Friday Q A Aging Muscles Bones and Joints

Adam and Eve by Lucas Cranach the Elder

Q: You all have been writing a lot about muscles and bones lately. I was wondering, how exactly does aging affect our musculo-skeletal system? And how can we influence the aging process with yoga and our lifestyle choices?

A: The process of aging affects our musculo-skeletal system in several particular ways. As I have written about previously, as muscles age, especially after about the age of 50, we start to lose muscle mass in a process called sarcopenia (see Strength and Aging). Sarcopenia is considered a normal part of the aging process, one that can lead to visibly smaller skeletal muscles—the ones that move our body and limbs around—which are then also going to be weaker. It is usually a slow, gradual process, but unchecked could lead to a point in a person’s life when the weakness could negatively impact his or her daily activities. According to an article Aging changes in the bones – muscles – joints from the National Institutes of Health: 

“Changes in the muscle tissue, combined with normal aging changes in the nervous system, cause muscles to have less tone and ability to contract. Muscles may become rigid with age and may lose tone, even with regular exercise.”

The body’s soft tissues tend to mostly made of water, and as we age, we also gradually experience a decrease in the amount of water in the muscles and the connective tissues (fascia and tensions) that surround the muscles and attach them to the bones, as well as the ligaments that connect bones to bones. As these changes occur, these structures become more brittle, less resilient and more likely to suffer injury, such as, strains and sprains. And because these structures don’t have a very good blood supply to start with, repair and recovery is typically slow, and slower as we get older. Other important soft tissue structures, such as the intervertebral discs between the vertebrae bones of the spine, and cushions, such as the meniscus in the knees and the labrum in the hip and shoulder joints, also suffer the same changes and the same potential for injury and degeneration. 

The skeleton, which is made up of over 200 bones, also undergoes changes as we age. Most commonly, the joint surfaces between the mobile joints can suffer wear and tear over a lifetime of use. The connective tissue barrier known as cartilage that coats the ends of each bone to make it slippery and cushioned can gradually thin out and leave the underlying bone exposed and sensitive to inflammation. This is commonly referred to as osteoarthritis (see Yoga for Osteoarthritis), an extremely common aging-related problem that can actually start at about any age, especially in those who use their bodies intensely for sports and work activities. 

Finally, the bones can begin to thin and lose density as we age, making them more vulnerable to fractures, which can then be slower to heal due to the abnormally thin bones. Thinning of the bones (osteoporosis) is extremely common in women over 65, with up to 50% developing it, and surprisingly common in men as well over 65, at 25% incidence. The bones of the thoracic spine (your mid spine) are at greatest risk for fracture, followed by the wrist bones and the femur bone (thigh bone) of the hip joint. Fractures from osteoporosis can lead to ongoing chronic pain, physical disability and, particularly with hip fractures, premature death. 

These factors and others, such the connection between the muscles and the neurologic system, can also lead to changes in posture and balance, which can also increase the chances of injury over time. An increase in general stiffness and pain can also arise with combinations of the above changes. 

On a brighter note, it has been noted in aging athletes, specifically long distance runners and cyclists, who maintain good cardio-vascular and respiratory function may see improved endurance in their sports compared to when they were younger! Here is a case where long term participation in physical activity pays off in improved function, not decline. This speaks directly to what we can do with regards to our lifestyle choices that can positively influence these changes of aging: stay active!  Regular exercise, modified to accommodate body changes such as arthritic joints or thinning bones, can help to slow, stall and even reverse many of these conditions. And for our purposes here, yoga can be an ideal standalone practice for some conditions, such as sarcopenia, and great in combination with other health practices for others, such as with osteoporosis or arthritis (which might also require medications and mineral supplements, for example). Eating a healthy diet and drinking adequate amounts of water to fuel and hydrate the body, and by extension these parts of the musculo-skeletal system, is another wise choice. 

For further information, check out these posts from our archives:

• Yoga for Strength: An Overview 
• Yoga and Flexibility: An Overview
• Healthy Bones for Men and Women Alike
• What is Osteopenia? How Can Yoga Help?
• Yoga for Osteoarthritis

—Baxter

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Healthy Bones for Men and Women Alike

by Baxter

Man and Woman by Marie Lossky

Upon reviewing our blog this morning on the topic of thinning of the bones or osteoporosis, and its precursor osteopenia, I found we had discussed the condition quite a few times, with some posts looking at the very technical aspects of diagnosis, Wolff’s law and other helpful concepts (see What is Osteopenia? And How Can Yoga Help?). However, my motivation for investigating the topic one more time arose out of preparing for a Teacher Training workshop I led over the weekend in Berkeley.  I was teaching to a group of 18 yoga teachers attending a post-graduate program in yoga therapy at the Niroga Institute. Over the course of the weekend, we covered topics ranging from basic skeletal anatomy to diseases and illnesses like arthritis, scoliosis and osteoporosis. And in preparing for the seminar, I purchased Yoga for Osteoporosis by Loren Fishman, MD and Ellen Saltonstall, and read, with great interest, the first several chapters that lead into their recommendations of yoga poses for osteoporosis.

There were several points that jumped out at me that I feel are worthy of repeating or, in some cases, sharing for the first time on these pages. First off, there is the perception that I believe still exists among the general population that osteoporosis is primarily a problem for women, and so men immediately tune out when the topic comes up. I’d recommend you tune back in, fellas! The following statistics are compelling for me as a man to start addressing prevention of osteoporosis in my own life:

While it is impressive that one in two women over 50 have an osteoporosis-related fracture, it is still quite impressive that one in four men over 50 will also experience an osteoporosis-related fracture.  More men over 50 will sustain a hip fracture due to osteoporosis than will develop prostate cancer (this was shocking to me!)  How come this is not being announced all over the country! And the mortality rate in the first year after a hip fracture is 25%! That’s right, one in four adults who sustain a hip fracture will be dead and gone within the 12 months that follow the break.

So, it is now clear to me that this condition is of equal concern for both men and women and has profound and serious consequences once it develops. The typical recommendation, still found on all of your standard info outlets, is for patients with osteoporosis or at risk for osteoporosis to do weight-bearing, impact exercise ( like walking and running) to stimulate bone growth.  The trouble with this, as Nina notes in her evaluation of the Fishman early protocol for osteoporosis (Friday Q&A: Is Loren Fishmans Osteoporosis Sequence Safe?), is that this approach can actually worsen other conditions we often have as we get older, like osteoarthritis.

But the great news that I shared with my aspiring yoga therapists is that low-impact practices like yoga asana may be as effective as older, mainstream recommended practices, like walking, hiking, aerobics and such, with less chance of worsening conditions like arthritis. The research data that shows that we can stimulate new bone growth along lines of stress by holding poses for between 8-72 seconds is, for me, the pivotal nuance to add to the yoga practice you are already doing. Because of this, I have been working recently with holding postures for 30-60 seconds, depending on the physical demands of a given pose (for example, holding Downward-Facing Dog for 60 seconds while holding Hand to Foot pose (Hasta Padangustasana), a much more demanding pose on many levels, for 30 seconds).

Remember that engaging opposing muscle groups while doing the pose increases the stimulation of the underlying bone cells that make new bone. So, in Downward-Facing Dog I consciously engage the muscles around all the joints I can think of: wrists joints (the third most commonly fractured joint in osteoporosis), elbows, shoulders, hips (the second most commonly fractured joint in osteoporosis and the one with the gravest consequences), knees and ankles. And because the vertebrae of the spine are the number one area of fracture in osteoporosis and often lead to chronic, debilitating pain, I have been adding in accessible back bends, like Locust pose, low Cobra pose and Bridge pose, which engage the extensor spinae muscles that attach along the entire length of the spine, and therefore each vertebrae, and holding these poses for 30-60 seconds.

Fishman also notes that while the mainstream medical community has often warned about twisting actions for osteoporosis, as they could lead to vertebral fractures, he and Saltonstall have continued to include simple, basic twists, like seated Sukhasana twist, in their protocols. He believes they may actually be stimulating vertebral bone strength. And the main caution in doing yoga if you already have osteoporosis or osteopenia (precursor to osteoporosis) is avoiding or modifying deep forward bends, which can increase your chances of vertebral fractures.

So, the take home messages for my trainees and all of you:

• Osteoporosis affects both men and women as we age, and it is easier to prevent than it is treat it, so get your yoga going, especially you fellas!
• A well-balanced yoga practice, done on the feet or hands or both, is a “simple, silent, inexpensive, and impact-free (for those with arthritis) way of applying force…” to build bone. 
• Holding your poses for 30-60 seconds is the key adaptation in transforming any yoga asana practice into a bone-building practice, even for your limbs that may not be bearing weight (such as your arms in Warrior 2, for example).
• If you already have a diagnosis of osteoporosis or osteopenia, minimize or avoid forward folding poses.

Live long and have strong bones!

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