 to physical therapy for a better life. I'm Christine Linders, physical therapist, board certified orthopedic clinical specialist. We are all aging, there is no debate there. And we wanna know what can you do to ensure you age the best you can. Skilled physical therapy can help you preserve your balance, prevent injuries, such as rotator cup tears, hip recitis and more, as well as improve your function and decrease pain from arthritis. How do we do this? Today, let's learn from an expert physical therapist with 40 years of experience. She's a board certified orthopedic clinical specialist. She's a certified strength and conditioning coach and a certified ergonomic specialist. Shirley Brewer, welcome and thank you for coming on to physical therapy for a better life. It's great to see you again, Christine. I'm sorry, it's not on the East Coast. I know, well, I was just there yesterday as a matter of fact. And so this is great because I have known Shirley for my whole entire physical therapy career and even before then because I played volleyball at UConn and she was a referee and we have connected over the years and her resume is so extensive. I highly recommend you go to her website and read about her because I could not even possibly talk about all the things you've done, Shirley, in these 28 minutes. I'm so impressed by you and so grateful to know you. But what I wanna, you're welcome. What I wanna know first is we're talking about aging and how physical therapy can help us all no matter what decade you're in, age more gracefully, continue to improve your function. What is the difference between now what they call physical therapist is DPT versus what you and I have achieved which is that orthopedic clinical specialist. Can you tell us? Absolutely. I go way back to the days when entry-level physical therapy was a bachelor's, then it went to a master's degree and I applaud our profession in trying to continue to educate people as to the scope of our knowledge and have it now be a doctorate-level degree. But that is an entry-level degree. They study more research methods than we had. Those weren't available when we were in school. They studied more about x-rays and clinical radiography, things that we have learned along the way. But just like your doctor when he finished medical school had to take a board certification, we also have that opportunity in our profession in a variety of fields, pediatrics, orthopedics, sports, chemotherapy or a cancer treatment rather, pediatrics and the list goes on. So you and I are both board certified in orthopedics. As you know, it was a tough exam, sat for eight hours and crossed your fingers for six weeks. We didn't get our results back immediately by computer and then you opened that envelope shaking and going, I passed. And then you think, great, I passed. And then 10 years later, you have to recertify again. So you have to do teaching and clinical research and all sorts of things in order and present that to our board certified people again and they look at it and read it with detail and say, okay, we'll let you go for another 10 years. And then, so I've done that three times. Yeah, so I'm amazed. I've recertified once so far and the amount of time it took me to do the paperwork for the recertification was about, I said it was at least 40 hours of time of me Xeroxing every community education talk I did, every student I had, every talk I did to physical therapists and printing out those documents and loading it in and supplying all this information and telling all the points to submit for my recertification and it is a very big deal and I'm so glad we're talking about it. Yes, me too. I think it's important that people recognize it is the practice of medicine for a reason. When people are kind enough to say to me, you're a very good therapist. I say to them, I've had very good teachers. And one of the things I think is so important in our profession is continuing to mentor young people. And it's why I keep working for a few more years. I'm trying to get a few more young fledglings under my wing and show them the way that we old, as I always say, old physical therapists used to do things. And the thing I'm most proud of is I still treat one patient at a time for an hour. That's not heard of much anymore. I'm sorry, go ahead. No, it's all right. It is the way that you have to be if you want to really understand what's going on with people and help them figure out, especially during this aging process, right? You have to ask questions. We're investigative reporters, I tell my students. If you're not figuring it out, that's what I love most about my job because people say, aren't you tired of doing orthopedics after 40 years? And I go, not at all. No, two people are the same. Your injuries aren't the same as my injuries from playing volleyball or from doing other things that we've experienced in life. So you have to ask the questions and figure out the pieces. No, I love that you said that investigative reporters because we are so much alike. And I remember talking a lot with you a couple of years ago about how our education differed than the education today and how we investigate. But that hour really does matter when you're trying to depict, like you said, we ask a lot of questions. This person's story, this person's injury pattern, this person's history of injury, whether they had a car accident 30 years ago, they fell down the stairs when their tailbone 25 or 40 years ago or they blew out their back 35 years ago, all those things lead up to the person that comes into our office today. If they have been aging, and let's say they're, I say aging like 40 years plus, you start seeing a lot of these old injuries that are now presenting a pain without an injury and somebody is 40 or older, right? And why is that, right? So as you know, I taught history taking and physical exam at UConn for 20 years, right? And I was always taught that that's the most important aspect of being able to figure out what is going on with your patient, as you said. So people say, well, how could this fall have hurt me 20 years ago? Or I know there are certain doctors that feel that physical therapy is not beneficial after like a hip replacement. And I think that person has been walking with an antelope gate for six months or a year before they've had that hip surgery. And what I say to them is I sprained my ankle playing volleyball in high school. And after it had healed, my coach looked at me and she said, are you still in pain? And I said, no. And she said, then why are you still limping? I had learned that motor program. And this is it, if you have an injury and you don't have it treated, then your body learns to accommodate and to adapt to that injury. And we can get away with a lot of accommodation and a lot of adaptation when we're younger because our tissues are more flexible, we're strong. We can just make up for it. We can hit that volleyball, like for instance, we have shoulder trouble in my family. I could hit that volleyball for years like that, right? And I don't have any pain in my shoulder, but all of a sudden the power was gone and I couldn't hit like that anymore. And I was like, hmm, I've lost that ability to adapt that. I have to learn a new way to hit the ball now, right? But if I had learned the right way to hit it when I was younger, I might have had a longer period with that shoulder. But yes, or your tissues get tighter and shorter and so all those postural changes that we start to get as we age, they say that 50% of the people over the age of 50 have arthritic changes in their spine. Well, those arthritic changes are there all the time. Why do you hurt some days and not others? Well, probably because you sat in bad posture, you slept on the couch. I mean, how many times have you heard that? I fell asleep on the couch. Your neck is way far forward. And then all those tissues have tightened up and shortened up and kind of put those joints in a vice grip. And then the arthritis starts to talk and be noisy to people. Absolutely. I want everybody to hear that because you mentioned posture too. And I also like to say to people, it's the things that you're doing that you aren't aware. Like you fall asleep or you have reflux and you're constantly having your head up or you like to read in bed with your head cranked up. Things, they don't hurt you at the time until you have had those adaptive changes or it hits strain. And now all the things that are normal age-related changes, the wearing away of the joint services, now they hurt and you have arthritis. And now it's like, oh, I have arthritis. There's nothing I can do for that. Well, me, we are here to tell you that there's so many things you can do for that. That's right. And again, I'm so grateful for the teachers I had when I was younger because I'm thinking of another time. I unfortunately had a period in Connecticut where people were driving and not looking where they were going, which they still do now, but they kept rear-ending me. So my neck had gone through a series of like whiplash injuries and I'm like, oh my goodness, right? And I'm just like, oh boy, I just want to take my head off and put it on a shelf because it was so heavy by the end of the day. And you look at all the muscles that are attached from your head all the way down to your back. People just don't realize all these attachments that occur. And so with your head going forward, we get this rounded back posture, which you and I know we call a kyphosis, right? And everybody thinks, oh, I can't turn my head. And I'm like, well, if you sit up tall, you can turn your head. I mean, all I did was change my posture. And there it is right there. Thank you. So I like to tell my patients, you know, if you weigh a hundred, your head is 8% of your body weight. And if you weigh 150 pounds, your head would be 12 pounds. And if you're lined up like that picture on the left where it says 12 pounds, that's great posture, the tip of your ears or the tip of your shoulder and it goes in front of your hip. And really, if you're standing with good posture, the only muscle working in your body is your calf. That's the only thing working. So people say to me, how can we have so much energy? I say, I only use my calf to hold me up. I don't use everything else to hold me up, right? You start to get forward like that little head there, that's 32 pounds and it goes way in front of you. That's 42 pounds. So now you've got less vertebral bodies of the spine because that head's out in front, trying to hold up the same amount of weight. And that head is being pulled back and you're like, oh, my neck is so tired. And that's why my head hurt after the car accidents because it was forward and until I could get it back again. But what was most interesting was I couldn't get it back again until I got the upper part of my back moving again. And at 28 years old and as a physical therapist who already had her master's degree, I didn't even realize I was stuck there. And my mentor treated me and got me unstuck and I went, oh, is this one? And if I didn't know that I had lost that range at 28 years old, how would I know that at 30 or 40 or 50 or now as I reach that next decade, right? And I'm happy to say as a 60 year old, nothing on me hurts. And I've broken my ankle, my shoulder doesn't have the power it has even though I work out and do high intensity training but I can still hit a volleyball lots of other ways and still make it go. So yes, we age, we lose certain things but you have to keep working to maintain your flexibility and most importantly, your strength as you age and you will deter many of those changes. Yeah, it's amazing to hear you say that. And I know when we were speaking on the phone I was telling you about all my various ailments that I have but I've actually been talking to my mom a lot lately over the past like six years and I was telling her despite all my injuries and you and I with the whiplash, I didn't realize we had that in common. Yeah, three whiplashes, not my fault. It's like we're a target, right? And my neck felt like well vertebrated as y'all know now and soon. So yeah, so I was saying to her that it's amazing all the neck pain that I had, I was right before I started physical therapy school is now just like almost gone unless I'm doing something wrong, like very bad. And even a physical therapist who has to look down, I have all these strategies in place because I know, because I've lived it, I've worked on my middle back and I can't believe at 49 years old, how good I feel with how painful my neck and my body was through my 25 to 40 years old. Yes. Everything that we know that we wanna teach everyone watching so that you can do the same thing because you said something to me shortly, you said, don't give up, don't let the doctor tell you you're old, right? We're all aging, we're all getting old and it's just because our cells are getting older and our tissue is getting less collagen and we're getting more dehydrated and less flexible, but don't give up because we know, you and I both know 80 and 90 year olds who are doing great because they didn't give up and they keep doing exercise, they keep working on their posture, they keep reminding themselves to improve. All of us wanna maintain the quality of our life. I have every intention of being active. My mom's high school presentation was still playing golf well into her 90s. I'm in play in tennis. I'd like to be there too and I have every intention of being there, but you have to keep working at it. And what I tell my patients, you know, if you've lost some of your flexibility, I've lost a little bit of mine, but if you work at it, you can get it back, but tissue, it takes six weeks to six months to change. So what happens is we're creatures of habit, right? We stretch a little bit and then we stop. You have to keep stretching because you lengthen that tissue and you think of it like plastic. And then it shortens back a little bit and then you lengthen it again and it shortens back a little bit and then it lengthens again. And finally, you can get your ranges, you can get your ranges, but you have to be patient and never stretch into pain. As you and I know, we grew up in that generation where they said, no pain, no gain. Horrible, horrible phrase. If it's painful, your body is telling you to please stop that behavior, like find another way in. And that's, I think the other, my shirt says physical therapy, that the science of healing, the art of caring. I think that's where the art of physical therapy comes in. It comes in because as you know, with your experience of mine, you can give somebody an exercise program. We could take two people that have the same problem and they could both get the same exercise program, but they're gonna respond entirely differently because their bodies are different. So that's where you need that therapist to look at your body versus my body, where are your areas of tightness versus my areas of tightness? And we might both end up on a similar exercise program in four or five months, but you might've come from the West and I might've come from the East in order to get to that program because I needed different tissues worked on than you did from your injury history and your past versus mine. I think that's key. It's the individualization of what physical therapists will give someone coming into the office when you're looking at them through the eyes of what you're talking about right now. This injury history, this person, this hip replacement that needs physical therapy, even though the doctor picked this hip because he walked with his foot turned out for six years or he was leaning over and now one muscle doesn't function well or he's leaning over and he's gonna hurt his back because he's adapted that pattern and we need to change it back to normal now that his hip is normal and fixed so that he can carry on with his life. And he doesn't even know what normal is. You know, I had a patient who was interested in it. This happened to me again recently and I love when this happens. You know, I changed their posture and I think I thought about this after my car accident too and they said to me, oh, I feel a little off balance. I actually feel like I'm leaning backwards and it is because they had spent so much time forward that now upright felt backwards to them and I thought, but that's great. Now you're aware of a change in your posture too. You know, so again, your point was so well made. You know, people sit in bed and they read and they do it year in and year out. They get more and more like this. You know, what I say to people, I'm only as good as you are at following through on what I ask you to do. And if I ask you to do something, then you come back the next time and I say, well, how did that work? And the answer is either it helped or it didn't help. And there are times when it doesn't help, right? So then the question off of that becomes, please show me how you did that because the question is, did they hear what I explained to them and integrated properly or did they not do the exercise properly? Cause they just either I didn't explain it well or they just didn't get it and that's okay. And that's where the time spent with the patient. You know, we're educators. Our job is to teach people how to take care of themselves. And I had a patient that had been undergoing treatment for years with somebody else and that person closed their practice and came to me. And I had a period in my life where I just took a break from working because some things had happened and I had the good fortune of going off to Australia and she was all panicked. Oh my gosh, what am I going to do? And I go, you're going to do fine because I was only treating her like every now and then. I said, you've learned how to take care of yourself. And she, I came back and she goes, I was fine. And I go, nothing makes me happier, you know? People say, well, you'll put yourself out of business. That way I go, no, you won't. Other people, I have the phone ring all the time because people say somebody told me that you got them better after they'd been in back pain for years and I'm like, I get fortunate with that sometimes some, you know, some people better than others they may not always be pain free but usually we can make some sort of change but they have to follow through what we suggest about changing your posture and changing your body mechanics because as you alluded to earlier it's the repetitive motion of doing something wrong time and time again, year in and year out, you know people bend over at the waist all the time you and I know that's the worst posture for you, you know, but I would give lectures and companies I'm an ergonomic specialist, you know? And I would go to these companies and I'd give a back lecture and then and I'd go through all the, all my slides and showing them how they should lift and how they should pick things up and then I'd walk through the floor and they'd still be bending over the wrong way and I'd go, here's my card, here's my card see you in a few months, a few years but you really have to apply what we tell you. It is amazing, I love that you, you talk about, you know, the art of caring too and that's the part when the person comes back and say it didn't work and you asked them to show you the exercise and they're not doing it the way it's designed for them we do care, we want you to be better and also the other point that you made I love it when people go on, I say our job is to make you an honorary physical therapist like you said, you're going off to hospital, yeah? You're going to be fine because we're just doing these little touch-ups and you don't want to take care of yourself and you know if you bend wrong and you forget because we will or you drop something and you go to clean it up quick and you forget about your mechanics and your back is sore later you say, okay, what did Shirley teach me? That's right, you go back to your routine and you get your nervous system back in that it feels like it's leaning back but it's actually straight and you treat yourself again and get yourself back on track and that's the art of caring that's what we do is we want you to be honorary PTs we're not going to run a business we just want you to, we want you to feel as good as we feel as we've aged from the knowledge that we know from our mentors and our education and our passion as a profession. One of my students said one time you quiz your patients, I go, I don't quiz them in a way, we are though, right? And it's always like, you don't need to be a physical therapist you don't have to explain it to me in physical therapy terms but I want to know what they understood from what I said to them, what did they hear? You know, we all communicate differently, right? What did they hear and how did they integrate it? And then if they got most of it, that's great if they didn't, let's see how we can clarify and make it apply again, so right, yeah. I learned a lot from my patients that way when they come back and they tell me, oh, I did this and they say it in a certain way and I'm almost like, you know what? That's what I need to tell people because it was one of those exercises that was hard I wasn't explaining it well and they finally came back and said, oh, well you, I figured out that you what you wanted me to do was X and I look at them and I'm like, I never thought of explaining it that way. So I do learn a lot from different with people and, you know, after what? May I have been doing it for 25 years? I'm still learning. Yes, well, people say to me all the time, aren't you tired of doing this yet? I said, when I get good at it, I'll let you know. You know, I'm always working to get better and as you clearly know, the more years you have, the more you know, the more you realize, the less you know. So we have this whole framework that we learned in school and this is how I teach my students now. I teach them fundamental, what I call fundamental orthopedics, what are the motions of the spine? What different types of problems can occur there? What are the motions of the shoulder? What are the motions of the knee? So we look at all those joints from what we call arthrokinematics and then the muscles that attach. But then we start to layer on top of that. We talked about fascia a little earlier and fascia came into being in 1983. I took my class up in Boston and there were 400 people there and everybody was saying, oh, fascia. Oh, people, you can't really do that. You just can't put your hands on people and think that that's creating any change. They just feel better because your hands are on them. And the osteopaths that I have spent so much time studying with them forever grateful to said, a good manual therapist is 15 years ahead of the research. Sure enough, 15 years later, the electron microscope comes onto the scene and they start looking at the microtrauma from the whiplash injuries you and I have had, right? And they're like, oh, well the x-rays didn't show any changes because I was in my 20s, right? But there were some vascular changes because the tissue was stretched and irritated and then there were scars, microspasm is the scars and that affected the vascular of the tissue and the healing. Oh, that's why they might have some pain after the incident is over if they didn't get their ranges back and they didn't get things restored properly, strength and posture. So voila, 15 years after we've been doing something, the rationale comes out why. And it's the same thing with a lot of the other advanced techniques that I've learned, craniosacral and visceral and strain counter strain. And they didn't know why they worked necessarily when they started doing them, but they were seeing results and patients. So then we had to figure it out. And that's where the doctorate in physical therapy is helping us, it's making it more proof positive about the things that we have been doing for years, our science and not just art. Yeah, I think it's amazing. That was one of those things that people would ask, when you do this, it works and you hear it from patients all the time. When you do that, it works. When you do that, it works. They're like, why, why, why? And you're like, well, you come up with a reason why you expect that it works but now there's actually evidence and research because they've done these studies to prove what we've been doing 15 years earlier than getting results with, now they're proving it. So we can say, we can show why, we can prove why. So we have about five minutes left and I know there's so much we can talk about but I do wanna ask too, like for someone who's aging and they wanna maintain their strength. We talked about flexibility and consistency. Are there any tips or secrets that you recommend to your patients about keeping strength as you age? Let's even say like in the 70s and 80s group of people who wanna play pickleball and they're known to play home weaker. I can't get up and down the stairs as much. My knees are kinda achy or more now and... I think everybody has to be looked at as an individual. You know that. I think I have the good fortune of still being able to tolerate high intensity interval training. That is not everybody's cup of tea but I have also strength trained my entire life. So I think you have to look at what level the person is coming in from. I love Shirley Sharman's four stage core exercise, because it just teaches you how to isolate your core muscles. I love just some basic body and band resistance exercises as you age because I don't think you need to, I don't lift the weights, I lift it in college by any means. My goal is to just maintain my strength and my fitness overall. So I challenge my system but I never challenge it to a point where it causes me pain. And if I did do something where I felt a little something, I think, what did I do in that workout? And I adjust it the next time. So what I do with my patients is I start them either gravity eliminated or against gravity depending upon what they're coming in with with a strength level. And I strengthen their trunk. I work a lot of trunk, lats on their stomach, rhomboids on their stomach. And then I say, then we're gonna do the same exercise but we're gonna do with bands now. So then I put the door anchor at the top of the door and I put the TheraBand in it and then I have them pulled down and I say, now how does, you're still working your latissimus which is a muscle off the back of your shoulder, it goes all the way down to your pelvis and helps maintain that posture. I say, you're still working your latissimus but how does this differ from lying on your stomach? Okay, well when you're lying on your stomach your whole body is supported. So then you're only really having to isolate that muscle group, right? When you're standing, now you have to work on your posture. You know, I don't wanna see when you get tired you start putting your head forward as you pull that band down, right? You're using your core, you're using what we call a concentric muscle contraction which is a shortening and then as you let it up slowly you're using a lengthening muscle contraction which is how we use our muscles daily in activities. We don't just shorten everything or we'd walk around like this, right? We have to shorten and lengthen. So I think, you know, looking at exercises I do a lot of good upper back strengthening glutes, core get your major muscle groups working. I think especially as we age people start to lose range in their calf muscles. We call that your gastrocnemius, right? Just a little guy. So they need to stretch that because if they don't have the ability to translate their tibia which is your lower leg bone over their foot they're gonna not push off they're gonna not be as efficient in their gait pattern they're gonna get more tired and also are many people their field of depth changes as they age and this is, you know their head starts going forward and they're gonna tumble as they go forward like that they're gonna start carrying themselves in that. And so stretching your calves strengthening your calves is important it's simple, just go up on your toes while you're, you know at the kitchen fixing breakfast in the morning or something like that. Stand on one foot while you're brushing your teeth in the morning and work on your balance that way. That's a great, great way because we also lose our balance as we age. There's so many simple things you can do. Walk sideways, walk sideways the other way so that you're working both directions, right? I mean, it's such a simple exercise. I tell all my older people you become old when you have to get out of the chair with your hands on your thighs you should be able to stand up out of the chair without putting your hands on your thighs. Obviously, if you're weak and you have a balance problem you should start with using your hands, right? But the goal you have to set goals. So, and if they can't do it from a lower surface I put them up on a couple of pillows and get them higher, put them up on some foam start from a height that you can achieve and build the strength that way. There's just so many wonderful things you can do to keep yourself in shape as you age that don't take a lot of, you know, equipment. A fair band, a door anchor and standing on one foot. There you go. I mean, it doesn't have to be at a gym. I think you just dropped the mic on aging. And I do think that this show in particular as we wrap it up is something that physical therapists and everybody else who wants to age gracefully is gonna need to watch more than once because of the incredible knowledge you just shared with us all, Shirley. I'm so grateful on posture, biomechanics, stretching, strengthening, simple things you can do, the insight that you gave us. So I so appreciate you being here. I hope that at some point I can get you on again. My pleasure. Thank you, Shirley Brewer for coming on. Let's pop up Shirley's website where people can find her if they wanna get some information or schedule an appointment with her. And as always, life is better when you listen to your physical therapist. Hello, hi everyone. Aloha.