Age-Defying Fitness: Restore Your Flexibility

Summarized by Robert W. Griffith, MD
May 17, 2007

Marilyn Moffat and Carole Lewis are physical therapists who have been in private practice for a number of years. They have published and lectured extensively, and have written "Age-Defying Fitness" based on their experience with their aging patients. Their aim is to inspire and motivate readers to do something good and long-lasting for themselves: exercise. We are pleased to post several extracts from their book. Here is the fourth. Robert Griffith, Editor.

Flexibility

"You are aging when your actions creak louder than your words."
Milton Berle

Flexibility is an often-neglected part of physical fitness. Being limber gives you the freedom to move, whether it's bending over to tie your shoes, reaching up to retrieve something from a high shelf, or picking up items more easily. Flexibility is associated with your joints and connective tissue as well as your muscles. You should approach flexibility training exercises in the same way you approach aerobic conditioning or strength training - you must do them regularly since they are an important part of total fitness, particularly as you age.

Susan, 59, could swear that the mailbox had moved. For 20 years she had been looking over her shoulder as she backed down the driveway, using that mailbox to line up her car. Lately she couldn't quite swivel her head around far enough to find her landmark. Of course, she knew her mailbox hadn't migrated - not even an inch. Her ability to turn her head had changed.

Proper Flexibility

Flexibility is simply the ability of body parts to bend without breaking, or in other words, the pliability of the body. Flexibility allows your joints to bend repeatedly without any damage or injury.

The connections between your bones are called joints; every joint has a specific range of motion. For example, you should be able to raise your arms overhead 180 degrees, bend your elbow 145 degrees, tilt your neck 45 degrees to the side, arch your back 30 degrees, rotate your hip 45 degrees, and extend your knee to 0 degrees (in a straight line). Staying limber helps you balance and perform daily activities more comfortably. Flexi¬bility helps reduce muscle tension, improve coordination, prevent injuries, develop body awareness, and even promote good circulation.

Flexibility Changes

Flexibility decreases as a result of inactivity and changes in the collagen structures of the body. Collagen is a protein found in connective tissue tendons, ligaments, joint capsules, coverings around the muscles, and skin. As you age, collagen tends to stick together, the linings of your joints thicken, and the fibrous tissue surrounding your joints increases. You may also experience degeneration of the ligaments surrounding your joints.

As a result, you may have a noticeable loss of elasticity and flexibility - a decline in your ability to move fluidly and precisely, a decrease in your range of motion, and possibly even conditions such as contractures (permanent shortening of muscles or tendons) or ankylosis (bone fusing in your joints). If you regularly stretch your muscles, ligaments, and joint capsules, you may avoid some of these problems and stay flexible.

Anatomical and Health Information

Joints
There are many different types of joints, including hinged (finger and elbow), modified hinge (knee), ball and socket (hip, shoulder), and gliding (spine). Almost all joints consist of a cartilage lining, a capsule, ligaments, and a membrane.

The cartilage lining allows the joint to move smoothly and absorbs some of the shock transmitted during movement. The capsule, which consists of connective tissue, helps stabilize the joint. Ligaments, which are also made of connective tissue, provide support for the joint. Many joints also have a membrane that secretes fluid to facilitate movement.

Connective Tissue
Connective tissue plays an enormous role in how loose or tight your body is. It stretches in 2 ways: elastic and plastic.

Elastic stretch occurs when a structure is elongated by an external force; when the force is released the structure returns to its original position. An easy example is a new rubber band: stretch it as far as you can before it breaks and then release it. It will snap back to its original position.

Plastic stretch occurs when a structure is stretched or elongated by an external force over a prolonged period of time; when the force is released, the structure remains stretched. For example, if you wrap a rubber band around a box and leave the box in a closet for a long time, the rubber band will remain permanently stretched once it has been removed from the box.

You can experience either of these when you stretch your hamstring muscles. Sit with your leg extended in front of you. If you try to reach for your toes by bouncing, you will be performing an elastic stretch. If you reach for your toes in a slow, gentle fashion and hold the position for 30 to 60 seconds, you will get a good plastic stretch.

Collagen tissue is a thick but flexible material and will respond to elastic or plastic stretch. To increase your flexibility and avoid injury, you need to hold your stretches for longer periods of time. Warming up first will also improve the quality of your stretching and lower your chance of injury. Bouncing while stretching is usually not recommended.

Health-related Conditions

Osteoarthritis, rheumatoid arthritis, and polymyalgia rheumatica are diseases that affect the joints and their surrounding muscles, making it painful to move and often leading to a cycle of decreased motion and increased stiffness. After appropriate treatment, a patient should return to a program of increasing physical activity to enhance fitness and functional ability.

Osteoarthritis (OA) is a degeneration of the joints characterized by the wearing away of the cartilage that covers the ends of bones. OA is divided into 2 types: primary and secondary. Primary osteoarthritis is the result of wear and tear on your joints as you age. There are many potential causes or risk factors associated with the development of secondary osteoarthritis, including genetic defects, trauma to or overuse of a joint, and diseases such as diabetes, obesity, inflammatory joint diseases, sickle cell disease, and Paget disease (a destructive bone disease).

Osteoarthritis is the most common joint disease. X-rays reveal evidence of OA in one-third of people over 35; this number increases to more than 80% in people over age 70. It is the leading cause of disability in people over 65.

Osteoarthritis increases bone formation at the edges of the joint and causes degenerative changes in the membrane surrounding the joint. It usually begins with a slow increase in pain, particularly in joints that have been subjected to large amounts of stress over the years, such as the hips, knees, lower spine, neck, toes, and fingers. Initially, the pain is often intermittent, but it may become constant. Eventually a person afflicted with OA may develop swollen joints and experience limited mobility. To diagnose OA, a doctor takes a history and obtains x-rays of the joint(s) involved; he may also take fluid out of the joint for analysis.

Treatment of osteoarthritis can include rest, medication, exercise, and surgery. If your OA is moderate to severe, please see a physical therapist before beginning any exercise program. Physical therapists may use exer¬cises, manual techniques (such as range of motion exercises and soft tissue massage) and modalities (such as heat, ice, electricity, and sound) to help you get started. It is not true that you must learn to live with OA. There are always new methods and treatments. Seek an appropriate healthcare provider who offers a wide range of interventions for joint changes associ¬ated with osteoarthritis.

Osteoarthritis can also be treated by joint replacement surgery, particu¬larly if the problem is located in the hip or knee joints. Shoulder, elbow, wrist, finger, and ankle joint replacements are also done, but are not as common.

No matter what the treatment, exercise is always beneficial. Physical therapy is one of the best and safest treatments for OA. If your condition is mild - or if your physical therapist has approved it - the exercises in this book will be helpful.

Rheumatoid arthritis (RA) is a systemic disease resulting in an inflammation of connective tissues throughout the body. The exact cause is unknown, but the immune system seems to play an important role. Researchers have also indicated that there may be a genetic link and infection may be a triggering factor. RA also leads to inflammation of the membrane around the joint, destruction of the joint cartilage, capsule, and muscles, and eventually total immobility or fusion of the joint. RA usually begins earlier in life than osteoarthritis, often appearing in individuals between the ages of 20 and 40. It is initially characterized by minimal symptoms of joint pain and swelling and later by intense inflammation of the small joints of the hands, feet, and wrists. As the disease progresses, the elbows, shoulders, knees, and hips can become affected. Other effects include fatigue, depression, loss of appetite, and significant stiffness lasting longer than an hour after waking. To diagnose RA, a doctor often examines the patient's blood to check for a high erythrocyte sedimentation rate (ESR) and rheumatoid factor (RF).

Patients with RA may be treated with medication (ranging from aspirin or nonsteroidal anti-inflammatory drugs to antibiotics and antimetabolite agents), physical therapy, an individualized exercise program, an energy conservation program, and appropriate assistive devices. Exercises aimed at improving posture, strength, and balance can also be beneficial. Joint replacement surgery is another treatment option, particularly for the hip, knee, and shoulder joints. If you have RA, please see a physical therapist before beginning an exercise program.

Polymyalgia rheumatica (PMR) is an arthritic disease primarily found in people - mostly Caucasian women - 50 years and older. The exact cause is unknown, but it is believed to be associated with an inflammation of the blood vessels. PMR is characterized by tender, swollen joints and painful, stiff muscles in the hips and shoulders. Though PMR usually gets better within 5 years of onset, it may become so severe that it leads to immobility and loss of function. Without treatment, a person with PMR may experience significant discomfort and may have complications that affect organs, including the kidneys and liver. This disease may even cause blindness. To diagnose PMR, a doctor will take a history, perform an examination, and order laboratory tests that may include measurement of the electric current in the muscles, muscle biopsy, and analysis of the erythrocyte sedimentation rate (ESR).

Treatment usually consists of a low dose of corticosteroids. Physical therapy can be helpful for decreasing pain, increasing motion of the joints affected, and regaining strength that may have been lost. Physical therapy may include strengthening and range of motion exercises, protection of body parts, instruction in how to perform activities of daily living, relaxation techniques, assistive devices, and modalities (e.g., heat, cold).

A future extract from "Age-Defying Fitness" will deal with aerobic, or endurance, exercise.

You can buy "Age-Defying Fitness" from Amazon or from Peachtree Publishers.

Source

• Age-Defying Fitness: Making the most of your body for the rest of your life. 1st edition. M. Moffat , CB. Lewis, Peachtree Publishers, 2006

Related Links
Amazon: Age-Defying Fitness
AAOS: Exercises for the Over-60s
Is Stretching Out-of-Date?

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