition. We can help get it back in sync by getting out in the sun and getting our heart rates up a bit. The sun also increases our Vitamin D levels, and we need this for healthy bones, so it is a win-win scenario. There is evidence that Vitamin D deficiency is related to sleep disorders (Gao, 2018). So in addition to getting in the sun for at least 20 minutes, a supplement may be appropriate as well. You can get your Vitamin D levels evaluated the next time you have a physical, along with your cholesterol levels. Those of us who live in the north are particularly at risk for low levels. 

Four. Go to bed and get up at the same time. We need to get our body’s back into a rhythm and to help with this, quiet your room, make it as dark as possible, turn off your devices and establish a bedtime. And get up when it is time to get up. Avoid napping during the day.

Five. Establish a bedtime routine that calms your nervous system. Read a book or listen to a guided relaxation. Prepare your body for sleep by keeping your devices in another room. Allow your nervous system to transition to rest and relaxation and out of fight or flight.

Some other things to consider.

Supplements and hormones. One popular supplement that has been found to be helpful and effective for getting to sleep is melatonin. Some studies have found that melatonin can be used to improve insomnia (Lee et. al., 2019; Caretto, 2019). Although you can buy melatonin yourself, check with your physician to help you come up with a dose that is safe. There are some side effects that you may not want to experience, such as depression and a heavy head feeling, and there are a few contraindications as well. So again, check with your physician before self-medicating.

Tart Cherry juice. If taking a pill is not appealing to you, consider drinking tart cherry juice, preferably organic, 2 hours before bed. The juice has both melatonin and tryptophan, which have positive effects on sleep. A study done by Losso et al. (2018), found positive outcomes when the participants consumed 8 oz of tart cherry juice. Another benefit, there were no side effects.

Hormone replacements - estrogen and/or progestin. If you are experiencing severe hot flashes that interfere with your sleep, it is worth a conversation with your physician about small dose hormone replacement. Contrary to what you may have heard, hormone replacement, when given to the appropriate women in the right dosage, can help with sleep, cardiovascular and bone health. The studies that were popularized in the early 1990s have been found to be flawed, and new research has reversed many of the assertions those studies made (Clark, 2006; Manson, 2016). Hormone replacement for sleep appears to be most effective for women with severe vasomotor symptoms i.e. hot flashes.

CPAP machine for sleep apnea. Sleep apnea is another contributing factor to poor sleep quality. In 2018, Heinzer et al. found sleep apnea in 30% of post-menopausal women, compared to just 9% of pre-menopausal women. It is associated with increased body weight, and women with sleep apnea are at a higher risk for depression and high blood pressure. As our bodies change during menopause and fat is distributed differently, this may contribute to the increased incidence of sleep apnea. Positive airway pressure machines (CPCP) are one way to treat this. If you have any of these risk factors, an evaluation for sleep apnea and proper treatment can improve your overall health substantially, by helping you get a good night’s sleep.

Let me know what you think of my suggestions. A good night's sleep is a wonderful thing. I wish you nothing but a peaceful night’s rest.

References

Caretto, M., Giannini, A., & Simoncini, T. (2019). An integrated approach to diagnosing and managing sleep disorders in menopausal women. Maturitas, 128, 1–3. https://doi.org/10.1016/j.maturitas.2019.06.008

Clark J. H. (2006). A critique of Women's Health Initiative Studies (2002-2006). Nuclear receptor signaling, 4, e023. https://doi.org/10.1621/nrs.04023

Gao, Q., Kou, T., Zhuang, B., Ren, Y., Dong, X., & Wang, Q. (2018). The Association between Vitamin D Deficiency and Sleep Disorders: A Systematic Review and Meta-Analysis. Nutrients, 10(10), 1395. https://doi.org/10.3390/nu10101395

Heinzer, R., Marti-Soler, H., Marques-Vidal, P., Tobback, N., Andries, D., Waeber, G., Preisig, M., Vollenweider, P., & Haba-Rubio, J. (2018). Impact of sex and menopausal status on the prevalence, clinical presentation, and comorbidities of sleep-disordered breathing. Sleep medicine, 51, 29–36. https://doi.org/10.1016/j.sleep.2018.04.016

Inkelis, S. M., Hasler, B. P., & Baker, F. C. (2020). Sleep and Alcohol Use in Women. Alcohol research: current reviews, 40(2), 13. https://doi.org/10.35946/arcr.v40.2.13

Lee, J., Han, Y., Cho, H. H., & Kim, M. R. (2019). Sleep Disorders and Menopause. Journal of menopausal medicine, 25(2), 83–87. https://doi.org/10.6118/jmm.19192

Losso, J. N., Finley, J. W., Karki, N., Liu, A. G., Prudente, A., Tipton, R., Yu, Y., & Greenway, F. L. (2018). Pilot Study of the Tart Cherry Juice for the Treatment of Insomnia and Investigation of Mechanisms. American journal of therapeutics, 25(2), e194–e201. https://doi.org/10.1097/MJT.0000000000000584

Manson, J. E., & Kaunitz, A. M. (2016). Menopause Management--Getting Clinical Care Back on Track. The New England journal of medicine, 374(9), 803–806. https://doi.org/10.1056/NEJMp1514242

Urinary Incontinence - What can I do to strengthen my pelvic floor?

Women with osteoporosis and osteopenia are often worried about falling and breaking a bone. Did you know that urinary incontinence is a risk factor for falling and sustaining a fracture?

This is a topic we sometimes skip over, but for many women, leaking and the need “to go right now” is a problem. For some, it may be the occasional dribble. But for others, it is “I need to wear a pad at all times” or even “I gave up going to yoga/running/hiking”.

I want to start by saying that one exercise, one breathing technique is not going to solve your issue. Just like building any muscle in any other part of your body, your pelvic floor has many components and it takes time to turn things around.

The pelvic floor is complicated. It is connected to your abdominal muscles, how you breathe, your hips, and your lumbar spine. Coordination of the entire system is needed for continence. If Kegel exercises alone could “fix” us, we would all learn them, do them and this wouldn’t be a problem.

If you have been doing your Kegels and they aren’t helping, you are not alone. Between 15-40% of women experience stress urinary incontinence (SUI) and roughly 1/3 of women with SUI do not perform pelvic floor contractions correctly (Henderson et. al., 2013).

Learning the anatomy of the pelvic floor is the first step in figuring out what part of your system is in need to attention.

Let’s start with the bladder itself.

The bladder is a muscle, not just a passive holding tank. When your bladder, the detrusor muscle, is relaxed, it fills with urine. When your bladder fills a certain amount, a signal is sent from the detrusor muscle to your brain saying “Hey, let’s find a bathroom”. Sometimes, the signal is sent when the bladder is not full. We respond to this signal, run to the bathroom, even when we know we went not all that long ago. We get to the toilet and out comes a weak stream and not much urine. We know that we should have been able to hold off going for a while more but we really felt we needed to use the bathroom.

Why does this signal get sent?

There are several reasons. One, we may have fallen into the habit of going to the bathroom “just in case”. In other words, we had no indication from our bladder that it was full, but we anticipated a shortage of bathrooms in the future, so we overrode our system and used the bathroom anyway. The unintentional effect is that we have now trained our bladder to tell us it is full when it is not. This results in more frequent bathroom trips, and an inability to hold a good amount of urine in your bladder. This change in our nervous system gets passed on to the muscular system, the detrusor muscle.

Second, we find ourselves with a weakening or overactive, bladder, the detrusor muscle. When we respond to the urge to go and run off to the bathroom, rather than letting the urge pass, our bladder gets “smaller”. It doesn’t tolerate larger volumes of urine. Again, we have unintentionally trained our bladders to hold just a small amount of urine. This often shows up at night, when we can no longer get a full night’s sleep because the urge to go comes on strongly and wakes us up.

This night time urge and running to the bathroom is when most falls occur. If you can strengthen your bladder and reduce the number of times you go to the bathroom each night, you will reduce your odds of falling.

Why do you get these faulty signals? One reason could be your diet. Bladder irritants, such as coffee, alcohol, spicy foods, and carbonated drinks, can all cause your bladder to be irritated. If you drink and eat these irritants every day, over time, you may find yourself with a bladder that likes to get your attention frequently. You become less and less able to hold more urine, and your pelvic floor muscles weaken. A history of urinary tract infections (UTIs) may also be a contributor to your bladder health, and your unwillingness to hold off running to the loo.

A few terms that are used to define urinary symptoms:

Stress urinary incontinence (SUI) - defined as a sudden unintentional loss of urine during normal day-to-day activities, and is commonly referred to as bladder weakness or a weak bladder.

Overactive bladder - defined as a sudden urge to go to the toilet to pass urine which is difficult to ignore, with nocturnia - getting up to use the bathroom at least two times at night. It is sometimes called an unstable or irritable bladder or detrusor overactivity. It means that your bladder wants to contract, even if it’s not full.

There are more conditions that affect our pelvic floor functioning, and finding out the root cause is beneficial for really solving the problem. Combining anatomy knowledge and the right exercises can be very helpful in getting these problems moving in the right direction. Exercises, such as Goblet Squats and Bridge Pose with a Kegel can help strengthen the pelvic floor by engaging the large hip and leg muscles. Breathing is also helpful, as our breathing diaphragm and our pelvic floor move together. And of course, meditation can help calm our revved-up nervous system.

I address issues related to the pelvic floor and how to breathe correctly in my Strong Women, Strong Bones program. Subscribe to my newsletter or check out the home page to find out when my next 4-week program is scheduled. Building strong bones, muscles and improving your pelvic floor strength are important to me, and I would love to keep you healthy and active for years to come.

Stay strong and retire active,

Andrea Trombley PT, DPT

References:

Henderson, J. W., Wang, S., Egger, M. J., Masters, M., & Nygaard, I. (2013). Can women correctly contract their pelvic floor muscles without formal instruction?. Female pelvic medicine & reconstructive surgery, 19(1), 8–12. https://doi.org/10.1097/SPV.0b013e31827ab9d0

Zou M, Lu R, Jiang Y, Liu P, Tian B, Liang Y, Wang X, Jiang L. Association between toileting and falls in older adults admitted to the emergency department and hospitalised: a cross-sectional study. BMJ Open. 2023 Jun 1;13(6):e065544. doi: 10.1136/bmjopen-2022-065544. PMID: 37263694; PMCID: PMC10254614.