Driving isn’t a sport for most of us, yet it does require strength, motor skill, joint mobility and fast reaction time. Chances are you aren’t offering functional exercise training for “driving skills,” but if you work with a senior population, you should be.
Senior fitness classes typically work on balance, hip strength and bone building to improve the self-efficacy of the aging adult. But one concept often overlooked is perhaps the most freedom-generating habit of all: the ability to drive. Just like climbing stairs and putting away groceries on high shelves, driving requires the efficient movement of limbs, trunk rotation and whole-body coordination. Guidelines for revoking driving privileges focus on the ability to execute these activities of daily life (Foley & Mitchell 1997).
While there have been no specific studies linking musculoskeletal health to car crashes, the lack of mobility commonly associated with aging is a risk factor for automobile accidents and is something doctors screen for when deciding whether to revoke driving privileges in the older adult (AMA 2010). Here are some key mobility issues specific to driving:
- Looking behind while backing up requires neck and trunk rotation.
- Rapid handling of the steering wheel while making large turns requires shoulder, elbow and hand mobility.
- Gas and break pedaling require ankle mobility and control.
Furthermore, general foot health is critical—especially the health of the foot’s sensory and motor nerves.
I recently moved to a city filled with retirees, where I often notice the effects of fading driving skills. In 2 years, I have seen the side of a specific building and guard pole smashed by cars five times.
Accidents like these have been blamed on drivers’ inability to tell where their foot is relative to the gas pedal or the brake. The brain must be able to sense where the foot is in space, which requires a well-functioning proprioceptive system, healthy intrinsic foot muscles and healthy nerves to control those muscles.
Where Does Personal Training Fit In?
Personal trainers are not in the business of teaching driving skills or testing driving capabilities. But you are in the business of keeping up the body’s mobility, and in this case, a review of the data gives us a specific list of joint motions necessary for driving.
It is hard to pinpoint exactly when mobility goes. There is no set age associated with stiff body parts. In fact, age-related mobility could just as well be the result of stiffness gone unnoticed (and untreated) for years. The best time for clients to start working on mobility is before they lose it.
Below is a list of mobility tests and correctives to keep the body sound for driving. You can add these to a session or create a class or series of classes aimed at addressing this issue before a lack of mobility becomes a problem.
The Sit and Twist Test
Have your client sit in a chair with both feet on the ground, pelvis sitting evenly on the seat, and hands resting on the lap. Cue her to rotate the rib cage without letting either side of the pelvis lift off the chair. Can she see behind herself yet? Next have her rotate her neck. How about now? Would she be able to see behind herself with her current range of motion, or does she already need to cheat by lifting one side of the pelvis and using her arms to compensate for muscles that are too tight?
Corrective. Twists and stretches to improve passive rotation of the neck and spine should be part of a daily routine.
The Ankle Mobility Test
Have your client get into a lunge position on the ground, with the front foot’s big toe 4 inches (3 inches if the client is under 5 feet 2 inches) from the wall. Without lifting the front heel from the ground, can he touch his knee to the wall? If not, then the dorsiflexion of the ankle is limited, and that can affect the ability to come easily off the gas or brake pedal.
Corrective. Calf stretch (gastrocnemius).
Place the ball of the foot up onto a rolled towel, keeping the heel firmly on the ground and the leg fully extended. The nonstretching foot can slide forward or back to increase or decrease the stretch, respectively.
Corrective. Calf stretch (soleus).
Repeat the calf stretch exercise, but add a bent knee. This places the tensile load on the low-calf fibers and Achilles tendon.
Both of these calf stretches are required to fully address chronic plantar flexion.
The Hand-Shoulder Mobility Test
Have your client get down on her hands and knees and arrange her hands so her middle fingers are pointing straight forward. Have her move her thumbs so they point directly toward each other, placing them (ideally) at 90 degrees to the middle fingers.
Shoulder assessment. To accomplish the desired angle in this hand-shoulder mobility test, do the client’s upper arms have to internally rotate (do the elbows point out to the right and left?)? This indicates excessive tension in the tissues between the wrist, elbow and shoulder of each arm.
Hand assessment. Are the client’s hands flat and relaxed on the floor, or is there noticeable flexion in some joints of the fingers? These are signs of constant “gripping” tension in the hands and immobility in the joints of the thumbs, fingers and wrists.
Shoulder corrective. Anterior elbow touch.
Have your client take her arms out in front of the body, with elbows at 90 degrees, and then bring her elbows together until they touch. While she keeps her elbows together, cue her to move the wrists away from each other. Common cheat: shoulder elevation. Cue the scapula to stay down.
Hand corrective. Finger stretch.
Have your client place one hand out in front as though she were gesturing STOP. As she keeps that elbow bent and pointed to the ground, cue her to pull each finger back individually (using the other hand) until she feels a stretch. Have her hold each stretch for a minimum of 30 seconds. Common cheats: hidden flexion in the finger joints, and wrist flexion.
The Intrinsic Foot Muscle (and Nerve) Test
Have the barefoot client spread his toes away from each other, trying to create space between each digit. Now have him lift his big toe. Can he accomplish these fine-motor foot skills?
Intrinsic foot muscle atrophy—weakness of the muscles that reside entirely within the foot—can be an early indicator of loss of nerve health in the lower leg (Greenman et al. 2005). For this issue, the corrective is the same as the test. Encourage the regular practice of “toe exercises,” like toe spreading and lifting to innervate and strengthen foot muscles and improve the health of the nerves (Balducci et al. 2006).
Create a Safe Workspace
When working with a population that is potentially at risk for low sensation in the feet, it is critical to create a safe space clear of hazardous debris. A personal surface like a yoga mat is also recommended. For general health, wiping the “barefoot” area clean before and after training is also recommended.
For decades, movement teachers have been lecturing on the benefits of functional mobility for many activities of daily living. Keeping the body fit to drive, preventively, is just another way exercise can improve the quality of life!
AMA (American Medical Association). 2010. Physician’s Guide to Assessing and Counseling Older Drivers. www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/geriatric-health/older-driver-safety/assessing-counseling-older-drivers.page; retrieved July 17, 2013.
Balducci, S., et al. 2006. Training can modify the natural history of diabetic peripheral neuropathy. Journal of Diabetes and Its Complications, 20 (4), 216-23.
Foley, K., & Mitchell, S. 1997. The elderly driver: What physicians need to know. Cleveland Clinic Journal of Medicine, 64 (8), 423-28.
Greenman, R., et al. 2005. Foot small muscle atrophy is present before the detection of clinical neuropathy. Diabetes Care, 28 (6), 1425-30.
This past year has been a long haul for you and your clients, and now is a great time to review some self-care tips. Summer…