Osteoporosis and cold feet instigated falls-Michael Gillan-long distance muscle recovery

specialist
Manual Therapies- Osteoporosis and poor circulation
Light Manual Muscle Relaxation-the walk you have when you are not
having a walk
Many people (mainly women) have osteoporosis (there is lots of research on this so
topic so I am not going to go there-I have placed some links at the end of the article)
I am going to discuss poor circulation and minimization of falls through pre-
movement-and also cold feet
Individual personal circumstances may restrict some people's movement - their
boundaries may be set by a many factors-medical conditions, age, pain, physical
restrictions, or illness may be stopping them having full leg function or moving them
I would stress that anyone with medical conditions should consult with their doctor or
other health professional before trying anything out of their treatment regime-there
may be underlying issues that have to be resolved and doing anything without
appropriate consultation and advice can make conditions worse
Assuming that everything has been consulted on or is being addressed

If someone has osteoporosis there is still have the same requirements to circulate the
blood in the body-the heart sends fresh blood out to all areas through the arteries-and
the veins get it back to the body again for refreshment and recycling
People who have osteoporosis have a high risk of breaking bones if they are involved
in a fall and this is not a good thing as they will not repair very quickly, if at all-
This makes it important not to have them, and it makes it more important to use all the
things available so they can be avoided
If you don’t us it you lose it
Many people with osteoporosis do not move much because of the falling fear-this
makes it more difficult for warm blood to circulate down to the feet-it also makes it
more difficult to move when they eventually do
Sometimes the reason for the fall is because the circulation is poor and the feet are
cold-one of the reasons for this is that the ‘calf muscle pump’ that moves cold blood
from the lower legs back up go the body for recycling and recirculation again is not
working and the depleted blood stays there and inhibits the receptors in the feet from
working properly and providing feedback

Cold Feet
To those who do not have them, or have them because of the weather it is not much of
a problem because they know they will warm up when the weather changes-for the
people who have them because of poor leg circulation they will never warm unless it
can be improved
Lack of movement and cold feet
There are many reasons for cold feet but the one we are concerned with is from the
aspect of little or restricted movement that leads to poor circulation-warm blood not is
not able to get down to the feet because used cold is trapped there blocking the
exchange

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 Osteoporosis and cold feet instigated falls-Michael Gillan-long distance muscle recovery
specialist

Long periods sitting down

During this time the muscles are stiffening through lack of use and walking is
difficult-the brain/mind/muscle combination has parted ways through lack of use and
cannot be reconstituted through just verbal communication of telling someone to
move
Pre-Movement can prepare the muscles for use

Simulating a walk before actually attempting it can provide a way of preparing the
muscles so that falls may be minimized as it pre-warns the legs and brain that
movement is imminent
• It warms the muscles before intense activity
• It passively stretches muscles that have possibly been immobile for many hours
• It manually works the calf muscle pump to send some of the used blood up the
legs so it can be replaced by fresh warm blood and warm the feet
But it is important to do it as simply and gently as possible because if the person with
osteoporosis has cognitive impairment any information given may be too complicated
for them to understand
Conventional massage systems

A weakness of conventional systems is that they rely for their success on the training
and skills of the person doing the work on the muscles they do not lend themselves to
working with osteoporosis in pre-movement
This is because they are used to achieve a certain purpose or specific intent which
needs the use of the fingers to manipulate the soft tissue-a downside to this is that
with someone who has osteoporosis, the bones are brittle and any hard pressure
inadvertently used can cause the integrity of the bones to be compromised
• Uncontrolled Finger Force

Conventional systems work on the muscles-it is very difficult for anyone doing
massage to predict how much force they are using on the muscle tissues and what
effect the depth of pressure is having during, or what the after effects will be
There are other disadvantages to using this approach with someone with
osteoporosis

• Undressing or disrobing
This can be difficult and painful for someone who has osteoporosis
• Cold
Cold is what can cause falls
• Time restrictions
In most cases time is important for both caregiver and those with osteoporosis

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copyright 2008 Michael Gillan long distance recovery specialist
 Osteoporosis and cold feet instigated falls-Michael Gillan-long distance muscle recovery
specialist
The skin-heat and cold

In the skin and muscle tissues underneath it are receptors for touch, pressure, pain,
pleasure, heat and cold sensors and everything else; all have the purpose of providing
feedback to the brain about the body and where it is in relation to our environment.
While being a protector of the body it can also be a conductor of bacteria into it,
especially when skin integrity has deteriorated-this is more so when we become
elderly and our mobility decreases
Heat is lost from the body in a number of ways
The elderly feel the cold more than other people because they do not move as much-
they neither generate nor retain body heat so any advantage gained from using
conventional methods can be negated through heat loss
Rubbing the skin generates heat by friction and this is quickly lost through

• Convection
As cold air passes over the body it lowers the skin temperature, the body tries to
compensate by increasing the flow of warm blood to the surface-this is also colled by
the air flow
• Radiation
Heat is naturally radiated from the skin into the surrounding air-it does this to
maintain the body's temperature within its natural range for comfort
• Conduction
When the skin is at a certain temperature and fresh clothes are put on they feel cold
because they are at a different temperature level- after a while the heat passes from the
skin to the clothes and warm air is trapped between them to maintain a comfortable
level
• Evaporation

Through water in the form of sweat bringing heat to the surface of the skin where it
changes into moisture
Other factors that may make conventional systems unsuitable are

• Pain stimulation
Rubbing skin of someone who is sore already from sitting or lying down on bed or
chair will stimulate pain receptors in the skin and muscle tissues
• Pain
They may be in pain issues already in place that conventional systems are going to
aggravate by aggressive stimulation of pain receptors-a different aspect is that many
elderly have movement restriction without having to get into the awkward positions
needed to disrobe them
• Medication
Medication is usually being taken for something or to prevent something; if it is a
drug like warfarin which thins the blood then the levels can be affected by massage
and there is a possibility of working too deeply and causing a bleed into the tissues

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copyright 2008 Michael Gillan long distance recovery specialist
 Osteoporosis and cold feet instigated falls-Michael Gillan-long distance muscle recovery
specialist
• Skin Integrity
Restricted movement means there may not be enough changing of position to alleviate
pressure on parts of the body, so sore spots and pressure sores may develop in these
places-these obviously can't be massaged over
• Oil Reaction-Skin Dermatitis and allergic reactions
People who have restricted movement usually have lowered immune system integrity
as well; they can have allergic reactions to oil and what is in it
• Chemical reactions
Contact with the skin-anything that is put on the skin that causes a reaction in that
person-it can range from perfumes, to creams, oils to naturally occuring substances
• Introduced reactions
Skin integrity is very important to prevent bacteria entering but there are ways they
can bypass the defenses when dealing with aching legs in the way using conventional
massage
• Stickiness
Have oil applied-warm oil goes cold and sticky if not removed properly-to take it off
needs friction from towel-thin skin tearing and possibly introducing infection through
bacteria breeding in towels if not washed properly
• Oil spills
It is difficult to work on someone who is confined to bed and prevent oil spills
especially if the are infirm and have shaking or tremors
• Lack of room
Many places have problems with the lack of space around the working area
• Ability to adjust position
It can be awkward to adjust the position of a heavy person, there is lack of room to
move or there are too many aids and equipment around them-there may be catheter
bags attached to legs and other things as well that may be accidentally unplugged
• Dressings
There can be problems with dressings that are covering the areas that need to be
worked on-the dressing may be too large to work over and around
• Hygiene
Not everyone is in a hospital situation where clean sheets are obtainable-they may be
in a home situation where hot water is not available or sufficient means of washing
them at hand
Incontinence is a problem for many people with restricted movement, this means
working around smelly wet sheets-these are horrible to wash out at the best of times
but if they are mixed with oil that has gone rancid they are unuseable
To summarize
There are too many variables to use conventional systems and this does not take into
account things like dementia where concentration can be very patchy and the person
being worked on will just get up and walk away

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 Osteoporosis and cold feet instigated falls-Michael Gillan-long distance muscle recovery
specialist
Preparing to move
Many injuries to carers happen not because they were careless in how they attempted
the move, but because the person they were moving was not prepared for it and could
not help in anyway even if they wanted to
Adequate preparation before moving can help both carer and person being moved to
reduce the risk of injury to both of them
Training
There are not too many massage schools in poorer countries or country areas and even
less teaching how to increase circulation without using expensive drugs
Many people cannot afford the cost of ancillary modalities and the extra care needed
in looking after someone with movement that is restricted and has cold feet through
the calf muscle pump not working properly
In the countries that do have health care systems like Australia, the money allocated
does not cover the cost of hiring massage therapists, so having one work on someone
in the hospital or home situations depends on the ability to pay
Passive leg movement followed by active movement can stimulate the stretch
receptors in the muscles and pressure receptors in the bottoms of the feet to start
feedback to the brain-this prepares them for standing and supporting themselves when
they contact the floor surface

Light Manual Muscle Relaxation provides a cheap natural alternative do-

it-yourself option for keeping the legs moving and the feet warmer

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copyright 2008 Michael Gillan long distance recovery specialist
 Osteoporosis and cold feet instigated falls-Michael Gillan-long distance muscle recovery
specialist
What is Light Manual Muscle Relaxation?
It is a Do-It-Yourself method based on encouraging the muscles and tissues to
assist in their own recovery
• It is not a massage system

• It is not invasive

• It is not aggressive

• It is not time consuming

• It does not need disrobing

• It does not need oil applied to the skin

• It does not need strong hands and fingers

• It does not need hand/brain coordination

• It does not need equipment

• It does not work on the muscles

• It does not work on any specific injuries

• It does not threaten the integrity of the muscles

• It does not use force on the muscles

• It does not need more than a few minutes to do

• It does not require a long course or workshop

What does it do?

It is a fully self contained non-technical, non-invasive 'cutting edge' system of
pre-movement

It’s not what you do but the way you do it that counts

http://www.nof.org/osteoporosis/

http://www.medicinenet.com/osteoporosis/article.htm

http://www.mayoclinic.com/health/osteoporosis/DS00128

http://seniors.aching-legs-relief.com/older_parents_pre-movement.html

© November 2008 Michael Gillan ultra marathon recovery specialist

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