"The fox knows many things, but the hedgehog knows one big thing."
Artists and theorists have been classified as foxes or hedgehogs since the beginning of Western civilization. The hedgehogs relate everything to one organizing principle. Foxes work on many levels, unconcerned about how things fit into a unitary theory. Shakespeare was a fox, Dante a hedgehog. Both types have their strengths and limitations.
We live in an age of ubiquitous specialization with little room for the generalist, a sort of latter-day fox. Nowhere is this more on display than in the field of health. People are identified by organ system, age, gender, blood tests and tumor types and sent to the corresponding experts.
Such focused fragmentation risks losing sight of the individual (one's relationships, values, goals, culture). As if one could appreciate a symphony while hearing only the violins. It also separates groups that may profit from being seen as similar.
Imagine the following scenario.
Someone has suffered repeated falls. On examination her balance is not good and she demonstrates low muscle strength. She recently was seen in the emergency room for a broken bone following a fall.
Who is this?
Is she an 80 year old women weakened by loss of muscle mass and the neurology of balance who suffers from osteoporosis?
Is she a 7 year old girl who loves climbing trees and has not yet developed adequate postural control and strength for such adventure?
Both situations are common. Falls are the most common reason for injury-related initial ER visits for children under 15 and seniors over 64 years of age. Fractures are most prevalent in these two age groups. Both populations have deficits in postural control and strength compared to younger adults. The annual treatment of fall-related injuries costs $1.2 billion for the 0-14 year age group and $34 billion for seniors.
Postural control, whether stationary or moving, is the control of the body's position in space for the purpose of balance. The goal is always to keep your center of gravity evenly distributed over your base of support. Children's balance is limited by maturational deficits. For the senior, it is the other end of the cycle, an age related loss.
Both groups are disempowered, so to speak. They have muscle power deficits. Here the distinction between strength and power is key. Strength is the force a muscle can generate. Muscle power, a dynamic form of strength, relates to how rapidly that force can be generated.
Activities that require muscle power may surprise you. Getting out of a chair, climbing stairs and avoiding a fall don't sound like particularly powerful moves but they are. They require speed. Numerous studies have shown that muscular power output is of greater importance than strength from a functional perspective.
Children and seniors also have a weak core, the muscles of the back, side, pelvis and buttocks. These muscles link the upper and lower body and are therefore essential for maintaining good posture and preventing slumping. To slump is to push your center of gravity forward and disrupt balance. In addition to a weak core, many adults are not flexible. Flexibility is also important for balance. Tight hip flexors pull the upper body forward, worsening a slump, throwing off balance.
Both power deficits and poor core strength are responsive to the right kind of training.
Power exercises focus on moving as fast as possible in the concentric (flex) phase. Such explosive resistance training improves peak power across a wide range of loads. Proper evaluation for injury, instability and medical conditions should always precede initiating these exercises. Core workouts come in many forms. Pilates has proven one of the best regimens for improving core strength.
Last but not least are exercises that specifically challenge balance. This ranges from heel raises to tight rope walking. Balance training should be part of anyone's fitness program, regardless of age. The best way to insure daily balance work is to incorporate it into your routine. Brush your teeth standing on one foot. Walk around the house on your toes. Get creative, construct a habit, reap the benefits.
One implication of all this is that children and seniors are natural workout partners. Imagine programs that bring these two groups together. How much more successful might we be at getting people to move if it meant a date with a grandparent/grandchild?