‘… not old, but mellow, like good wine …’ (taken from S. Phillips, Ulysses III.ii)
Manual therapy often conjures up an image of young track-suited practitioners treating athletic patients who have suffered sports injuries. This is occasionally true – although neither of the practitioners at Devonshire Osteopaths are young or wear tracksuits, we do often treat younger people with sports injuries. However, many of our patients are old, and some are very old – or, as we might prefer to say, mature.
There are many challenges in treating the elderly or infirm. We have gained experience at the two free weekly osteopathic clinics we run in conjunction with local community organisations. We provide a clinic at Toynbee Hall in Whitechapel, E1 and another at the Sundial Centre in Bethnal Green, E2.
Many of our younger patients come to our practice and present with one particular problem – a stiff neck, for example, or a strained knee. Older people on the other hand are more likely to have a range of symptoms and illnesses all at the same time. The experiences of a long life may have resulted in the accumulation of many different conditions, such as high blood pressure, heart problems, mobility or breathing difficulties, or arthritis, and often, as if that were not sufficient, poor memory. They may also have had recent hospital episodes and are taking a number of different medications prescribed by the GP.
In order to treat an older patient we have to take extra care and ensure treatment is completely safe. In our regular practice we may often ask patients to undress appropriately and we may treat them on a plinth. Older people will need treatment without undressing, and we may treat with the patient sitting comfortably in a chair. We work slowly and quietly, with the patient remaining comfortable, and stop before the tissues become fatigued.
We do also prescribe some appropriate exercises or beneficial movements. It is important that patients feel they can help themselves and enjoy the benefits of increased activity. For patients with low back or buttock pain we might suggest while lying in bed to hug one knee at a time or slowly to roll the legs like windscreen wipers.
For those able, we might suggest that the patient sits safely on the kitchen table with their legs dangling over the edge and knees together, and then simply swing the ankles from side to side. That provides good movement for the lower back and relaxes the hip and buttock muscles. Mary, who is one of our patients and aged 78, was so taken with this exercise she produced the above drawing of the exercise and caption.
In the same way that techniques are modified, the expectations of treatment are also different. Many conditions, such as rheumatism, arthritis, and diabetes are continuing and degenerative: we will not be able to effect cures, but we can alleviate or slow some of the symptoms. A small change in function can make a big difference to a patient’s quality of life.
We treated a Rose, robust 83-year old, who had very restricted shoulder and arm movement on one side. The range of her arm movement increased with treatment, until she was able to wave her arm quite vigorously. This meant that she could now return to using the bus and go shopping, as she could hang onto the rails safely. Or, as she put it, ‘Now I can use my arm I can give anyone who annoys me a good slapping …’
In addition to providing pain relief or improvement in function for some of our patients our manual therapy may provide one of their few remaining experiences of being physically being cared for.