[Paleopsych] NYT: Stretch Yourself (Your Joints and Muscles, Too)

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Tue Apr 19 13:12:32 UTC 2005

Health > Personal Health: Stretch Yourself (Your Joints and Muscles, Too)
    By [1]JANE E. BRODY

    My biking partner was in his 80's when he traded in his men's bicycle
    for a women's version because he could no longer swing his leg over
    the high bar. But at least he could still ride a bike. Others his age
    have far less physical mobility.

    Walking, rising from a chair, getting in and out of a car or bathtub,
    going up and down stairs, reaching for an item on a high shelf, even
    putting on shoes or an overhead shirt and buttoning a blouse are
    problems for many older adults who have what physical therapists call
    limited range of motion.

    I had given little thought to this until at age 63 arthritis in my
    knees made downhill movement almost too painful to contemplate. Now,
    after total knee replacements, range of motion is what I struggle to
    restore so that I can return to activities like cycling and hiking
    without pain.

    The secret, I've learned, is to keep moving, exercising my new joints
    and stretching and strengthening the muscles that support them.

    I've also learned that with or without arthritis, none of us can
    afford to ignore the natural physiological declines that affect range
    of motion as we age, since such declines can greatly impair the
    quality of our later years.

    Range of motion refers to the ability of a joint to flex, or bend, and
    extend, or straighten. Movement occurs where two bones meet and the
    muscles that cross over these joints enable them to bend or

    Chances are you've seen older people with a shuffling walk because
    they can no longer fully straighten their knee joints. They may also
    be unable to flex their knees enough to put on pants, socks and shoes.
    Different joints have different ranges of motion, but the same kinds
    of losses can occur in hip, shoulder, elbow, wrist and finger joints.

    Changes in one part of the body can lead to a host of others. Lisa
    Jenkins, a physical therapist and instructor for RehabWorks in
    Heathrow, Fla., describes a common situation: an older woman has
    forward, rounded shoulders, forcing her to raise her head to see

    The resulting position of the shoulder joint prevents her from fully
    raising her arm overhead, and that can make it hard to take clothes
    from a closet, reach items on a high shelf or even put on an overhead
    sweater or shirt. How she holds her head to see causes the joints and
    nerves to compress in the back of the neck, and that in turn can lead
    to symptoms like headaches and difficulty engaging the nerves and
    muscles in the arms.

    Common Causes

    "People lose about 20 to 40 percent of their muscle mass as they age,"
    Ms. Jenkins says. This is the combined effect of normal age-related
    changes in the cells and fibers of muscles - and the principle of "use
    it or lose it," which is related to the fact that most older adults no
    longer participate in everyday activities requiring muscle power.
    Probably the single most common cause of lost range of motion is being

    "This lack of use produces a wasting effect on the muscles, decreasing
    the available range of motion," Ms. Jenkins wrote in The Journal on
    Active Aging. She described various physiological properties that
    could influence a decline in range of motion. One is the way
    electrical impulses through the nerves recruit the muscles used to
    produce movement and function, or nerve conduction. Another is the
    ability to recognize how the body is positioned in space, or

    "Aging alters nerve impulse conduction, proprioception and velocity of
    movement," she explained. "Given these alterations, it is easy to see
    how it becomes increasingly difficult to maintain balance during
    functional movements such as walking and changing positions as an
    individual ages. Often the fear of falling in itself is enough to
    prevent some older adults from participating in certain activities."

    In addition, various conditions common among the elderly can increase
    the loss in range of motion. Injuries, for example, often result in
    temporary immobility. If, say, someone breaks a leg bone, the muscles
    that support the knee and hip will begin to atrophy when the injured
    leg is immobilized to permit the bone to heal. A broken hip leads to
    even more extensive immobilization.

    A debilitating disorder like Parkinson's disease or stroke or the
    wear-and-tear arthritis that I experienced can also limit a person's
    ability to produce movements that maintain muscle strength and

    In a normal healthy joint, movement increases the flow of blood to the
    joint capsule, providing the nutrients, oxygen and lubrication that
    enable the bones of the joint to move smoothly and without pain. When
    joint mobility is impaired, blood flow declines and the joints become
    stiff and painful. Stiffness and pain, in turn, prompt people to avoid
    further movement.

    The less people move their joints, the greater the chances that they
    will suffer significant losses in range of motion. A decrease in range
    of motion not only creates difficulties in performing activities of
    daily life, it also increases pain when trying to use the affected
    joints. This, in turn, leads to reduced activity and further loss of
    range of motion.

    It is indeed a vicious cycle that can require intensive physical and
    occupational therapy to reverse. If the process is not interrupted,
    the joint may become deformed and unable to function at all.

    As Ms. Jenkins explained: "When a joint remains immobile for an
    extended time, the muscles that surround the joint become tight and do
    not slide as easily upon one another to produce movement. Eventually,
    changes occur at the cellular level. The musculoskeletal components of
    the joint can actually lose their ability to stretch and become
    permanently shortened," a condition called contracture.

    Changes also occur in the skin that covers a contracted joint. If the
    skin remains folded upon itself for a long time, it eventually breaks
    down, and as it heals, it reforms to fit the formation of the deformed
    joint, making it even harder to move that joint.

    Prevention and Treatment

    The best remedy is, of course, prevention, and the best preventive is
    to maintain physical activity as you age. There are many enjoyable
    programs that can improve strength, stamina, balance and flexibility
    while you're having fun. They include fitness walking, yoga, water
    aerobics, line dancing, square dancing, tai chi, golf and bowling.

    Other helpful activities include swimming, stationary cycling, using
    an elliptical trainer and walking on a treadmill. Each can be adapted
    to the needs and limitations of an older user.

    If noticeable losses in range of motion have already occurred,
    physical therapy to restore mobility is advisable. Not only will this
    make it easier to live independently, it can also decrease the risk of
    a fall or other injury that can lead to immobility and a further loss
    in range of motion.

    Speak to your primary care physician, and be sure to obtain insurance
    clearance before starting therapy.

    During physical therapy after my knee surgery, I met a number of older
    men and women who were being helped to walk better, improve their
    balance and increase their ability to use their arms and shoulders.
    Some had sustained injuries or illnesses that limited their mobility,
    but others were just experiencing age-related declines. To a person,
    all said the therapy was improving their lives.


    1. http://query.nytimes.com/search/query?ppds=bylL&v1=JANE%20E.%20BRODY&fdq=19960101&td=sysdate&sort=newest&ac=JANE%20E.%20BRODY&inline=nyt-per

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