The Problem Nobody Talks About Enough

There is a quiet epidemic happening in older adults that does not get enough clinical attention: muscle loss. Starting around age 30, adults lose roughly 3 to 5 percent of muscle mass per decade. After 60, that rate accelerates. The clinical term is sarcopenia, and its consequences, falls, fractures, metabolic dysfunction, loss of independence are among the most significant health risks facing older adults.

Here is the frustrating part. Sarcopenia is largely preventable and partially reversible with one intervention: progressive resistance training. The research on this is consistent and has been for decades. Older adults who engage in regular, progressive strength training maintain muscle mass, improve bone density, reduce fall risk, improve balance, and extend functional independence significantly longer than sedentary peers.

The barrier is not biological. It is logistical. Most gyms are not designed for older adults recovering from injury, managing chronic pain, or navigating the real fear of hurting themselves on equipment built for 25-year-olds. That is where our in-house Tonal changes the picture.

Why Tonal Is Different

Tonal is an electromagnetic resistance training system, a wall-mounted unit that replaces an entire cable and free weight setup. Instead of plates, it uses electromagnets to generate resistance. The resistance is digitally controlled, adjustable in one-pound increments, and can be changed in real time during a set.

For senior patients, this matters for several specific reasons. First, the load is precise. I can program a patient at exactly 12 pounds of resistance for a hip hinge and increase to 13 the following week. This level of precision is not possible with conventional dumbbells or machines, and for patients whose load tolerance is narrow, it makes the difference between productive training and overloading.

Second, the Tonal can provide assistance (a form of assistance) during certain movements. For patients who cannot yet perform a movement against full gravity, the system can actually help them through the range of motion while still producing a meaningful muscular stimulus. We use this in the early stages of the progression for patients who are stronger in some directions than others.

Third, it tracks every rep, every set, and every weight. Progress is visible and measurable, which matters both for patient motivation and for clinical decision-making.

How We Use Tonal at COSJ

The Tonal lives in our gym space and is integrated into the clinical care model. It is not a standalone gym membership, it is part of how we structure progressive loading for patients who have completed the hands-on phases of their care.

Before a senior patient touches the Tonal, we do the clinical work that needs to happen first. That might be chiropractic adjustments for joint restriction, dry needling for trigger point pain, or shockwave therapy for chronic tendinopathy that has been interfering with their ability to load a joint. We cannot ask a 70-year-old with hip bursitis to progressively overload a hip hinge until the bursitis is addressed. The tissue work comes first.

From there, we move into neuromuscular re-education, reactivating muscles that have become inhibited and re-establishing movement patterns that have degraded over time. A hip hinge is not intuitive for someone who has been protecting a painful hip for two years. We use corrective exercise and manual guidance to rebuild those patterns before we load them.

Then comes the Tonal. Progressive resistance training, starting at precisely calibrated loads and increasing week over week, is what drives the adaptation: muscle hypertrophy, bone density response, tendon and ligament strengthening, and neuromuscular efficiency. Typical exercises in senior rehab programs include hip hinges and Romanian deadlifts for posterior chain strength, single-leg movements for balance and hip stability, seated and standing rows for upper back and posture, overhead press progressions for shoulder strength and rotator cuff function, and split squats for quad and glute development with reduced spinal load.

What Patients Tell Us

The most common thing I hear from senior patients who complete the strength progression using the Tonal is some version of this: “I didn’t know I could still get stronger.”

The defeatism around aging and strength is deeply embedded. Patients come in expecting us to manage their pain, not to build their capacity. When they leave genuinely stronger than they came in, and they consistently do, it changes how they see the next ten or twenty years.

One patient, a 71-year-old woman who came in after a fall with hip pain and significant fear of further falls, went from being unable to stand from a chair without using her arms to performing loaded split squats over the course of four months. Her balance score on standardized testing improved by 40 percent. She has not fallen since.

Is This Right for You?

If you are over 60 and you are dealing with pain, weakness, or balance concerns, or if you have simply been sedentary and want to change that in a supervised, structured way, come in for an assessment. We will start with the clinical picture, address whatever tissue or joint issues are present, and build a progression plan that uses the Tonal to move you toward real, measurable strength.

Aging does not have to mean getting weaker. It should not. And with the right approach, it does not have to.

 

In your corner,
Dr. Blake Richard, DC
Central Ohio Spine and Joint | Westerville, OH
cospineandjoint.com/schedule-appointment