The following was first published in the September 1998 Rancho Los Amigos Post-Polio Support Group Newsletter and is reprinted here with kind permission of the author, Mary Clarke Atwood and the Rancho Los Amigos Post-Polio Support Group.
CONSERVE TO PRESERVE PPS MUSCLES
Summarized by Mary Clarke Atwood
Editorial assistance by L. Craig and M. Jennings
Rancho Los Amigos Post-Polio Support Group Newsletter - September 1998
An enlightening program on muscle care was presented at the February 28, 1998 meeting of the Rancho Los Amigos Post-Polio Support Group in Downey, California. The featured speakers were members of the Rancho Los Amigos Physical Therapy Department: Jennifer Fitzpatrick, SPT, and Katy Schultz, SPT, under the supervision of Maureen Jennings, PT, from the Rancho Polio Clinic, and Eirik Blydt-Hansen, PT, APT.
The primary focus of post-polio rehabilitation is to eliminate strain on muscles, joints, and ligaments. In this report, polio survivors will learn how to monitor activity levels and achieve these goals with lifestyle modification, stretching exercises and using functional devices when necessary. These strategies will help preserve muscle function. "Conserve to Preserve" is the name of the game.
The key for people with PPS is to understand that "pushing through" pain and fatigue is no longer acceptable. Rather, it is important to realize that pain and fatigue are signs that an activity is too stressful for the muscles and may lead to permanent damage and weakness. Prolonged or repetitive high demand activities, which result in pain and fatigue, must be moderated or discontinued.
One way to monitor muscle overuse is by keeping a log of daily activities. [See sample log] This will help pinpoint activities causing excessive fatigue and which may need to be moderated or avoided.
A survivor may be able to continue performing some activities but with frequent rest periods and monitoring. Studies have shown that resting for twice as long as the activity time may result in improved endurance and avoidance of fatigue. If these changes are made early, strength may be recovered enough to bring the muscles up to a more useful level but not for excessive strain. [Dr. Jacquelin Perry's activity guideline is that a polio survivor can do anything as long as it causes (1) No pain and (2) No fatigue that last longer than ten minutes.]
Many people with PPS want to exercise to strengthen weak muscles, but in most cases this is contraindicated. PPS muscle weakness is not usually due to lack of exercise but rather from damage due to overworked muscles in everyday activities. In rare cases, minimal strengthening exercises have been beneficial in some muscles once major lifestyle changes have reduced the strain from everyday activities. Although there have not been any studies on stretching for PPS, most sources advocate maintenance of normal range of motion to preserve function.
Muscle weakness and tightness vary in each person with PPS so there is no general program appropriate for all -- an individually tailored program is best. Stretching exercises should be gentle and focus on tight overworked muscles.
It is important to understand that all contractures (joint or muscle tightness) are not bad. For instance, calf tightness can help increase stability during walking for persons with weak calf muscles. If this tightness were stretched out, it might decrease stability and result in the need of a brace.
A common contracture that is not beneficial is hip flexion tightness (inability to fully straighten the hip). An effective exercise would be lying on the stomach for 15 minutes each day to reduce existing hip flexion tightness and help prevent new or increasing tightness.
Gentle range of motion exercises performed independently or with assistance can be beneficial for most survivors. These consist of gently moving each joint through its available range -- avoiding fatigue or pain. The following general range-of-motion exercises are an example. Each exercise may not be appropriate for all individuals. If appropriate, each exercise should be performed SLOWLY and very gradually. A survivor might start with as little as one repetition and gradually work up to as many as 5 to 10 repetitions daily, spread throughout the day if necessary. The keys are avoiding fatigue, increased weakness, and pain.
Make circles with each ankle while sitting or lying down.
While sitting, straighten one knee, lifting the foot from the floor, then lower slowly. Alternate left and right legs.
Slide/raise one knee up towards the chest, then lower slowly. Alternate left and right legs.
Slide one leg out straight to the side, then return it to the middle. Alternate left and right legs.
Bend hands up towards the shoulders then straighten arms back down to your sides.
Shrug shoulders up towards your ears, then slowly lower.
Lift one arm straight out in front, then lower. Alternate left and right arms. (This is easier to do lying down.)
Lift one arm out to the side then slowly lower. Alternate left and right arms.
With elbow bent and held at your side, slowly rotate hand in toward stomach and then out to the side. Alternate left and right arms.
Many polio survivors find it difficult to return to the functional devices they worked so hard to get rid of in childhood. But many of these devices can help take the strain off muscles and joints:
All of these devices decrease demands and help protect weakened muscles thus prolonging the person's ability to perform functional activities.
Overuse of muscles can cause swelling and inflammation. These may be reduced by the use of Non-Steroidal Anti-Inflammatory Drugs such as Ibuprofen. (Consult your physician before taking any medications). But, keep in mind that these drugs only mask the pain, they are not a cure. Dr. Perry says, "Pain is a sign of injury and overuse, so don't let it happen. Try to determine what causes your pain and avoid it."
Unfortunately, the popular phrase "Use it or lose it" does not apply to PPS. Polio survivors must reprogram their minds to think "Conserve to Preserve."
Think of your muscles as money. You have a certain amount that is available for use each day, which is based on your income. The actual amounts you use during each day are your expenditures. You also have a savings account or reserve of muscles. If your lifestyle continuously exceeds your daily income, then you begin depleting your savings account until there is no reserve. Continuing at this pace will lead to decreases in function as your muscles are "repossessed" -- one by one.
Lifestyle modification is the way to protect your muscles so they will last. Functional devices can help take the strain off weak muscles and joints if appropriate. Remember, a muscle has only so many contractions within its lifetime, and once used up, there is no turning back.
Sample Log Form
For more information, Contact:
Rancho Los Amigos Medical Center
Physical Therapy Department
7601 E. Imperial Hwy.
Downey, California 90242-3496
562-401-6847 FAX 562-401-6052
The Rancho Los Amigos Post-Polio Support Group meets the 4th Saturday,
from 2:00-4:00 in Downey, CA.
Contact: RanchoPPSG@hotmail.com for more information.
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