Challenging Geriatric Patients

Giving older patients the push they need to get results.

We talk a lot about the soft ageism of low expectations. Simply put, we often fail to ask our older patients to complete tasks that are challenging enough to create meaningful change.

Nowhere is this more evident than in assessment and treatment of trunk strength and core stability. When was the last time you asked an older patient or client to perform a plank?

More than 20 cross-sectional and longitudinal studies indicate that core strength is important for the successful performance of activities of daily living in old age.1

Conversely, a number of studies have started to ask why balance and resistance training alone poorly translate into improvements in balance, functional tasks, activities of daily living and fall rates. A consensus is emerging that core strength training must be a component of any program aimed at the overall health and well-being of older adults.

To assess core strength, we’ve never been particularly fond of traditional manual muscle tests. Instead, we prefer to use a series of timed functional tests to measure core strength and stability. These tests have been shown to reliably correlate with activation of the muscles of the anterior and posterior trunk and include the following.2-3

Plank (anterior trunk): From a prone position, ask the patient to prop on his/her elbows and lift the body up in a straight line from the toes to head. Time how long the person can hold the position. The time stops when the patient bends at the hips, starts to shake, or can no longer hold the body up. Normal score is greater than two minutes.

Curl-up (anterior trunk): From a supine position with knees flexed to 90 degrees and feet flat on the floor or table, ask the patient to fold his/her arms across the chest and lift the upper body until the shoulder blades no longer touch the table. Time how long the person can hold the position. The time stops when the shoulder blades touch the table. Normal score is greater than two minutes.

Back extension (posterior trunk): From a prone position with a small pillow under the abdomen, ask the patient to lift the sternum off the floor. Time from the lift until the patient can no longer hold the position. Normal score for men is greater than 200 seconds and for women is greater than 150 seconds.

Some of you may be thinking, “My patients could never hold a plank for 200 seconds!” For many patients, that may indeed be true. But if we fail to draw a line in sand, use the evidence to define what is normal, and push our patient toward that goal, we are truly failing to meet their needs.

Next month, we look forward to sharing evidence-based core stability training ideas with you.


  1. Granacher U, Gollhofer A, Hortobagyi T, et al. The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors: A systematic review. Sports Med. 2013;43(7):627-641.
  2. Schellenberg KL, Lang JM, Chan KM, Burnham RS. A clinical tool for office assessment of lumbar spine stabilization endurance: Prone and supine bridge maneuvers. Am J Phys Med Rehabil. 2007;86(5):380-386.
  3. Ito T, Shirado O, Suzuki H, et al. Lumbar trunk muscle endurance testing: An inexpensive alternative to a machine for evaluation. Arch Phys Med Rehabil. 1996;77(1):75-79.