I call it "the rusty suit of armor syndrome,’’ and baby boomers are prime targets. This joint or that one is a little achy, your neck is stiff in the morning, you have lower back pain that’s worse when you’re tired, or a shoulder that acts up. Those of us who jog, do aerobics, engage in sports, or work out with a vengeance suddenly discover we’re nursing a chronic sore knee or tennis elbow.
This is the age of soreness. Even if you’re basically healthy, with no serious ailments, you may be plagued by a shifting collection of nagging aches and pains that just never seem to completely go away. And you’re just not as flexible. You used to pop in and out of little sports cars and compacts, and now you like the tall, roomy sport utility vehicles. You notice you’re shopping for orthopedically correct chairs instead of futons and pillows for the floor. For many, a chronic ache or pain is the first initiation into the realities of aging, the first intimation that they’re not indestructible.
When confronting accidental injuries, or even just the aches and pains of this period of life, whether they’re "natural" or self-induced, many react with impatience and dismay. They look for a sure-fire solution, a quick fix. They start consuming medications daily, or go for the operation, but often without achieving real relief from pain. Our preferred model for healing is the "magic bullet" model: find a bug and zap it with a drug, or find the broken body part and fix it up with surgery. Unfortunately, many of the ailments of the musculoskeletal system are slow to develop and slow to correct. Often, gentle physical therapy or nutritional support can help correct problems of the musculoskeletal system, but it doesn’t happen overnight.
Chronic neck pain or stiffness or tingling in the fingers can signal the onset of arthritis, a degenerative process that affects joints and the spine and can develop slowly, over the years. This is not something that happens just to old people — it can strike people in their thirties and even their twenties. The first symptoms in midlife are generally not very troubling, but they can become painful and debilitating in old age. Treatment is complicated by the fact that arthritis is not a single, clear cut disease with a single, clear-cut cause. Doctors divide arthritis into two major types: osteoarthritis, which affects the bones, and rheumatoid arthritis, which has an immune component. But in fact, a long list of factors — from diet to infections — can initiate or complicate arthritis, and at this time we still don’t know the whole story. Fortunately, we are finding new ways to treat or possibly prevent this problem.
People often suffer mysterious aches and pains in muscles or joints that are difficult to diagnose or treat. They just don’t find much relief from the standard medical therapies. They may be suffering from an infectious disease that affects the system, such as Lyme disease, or they may be victims of the vastly underdiagnosed ailment called fibromyalgia. Others suffer from trigger point pain, which may be caused by blockage of nodes of the autonomic nervous system. In this article we’ll look at some of these lesser known problems that can affect the musculoskeletal system, as well as exercise patterns, chronic aches and pains, and arthritis.
If we give these problems proper attention now, we can avert many of the syndromes that we think of as typical ailments of the elderly. It is possible to keep the body strong and flexible well into old age.
Exercise — But Don’t Kill Yourself
More and more studies show that regular moderate exercise is one of the most powerful ways of maintaining the strength, flexibility, and health of the musculoskeletal system as well as benefiting almost every other organic function of the body, from cardiovascular health to a strong immune system. It’s also a means of stretching out or delaying the aging process. Regular exercise can slow the normal loss of lean body mass that comes with aging and allow a person to maintain a higher degree of strength, flexibility, and vigor. It’s almost never too late to start gaining these benefits. A recent study of effects of moderate weight-lifting exercise among nursing home residents found that even those of advanced age and feebleness significantly improved in flexibility, energy, freedom from pain, and the ability to get around.
Exercise is also positive for the bones. It helps keep them mineralized and, along with sufficient calcium intake, should be part of any program to prevent osteoporosis. The effects of exercise, or the lack of it, on our bone structure can be startling. When astronauts are on long voyages with sustained weightlessness, their muscles tend to atrophy because they are not pushing against the pull of gravity. But there’s an effect on bone mass as well. Astronauts lose a tangible percentage of bone mass on longer space flights — and this happens to healthy, middle-aged men and women who work out regularly as part of their training. It’s remarkable that this change can be measured over a period of just days or weeks.
We think of creaky, inflexible joints as a sign of aging, but it may really be a sign of insufficient use. Joints are really amazing mechanisms. What other machinery do we know of in the physical world that can move flexibly and carry weight for decade after decade without breaking down? And joints are a very complex kind of machinery — a system of interface between muscles, bones, tendons, and the blood supply. All of these components benefit from safe exercise and can decline if they don’t get it. Joints also contain specialized tissue, cartilage, which cushions the bones, and synovial fluid, which lubricates the joints and keeps them slippery. There is a decline in synovial fluid with age and a concomitant risk of arthritis, which involves damage to the cartilage. Twenty years ago, arthritis sufferers were advised to avoid moving painful joints, but we now know that moderate, gentle exercise can help keep joints flexible and reduce pain, even in advanced arthritis.
Though there are still far too many people who don’t get enough regular exercise, the 1970s and 1980s witnessed an explosion of interest in sports and exercise, reflected in the jogging phenomenon, the marathon craze, aerobic exercise classes and videos, and coed urban gyms filled with businessmen and businesswomen wearing Spandex and doing their repetitions, or "reps," on space-age exercise machines.
But the wrong kind of exercise can be dangerous. The New England Journal of Medicine recently devoted almost an entire issue to the question of whether exercise is good for the heart. One study showed that people who normally exercised less than once a week were about fifty times more likely to have a heart attack after exercise than people who exercised four or more times a week! This is why couch potatoes who decide to get out and clear the driveway during the first big snowstorm of the year are putting themselves at tremendous risk.
The same risks apply to musculoskeletal injuries, from tendinitis to muscle spasm to joint injury. Someone who feels guilty about not having exercised for years and suddenly starts training for the marathon is running the same risk. Someone who spends most of his time behind a desk and then goes out once a week to run around a tennis court and whack the tennis ball with a good strong serve is really asking for trouble. Sporadic exercise puts enormous strain on muscles, joints, and tendons that haven’t been built up to handle this kind of physical force and stress. Sure, you can physically propel yourself around the court, but you’re unleashing forces that your body just may not be able to handle safely. If you have a basically sedentary lifestyle but go out once a month for a touch football game, or go skiing two weekends during the winter, you’re putting yourself at risk. The consequences are worse if you engage in a sport like tennis or skiing that challenges unusually specific muscle groups.
A Sane Approach to Exercise
Let’s look at some of the keys to safe, beneficial exercise.
• Make exercise a regular habit—avoid intermittent bouts of intense activity.
The most beneficial exercise pattern is to do something three to four times a week, even if none of the sessions are terribly long or intense. This is much better for you, and safer, than doing one big workout or sports session on the weekend.
• If you haven’t been physically active for a long time, start very gradually.
lf you’re not used to exercise, you won’t have a good internal gauge of just how much you’re pushing yourself. The first couple of times you go jogging or take a dance class, you may find the experience so new and exhilarating that you seriously overdo it. But if you’re limp and sore for a week after you start a new activity, this is a sign that you did too much. Give yourself a time limit or activity limit when you start an exercise program, so that you stop long before you’re exhausted and sore.
• If you’re starting a specialized sport or activity, find out whether you’re going to be stressing specific muscle groups, and deal with this appropriately.
There are two ways to deal with this. One is to gradually build up the specialized muscle groups before you start to stress them with the sport you’re interested in. This is the theory behind the specialized exercise machines that work the muscles used for skiing. But be careful not to plunge into a sport while at the same time trying to build the specialized muscles — this is just doubling the strain.
The other approach is cross-training. Simply vary your exercise patterns: switch between two or three different activities — a little swimming, a little running, a little tennis. Realize that you’re not going to build up the speed or skill level in any one activity that you would if you were to specialize.
• Listen to your body — don’t ignore chronic pain.
Because exercise makes you feel better, and because sports or other physical activities can be really enjoyable, they can be habit forming. This is all to the good, right? What could be wrong with a good habit like exercise? Well, the downside is an exercise habit that becomes a psychological addiction, so that you want to keep doing it even if you’ve suffered an injury or strain. This is a syndrome professional athletes get into. They suffer a strain or injury, push themselves to get back on the field before they’re completely healed, and suffer a re-injury. This can lead to chronic pain and debilitation that are even harder to treat and take longer to cure. Amateurs get into this too — they want to keep on running on that sore knee and then drive it farther and farther into trauma.
There’s a physical process that plays into this syndrome. Exercise causes the release of neurotransmitters called endorphins, which mask pain and produce a kind of natural euphoria. Runners are always talking about the "runner’s high.’’ Dancers know about this too. They may be hobbling around with all kinds of aches and pains, but once they start moving they feel fine — until later. This experience can be very deceptive — if your knee doesn’t hurt while you’re running, you figure it can’t be a serious problem. Well, that’s just wrong.
No matter how enjoyable your activity is, it’s better to pull back a little and have the possibility of continuing later, perhaps at a less intense level, than to keep driving on until you have to stop anyway, permanently, because of irreversible damage that may affect even your normal daily activities.
• Consider an orthopedic or chiropractic check-up to see whether you have any quirks in your muscloskeletal system that might predispose you to strain or injury.
This is advisable if you plan to take up a heavy sports or exercise program. Find an orthopedist who will take time with you or less surgically oriented health care professionals, such as chiropractors or physiatrists (physicians who practice rehabilitative medicine), who will give you a more prevention-oriented check-up
If you’re beginning to run or take up related sports, you might want to visit a good sports podiatrist who can analyze the wear patterns on your shoes, check your footfalls, and offer corrective exercises or shoe inserts called orthotics to reduce stress on your feet, ankles, or knees. This could also help you prevent serious injury.
• If you develop chronic pain, consult with a trainer or professional to see if you need movement retraining.
Ergonomics, the study of safe, efficient movement, began with scientists looking at movement patterns in factory workers and has since been extended to sports. An athlete may adopt a non-ergonomic movement pattern, such as a faulty gait as a runner or a faulty swing as a tennis player, that could induce chronic injury. A sports medicine doctor or a good trainer should be able to analyze your movement patterns and recommend changes.
Dr. Ronald Hoffman is Medical Director of the Hoffman Center in New York City and host of Health Talk, a syndicated radio program heard weeknights in New York on WOR (710 AM) from 9:00 to 10:00 pm, Saturdays noon to 2:00 pm. He is author of several books, including Intelligent Medicine (Fireside, 1997). Dr. Hoffman’s website contains useful health information.