I’m stiff, my back hurts, and it’s hard to get up off the floor! What’s up?
Unfortunately we do have “normal” changes to our joints and muscles as we age. But it doesn’t have to mean giving into these changes or succumbing to a lifestyle of inactivity. In fact, activity and exercise is exactly what we need to manage, delay and minimize the effects of these changes. This post is intended to review some of the typical age related changes we see in our musculoskeletal system (osteoarthritis; spinal changes; loss of flexibility and muscle mass) and some of the types of activities we can do to counteract them.
Osteoarthritis: Osteoarthritis (OA) is a form of arthritis and usually is caused by the deterioration of a joint. The most typical joints affected include the knee, hip and hands. An estimated 30 million Americans have some form of OA according to the Centers for Disease Control and Prevention. Osteoarthritis occurs when cartilage that helps to reduce friction in the joints starts to wear away and the result is increased bone on bone contact which can result in the formation of bone spurs and other bony changes. The result can be pain, stiffness and swelling.
Risk Factors for OA include the history of an injury or repetitive stress to your joints, age, obesity, and your genetics. Women are more likely to develop OA than men; especially after age 50.
Gone are the days of recommending rest for painful joints. In fact, physical activity can reduce pain and improve function and help to prevent progression of the arthritic changes. Recent studies have shown that participation in moderate-intensity, low-impact physical activity improves pain, function, mood, and quality of life without worsening symptoms or the disease.
It can be difficult to know how to start, what type of exercise to do, and at what intensity without increasing symptoms. A Physical Therapist can play a vital role in evaluating specific areas of weakness and impairment, training and education for joint protection activities and postures, and to work in conjunction with your personal trainer and exercise instructor to help develop and structure an individualized program for you.
Spinal changes: Normal degeneration of the spine begins often in the 30’s and eventually leads to a pattern of drying out of the intervertebral discs, disc height loss and facet joint (joints that allow movement in our vertebra) degeneration. Common clinical diagnoses include spinal stenosis, and degenerative disc disease.
The degenerative process of the spine is an inevitable one. In most people this degeneration does not severely compromise quality of life. We don’t really know what makes one person have pain and disability, and another not. In fact, many people with degenerative changes on X-ray and MRI, are pain free. Studies have consistently shown that many of the findings on MRI and X-rays are typical changes with aging and that people with similar imaging results will have different clinical presentations. We do know that pain and disability are affected by other factors such as weight, general health, stress, activity level, and posture. Current best practices in caring for spine pain involve correlating imaging results with signs and symptoms before proceeding w/medication, spinal injections or surgery. Many studies over the past 5 years have shown similar long term outcomes with physical therapy and guided physical activity vs spinal surgery in people with pain. Surgery certainly is sometimes the best option and has been shown to be very effective when appropriately used.
Although aging and degeneration cannot be avoided, there is increasing evidence that maintaining an active lifestyle including exercise on a regular basis is very helpful in avoiding clinical symptoms. Cardiovascular exercise has been shown in particular to be very helpful. Maintaining strength, flexibility, and balance are all important. Exercise and therapy should be tailored to the primary degenerative problem as certain activities or exercise may aggravate one type of degenerative change, while helping another.
Loss of Flexibility: Ligaments, tendons, and soft tissue (muscle and fascia) become stiffer and less flexible as we age. For those who have been stiff all their life, this will increase and provide more of a challenge in maintaining their mobility. For those who have actually been hypermobile throughout their life, this typical stiffening in the connective tissue can actually help to reduce injury and strain as you age.
Continuing to work on active mobility and flexibility as we age is imperative. Active movement into our available range of motion, and strengthening into these movements, will result in better overall mobility than just doing static stretches. Perform active movements before performing static stretches for better outcomes. Examples would include doing wide-legged deep squats before stretching your hips or doing a Pigeon pose and performing lat pull-downs before shoulder stretches.
Loss of muscle mass: Muscle changes often begin in the 20s in men and in the 40s in women. Muscle tissue is replaced by fatty deposits and the muscle fibers shrink. Current science also shows that the number of mitochondria in our cells decline as we age. Mitochondria supply cellular energy. Muscle tissue that has more mitochondria and less fatty tissue has been shown to have an influence on weight, energy level, risk of diabetes and heart disease. Diminishing muscle mass increases risk of falls, injury and makes daily activity more difficult.
Exercise can help to maintain and build muscle mass, replace fatty tissue deposits with muscle fibers, and increase mitochondria in the muscle tissue. Aerobic exercise has been shown to increase mitochondrial number and efficiency. Consistency in exercise is important and the more efficient our muscles become at burning fat and providing energy. Research has shown that in as little as after 3-7 days of brisk walking for 45 min, new mitochondrial growth has started. Another study showed that sedentary men and women in their late 60’s who walked on a treadmill or rode and exercise bike for 30-40 minutes, 4-6 days/week increased mitochondria volume by as much as 68% in 12 weeks. The more we exercise, the more we use and increase mitochondria; the less we exercise, the mitochondria diminish and become less efficient
An exciting recent study published in Cell Metabolism showed that subjects who did interval training increased the number and the health of their mitochondria. This was in comparison to weight lifting, or 30 minutes of cycling at a moderate intensity. What was really exciting was that the results were more pronounced in older subjects than younger.
In contrast, another study found that inactive people in their 70s and 80s had an 18% increase in fatty tissue in their muscle in just one year. While active people did not have any increase. This could mean the difference in preventing life-changing drops in strength and mobility, and overall quality of life. Check out the following pictures on the Better Movement website to see a perfect example of what I’m talking about – https://www.bettermovement.org/blog/2012/use-or-lose-looks-like
So even when you’re stiff, a little achy and you’re having a hard time getting off the floor, remember that activity and exercise is exactly what we need to manage, delay and minimize the effects of our normal aging process.
Written by Amira Ranney, PT – Pivot Physical Therapy (formerly Mtn. Physical Therapy). Thank you Amira!