[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 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
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.
"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
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.
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