Health Features

Don’t Act Your Age

The aging process is not our friend. It decreases our body’s ability to perform well with aching backs, stiff necks and painful hip joints. And it increases attributes we’d rather not have, like wrinkles and sagging skin. But we live in a day and age when technology—and a good set of physical therapy exercises—can at least make us feel younger.

stronger back & hips
A lifetime of big boom-booms and little ouchies exerts a toll on the core neck, back and hip joints that support everything else in our body. But with a little determination, we can do some exercises at home to condition those important parts for a longer, healthier and more pain-free post-middle age.

skeletal wear & tear
“Stiffness and pain can come over time,” says Dawn Kennedy, who has a doctorate in physical therapy and is manager of SSM Health Physical Therapy in Hazelwood. In individuals younger than 40, there is a higher incidence of herniated disks. And a strenuous, high-labor job can aggravate things. Older patients can get osteophytes—bone laying down more bone to protect itself, which can be called arthritis or degenerative joint disease or stenosis.”

The core joints and muscles carry heavy burdens that can become creaky, even in the absence of injuries. “Stiffness, tension and tightness in the neck, hip and back are extremely common, especially for people who have desk jobs or sit all day,” says Courtney Tucker, a personal trainer and group exercise manager at The J in Creve Coeur. “Your muscles aren’t getting enough movement. Strengthening and stretching exercises are going to be a huge benefit.”

use it or lose it
The prevention or remedy for core stiffness might be as simple as moving. “Just doing 10 reps of a couple of exercises every day can make a big difference,” Tucker says. Kennedy agrees: “The stronger your muscles are, the more you can off-load any joint. Decreasing that load decreases pain and stiffness.”

Their favorite home exercises for the back include a couple of seated motions. While at the front edge of a chair, Kennedy advises to “tighten your abdominal muscles like you are trying to pull your ribs down to your hips and do a marching motion with your legs. If you are at a higher skill level, you can do that standing on a solid surface.” For a good back stretch, start in a seated position and slide both hands down the outside of each leg, reaching toward the ankle. “Do 10 to 15 on each side,” she notes.

Tucker recommends the ‘cat-cow’ pose. “While you are on your hands and knees, round your back up like a cat and lower it like a cow,” she explains. “That really elongates the back.” The ‘bridges’ stretch, which is done lying on the back with knees bent, strengthens the back and abdomen, Tucker says. “ Lift your hips off the floor and hold your abdominals tight.”

hips & neck
“When we walk, we use the same muscles to make our legs go back and forth, but when we are younger, we do a lot more side-to-side movement and rotation,” Kennedy says. Her hip solutions: “Do side-steps and clamshells—lie on your side with your knees bent at about 90 degrees. Keep feet together while lifting the upper knee toward the ceiling, like a clamshell opening with hinges at your hips and feet. Do both sides and do enough to start feeling tired, about 10 to 30 reps.”

As for the neck, it mostly needs stretching, Tucker says. “Place your hands behind your head and gently push your chin down to your chest.” Tilting the head from side to side also helps with flexion. “One good neck exercise is just turning your head and looking over your shoulders, going slowly from side to side,” Kennedy suggests. “Another is a chin tuck—stick your neck back until you give yourself a double chin. That works the smaller muscles.”

The shoulders often are overlooked, Tucker adds. “Relaxing the shoulders and pulling those muscles down can release some of the tension in the neck.”

botox & fillers
One of the most misunderstood concepts in facial procedures is the difference between Botox and fillers. A brand of neuromodulator toxin with a variety of medical uses, the term Botox is often used to reference any injectable facial treatment. But that is inaccurate.

botox: it’s not a filler
“I hear it at least once a month. People think Botox is a filler for lips and other things,” says Dr. Richard Moore, a cosmetic surgeon and medical director of The Lifestyle Center in Ladue. “They have misconceptions about what is going to work and where.”

The term ‘Botox’ is often used generically, agrees Carol Anderson, BCRN, BSN, CANS, certified aesthetic nurse specialist and owner of Nouveau MedSpa in Kirkwood. “Botox keeps muscles from making creases. Fillers volumize space,” she explains. So you might use a filler to plump lips, for example, and Botox, a muscle inhibitor, to control wrinkling.

wrinkles, be gone!
Wrinkles and lines are nature’s way of stamping age on the face. “We have two kinds of wrinkles,” Moore explains. “Dynamic wrinkles appear when you move a muscle. These can become static wrinkles—those that are present at rest. The ‘11s’ between the eyes, for example, can turn into static wrinkles. Neuromodulators (like Botox) will soften those and help prevent them from getting deeper, but won’t necessarily take them away.”

Fillers like collagen also can be used to treat static wrinkles, as with nasolabial folds (between the corners of the nose and mouth) and marionette lines (from the corners of the mouth to the chin). “These are the folds and lines people typically want filled,” Anderson says. “Often we have bone loss in the face as we age, and the deep fat pads go away, causing some laxity and folding in the face.” Replacing lost bone and fat with fillers may reduce lines resulting from laxity. Moore adds, “We can use dermal fillers to do three things: fill the static wrinkles; restore volume in the lips or cheeks; and lift the cheeks and corners of the mouth.”

what’s in a name?
Botulinum toxin was approved for cosmetic use by the U.S. Food and Drug Administration in 2002 and is marketed under three brand names: Botox, Dysport and Xeomin. “They are each minutely different,” Anderson says.

Fillers, which come in varying formulations, were first approved by the FDA in 1981. Among the popular brand names are Juvederm, Restylane, Belotero, Radiesse, Sculptra and Bellafill. “In our office, we have 10 fillers,” Moore says. “Some products are specialized for lifting and will volumize better. Wrinkle lines take a different type of filler that is designed to be placed just beneath the surface.”

The neuromodulators normally last about three months, Anderson says. “When I inject one into a muscle that creates a frown and the brain tells your face to frown, the muscle doesn’t recognize the message. We are not ‘paralyzing the muscle’ (as is commonly thought), the message just doesn’t get through.” Over time, the nerve generates new pods of that transmitter, so most people will need treatment three or four times a year.

The benefits of most fillers will linger three to 12 months, Moore says. “A physically active person will go through fillers faster than an older person, and the location (of the injection) will make a difference,” he adds. “We move our mouths a lot, so fillers in the lips are going to last a shorter period of time.” A deeper filler like Bellafill may stay on duty for two years or longer, Moore says.

To add to public confusion over fillers and neuromodulators, they are often used together. “When we use them in combination, we call it the liquid face-lift,” Moore says. “An injector has to have a good, three-dimensional eye and know where to put things.”

facial peels
Said to give you fresher, younger skin, the facial peel was once a beauty secret of Hollywood stars in the silent film era. A weak acid solution that slightly burns one or more outer layer of facial skin carries off lines, splotches, rashes and other damage, leaving a new, better surface.

skin quality: a matter of dna?
The natural course of skin aging is predetermined by heredity, says Dr. Gregory H. Branham, chief of facial plastic and reconstructive surgery at Washington University Facial Plastic Surgery Center in Creve Coeur. The next determinant of skin quality is the naughtiest word in dermatology: sunlight.

“Over time, ultraviolet light from the sun penetrates deeper into your skin. If it gets down to the dermal layer, it disrupts the collagen and elastin, two proteins that cause the skin to be plump and stretchy, not tough and leathery,” he explains. “As the sun damages the skin, you can get wrinkles, scaly patches and pigment spots. You can even get pre-malignancies and malignancies from DNA damage.”

An individual’s skin clock also may tick years more quickly due to hormonal losses accompanying menopause and another skin plague, smoking. “The need to reverse some of those changes brings us to talking about peels,” Branham says.

new skin, fresh slate
A peel is a form of skin resurfacing, and there are a number of ways to do it, Branham notes. “You can use a laser, which vaporizes or burns off the skin, or you can apply an acid substance.” Acid causes a chemical burn of varying depths, depending on the strength. “A superficial peel strips off the dead skin-cell layer,” he says. “Those are the peels that would be done in a spa or by an aesthetician. That gives you fresher skin and allows moisturizer to penetrate deeper. It gives you a little bit of plumping and helps the texture, but it doesn’t provide long-term changes to the wrinkles.”

When additional issues remain, your clinician will call in a stronger acid. “For what I call a therapeutic peel, we go into the dermis and the living layers of skin. A medium-depth peel will bring long-term change to wrinkles and improvement to pigment, texture and fine lines,” Branham says. “There are still deeper peels, but if we go that deep, we probably want to use a laser.”

The procedure will be followed by a week or two of downtime. “Recovery is dependent on how deep we go,” he notes. “With a medium-depth peel, it’s about a week. Your face will be red and you will need to use a healing ointment because your skin is vulnerable.”

a new you
The result will be a significantly younger face, Branham says. “You have reversed the clock; how much depends on how severe the damage was and how you take care of your skin,” he says. “Deep lines and wrinkles are not going to be completely erased, but you generally get quite a bit of improvement with fine lines and wrinkles. If you have tough and leathery skin, you probably are not going to make as much headway because the collagen and elastin have been damaged so much that the skin may not recover as well.”

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