Over the Next Hill Fitness
Welcome! We all know, as we age, it’s harder to put ourselves first and get in enough fitness, flexibility, and nutrition. Maybe you’re new to formatted exercise, maybe we need to push to the next level or set some goals. Perhaps you’ve always wanted to run a 5K, a marathon, or even an ULTRA marathon. This podcast is designed to get you moving and headed towards those goals. You’ll have opportunities for general coaching during each episode or you may contact me for personal coaching afterward. Are you ready to get over this next hill in life? Let’s get started.
Over the Next Hill Fitness
S2 Ep24 Transforming Lives: Will Harlow's Strategies for Healthy Aging
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Discover the inspiring journey of physiotherapist Will Harlow in this episode, where he shares how he transitioned from the high-stakes world of professional football to finding his true passion in supporting individuals over 50. Will's experiences reveal the unique challenges older adults face in maintaining muscle and bone health, offering insights from his book, "Thriving After 50." Through engaging discussions, we uncover strategies to counteract age-related physical decline and explore the importance of patience in healing, while proposing alternatives to surgery for greater mobility and independence.
Will brings an empowering message that it's never too late to enhance your physical health, regardless of past activity levels. Even in one's 70s, 80s, and 90s, significant improvements in muscle mass and bone health are achievable through resistance training and consistent effort. This episode introduces the innovative "nine at 90" concept, a set of movements to maintain full-body mobility into one's 90s, offering listeners both personal goals and a framework for assessing their movement health.
Throughout the conversation, we delve into practical strategies for injury prevention and rehabilitation. Will emphasizes exercises like the goblet squat and effective warm-up routines, advocating for rehabilitation over surgery in many cases, and highlighting the body's natural healing capabilities. We tackle common issues such as back pain and kyphosis, underscoring the power of exercise as a primary treatment. Tune in for a comprehensive guide on building strength and mobility after 50, and be inspired by Will's expertise, his YouTube channel, and his bestselling book, "Thriving Beyond 50.
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Thriving After 50
Speaker 1Hello and welcome back to Over the Next Toe Fitness Podcast. I'm Carla Coffey, your coach and host for today's program. I just want to thank everybody who's following, rating and sharing the program. Please keep doing that. If you haven't rated it yet, I appreciate five stars. Just go to whatever platform you're listening on. There should be a place in there to rate the show, and I really appreciate that listening on. There should be a place in there to rate the show, and I really appreciate that.
Speaker 1You can look in the show notes for some links to today's episode where you can follow Will Harlow, who will be featuring on the show today. There's some links in there for some discounts for some products, hydra Patch being one that I just love for extended exercise. And you can follow me on all the socials. You can email me directly, carla, at coffeecrewcoachingcom, and as well as go to the website coffeecrewcoachingcom and look me up to be your coach. We can do fitness. We can do running. If you're local to the Madison Wisconsin area, I do in-home coaching as well, so I come to your house and make you lift some weights and we can go for a run together. So there's a lot of options and, of course, obviously the virtual. So I appreciate you for that. And if you'd like to help me directly and buy me a cup of coffee there is a link for that Do a dollar, you can do $5. And it's not like a continual, it's a one time thing. So if you want to support my habit, you can definitely reach me there.
Speaker 1So today I'm going to be talking to Will Harlow. As I mentioned, he's a fantastic physiotherapist. He has a great YouTube channel. There'll be links in the show notes for that. You'll want to listen to or read his book Thriving After 50. And we're going to talk about the muscle loss and the bone loss that happens to us after 50, but what we can do to regain that and that it's just never too old. So you'll want to listen in for those tips how surgery is not always the best option that you can really heal just about anything if you're patient enough, and that's usually where we lack. So please listen along and we'll see you at the end. Welcome to the show, will. It's so great to have you here.
Speaker 2Thanks so much, carla, it's great to be here.
Speaker 1So I wanted to have you on the show because I found your book online, thriving After 50, and I wanted to talk to you about that. Most of my listeners are women, most of them are runners, and I think a majority of them are over 40. And I know you specialize in over 50. So I wanted to get your input on helping women with their skeletal functions and muscle functions as we age. So if you would like to tell the listeners like your qualifications and then just knock it out of the park, yeah, absolutely no.
Speaker 2I'm more than happy to help out where I can, and I think running is such a great sport for people to be a part of, and it's something that they can do throughout life, hopefully. So, yeah, more than happy to try and bring some of my experience to this one. So my name is Will Harlow and I'm a physiotherapist from the UK. You guys would call that a physical therapist there's no difference whatsoever, just terminology. And I studied physiotherapy and sports science. I did two degrees and graduated from Brunel University with a master's in physiotherapy in 2015.
Speaker 2And, like most young male physios, I thought I want to go and work in professional sport when I finish. I want to go and work in professional sport when I finish. So I had my heart set on soccer, or football as we call it here, and when I graduated, it was all I wanted to do. So I was interested in helping the young players get back onto the football field and, through a stroke of luck, when I finished university, I got a job offer at a professional football club not just any club, but the one I supported as a child. So I went straight into the world of professional football, thinking I'd struck gold. But when I got there. I did a couple of years and realized this really isn't for me. It was a terrible fit for my personality. It wasn't quite what I thought it was going to be and after a bit of soul searching I decided this is not where I'm going to belong.
Speaker 2So I made the difficult decision to leave professional sport and while I was trying to decide what to do next, I moved into the NHS as a physio, and the NHS is our national health system. It's a great system. It's packed full of people because it's free at the point of care. But as a physio, that's cool because it means you get to see a lot of different patients and you know your diary is always busy. So it's a great learning ground. And most of the people coming to see me when I was in the NHS were over 50, just because people of that age tend to suffer with more musculoskeletal problems. And I look back on my kind of first six months in the NHS one day and I was thinking this is the most fun I've ever had. I'm helping these people to improve their mobility and to become more independent and to get stronger and to not necessarily get back to sport, but to get back to living life and enjoying life. It was so, so rewarding for me.
Speaker 2So from that point, I realized that specializing in helping people over 50 was what I wanted to do.
Speaker 2The issue with the NHS is your listeners probably don't know a huge amount about it, but it's very well set up for emergency problems. So if I was to have a heart attack right now, I'd get world-class care, but for long-term kind of chronic health problems it's overstretched, it's overcapacity capacity and it isn't really set up to help people in the best way possible. So I knew that if I wanted to help my um, my interest group, these people over 50 the best way I could, I was going to need to go and do it on my own. So I left the NHS. I set up my own business in 2018 and we've just gone from strength to strength, specializing in the over 50s, and the beautiful thing about that category of people is it's such a diverse group. You've got people who are still running and doing you know master's sports and then you've got people who just want some help in being able to climb the stairs at home, and I enjoy helping all different kinds of people within that age group.
Speaker 1Wow, that's. That's quite a story to start with, the fact that you went with what you thought you were going to love and found something else that now you love. That's good for you for just not going. Well, this is where I'm at, so, and I I know from watching your videos that you've helped a lot of people. I read the comments sometimes and then your examples that you gave in the book of the people that you've saved from surgery, because sometimes we feel like that's you know, oh well, I guess I'm having surgery now for my hip or my knee, and the fact that you're helping those people is so fantastic.
Speaker 2It's really rewarding. Yeah, thank you.
Speaker 1Yeah, I'm sure. One of the things I wanted to talk to you about was the muscular skeletal health of those over 40, right, because we have to look forward to osteoporosis just muscle loss. We have to look forward to osteoporosis, just muscle loss. What can we start to do? Or at any age, I suppose. But at what age do we start losing those things to where we?
Speaker 2really need to focus to maintain our health? I think, to answer that question, it's really important to think about what actually happens to the body as we get older, and one of the things that happens is we have changes in our joints, so we end up with less cartilage, and the quality of the remaining cartilage can decrease in our soft tissues. So in our muscles and our tendons we end up with a slightly decreased stiffness, which sounds like a good thing. But in your soft tissues, you want some degree of stiffness. You don't want them to be too kind of mobile, and we also end up with a decrease in your collagen quality as well. So that can leave us wide open to problems like muscle strains, where when you're in your 20s, you feel bulletproof, don't you? But in your 40s and 50s, suddenly, something that would have been totally fine can cause a strain.
Improving Health Through Exercise and Lifestyle
Speaker 2And, as you say, we can also start to lose muscle mass with age as well, and the statistics on that are quite scary. We can lose the average is about 8% per decade of your total muscle lost after 50. So every decade after 50, you lose almost 10% of your muscle mass, unless you do something about it Now. Rates of bone loss are pretty similar. They differ depending on your age and your gender, but again, we're looking at a similar kind of rate for bone loss over the age of 50 in the average population. For women it's faster, so that all paints quite a gloomy picture, but the truth is a lot of these things are still in our control. And in answer to your question there, carla, when should we start to think about it? I mean, yesterday was the best time. As soon as you possibly can start acting to prevent these things is the best time to do it. But the important message I want to get across is that you can control your muscle mass or the rate of loss, and even gain it over the age of 40 or 50. Same with bone.
Speaker 2For many people it's possible to regain lost bony tissue if you know what you're doing.
Speaker 2You can improve the health of your soft tissues again by lifestyle changes and exercise, and you can stave off all manner of problems that we once used to think were inevitable, things like arthritis. Well, we now know that some of that is in our control as well. So I hope that's quite an empowering message, but it's also an urgent message, and starting as quickly and early as possible gives you the best chance of staving off those problems now. To sort of call on some specific data the number one predictor of whether or not someone's going to suffer with osteoporosis later in life is how active they were in their teens and their 20s which might surprise people and that just shows that it's never too early to start working on these things, and people who were sportier and more active and did more weight training when they were younger have lower rates of osteoporosis later in life, even if they've given those things up. So starting early and doing it regularly is key, but knowing that more of it is probably in your control than many people realize.
Speaker 1Okay, so let's suppose so for myself. I didn't start working out in my 20s or 30s, right? That's when I was raising a family and things, and the 40s slipped by. And then let's say, I'm 60 now and I haven't worked out, but I just come from the doctor and they tell me that I'm being diagnosed with some muscle loss, of course, and some bone loss. So is it too late for me? Or can I start today and correct that, or will it just stop it and not progress? So let's suppose that's me, and what would your advice be for me?
Speaker 2me, and what would your advice be? For me, it's never, never, too late to start. There is always something that can be done to improve your situation when we're talking about muscle loss and bone loss. And there are many, many people who are only just getting the message now of how important exercise is and how much our lifestyle can influence these things. And these people are in their 60s, 70s and things. And these people are in their 60s, 70s and even above. They're in their 80s or 90s.
Speaker 2But there was some fantastic research done very recently about the about the muscle loss issue that we were talking about there and we know that resistance training, which is one of the best ways to regain muscle, we know that works for people in their 50s and 60s because we've got lots of data to show that. But before this study, there wasn't very much data to say what will happen if we do resistance training in our 70s, 80s and 90s. Well, the researchers took basically two groups of older people One group was in their 60s or 70s and the other group was even older. They were in their 70s, 80s and even early 90s and they put them through the same resistance training program to see what would happen to their muscle. Now what they hypothesized would happen was the people in their 60s and 70s would gain some muscle and the people who are older would probably stay about the same. But what they found was there is a completely equal increase between the two groups, so the older people gains just as much muscle mass as the ones in their 60s and 70s. So that shows to me that it is never too late to start working on putting muscle on your body. And even if you don't manage to regain muscle, just doing a small amount of resistance work or other forms of exercise sends such an important signal to your body that the muscles are still needed and can help to maintain what you've got, which is absolutely precious.
Speaker 2Now it's a little bit more complex with bone. I always think of bone as a bit more of a stubborn tissue. It takes more stimulus to increase your bone tissue than it does to increase your muscle mass, and it's also more of a demanding exercise that's required to do that. It is still possible. There is evidence to show that heavy resistance training done over the course of a year can gain you about two to three percent of total bone mass in your body.
Speaker 2And you might be thinking well, that doesn't sound like very much. But in the control group in that same study, that didn't do very much. They actually lost somewhere between three and four percent. So really it's a kind of five to seven percent swing in favor of the resistance training group. But again, these people were much, much more over 50, they were in their 60s, 70s and beyond and they still managed to gain some bony tissue. But both of those things if you've been given a diagnosis of that from your doctor, that's certainly not a life sentence. There's things that can be done and having a a good plan in place will help you to to hopefully make progress on both fronts okay, in your book you have um, I don't know if it's dedicated chapter, whatever what you call it um, the nine at 90.
Speaker 1There were nine things, things that you feel that you need to be able to do at 90. So we want to start those yesterday for sure. Can you tell us about those nine things and maybe get into each nine a little bit?
Speaker 2Yeah. So the nine at 90 is a bit tongue in cheek. What it is is a collection of nine movements that I said to myself that I would like to be able to do when I'm 90. Now, if I get to 90, I'll be delighted, and if I can do those movements I'll be even happier. And I'm not expecting everyone who gets to 90 to be able to do those movements, but I think they're a fantastic thing as like an aspirational goal.
Speaker 2And the nine at 90 are also movements that I often use in the clinic to almost screen people's bodies for how well they're moving. And the reason I put together these nine movements is because I feel that they basically cover the entire body when you take them as a combination. So, to give you a couple of examples, one of them is the suitcase lift, and the suitcase lift is lifting a piece of hand luggage, hopefully filled with stuff, up to your chest and then up over your head, as if you're putting it in the overhead locker on an airplane. And the reason I've got that is because, hopefully, when you're in your 80s and 90s, you still want to be holidaying and to be able to do things like that means that you've maintained your independence really really nicely.
Speaker 2So the things in the 9 at 90 are all practical. They're things that we should be able to do every day. One of them, for example, is digging a hole in the garden. Can you comfortably do all of the movements required to dig a hole? Can you comfortably walk five miles? Doesn't matter how long it takes you, but if you can do that five mile walk, even if you have to stop a couple of times, for me that's a big tick. And essentially, if you can do all the things in the 9 at 90, you know you've got good strength, you know you've got good fitness and you know you've got good mobility, which means that you've got good fitness, and you know you've got good mobility, which means that you're well on your way to a healthy life.
Speaker 1Awesome. So you just mentioned walking five miles. Is that the 10,000 steps we hear all the time? That sounds like it's a little bit further than 10,000 steps.
Speaker 2I don't know, but that isn't necessarily why.
Speaker 1I included it.
Speaker 2And I do have a couple of bits and bobs to say about the 10,000 step goal. It's actually quite an arbitrary, random goal. It was originated in Japan in the 1960s and a Japanese researcher had a look at the population in Japan and said people are gaining weight, we're at risk of becoming like those Westerners. We need to do something to improve the health of our population. And they estimated in the government that the average Japanese person was walking between 3,000 and 4,000 steps per day. And the researcher said well, this is clearly not enough. And they calculated that that extra 6,000 steps per day would add up to enough calories burned that the average person would lose about a pound of fat per week if they implemented it. And this was also the advent of the very earliest forms of the pedometer, which are those little measuring tickers that you put on your belt and they count your steps. So the Japanese government they invested in the pedometer. They had loads and loads of pedometers produced, they gave them out to their population and they almost launched this big positive propaganda campaign to try and get their citizens doing 10,000 steps per day. The campaign was a complete success and they did actually improve their health on a population level. But the 10,000 steps per day number was literally just plucked out of the air by the researcher.
Speaker 2There's very little science behind it. Now, in terms of how many steps we should do per day, there's no should, because everyone is different and everyone's going to be starting from different places. But there's some very solid research to show that we get significant drop-off in risk of heart disease at about the 4,000 to 6,000 steps per day mark. So it's actually less than 10,000 steps. But the research does show that with every incremental 1,000 step a day increase that you make, you do get some additional health benefits, and when we reach about 10,000 to 12,000 steps per day, those benefits start to plateau.
Speaker 2So there's definitely a law of diminishing returns. So to sort of put this into context someone who's currently only doing 2,000 steps per day, if you increase their walking to 4,000 steps per day, they'd get a massive boost in their health if they sustained that for a period of a year. But if you have someone who's already doing 10,000 steps and you increase it to 12,000, they're not going to see a huge change. It's going to be much, much less. So walking is amazing. There isn't much evidence in the 10,000 steps thing, but most of us should be doing more. I think is the take home.
Speaker 1Okay, yeah, were there any others of the nine things at 90 that you would like the listeners to that kind of jump out at you, besides the suitcase in the bin and the digging of a hole in the walking that you really would?
Speaker 2like. Can I give you my favorite? Yes, I'll give you my favorite. One is the the chair squat with load, and this is essentially a simple movement. It's sitting in a dining room chair, holding something heavy to your chest and then getting up and out of the chair, holding the object without using your hands and then very slowly lowering yourself back down to the chair. Now you might might be thinking well, that sounds like a very simple movement, and it is, but the reason I like it so much is because it's so functional and it works so many of the muscles in the body that are very important for the things we do every day.
Speaker 2So that movement there we could also call that a goblet squat, which is a genuine exercise. It works your quad muscles, which are the muscles at the front of your thigh. These are incredibly important, not just for walking but for for running as well, and your quads keep your knees straight when you walk and run, and they also act like your brakes. So if you're running downhill, you need to engage your quads to slow yourself down against gravity, okay, so that's super important. And that same exercise also works your glutes, which are another set of muscles which are again incredibly important for daily life.
Speaker 2The glutes control the alignment of your thigh bone, and if your glutes aren't working very well, then we can end up with problems both in the hip and in the knee, and also back pain as well has been associated with with weakness in the hip and in the knee, and also back pain as well has been associated with with weakness in the glutes. So with that one simple movement that chair squat, holding on to a weight, you can strengthen all of those key muscles and protect yourself from a lot of different problems. And it's also a movement we do all the time, you know. We're getting up and out of chairs, we're getting in and out of chairs, we're getting in and out of cars, we're on and off the toilet. All of these things are that same movement. So it's super practical to our daily lives and it's probably my favorite out of the nine.
Speaker 1Okay, yeah, I remember. I feel like you use that later in the book for injuries. You use that Galba um, starting with no weight if you can't, and then as soon as you can do 15 repetitions, you start adding in the weights um so would you say that, not only for building, but for um repairing, like any injuries or whatever, that would be your go-to.
Speaker 2It depends on the injury and it's a great strengthener in general.
Speaker 2The issue we have with exercises like that, big gross exercises that we do in weight-bearing positions, if you already have a very painful knee or a very painful hip, sometimes that can be too much.
Speaker 2So we have to wind back a few steps and maybe start off with something that's a bit gentler on that area. But I'd say, in general, the, the chair squat with the load, is a fantastic rehab exercise, but probably for the second half of your rehab, as you're starting to, you know, think about you know, this is mostly 70 80 percent better now and I'm looking to rebuild strength. That's when I would use it. But if you're in a lot of pain we often go for things that are a little bit more, a bit gentler to start with, maybe something to just improve the range of motion or to reduce the pain or to improve the strength of an isolated muscle, and then as we get stronger we make the movements bigger and we incorporate more of the body. So it kind of yes and no is the answer to that question. It's a great exercise for many purposes, but it would certainly depend on the problem the person had okay.
Speaker 1So I know one of the things that, um, I think was like in the first sentence of your book your number one thing that you tell people over 50 is don't get injured Right, so obviously that's our first goal is don't get injured.
Speaker 1Sure, but for myself, as I've gotten older, my warm ups when I was younger, before I would run, were non-existent, and then, as I got over 30, close to my 40s, I would warm up for about 10 minutes. And I've noticed and I'm well over 40, past 50, or late 50s now that 10-minute warm-up now is 15 to 20 minutes, now that 10 minute warm up now is 15 to 20 minutes. And yet I am currently just about through with this injury. I should be able to run here in the next week, or so I'm hoping. So. Now my warm up has extended the length of my actual workout, sometimes because of my age. Because of my age uh, what? How can you, how can we like get past that? Because now you're talking like if I only have an hour to work out, to go for a run, and 30 minutes of it is a warm-up and 15 minutes of it's a cool down, what am I doing? Can you help me with that?
Speaker 2yeah, get.
Speaker 2Me through that I totally see what you're saying and it is is tricky. It's totally true that as you get older it does take longer to warm up and to prepare the body for exercise. But what you've described to me is absolutely what you should be doing. You should be increasing the length of your warm-up with age, because the body simply needs more. Now you can always have a look at the efficiency of the warm-up and see what you're actually doing.
Speaker 2There's many different ways to warm up, and many people think of a warm-up just as a way to physically warm up the body, but really what it's doing is it's preparing both your body and your mind for what's about to come. So when you're running, we'll talk about running specific warm-up. I think one thing you have to do, obviously, is raise that core body temperature and also raise the temperature of the muscles to make them almost more pliable when you start running. So you know, a slow walk and then a faster walk and a jog would make sense. But there's another element to our warm-ups as well which can actually be even more protective from an injury, and I like to call this element of the warm-up something called priming, and priming is basically a very specific warm-up to certain muscles that you want to use when you're about to do your run.
Speaker 2Okay, now, if I was thinking about a runner, I would want to prime the calf muscles, which are the ones down in the lower leg. I would also want to prime the glutes up in the hip, and probably the quads as well. So, for those purposes, I would start off probably with your you know, slow walk, fast walk run, just to kind of get the body moving. And then, before I went into my actual run, I would do some heel raises, which would take a couple of minutes. I would do some leg lifts, so lifting the leg out to the side, which would warm up the glutes, and then I would probably do some mini squats nice and quickly, to sort of keep the heart rate up. Mini squats, nice and quickly to sort of keep the heart rate up, but to also warm up the, the quads at the front of the thigh.
Speaker 2Now, to me, we've now ticked off both things. We've got the body ready to go, the temperature is up, but we've also switched on those muscles that we actually want to be using when we're out and about, and those are the muscles that are going to protect the joints and the soft tissues which are commonly at risk from running injuries. So that's how I like to think about warm-ups. I would like to make them very specific to the thing I'm going to do, which is why we want that, you know, walk and run element to it. But also, which muscles do I actually want to be active while I'm doing this exercise, because your body obviously will use muscles to help you move, but sometimes the body doesn't use the muscles in the optimal way. We can almost get the body using our muscles better if we remind it which ones should be working, which is why I like to target those key muscles before I get going, and then that seems to be such a, you know, more efficient way to get through your warm up whilst also preventing injury.
Speaker 1Okay, yeah, that makes sense. Hopefully that'll resonate with my body when I get back to my running and those listening that that'll help them as well. Do you feel that, as we age and we do get injured, that the injuries last longer or don't completely get healed or require surgery for healing? What have you found?
Choosing Rehab Over Surgery
Speaker 2in your practice. As we age, injuries definitely do take longer to get better. The tissue healing timescales, we would call it. They do prolong, and the reason for that is because the quality of the tissues is not quite the same as when we're in our teens and twenties. So you know, it isn't as much collagen in there, so it just takes longer for them to knit back together.
Speaker 2Now I think it's actually a myth that once you've had an injury over 50, you're always going to be fighting it and you can never quite get rid of it. Sometimes that's the case, but for many of the people we see in the practice, we can get them back to 100%. It's just that that last 10 or 20% takes sometimes the longest, and that's often where people give up. They say, well, I'm 80%, better, better, I'll just get back to everything that I'm doing. And then they've always got that little bit where it's not quite 100% or it just bothers them from time to time. Many cases, if you persist and keep going with your rehab, you can fix that last little bit. Now, as for the surgery thing, one of the big goals I've got with my practice and with my YouTube channel is to give people an alternative to surgery and some surgeries are fantastic and necessary. You know, if you've got bone on bone arthritis and you can barely walk, you know no amount of exercise is going to fix that and surgery might be a good option there. But for many of the problems we have, if we are patient with our rehab, we actually get a better outcome from that than if we went ahead with surgery.
Speaker 2There's some very, very interesting research coming out at the moment in different areas of the body. I can think of a couple of areas definitely a shoulder and the knee where keyhole surgery. The outcomes there are not superior to people that just did a longer period of rehab with no surgery. If you interview two groups, one had surgery, the other didn't two years on the outcomes are exactly the same and it's made us really question as to what is surgery's role for these long-term conditions if with the proper rehab they're going to get better anyway.
Speaker 2So I'm a big believer in the healing power of the body. I think within us we've got more power to heal than we often realize and every time we cut the body open I feel that we interrupt that, that healing process, and it's best left alone and encouraged whenever we can, as opposed to trying to rush it by going under the knife. That's my personal opinion. It's what we see in the practice and I think, as we get um, as we go through the the generations, I, I see a shift away from surgery to more natural approaches. That would be my estimate of what's going to happen in the next sort of 25 to 50 years. I think we'll see less and less surgery for musculoskeletal problems because the evidence is showing that long-term the benefits just aren't there compared to continued rehab.
Speaker 1Yeah, so we just have to be patient and go through every day of the rehab rather than just giving up and going into surgery.
Speaker 2Yeah, I mean, everyone's different and there are always going to be cases where surgery is absolutely the right thing and it certainly certainly has a place. But I think that it's important not to give up too early. And some people will go to see a physiotherapist for six weeks and say, well, it's not better yet, so I'm going to have surgery. And those are the ones that I think are a real shame, because many of those people, if they had been able to persist for another 12-16 weeks, they would have the outcome they wanted without having to go through surgery and doing the rehab.
Speaker 2I always say to people there's very little risk and even if it doesn't work, you're going to be stronger and more mobile after you come out of the surgery.
Speaker 2So you've almost got nothing to lose by giving the rehab a chance before you opt for surgery. But if you go straight for surgery, you've got all the risk of what actually happens when you're in there, plus all the risk that the surgery doesn't actually help it but makes it worse, which happens a lot, and we see that all the time in the practice. People come in saying I had this surgery a couple of years ago and I've never been the same since and I always have those people's stories ringing in my ears when I'm trying to advise someone and I think I've never had anyone say that about rehab They've never said, oh, I had this 12 weeks of rehab and I've never been the same since. I've never heard someone say that and I think that it's a much safer option and it's almost like surgery can be a plan B. But if you commit fully to plan A, I honestly think that 70 to 80% of people who thought they need surgery would end up getting better.
Speaker 1And after surgery you still have to do the rehab, right? I mean there's got to be some type of process they have to go through anyways.
Speaker 2Yeah, 100%. And so you know that there's that cost of, you know, six weeks in a in a brace or six weeks at home where you can't use it after the surgery, and the amount of muscle and mobility you lose in that six weeks is astonishing. So I'd rather people avoid that if they can and that's why I try and give that alternative option sure, yeah, and the expense as well.
Speaker 1I'm sure of either just the surgery itself but any downtime if you're still working and having to get incoming care, for you know someone to come help take care of you, so it makes sense just to be patient, particular injury or anything that you focus on. I know for a lot of my listeners it's ankles, knees and hips, you know because, and sometimes shoulders, right, depending on if they do other like swimming, sports, things like that. But is there anything in particular that you see the most? But is there anything in particular that you see the most.
Speaker 2I think the two biggest areas that we help people with are backs and knees. If I had to hazard a guess and the reason for that is that if you've got back pain or knee pain that really threatens your independence more so than like a shoulder or an elbow, for instance, in the running population I would say it's certainly knees and hips, and there are a variety of things that can affect knees and hips because of the people we speak to. In the videos and in the clinic we see a lot of people with symptomatic arthritis, which is essentially like a mechanical pain which is linked to the loss of cartilage in the joints. But in runners we see a lot of tendon problems. So people who have what we would term as an overuse injury or repetitive strain injury to the tendons, sometimes on the outside of the hip. That's very, very common, but many of these problems can be remedied with the right approach, with with strengthening and some hands-on treatment and some mobility work so with the back injuries that you see, what does that regard?
Speaker 1is that from twisting or picking up the wrong way, or what are the back injuries?
Speaker 2back injuries are such an interesting topic because the vast majority of back pain we call it non-specific, which means it doesn't have an obvious single cause. And for most of these people at least 70 or 80% of them if you put them into an MRI scanner and you scan their backs, you wouldn't really be able to pick out any one thing that's injured or twisted or out of place or ruptured, nothing like that. You usually see normal aging changes, but you can't put your finger on anything and say, well, that's the problem, but they still have the back pain. So backs are really, really interesting. I find them interesting anyway, and we would call this kind of back pain mechanical, which means it is driven by forces acting on the back that aren't quite optimal. So either some muscles aren't doing their job very well or other areas have got very tight or stiff, and you can't see these issues on a scan, but they're certainly happening in the body and then over time that's leading to someone's pain. So these are some of my favorite people to treat, because if they don't fix their underlying problem, they can have it for a very, very long time. So we sometimes get people coming in who've had it for, you know, four or five years. And then you look at them and you say, well, you've got, you know, a lot of weakness in your, your core muscles and in your, your glutes and you're very, very tight in your hip flexors. And then we work on those things and their symptoms just start to improve and they're delighted, obviously, because they've had it for such a long time and they're finally seeing some relief. But one of the best parts about my job is being able to reassure people that just because they've got pain there, it doesn't mean that they're damaged or that something has broken inside them. They just need a little bit of a helping hand to to get the right areas working again so that their pain can start to resolve.
Speaker 2We do sometimes see some physical injuries to the back. The most common one is probably disc injuries. I had one myself, actually last year. It was pretty unpleasant, but again they do get better if you do the right things. And they can cause a symptom called sciatica, which is nerve pain in the leg, which many, many, many people do get. But providing you do the right things, most cases of sciatica, which is nerve pain in the leg, which many, many, many people do get, but providing you do the right things. Most cases of sciatica 90, 95% they do eventually resolve within sort of six months time.
Speaker 1That's really interesting. That your knees and hips, you know, either not pulling their weight, so to speak, would affect your back. I mean, I understand the core portion of it, but to go lower than that, that's really interesting. That it's a whole body thing, that's incredible.
Speaker 2Yeah, I mean the whole body is connected and there's even some research to show that people with um pronating feet tend to have a higher incidence of back pain. So it shows that the entire body is is connected. So we can go all the way down to the feet if we wanted to um. With that comes the issue that sometimes you can, you know, you can confuse yourself and you end up looking at a completely different area of the body than the one that came in. So, again, there's complexities there and it can sometimes be difficult to work out the actual cause of the pain.
Speaker 2But back pain is almost always multifactorial. There's hardly ever just one reason that someone has back pain. It's usually a combination of things, and we've spoken a lot about the physical. But there's also psychological influences, people who are under stress or depressed or anxious. They are much more likely to suffer back pain than people who aren't, people who are overworked or people who don't get enough exercise, people who sit at a desk for too long. Again, these people are all more likely to have back pain as well. And we've got some ideas behind the mechanism, but we're not 100% sure. But we know that the body is is so, so complex and there's so many things that can feed into pain, especially in the back. It just makes it a very interesting area to treat.
Speaker 1Oh, yeah, sounds like it and I really appreciate the fact that everything is treatable and not necessarily needing surgery. Where I feel like drugs and surgery is what a lot of people prescribe. Where you're saying, no, let's get back to the basics and do the strength training and the mobility to fix everything. That's so refreshing to hear today, because there's that's everybody wants to the quick fix, which is usually drugs or surgery.
Speaker 2So that's really nice yeah, there's no free lunch, that the quick fixes often don't work um long term it's. It's like you know if, if, if you could just take a pill for something, you can bet your bottom dollar there's some kind of horrible side effect that's going to come along with it. So I think you know exercise is the closest thing we've got to a magic pill, because it doesn't have very many, uh, bad side effects or drawbacks and the the effects of it are magnificent. So I think if you can use exercise to fix a problem, that is almost certainly the best thing to do. But I do appreciate the fact that some problems need, you know, more of a nuanced approach, and sometimes surgery and medications can be useful. But exercise is certainly where I start with most of my people.
Speaker 1Yeah. So since we're kind of working our way up our body and we're at the back, would the tight hips or the knees or whatever also cause that rounding that we see as age, when we see older people and they kind of have that little hunch going on? Is that from too much sitting they're just getting old, things are giving up, and can that be reversed?
Speaker 2Again, it's multifactorial, so there's a few different things that can cause that. We call that a kyphosis and essentially it's that curving of the spine, now some of its genetic uh. It's more common in women and it also happens much more in people who have osteoporosis. So some of those things we can't do much about. But it can be increased by repetitive postures. So if someone allows themselves to round a lot of the time, then the muscles between the shoulder blades become quite weak and they start to spread apart and then the muscles at the front of the body become shortened and tight and they almost constrict, which pulls that person into that position. So if that is the cause in that individual's case, those issues can often be remedied.
Speaker 2And have some postural exercises in my book that I'm sure you've seen that can help to reverse some of these cases of rounding. And rounded posture isn't necessarily harmful, but people don't like the way it looks and it does increase your risk of shoulder and neck pain. So personally for me I do think it's worth working on if that's something that you're you're suffering with, and one of the best exercises I can give people for that is one to just strengthen the area between the shoulder blades. You have a resistance band and you hold it out in front of you with your arms straight, and then you pull it tight across your chest, feeling that area between the shoulder blades squeezed together. Do that repeatedly until you get some tiredness between your shoulder blades. It can be such a good way to rebuild strength there and it also helps to open up the chest.
Speaker 2And I had a person I gave this to the other day. They said to me oh, I felt for six months that I haven't been able to breathe properly, and it wasn't until I did this exercise for a while and opened my chest up that I realized how little air I was getting into my lungs. So I think there's other benefits to improving that posture and, you know, preventing that roundedness. But there are certainly people who they've got osteoporosis. You know it's very, very difficult to to fix the skeleton once it's actually started to, you know, permanently go into that shape. But for many of us, if we catch it early, there's definitely a lot to do to help it and you can make real progress.
Speaker 1Wow, wow, that's. That's incredible, I suppose, especially now, with technology and everybody looking down, it's probably gotten worse.
Speaker 2Definitely, definitely it's. Uh, yeah, it's the old mobile phone neck and yeah, use of phones and tablets is associated with higher rates of neck pain, unsurprisingly so I just wonder about when Gen Z, as they call them, when they get to their 60s and 70s. You wonder what kind of problems they might be suffering with. But maybe they'll have had it all figured out by then and you know they'll have the magic pill that we don't have. Who knows?
Speaker 1Yeah, they start watching your videos and implementing them. I'm sure they'll get. They'll be better by then. Um well, is there anything else that we haven't covered?
Speaker 2um for the 50s and older that you would like them to know before I cut you off here I think one of the key things I want to get across and I've been speaking a lot about this on my YouTube channel is that resistance training and particularly for runners, resistance training is possibly one of the most beneficial things that people over 50 can do. Resistance training is moving your body, either against your your own body weight or an external resistance, so it could be resistance bands or dumbbells or a barbell, or even just your body weight, like squats or push-ups, and doing this kind of thing as a regular practice has been shown to have so many health benefits. It can improve your muscle mass, improves your strength, your balance, reduces your falls risk, reduces the risk of osteoporosis. It's just so many things it can do for you and especially for your audience. Carla, I think runners. They often can say well, I'm a runner, I don't do resistance training because my thing is running. But resistance training will help you to run further and for longer and keep your running career going for as long as it possibly can, because it safeguards you from all of the common injuries and problems that can occur from lots and lots of running and it also can literally extend your life.
Speaker 2So if I had to recommend one thing for people over 50, it usually would be resistance training, just because it's like a catch-all and it doesn't have to be, you know, five times a week in the gym. It can be two sessions a week, 20 minutes per time, three or four exercises each session just to work almost the whole body. Three or four exercises each session just to work almost the whole body. Very, very short workout and you can cover so many bases and make make such progress with just that small amount of work. So if I had to give one message, that would be it. I would put that on the billboard and show it to as many people as possible because I really, really believe in it and the power of it is just so great can you give us um, say, three or four full body, um exercises that you would recommend for that 20 minutes twice a week?
Speaker 2would you like me to go for runners in particular, or just for anyone?
Speaker 1um, let's say runner, because then maybe more people will start running I love it.
Building Strength Over 50
Speaker 2Well, these would be relevant for everyone, but for runners, um, this will be especially useful. Certainly something that works the calves. So I like that. The heel raise, which would be where you have the balls of your feet on your bottom step hanging off just until you feel a stretch in the back of your calf, and then you push up onto your tiptoes and then bring yourself slowly back down. Now, for many people, that's going to be super easy. So what we want to do is add some resistance, and you can do that by either wearing a backpack filled with books or weights or holding a dumbbell or weight in one hand, and when we're doing these repetitions, we want to be doing anywhere between sort of 10 and 30 repetitions in a row. That works super well. Anywhere in that range is going to give you great results. So the calf raise or heel raise is number one.
Speaker 2Number two I love, uh, the lunge or the split squat, which is where you have one leg in front of the other in almost like a straddle position and then you dip down like a, as if you're trying to touch your knee to the floor, and then come back up. The reason I like that so much is because it works your legs unevenly, which challenges your pelvic control, so your glutes have to work really hard to keep your pelvis level. Very relevant to runners, because what do we do when we run? We go from left foot to right foot, left foot to right foot, so we need that pelvic control. So the split squat would be the second one.
Speaker 2I really really like the Romanian deadlift as a third exercise, which again is a leg exercise, where you're holding some weights in front of you and keeping your back straight, you're hinging forward at the hips, sliding the weights down the legs just until you feel a stretch in your hamstrings, then coming back up. That's a fabulous exercise for runners and then to give you something for your upper body as well. Any kind of rowing movement works super well for building strength in your arms and your shoulders and your back muscles. So I like the the dumbbell row support your body with one hand leaning forward, let the other arm hang down holding the dumbbell, and then pull it back up as if you're starting a lawnmower. That works really, really well. You'll feel it right between the shoulder blades and that kind of rounds off most of the body and you can do all that in 20 minutes.
Speaker 1Very good. Thank you so much. So where can these people find you? I'll put the links in the show notes. Tell us about your book and where they can find that and all things will.
Speaker 2So the best place to find me is probably on YouTube. If you type in HT Physio then I'll come straight up. You could also type in Will Harlow and we'll come up. We've got over a million subscribers on there now, so a big channel, and we do four videos every single week showing tips and exercises and, hopefully, easily accessible stuff to everyone over 50.
Speaker 2And my book a brand new book came out on the 1st of October. It's called Thriving Beyond 50. It's the updated and expanded edition. It's basically 450 pages worth of my best advice on improving your health, your mobility and your independence over the age of 50. It's got hundreds of exercises inside and a few free giveaways that you can get inside the book too. And if you search beyond 50 on amazon or barnes and noble or waterstones, it will come up. And we had some great news, um, a couple of weeks ago it became a sunday times bestseller, which I was delighted with. Um, so, yeah, it's been really well received and if you get it, I hope you love it. Um, we also have an instagram page, which is ht physio official. So if you type in ht physio again, you'll see my face and you can click on that, and we've got more tips on there too very good.
Speaker 1Yes, uh, I'm on my second time through your book. I'm enjoying it just as much the second time as I did the first time. But you know, as you get older you can't remember stuff, so you gotta got to read it again.
Speaker 1But yeah so we'll put some links in the show notes. People can reach out and watch your videos. They're really fantastic friends, so make sure you do that. I do want to thank you just from the heart for being on the show. I've learned so much and I really wanted my listeners to hear your great advice, so hopefully they'll get some tips and your book. Hopefully they'll reach out to you in there.
Speaker 2I hope so. Thank you so much, Carla. I really appreciate your time today and having me on.
Speaker 1Thank you and we'll talk soon. Bye-bye.
Speaker 2Bye-bye.
Speaker 1All right. Well, thanks for listening to the episode. I hope you enjoyed it. Please continue to follow, share and rate the program. If you're needing that coach, reach out to me. There's a button in the show notes that you can contact me directly. Share it with a friend. If you think their story needs to be on the podcast, I'd love to hear from them. So thanks again and have a great day.
