This doesn’t have to hurt

In the work I do, I often meet women who are resigned to the fact that as their body gets older, it is going to hurt.  As such, they put up with the pain, turning to medication if it gets too bad and restricting their activities in order to cope.  Ageing equals aching. That’s just how how it is. Except it’s not, or at least, it doesn’t have to be. This blog looks at the musculoskeletal changes we can expect and how to minimise their impact, and eliminate pain from your life.

THE PHYSIOLOGY

1. Joints

There are different types of joint, the point at which two bones come together. Some are immobile such as those in the skull, and others, in conjunction with the muscles around them, create movement. The most common of these are synovial joints. The joint is surrounded by the synovial membrane containing fluid which lubricates the joint as it moves. If a joint is not moved regularly it will become stiff and restricted in its range of movement. Just like a hinge on a door, if it is not kept oiled and lubricated it gets creaky and stiff.

Joints are cushioned by cartilage, flexible connective tissue which also acts as a shock absorber . With age, this cartilage tends to thin which can cause friction and pain, sometimes leading to conditions such as osteo-arthritis.

Solutions

Keep mobile: Joint health can be maintained by ensuring that each joint is moved regularly through its full range and in each of the directions for which is designed. Regular mobility work, either in an exercise class or as part of daily activities, will maintain blood flow to the area and preserve function and range of motion. Focus on areas that otherwise may not get moved eg the elbow bends and straightens a lot in daily life, the shoulder less so and therefore needs more attention.

Lifestyle: Understand the impact of lifestyle. Sitting for extended periods leaves the spine immobile when it is built to flex, extend, bend and twist. Other joints such as the hip, neck and shoulders are impacted too. Make sure you are creating opportunities to compensate for this by giving the body the movement for which it is designed.

Stay hydrated: just like a sponge, cartilage is soft and supple when it is hydrated and hard when it it dries out. Water will also help to flush away toxins, reduce inflammation and ensure there is sufficient lubrication for optimum joint function. As a first step, establish how much water you are currently drinking and then aim for around 2 litres a day.

Nutrition: sugar, refined carbohydrates such a white bread and pasta, alcohol and processed foods are known to increase the inflammation markers in the body and have very little nutritional value. Aim to eliminate them from your diet as much as you can in favour of lean protein, lots of vegetables, healthy fats and wholegrains.

Weight management: if you have ever done an exercise class using weights, you will know that even the very lightest weight of 0.5 or 1kg quickly makes its presence felt. If you are carrying some extra body weight, it will have exactly the same effect on the joints. There is no need for ‘diets’ to achieve this, it really is possible to eat normally and maintain a healthy weight.

Bones

Bones are constantly being built, broken down and rebuilt via cells called osteoblasts and osteoclasts. Oestrogen plays a role in preventing too much bone being broken down and so as levels drop, maintaining bone mass becomes more challenging. Additionally, as calcium levels decline, bone density is impacted causing the bones to become more brittle and more inclined to break. Vitamin D, which, in countries where there is less sunshine can often be deficient, also plays an important role in absorbing calcium and maintaining the correct levels. In severe cases, this leads to osteoporosis most commonly in the hip, arms and wrists and spine.

Solutions

Load: weight bearing activity will load the bones and in so doing, stimulates bone growth. Regular strength classes are invaluable or any activity puts that adds load at the right level. Swimming is, in this case, not the best choice as the water takes the weight rather than the skeleton.

Diet: have your levels of calcium and vitamin D checked.

Balance: working on your balance will reduce the likelihood of falling and the risk of fractures. This doesn’t necessarily help with treating the root cause but it certainly limits the damage.

Muscles

It is well documented that we lose muscle mass from around the age of 30. While there is no question that this is the case, it is estimated that no more than 10-15% of muscle needs to be lost over a lifetime. Our muscles respond to the demands that are placed upon them. If there aren’t any, the muscle reacts accordingly and the percentage loss will be much higher. Age exacerbates this. I saw a staggering statistic that estimated for every day of bed rest for an older person, it can take up to two weeks to regain the muscle mass that will be lost.

Muscles can also get tight, so misaligning and compromising the movement of the joint. It is not unusual for the body to have imbalances where one muscle or group of muscles are overactive and others underactive. These patterns repeated over time can cause tension, pain and injury. Common areas of concern are the neck and shoulders, the mid back (thoracic spine), the bottom and the hips, especially the hip flexor muscle which crosses the front of the hip.

Solutions

Strength: challenging a muscle with a load that is a little heavier than it is used to, stimulates muscle growth. Bodyweight exercises or other types of resistance such as bands or weights will provide the stimulus needed. It is important to work with a professional to guide you on correct technique and the most appropriate exercises.

Posture and alignment: being aware of correct postural positioning and working to alleviate muscular imbalances will help to reduce the pain. Pilates is an excellent discipline for this and brings with it many other additional benefits. It is a welcome addition to any programme.

Massage: helps to ease out knots and tension as well as releasing the fascia, the connective tissue which surrounds the muscle fibres. It’s also a perfect way to de-stress which in itself, can wreak havoc with our body and the level of pain.

Nutrition: ensuring the right amount of protein in the diet assists in the synthesis of new muscle fibres. It is recommended to eat an average of 0.8g of protein per kilo of body weight. For older adults the amount is higher at between 1 and 1.2 g per kilo. It is worth monitoring how much you are actually eating – you may be surprised!

MINDSET

As with anything, mindset is the difference between what is possible and what is not. If you think you can you will. Understand what can be achieved and believe you can do it and you’re halfway there. To help you on your way, here’s just a few of the transformations, I have witnessed simply through the power of exercise and movement:

• Knee pain that has been cured completely
• Lower back pain alleviated
• Hip replacements avoided
• Neck tension reduced
• Frozen shoulders returned to normal movement
• Postural issues such as Dowagers Hump corrected

If you can incorporate some of the solutions suggested above consistently, you too should start to see improvements. Sometimes it happens without you even noticing and then you realise that a pain you used to have all the time has gone away. The important thing is that age doesn’t have to mean an aching body. Don’t put up with pain and allow it to impact your life, there’s really no need.

**Please note that it is best to get injuries and areas that are causing pain checked by a musculoskeletal physiotherapist first before commencing an exercise programme.