Ageing is inevitable, with specific changes affecting the musculoskeletal system. Changes can occur to all of the musculoskeletal system. This includes the bones, joints, muscles, ligaments and tendons. Having knowledge of these age related changes and taking the appropriate steps to remain healthy, will keep the reader disease free and will reduce the burden on the already stretched healthcare system. It is impossible to cover all the changes in this article. However key areas will be addressed in order to empower the reader to take adequate steps to prevent future injury.
As bones age, they are prone to osteoporosis. This is a progressive loss of bone mass and mineral and is more prevalent in women and affects over 3 million people in the UK. It is associated with lack of exercise, excess smoking and drinking and deficiency of calcium in the diet. There are ethnic variations with south Asian women affected disproportionately. Osteoporosis is associated with an increased risk of fracture. Osteoporosis is hastened by menopause as there is a reduction in the production of oestrogen, a hormone that promotes bone health. It typically occurs in a woman’s mid fifties but can occur as early as the 30’s. For men it presents later. Whilst all bones are affected by osteoporosis, specific areas of concern are the spine, pelvis and hip region, as injuries in these regions may result in prolonged immobility and illness. 1 in 2 women over the age of 50 will break a bone secondary to osteoporosis. A woman’s risk of breaking her hip is equal to her combined risk of breast, uterine and ovarian cancer.
Spinal changes that occur are loss of height due to collapse of the spinal vertebrae and degeneration of the intervening discs and potential deformity. Symptoms experienced may be pain but nerve or spinal cord injury may result. Injuries around the pelvis and hip due to osteoporotic bone can occur from minor injuries. These result in pain and immobility. Treatment varies from bedrest and painkillers to surgery, particularly for fractures around the hip. Prevention is better than cure and hospitals are best avoided, particularly now amidst the Covid crisis.
Another consequence of ageing is osteoarthritis (wearing of the joint cartilage with associated bony changes). This can lead to pain, swelling and progressive deformity. Studies from the USA have shown African American men and women and are 2-3 times more likely than Caucasian women to have radiographic changes of knee osteoarthritis. African American men more likely than Caucasians to have osteoarthritis of their hips. In my own practice (UK), I have noted a higher prevalence of knee arthritis in my Asian patients compared to my Caucasian patients. Whilst one cannot prevent the onset of arthritis, one can slow the progression. This is achieved by avoidance of excess weight, whether body weight or external weight, to reduce the stress on the joints. Regular exercise keeps the muscles, ligaments and tendons that support the joints supple. Other treatments are painkillers, modification of activity and physiotherapy. Injections or keyhole (arthroscopic) surgery are unlikely to give long term benefit. Ultimately if symptoms worsen, joint replacement surgery is required.
Ligaments and tendons lose their water content and hence elasticity with ageing, making them stiff and more prone to injury. As joints deform with arthritis, they shorten which may influence the outcome of subsequent surgical procedures. Muscles shrink and lose their bulk, which can lead to difficulty carrying out daily tasks and affect balance. Exercise counteracts these changes.
Hence it is imperative to perform regular exercise to counteract all changes to the ageing musculoskeletal system. Exercise has other health benefits such as weight management, cardiovascular health and release of endorphins that improve mental wellbeing.
Equally important are a balanced diet containing essential vitamins and minerals as well as behaviour modification, to prevent excess strain on the skeletal system. Postmenopausal women (and men over 70), should take 1,200 mg of calcium per day and 800 international units (IU) of Vitamin D. If dairy free, ensure calcium is supplemented. Behaviour modification such as avoiding excessive use of mobile phones or tablets that are often not at the correct height and require persistent and excessive bending of the neck and rest of spine. This will cause strain to spine and combined with effects of ageing make a significant injury more likely. Specific regular exercise will strengthen the muscles that support the spine (abdominal as well as back muscles). These exercises do not require resistance (machines or weights) and Yoga and Pilates are adequate. It is important that you are taught to perform the exercises adequately as poorly performed exercises may themselves lead to injury. Avoid rushing, where you may trip as balance worsens with age. Check your eyesight regularly and wear adequate footwear that is well fitting, with a broad base to reduce the risk of falls. There isn’t strong evidence available at this time to support the use of hip protectors (padding to place in underwear).
Apart from improving balance, use supportive footwear is important as the ligaments in the feet lose tone as we get older and the arch supporting the foot flattens. The change in foot shape leads to a change in the alignment of the limbs, which in turn leads to excess strain on the knees and hips. This may lead to or exacerbate an underlying injury.
Due to manual occupations, socioeconomic factors, pre-existing conditions such as diabetes and certain musculoskeletal genetic predispositions, the BAME community may be more at risk for musculoskeletal injuries. It is hoped this article will help ion someway to reduce these risks.
IN SUMMARY, To prevent musculoskeletal injuries:-
– Have a balanced diet and maintain adequate weight.
– If necessary supplement with Vitamin D and calcium.
– Take regular exercise, paying attention to core strength.
– Avoid behaviours that stress the musculoskeletal system
– Wear well fitting, broad based shoes, that support the medial arches of the feet. – Avoid rushing and have regular eye tests.
Written By: Samantha Z. Tross MBBS, FRCS, FRCS Ed, FRCS Ed(Tr&Orth)
Miss Samantha Tross is a Consultant Orthopaedic Surgeon specialising in treating conditions of the hip and knee. She is the Lead Orthopaedic Surgeon at Ealing Hospital, part of London North West University Hospitals NHS Trust. When she was appointed in 2005, she became the first female of Afro-Caribbean descent to become a Consultant Orthopaedic Surgeon in the UK.
Apart from her clinical work she oversees the orthopaedic training of junior doctors and surgeons in her hospital. She is an Associate Editor of the Journal of Medical Case Reports, an examiner for medical school final examinations for Imperial College, London and University of the West Indies in Trinidad and an Associate Professor of Orthopaedics for the American University of the Caribbean. Miss Tross is a recipient of a Black British Business Award for her work promoting science and medical careers to her community. She is listed in the Powerlist of 100 most Influential Black Britons and recent recipient of the WINTRADE Award for Woman in the Public Sector. She is an Ambassador for the BAME Health Collaborative.
Miss Tross sees patients privately at the Chiswick Medical Centre, the Clementine Churchill Hospital and the Cromwell Hospital. She can be contacted via her secretary Ms. Sharon Lambe. Phone 020 7952 1009/ 07943 947639. Email: firstname.lastname@example.org
Web address: www.jointreplacementsurgery.co.uk