March 1, 2022 danny

“I’ve Fallen and I Can’t Get Up!”

“I’ve fallen and I can’t get up!”. If you are my age, you remember this commercial (back when we actually watched commercials). It was a commercial for a product called life alert if I remember correctly. It was a necklace meant for the elderly person living alone that sent an alarm to an emergency service if they had fallen and couldn’t get to the phone.  Well it’s a not so fun reality for some people as they get older.

What made me think of this commercial recently was a new patient I had the other day.  She was 72, in relatively good health with moderate low back pain that had been off and on for years.  She did water aerobics, yoga and even some light resistance training with exercise bands.  But what really made this patient stick out in my mind was one thing.  Despite the somewhat regular physical activity, she couldn’t get up off the round without some help or something to hold onto. 

One question I love asking my patients is “WHY are they here?”  I mean really WHY?  Is it pain?  Is it a certain activity they can’t do? Are they trying to go on a cruise and win a Limbo contest? (No judgement.) So this patient’s “WHY” really struck a chord in me. She said “Dr. Govenar, my WHY is my granddaughter.” I was intrigued so I asked her to explain further. She then told me how her granddaughter loves when she gets down in the warm sand on the beach with her so she can help her build a sandcastle which is something she also loved to do as a little girl. But unfortunately, she couldn’t because once she was down, she couldn’t get back up  

So why was she having so much difficulty getting up off the ground? At first, I thought it was her knees or ankles. She had been a runner in her 20s and 30s. But those had adequate movement. Then I thought it was her arm strength that was a problem. But watching her perform a plank was impressive. But there was one basic move that she struggled with when I was performing my physical examination. She could not perform a squat. In fact, her back hurt more when trying to do a squat. Then I started to think about her back pain. She had full range of motion in the lumbar spine (low back). In fact, she had too much motion. So, we looked at the hips once again. The motion was good, but she lacked some strength in the glutes AKA butt muscles, hamstrings, and quads. What I realized at this point was that it was not from lack of use but lack of PROPER use. What do I mean by this. Well, performing a squat may seem simple to some but many people don’t know how or can’t do it without rounding the back too much which can put pressure on the discs and surrounding structures leading to more low back issues, better known as “PAIN.”  

But I had an idea.  What if we just go over a proper ‘hip hinge”.  Why you say?  Well, in my humble opinion, the hip hinge is the key to any type of proper squat or lunge you can ever learn and without a proper squat or lunge it’s very difficult to get up and down off the floor. There is a very simple way to teach someone how to do a proper hip hinge. Learn a hip hinge here: 

We worked on this technique for about 10 minutes until the feeling of the movement finally clicked. To her surprise she could now get up off the floor on her own and with less back pain!  She was so excited that she proceeded to do more squats than she had done in 20 years which also made it so she couldn’t walk the next day. But it was worth it. 

Because that very next weekend, she could get face to face in the warm sand with her granddaughter and build sandcastles together. 

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