Life is Easy?
Life in the technology saturated world is less demanding than ever. Most of us don’t have to be able to carry 100lb, run 10 miles or climb a coconut tree to function in life. Just how much mobility, stability, motor control, strength and endurance are required to do the simple movements of daily life?
Probably not your morning commute. I took this picture of this man’s daily commute along the trail from his village to the highway outside if Tingo Maria in Peru.
The front porch requires considerable balance.
/>Excellent left hip mobility in flexion, and abduction.
The morning commute would be a balance challenge for the average westerner.
The Korowai of Papua New Guinea live in tree houses. Watch the BBC program Human Planet: Jungles to see how their life requires considerably more mobility, stability, motor control, strength and endurance the average westerner’s. You can find the program on itunes.
Activities of Daily Living
As healthcare providers we call the basic movements that people do throughout the day to take care of themselves, get where they want and generally participate in society the “Activities of Daily Living”, abbreviated ADLs. The acronym DEATH covers the basic ADLs: dressing, eating, ambulating, toileting and hygiene. The acronym SHAFT covers the instrumental activities of daily living which are more complex task that are necessary to function independently in the community: Shopping, housekeeping, accounting, food preparation, transportation/telephone. ADLs are the minimum requirement of function and someone who is not able do one’s ADL independently is considered disabled. Think of grandma not being able to get up and down off the toilet after a hip fracture, she will need a modification to raise her toilet seat and a caregiver until she is able to do it safely again. Medicare and some Insurance companies will only pay for care if the patient has a deficit in their ADLs.
The Most Demanding ADLs
While technology has almost completely eliminated heavy lifting and cardiovascular endurance activities from the daily requirements of most people in the developed world, the demands on mobility, stability and motor control remain relatively high.
Take a look at the following list, can you do all of these movements without pain? Can you do them all with compensatory movement?
The latter is harder to answer but is equally important. A lack of mobility in one area will be compensated for by more mobility in another area, a lack of stability will be compensated for by a lack of mobility to create stability, these compensations load the body unevenly and increase risk for injury. For example: if every time you get in and out of a car you bend your back excessively because of stiffness in your hips and ankles your risk of back pain is elevated.
Here is a list of what I think are the most demanding activities of daily living and what makes them so demanding. These are the activities that people take for granted until they come to physical therapy because it is difficult or painful.
-Crawling under the desk to plug something in etc: knee hip and spine flexion
-Reaching across for the seat belt: shoulder adduction and internal rotation
-Reaching back for a bag in the back seat of the care: thoracic spine mobility, shoulder mobility, stability and strength
-Looking back over your shoulder while driving: thoracic and cervical spine mobility and stability
-Putting your carry on in the overhead compartment: thoracic spine mobility, shoulder mobility, stability and strength
-Tucking in back of shirt and strapping a bra: shoulder mobility in internal rotation, adduction and extension
-Putting shoes on: hip, knee and ankle mobility, stability if standing on one leg to do it
-Running to catch a bus: cardiovascular capacity, all the mobility stability and strength required to run safely
-Getting into a low car: hip, knee and ankle mobility
-Changing a car tire: hip, knee and ankle mobility
-Changing oil on the car: hip, knee and ankle mobility to get down, muscular endurance to perform the task
-Getting into crawl space of the house: hip, knee and ankle mobility to get down, muscular endurance to perform the task
-Cimbing into the attic: upper body strength
-Moving furniture: full body strength
-Carrying groceries into the house from the car: upper body strength and muscular endurance
-Going down stairs: hip, knee and ankle mobility, stability and strength
-Walking on an icy sidewalk: stability
-Picking something up from the ground: trash, dog dish, dust pan: hip, knee and ankle mobility to get down, or hip and spine mobility to bend over
-Sitting for long periods of time to travel: hip mobility to allow for upright posture with minimal muscular effort
-Combing hair: thoracic spine mobility, shoulder mobility and stability
-Washing mid back: shoulder mobility in internal rotation, adduction and extension
-Getting things out of bottom of book shelf or kitchen cabinet: hip, knee and ankle mobility, stability
-Taking something in/out of the oven: hip, knee and ankle mobility and stability
-Getting on/off a bicycle or motor cycle: hip mobility of the moving leg, stability of the standing leg
-Catching oneself when falling: upper body strength
-Stepping in and out of tub/shower: hip mobility of the moving leg, stability of the standing leg
-Getting on/off toilet seat, low couch: hip, knee and ankle mobility, stability and strength
-Putting something away/ taking off a high shelf, bookshelf: thoracic spine mobility, shoulder mobility and stability
-Shaving the neck: cervical extension
-Riding a bicycle: cervical extension, balance
-Getting up at night to go to the bathroom and finding the way without falling: balance
-Putting pants on: hip, knee and ankle mobility, stability if standing on one leg to do it
-Putting a t-shirt on: thoracic spine mobility, shoulder mobility and stability
-Carrying dog food bag: upper body strength and muscular endurance
-Gardening planting, weeding at ground height: hip, knee and ankle mobility to get down, muscular endurance to perform the task
-Making the bed: hip mobility to allow for proper bending, low back muscular endurance to perform the task
-Washing floor: hip, knee and ankle mobility to get down, muscular endurance to perform the task
-Shoveling snow: lower and upper back, biceps, hamstring and gluteal strength depending on technique as well as cardiovascular endurance
-Walking in snow or on ice: balance, cardiovascular endurance
What have I missed? Leave a comment!