The Calf Muscle Pump-Why Older Patients should have Exercises and Socialization

Patients Need Socialization-and Exercise The patient long term stay has 3 main problems
• • • The isolation gap Lack of touch Lack of movement

I am doing voluntary work in a hospital and they are just starting a program for exercise for patients-I joined the first class as an active participant, and saw from the inside the problems these people experience in a modern hospital, and can only speculate on how bad it must be in a less forward or less well equipped and staffed one I am not involved in a professional capacity; it should be understood that I am not criticizing the hard worked staff or the people in charge of the hospital or their methods, but just making a comment on patients and the view from their side of the coin, (I could be one of them myself) I wander from ward to ward just talking to patients who are feeling overwhelmed by their stay in hospital however long or short the time may be Most are making an unplanned hospital stay, and their first feelings are shock at finding themselves there suddenly removed from their usual surroundings, comforts, friends and other familiar territory and routines they have become used to They are plunged into a medical world where the day consists of being, poked, prodded, discussed, having procedures done, washed, bathed, fed, sharing a room with total strangers who snore, snuffle, moan with pain and discomfort who rely on pumps that tick and beep all hours of the day and night A hospital is really not a place for sick people to rest and get better; it is too busy and very threatening for the older ones who have problems relating to all the confusion around them-this can be even more uncomfortable when the patient is deaf, or when they are sight affected If a television is available to pass the time, they not be able to see it, or even hear it as the sound has to be kept low enough so that other patients are not disturbed, and they may not even be able to read books or newspapers that may or may not be supplied by friends or the hospital volunteers (if any) When you are an older patient, you may not get too many friends or family visiting because they may live too far away, or your friends find the prospect of visiting too daunting or impossible as they are in your age group and have medical problems of their own The only thing you have to mark the passing of the days, are basically mealtimes, breakfast dinner and tea, so the days and time can hang heavily, and the isolation between your other life and this one increases The world outside is somewhere on another planet (it might as well be) as you are totally isolated from it (if lucky, you might have a good view from a window if your eyesight is good enough to see it-so the main things missing from your life are stimulation, movement and company When you are really sick, none of these matter anyway, but as you improve, they become more important to your recovery
1 Copyright Michael Gillan Long Distance Recovery Specialist http://aching-legs.org/closing_the_patient_isolation_gap.html

The Calf Muscle Pump-Why Older Patients should have Exercises and Socialization Lack of touch

Lack of touch is a problem for many patients; they may get medical touch from doctors, and nurses when they are being examined, having observations done, or assisted with their daily needs, but because of the workload they are dealing with, this touch is minimal Also in this modern age of nursing, infection control, political correctness through accusations of sexual harassment, and threat of lawsuits through what can be perceived as ‘inappropriate’ touch is a worry for nursing staff and others involved in patient care giving
Lack of movement

Other than trips to x-ray, ultra sound, and other departments, the older patient in the modern hospital is usually confined to their bed or bedspace surrounding them unless they are mobile enough to take themselves a walk around the hospital-the modern hospital though is so big, impersonal and busy that it is easy to become disorientated and get lost If they are not ambulant they just sit an wait for time to pass-slowly Lack of movement can lead to many problems, it reduces any mobility that may have been there if they were able, it can lead to wasting muscles, even more isolation, and of course the risk of deep vein thrombosis from lying in bed affecting circulation Moving and exercise groups The hospital I do volunteer work has introduced movement and exercise groups to give patients who can’t do physical therapies because of the conditions they have some form of therapeutic activity during their stay These groups are run and supervised by the physical therapy department at the hospital and cost very little to run except for the time needed to get the patients to the group and back to the ward again-it is also cost effective as the therapists can give a whole group of people some attention they may not have worked with It also means that they can give more individual time to those patients who need more intensive work in their bed area The sessions also have side benefits attached to them, they give them something to look forward to other than meals-they get up, showered and engaged in getting ready to go to the group, they can have a change of scenery from the ward, they can work at their own pace and within their movement capacity It also gets the brain working as they have to start thinking for themselves as each exercise is explained to them what they are required to do, and they have to start to relate to legs feet and arms which may not have been used for some time Social interaction with a wide range of people (other patients) not connected with them medically is also included in the group situation as they are seated in a circle facing each other, and laughter and jokes are quite frequent during the working time of approximately 20 minutes A further benefit to the patients is that the simple leg activity also affects their leg circulation by moving the calf muscles during the exercises Leg Movement is good for patients because it works the calf muscle pump
2 Copyright Michael Gillan Long Distance Recovery Specialist http://aching-legs.org/closing_the_patient_isolation_gap.html

The Calf Muscle Pump-Why Older Patients should have Exercises and Socialization

The Calf Muscle Pump
To keep the lower leg circulation working, the muscles rely on having a constant supply of fresh blood to the tissues to help prevent fatigue and to recover when they do While the effects of the pump has a great effect on the physiological condition of the body, broken down into its various parts it is just a pump-not too sophisticated in the way it operates, except that it is made from living tissues rather than manufactured components Basically the way it works is there are a series of flexible tubes (veins) to take fluid (used blood) from the lower legs back to the body against gravity-in the tubes are a series of one-way valves that open to let fluid pass through when the tube is squeezed by the motors (the calf muscles) When the pressure on the tube is released, the valves close again to prevent the fluid going back down to the feet again The calf muscles ability to keep working at applying and releasing pressure the tubes-once this stops, the fluid can’t be moved up the legs-the used fluid is allowed to just become static Swollen ankles from lymph fluid (or water) separating from the static blood and migrating through the vessel walls into the tissue spaces instead of being pumped away can be the result inefficient use of calf muscles Being a mechanically based pump, the system can be serviced or restarted using a manual system to remove some of the fluid and pressure that has built up-once started, fresh blood can more easily enter the muscle tissues and start the recovery process

The Calf Muscle Pump and the muscles that are its motors
The calf muscle pump is responsible for circulation in the lower legs-another name for it is the peripheral heart because it is outside the body Its main purpose is to move used blood from the lower legs back to the body for refreshment with oxygen and other elements that the muscles need to maintain an optimum environment for efficient working of the muscles

Old blood and fluid is taken out of the lower legs through the veins, fresh blood is supplied to the muscles through the arteries

3 Copyright Michael Gillan Long Distance Recovery Specialist http://aching-legs.org/closing_the_patient_isolation_gap.html

The Calf Muscle Pump-Why Older Patients should have Exercises and Socialization

The calf muscle pump is made up of all the muscles in the legs, the motors that provide the power for the pump are the calf muscles-these are made up of 2 basic movers-Soleus which is used for standing upright, and Gastrocnemius used for running and jumping

Soleus

Gastrocnemius

As the muscles move, they increase and decrease pressure on the vessel walls (the veins) opening the one way valves to let the blood pass along them, and close to prevent the blood flowing back towards the feet To keep the circulation in the lower legs going, a similar volume should be pumped out of the legs as flows into them

4 Copyright Michael Gillan Long Distance Recovery Specialist http://aching-legs.org/closing_the_patient_isolation_gap.html

The Calf Muscle Pump-Why Older Patients should have Exercises and Socialization

Lower Leg Circulation
Blood is sent to the lower legs under pressure through the arteries and vessels called arterioles and even smaller capillaries-as the vessel size reduces the pressure taking it there also decreases

On return to body blood is renourished and recycled

Blood pumped from heart through arteries under pressure

Used blood is moved up the legs through the veins

Reaches feet Pressure runs out

Calf muscles act as pump motors

By the time the blood reaches the feet, all the pressure has been used, and there is none left to return the used blood back up the legs to the body against gravity again The Veins Used blood is sent back to the body by a pumping system made up of the leg muscles and veins which have one way valves in them which prevents it going back down to the feet There are three types of veins • • • Superficial veins act as a reservoir for blood, supplying it to the tissues as needed, they also carry blood from the muscle tissues to the perforating veins. Perforating veins that carry blood from the superficial veins through to the deep veins. Deep veins carry used blood and lymph fluid away from the legs towards the heart.
Low-pressure High pressure

Blood is forced upwards

Blood is resting on the valve

As muscles squeeze the vessels valves are open

as they relax the valves close preventing leaks

In this way, a balance is kept between the fresh blood going into the lower legs and the old blood leaving them on its way back to the body for refreshment and recycling again When the muscles are not doing their job properly they become incompetent and the pump becomes inefficient
5 Copyright Michael Gillan Long Distance Recovery Specialist http://aching-legs.org/closing_the_patient_isolation_gap.html

The Calf Muscle Pump-Why Older Patients should have Exercises and Socialization

A result of calf muscle inefficiency

Poor circulation means less movement of fluids which may become trapped in the lower legs; water (or lymphatic fluid) may separate from the blood, migrate through the vessel walls and fill the tissue spaces-as it can’t be pumped away quickly enough, the ankles swell (edema) Used fluid build up restricts the supply of fresh oxygen filled blood to the muscle tissues without it, they quickly fatigue become inefficient and reduces the circulation

Problems caused by calf muscle pump inefficiency include
• • • Poor circulation Lymph system inactivity Venous return reduced
Calf Muscle Fatigue

Fresh blood reduced

Tight calf muscles

Poor blood return

Because of gravitational pull, fluid always finds its own level It is generally accepted that reversing the effects of gravity by having the legs higher than the body to change the direction of fluid can help the legs to drain of fluid

However many patients have bed rest anyway and they need movement not static leg raises

This is where a process of getting the legs conditioned for walking by using Light Manual Muscle Relaxation may be of more benefit to them
6 Copyright Michael Gillan Long Distance Recovery Specialist http://aching-legs.org/closing_the_patient_isolation_gap.html

The Calf Muscle Pump-Why Older Patients should have Exercises and Socialization

What is Light Manual Muscle Relaxation?
The walk you have when you are not having a walk
It is a Self-Service leg circulation system It is system developed for ultra marathon runners and walkers leg recovery and has been tested on long distance events worldwide (ultra marathon is any distance over marathon42.19 kilometers/26.385 miles)

Ultra marathon is very long distance competition where they have to run or walk as far as possible in a given time; it can be over 6 hours-24 hours-48 hours-6 days-16 days or even around the world www.worldrun.org

It is making the calf muscle pump work again to take some of the pressure away from the lower legs and let fresh blood into the muscle tissues to help the legs recover They have to get up and get back on the track or road on a constant basis whether they want to or not to achieve their objective-the person with aching legs also has to get up and move on a constant basis whether their legs have recovered or not www.hazards.org/standing

Light Manual Muscle Relaxation-the leg servicing system

Light Manual Muscle Relaxation-A Tested Trusted Environmentally Friendly Alternative
7 Copyright Michael Gillan Long Distance Recovery Specialist http://aching-legs.org/closing_the_patient_isolation_gap.html

The Calf Muscle Pump-Why Older Patients should have Exercises and Socialization How Light Manual Muscle Relaxation leg servicing works

Fresh blood moves through the arteries into the muscle tissues

Light Manual Muscle Relaxation applied

Used fluid moves through the veins back to the body

Tense tight muscles are calmed relaxed and moved gently

Using just these-and the knowledge of how to use them

Calf muscle fatigue, tight muscles, and poor lower leg circulation can chase each other around in a cycle that is difficult to break out from-each is a self destructive part that props up the other parts of the cycle and it will take a circuit breaker to disrupt the cycle of fatigue Medically caused leg health should be referred to those best qualified to deal with it-the doctors, but there are non-medically related problems that can be dealt with by some simple activities

Such as knowledge about how the calf muscle pump works and using it to the best advantage

8 Copyright Michael Gillan Long Distance Recovery Specialist http://aching-legs.org/closing_the_patient_isolation_gap.html

The Calf Muscle Pump-Why Older Patients should have Exercises and Socialization What effect can Light Manual Muscle Relaxation have on the legs? Can chance give you recovery results like these?
FIGURES TAKEN FROM THE (1995 COLAC 6 DAY FOOTRACE) NAME Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 A Krouglikov 237.2 113.6 130 106 126 108Kilometers 539 284 325 265 315 270Laps T Rusek 215.2 98.8 98 139.6 138.4 122.4Kilometers 538 247 245 349 346 306Laps M Taylor 174.4 128.8 143.6 123.6 120.8 89.2Kilometers 436 322 359 309 302 223Laps B Beauchamp 180.4 133.2 124 117.6 110 93.2Kilometers 451 333 310 294 275 233Laps P Gray 150 134 105.2 94.8 111.6 106Kilometers 375 335 263 237 279 265Laps D Parris 138.4 108.4 106.8 116.4 106 107.2Kilometers 346 271 267 274 265 268Laps 72 98.8Kilometers I Davis 168 119.2 90 116.4 420 298 225 291 180 247Laps G Watts 131.2 96.4 99.2 104.4 92.8 133.6Kilometers 328 241 248 261 232 334Laps C Young 142 91.2 90 97.6 88 92Kilometers 355 228 225 244 220 230Laps D Kettle 138.2 86.8 90.8 95.2 94.4 84.8Kilometers 332 217 227 238 236 212Laps R Hill 128 80.8 99.2 70 95.6 96.4Kilometers 320 202 248 175 239 241Laps K Fisher 164 91.6 50 115.2 49.6 81.2Kilometers 410 229 125 288 124 203Laps G Pollard 120 74.8 73.6 68.4 69.6 61.2Kilometers 300 187 184 171 174 153Laps The above group came in for mass age and stretching The group below did not or had their own mass age people 141.6 112.8 104.8 101.6 98 96.4Kilometers T Rafferty 354 282 262 254 254 245Laps G McConnell 145.6 110.8 114.8 113.6 108.4 106Kilometers 364 277 287 284 271 265Laps G Audley 152.8 110.8 126.4 113.6 114.8 95.2Kilometers 382 277 316 284 287 238Laps S Scanlon 140.8 82 84 34 0 0Kilometers 352 205 210 85Pulled out (Blisters) J Timms 127.2 98.4 74.8 0 0 0Kilometers 318 246 187Pulled out 0Laps N Mercer 166 16.4 0 0 0 0Kilometers 415 16.4Pulled out 0 0Laps Underlining in the top group show where the results of Gentle Manual Muscle Relaxation s was starting to take effect. The inconsistencies in the results on a daily basis was caused by reverting back to conventional massage to see what happened Note the higher injury and drop out rate in the bottom group.

The above figures show what a leg service using the calf muscle pump can do for recovering the legs-they are from the 1995 Colac (Australia) 6 day event-and show on a daily basis (Across the page) the increase that was obtained using Light Manual Muscle Relaxation More importantly it demonstrates the decrease in time needed for recovery when increased fresh blood flow is obtained by working with the muscles not on them
9 Copyright Michael Gillan Long Distance Recovery Specialist http://aching-legs.org/closing_the_patient_isolation_gap.html

The Calf Muscle Pump-Why Older Patients should have Exercises and Socialization

The advantages of using this system
• • • • • •
Do It Yourself recovery No disrobing Works with the muscles not on them No oil used Non invasive User friendly

Using a simple but effective lower legs strategy will help to keep them moving during those enforced long hospital stays

All that is needed are the hands
The hands are the tools to close the isolation gap and increase lower leg circulation When the talk has dried up, and the silence is deafening, let the hands communicate for you; give some constructive touch to both cross the isolation divide and help to minimize the long term effects of restricted movement in walking Use Light Manual Muscle Relaxation the walk you have when you are not having a walk Many hospitals such as those in third world countries do not have enlightened Nurse Unit Managers such as the one I am volunteering in nor do they have the services of Physical Therapists to work with the patients-therefore the money I make from the sale of the manual on this page
http://aching-legs.org/closing_the_patient_isolation_gap.html will be going to the establishment of workshops in these countries Note-never doing anything with the patient without first discussing with the managing nurse/doctor and obtaining their permission or you may be interfering with any treatment for their health problems 10 Copyright Michael Gillan Long Distance Recovery Specialist http://aching-legs.org/closing_the_patient_isolation_gap.html

The Calf Muscle Pump-Why Older Patients should have Exercises and Socialization Some References Michael’s methods of massage and blister care helped me to stay mobile throughout the race and to recover quickly afterwards. His techniques are safe and gentle. Unlike some treatments, which put the runners and walkers at risk of muscle tears or infection, Michael’s techniques are gentle, safe, reassuring, and highly effective. They enhance comfort and flexibility, build confidence, and promote success. This booklet will help others to learn and practice Michael’s methods. It is recommended reading for everyone who walks and runs and who wants to go further, go faster, or just to enjoy life more!!' SANDRA BROWN 1996 Ladies 1000 Mile World Record Holder 1999 Ladies 100 mile Race walking World Record Holder “I know that your massage kept a number of competitor<>s in the event. The cold weather of Saturday afternoon and night certainly got to many of the walkers and your prompt action had them back in the race after a short stop. In years past, that would have ended up as a non-finish. A number of walkers were able to keep going for the full 24 hours on the basis of your expert help.” Tim Ericson Secretary Australian Centurions Club 'I have known Michael Gillan for many years and have always got quick relief for my aches and pains from the stretching he performs'. CLIFF YOUNG-75-80 24 Hour World Record Holder (150.07 kilometers) A word from Jesper Olsen World Runner about Light Manual Muscle Relaxation “If I hadn't had the qualified help from the excellent masseur Michael Gillan, taking several thousands of km out of my legs, I could spare myself the effort!” “My crew for the current stages, Michael Gillan, has proven to have other talents than the quite taxing job of taking care of all the requirements of a really tired ultra runner! He has since years back been working on a new approach to stretching and muscle-rebuilding for ultra runners. I have the last two days tried his careful stretch and massage, and a bit to my surprise the muscles are beginning to feel like before the start back in Greenwich, London!! Usually I doesn’t take massage as the legs of an ultra runner will often be quite sore during the long time events (and especially in an multi-year event like this...), and getting a massage can at times cause more injury and cramping up than good. For example my last massage was some 12 000km ago when I ran the 12hour competition in Finland. And so far that has been the only one. But Gillan came with best recommendations from my main contact in Australia, Phil Essam, who besides being vice president in the Australian Ultra runners Association has heaps of good knowledge to share. And this new kind of mild massage for ultra runners is definitely one of the good tips! There should be a fair chance that I actually get fresh enough to do some decent running at the 6 Day Race that I have coming up in Colac from the 21.November. I quite look forward to that, even though I can’t expect to make a top class result :-)” He won! 756.2 kilometers (Jesper holds the record for the longest run in history over 26000 kilometers and the first person to run around the world Taken from www.worldrun.org

11 Copyright Michael Gillan Long Distance Recovery Specialist http://aching-legs.org/closing_the_patient_isolation_gap.html

The Calf Muscle Pump-Why Older Patients should have Exercises and Socialization Some references for Light Manual Muscle Relaxation To: mgillan@hotmail.com Subject: RE: Emailing: m gillan reference.doc Date: Mon, 4 May 2009 16:48:31 +1000 Hi Michael, COBURG 24 HOUR CARNIVAL May 3rd 2009 TO WHOM IT MAY CONCERN For many years Coburg Harriers has conducted the Victorian 24 hour Track Championship and the Australian Centurion 24 Hour Race Walk, the overall event being the Coburg 24 Hour Carnival, which also includes a separate 6 Hour run/walk event. This type of event is very demanding on Competitors, and each year, in addition to First Aid support, we seek to have the services of a masseur who can work on tired legs and also treat blisters in order to keep entrants on the track. We have been privileged for many years to have had the voluntary services of Michael Gillan who with his techniques is able to coax renewed life from extremely tired muscles and legs to get athletes back on the track when they were thinking that they would have to retire. Michael has a very well deserved reputation in the "Ultra" running and walking fraternity who look forward to his presence at our events as they know he gets results without causing further injury with his treatments. It is rewarding to see exhausted competitors come from the track in the early hours of the morning, convinced that they are unable to continue, only to see them return to the event after being treated by Michael. Our Organising Committee at Coburg is grateful to Michael for his dedication to the sport and can commend his techniques to Athletes. Yours Sincerely, Bernie Goggin Raceday Director / Referee Coburg 24 Hour Carnival 2009
http://www.coburgharriers.org.au/joomla1/component/option,com_frontpage/Itemid,1/

12 Copyright Michael Gillan Long Distance Recovery Specialist http://aching-legs.org/closing_the_patient_isolation_gap.html

The Calf Muscle Pump-Why Older Patients should have Exercises and Socialization Physiology References
The calf muscle pump (p.209) Physiology: a regulatory systems approach. Fleur L. Strand. Macmillan Publishing Co. Inc.ISBN 0-020979860-4 (p.209)Physiology: a regulatory systems approach. Fleur L. Strand. Macmillan Publishing Co. Inc.ISBN 0-020979860-4 "Venous valve incompetence and varicose veins" 'Guyton-Textbook of Medical Physiology eighth edition-1991 W.B. Saunders Company-ISBN 0-726-3994-0 Effect of "Hydrostatic" Pressure on Venous Pressure ( P.165) 'Guyton-Textbook of Medical Physiology eighth edition-1991 W.B. Saunders Company-ISBN 0-726-3994-0 Effect of Hydrostatic Factors on Arterial and Other Pressures (P.167) 'Guyton-Textbook of Medical Physiology eighth edition-1991 W.B. Saunders Company-ISBN 0-726-3994-0 Calf muscle pump inefficiency 'Guyton-Textbook of Medical Physiology eighth edition-1991 W.B. Saunders Company-ISBN 0-726-3994-0 ' (P.177) 'Guyton-Textbook of Medical Physiology eighth edition-1991 W.B. Saunders Company-ISBN 0-726-3994-0 The Blood Circulatory System (P.150) 'Guyton-Textbook of Medical Physiology eighth edition-1991 W.B. Saunders Company-ISBN 0-726-3994-0 "The Lymphatic System (P.180) 'Guyton-Textbook of Medical Physiology eighth edition-1991 W.B. Saunders Company-ISBN 0-726-3994-0 "Pumping caused by external Compression of the Lymphatics Guyton-Textbook of Medical Physiology eighth edition-1991 W.B. Saunders Company-ISBN 0-726-3994-0 (p. 182) ‘Peripheral Nervous System’ ‘Textbook of medical Physiology” (Physiology- fourth edition-Robert M. Berne, Mathew N. Levy, Bruce M. Koeppen, Bruce A. Stanton-Mosby ISBN 0-8151-0952-0) (P.98)

You can buy an expensive book on medical physiology or you can check up for further information on Light Manual Muscle Relaxation at When you refer to medical physiology and use it to work for you, it is possible to achieve things that were previously left to chance-a faster recovery is one of them Contact mgillan@hotmail.com

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13 Copyright Michael Gillan Long Distance Recovery Specialist http://aching-legs.org/closing_the_patient_isolation_gap.html

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