Maintaining good posture is important for everyone, but especially for older patients.
In general, flexor muscles are always stronger than extensor muscles. In the upper body, the muscles high in the chest become tight over time, which makes for a rounded back. The hip flexor muscles also become tighter over time. That is why many older people, especially those who have been sedentary, have a tendency to pull the trunk forward and have rounded shoulders.
Maintaining good posture as we age requires strengthening the upper back muscles, and a balance of strength between opposing muscle groups is essential.
Patients who are sedentary are at increased risk for poor posture, so it is important to encourage them to walk, which can also fend off osteoporosis.
A regular form of weight-bearing activity, such as walking, helps to maintain good posture as we age, and in order to continue weight-bearing activity, regular stretching of the hip flexors and adductors is necessary.
The muscles lose their elasticity as we get older, and we have to take more care of them. In younger people, perhaps less than 35 years old, if they stretch twice a week they are doing quite well, but people older than that really need to stretch every day.
If patients can lift light weights without pain, I recommend simple weight-lifting exercises. I do not recommend heavy weights, because senior patients often have difficulty raising their arms. Multiple repetitions (15 times) with a light weight are a good choice for senior patients because they are more aerobic than fewer repetitions with a heavier weight. Multiple repetitions also allow the muscles time to fill with blood, which happens more slowly with age.
For seniors, it is much better to do something moderate nearly every day than to do something more intense only twice a week. What often happens is that after a week of moderate daily exercise, people continue doing the exercises every day because they notice that they feel better, even after an injury has resolved.
I recommend that anyone who is unsteady on their feet use a cane to help them walk. It is better to walk with a cane and walk 2 miles than to limp along unaided for 500 meters. People should not be ashamed to use a cane if they need one. The important thing is to move comfortably, and if senior patients can build strength, they may no longer need the cane after a while. The tip of a cane of the correct length should strike 6 inches in front of the foot and 6 inches to the side of the foot when the patient's elbow is bent at a 30-degree angle.
Exercises for Improving Posture in Seniors
Scapular adductor stretch, 90-degree angle. This exercise will help to strengthen the upper back. Lie on your stomach with a pillow under your abdomen. Extend your arms out to a T, at shoulder height. Lift one hand at a time, hold for 5 seconds, then lower and relax. Start with 8 repetitions and work up to 12. When 12 repetitions become easy, add a 1-pound weight and start again with 8 repetitions. Gradually add weight as you gain strength over time.
Scapular adductor stretch, 45-degree angle. Lie on your stomach with a pillow under your abdomen, but this time extend the arms at a 45-degree angle from your body. Lift one hand at a time, hold for 5 seconds, then lower and relax. Start with 8 repetitions and work up to 12. When 12 repetitions become easy, add a 1-pound weight, and start again with 8 repetitions. Gradually add weight as you gain strength.
Upper back extensor strengthening. Stand with your back touching a wall and use your shoulder muscles to brace your head and shoulders against the wall. This movement should bring your shoulder blades closer together. Hold for 5 seconds, and then relax for 2 seconds. Repeat 12 times.
Standing hip flexor stretch. Start in a standing position, with your left hand on a table for support. Bend the right leg behind you, grasp the right foot with the right hand, and pull it toward your buttock to create a feeling of stretch in the upper hip and thigh. Bend the leg you're standing on if necessary. Tighten your stomach muscles while stretching and do not arch the back. Hold for 5 seconds. Start with 3 repetitions and work up to 6 or 7. Gradually increase the length of time you hold the stretch to 15 seconds.