Age-Related Musculoskeletal Changes

As we get older our bodies become more fragile, as bone and muscle densities reduce, increasing the likelihood of broken bones and body instability. Movement may become slower, and walking gait may become shorter, more unsteady, and with less swinging of the arms. Older individuals may become tired more easily and perform tasks less energetically, but what are the internal processes that drive these changes in musculoskeletal function?

From around the age of thirty bone mass begins to decrease in both men and women, increasing in rate in women after the onset of menopause. As a result, the risk of bone fractures increases. One common feature of ageing is a gradual shrinking in size. This is due to fluid loss in the spinal disks. Between the vertebral bones in the back are the gel-like cushions which serve to absorb shocks between the vertebrae. With age these discs begin to lose fluid, meaning the spinal bones grow closer together and the spine shrinks. Furthermore, the actual bones begin to lose mineral content, becoming thinner. Being less rigid the spinal column becomes curved, adding to the appearance of height loss.

As with the spinal disks, lubricating fluid between joints may also be lost during the ageing process, reducing protection against cartilage rubbing together and wearing away. As a result, the joints may become stiffer and less flexible, increasing the risk of developing arthritis. As bone wears away the minerals may be deposited around joints and calcify, causing extra joint stiffness.

In tandem with skeletal wear, the muscular system is also affected by age. As bone density decreases around one's 30s so does muscle mass. The result of this muscle loss, known as sarcopenia, is that the muscles are less able to support the bones, and stress on certain joints, such as the knees or back, increases. Deterioration is not universal throughout all types of muscle, and the muscle fibres that contract faster are more susceptible to damage than the slower contracting fibres. This translates into overall slower contraction of the muscles in old age and affects physical mobility, muscular strength, and grip. Around 7% of people over 70 are affected by functional sarcopenia - age-related muscle loss – and this figure increases to around 20% of the elderly over 80. As muscles lose function people become less able to move autonomously and this may translate into the development of muscle contractures, where the muscles shorten and harden.

While it is a natural process of ageing to lose both muscular and skeletal mass, the process can be slowed and prevented to a certain degree by maintaining a healthy lifestyle, with regular exercise to promote strength, balance, and flexibility. Keeping fit can also help the bones to stay strong, to reduce the risk of shrinking or breaking. To further support the maintenance of sturdy bones diet control is crucial, being well-balanced and high in calcium. Particularly women need to be aware of getting enough calcium and vitamin D in their diet as they age to lessen the risk of developing arthritis or osteoporosis. 

Living With Osteoarthritis – Managing the Symptoms

 As we get older the cartilage covering our joints become worn, resulting osteoarthritis. This condition manifests itself in the form of joint pain and stiffness and, while there is no cure for this chronic disease, there are treatments and measures that can be taken to reduce suffering.

It may seem counter-intuitive to reduce joint pain by increasing your movement, however, exercise is proven to be incredibly beneficial in reducing osteoarthritis symptoms. Rather than wearing down the cartilage further, strengthening exercises will alleviate pain, through building up the surrounding muscles, reducing strain put on the joints. Exercises that focus on range of motion are also excellent for improving the condition, as they encourage flexibility of the joints and reduce stiffness. Choose exercises that work the joints but that aren't too strenuous. Taking a brisk walk, or joining a relaxing class such as yoga or tai chi, that gently uses your muscles, will keep your body working to support your bones and joints. For less impact while working out, swimming or water aerobics both engage muscles while avoiding putting force on the joints.

Linked to exercise, maintaining a healthy weight is integral to relieving osteoarthritic symptoms. Excess weight can add additional pressure to weight-bearing joints such as the hips, knees, feet and back bone. Losing this extra weight, and then maintaining a healthy one, will reduce pain and restrict further damage to cartilage. Combined with living an active and healthy lifestyle, medications are available that can reduce symptoms, such as pain and inflammation around the joints, making it more manageable.

Physical, or occupational, therapists can teach osteoarthritis patients the best ways to use, and move, joints to prevent further wear and tear of the cartilage. As well as introducing range of motion and flexibility exercises, thermotherapy treatments may be suggested to mediate symptoms. Cold treatments are effective at numbing pain, decreasing swelling, and blocking nerve impulses to the joints while heat therapy will improve blood circulation and relax muscles, removing tension. Often a combination of the two techniques are used, applying heat in the morning to loosen up joints, followed by cold treatment later in the day to reducing any swelling that builds up.

Although steps can be taken to reduce osteoarthritic suffering, assistive devices may become necessary. These can range from walking aids, such as walking sticks or specially modified shoes, to devices that help in carrying out everyday activities. Kneelers for gardening, extenders for door knobs and taps, and clothing that is easier to fasten are all available so that patients can keep their everyday lives as normal as possible.  

World-Class Care – Introducing Dr. Donald Kastenbaum

This week we introduce one of our senior faculty members in orthopaedic surgery, Physician-In-Chief Dr. Donald Kastenbaum. Having performed over 5,000 primary and revision total hip and total knee replacements Dr. Kastenbaum has certainly earned the position of authority he holds in the field of orthopaedics. An expert in hip and knee surgeries, he has helped to develop several prosthetics for hips and knees that are being used worldwide in replacement surgeries.

Dr. Kastenbaum's journey to his current position of prestige began with studying for a medical degree at the University of Health Sciences – the Chicago Medical School. On completion of this he began an internship in general surgery at the Lenox Hill Hospital, followed by a residency in orthopaedic surgery at the Hospital for Joint Diseases Orthopaedic Institute. His specialisation into the field of hip and knee surgeries was further honed with a fellowship in Sports Medicine at New York University Hospital Medical Center before crossing the pond to complete another in Total Hip and Knee Replacement Surgery/ Arthritis at the London Hospital Medical Center.

His medical work on an international scale continued after his British fellowship, and over the past decade he has both lectured and worked worldwide. Having trained over 30 Chinese orthopaedic fellows, Dr. Kastenbaum returns to China every quarter in order to carry out, and teach, advanced surgical techniques, including minimally invasive and revision hip and knee surgery. Closer to home, he created Mount Sinai's first Comprehensive Arthritis Center, a facility designed to provide complete orthopaedic and rheumatological care, and physical therapy services. Dr. Kastenbaum holds positions within this institution as both Co-Director and Surgeon-In-Chief.

That, however, does not complete his list of medical contributions. In 2002 he was invited to be a part of the Insall Scott Kelly Institute for Orthopaedic and Sports Medicine, and was given the position of Associate Chairman of the Department of Orthopaedic Surgery, before becoming the Vice President in 2005. To add to his already-full career Dr. Kastenbaum also holds the position of President of the Mount Sinai Beth Israel Medical Board and Chairman of the Surgical Chairs. He is renowned as an expert in Hospital Perioperative Management, Safety/ Efficiency/ Outcome Analysis and aids hospitals across the world in developing their models of “best practice”.

All of Dr. Kastenbaum's involvements in different institutions are predicated on his great knowledge and expertise in the field of orthopaedic surgery. For more information on the medical procedures this world-class doctor can provide call 212-241-6335 to book a consultation.

Our Tips for Healthy Bones and Reducing Joint Pain

 It is estimated that between one third and one half of the population of the United Stated aged 20 and over suffers from some form of joint pain. This can be caused by a variety of factors, from genetic predispositions to natural wear and tear of bones as we get older. While there may be no definite cure for chronic joint issues, there are ways that pain can be reduced so that it does not restrict everyday activities.

One tried-and-tested technique for reducing pain and inflammation around affected joints is to use temperature therapy. Cryotherapy, or ice therapy, is suggested as colder temperatures reduce the blood flow to the problem area and thus lessen swelling in the surrounding tissue. It is recommended that, on the first day pain is experienced, you should ice the area every hour for 15 minutes, reducing this to four or five times the next day, and each successive day that the pain remains. If the pain is caused by stiffness rather than inflammation, heat therapy can be used to relax the muscles and to warm up the joints so that they move more smoothly. Hydrotherapy with warm water will ease

pressure on the joints, and immersing the affected area while massaging it will stimulate blood flow to the area.

Often chronic joint pain is caused by the breakdown of protective cartilage over time. This can be counteracted to a certain extent by increasing intake of vitamin D, which is needed to help the body absorb calcium to strengthen bones. Increasing vitamin C levels can also be beneficial as it is a key component in making the cartilage that cushion the bones, and as such may reverse some of the damage. Diet plays a large role in join pain, and reducing sugar intake is an effective step to maintaining healthy joints as, if too much sugar is consumed it can begin to bond to proteins in a process known as glycation and can cause further weakening of the bones and joints.

Temporary relief from joint pain can be obtained with pain killers, however, there is also a whole range of more natural home remedies that have been suggested as having pain-alleviating properties. For reducing inflammation around the affected joints, turmeric and ginger tea may prove an effective solution. Turmeric contains an antioxidant called curcumin while ginger is high in compounds known as gingerols. Both of these active substances are known to be anti-inflammatory and as such can reduce painful joint swelling. For pain relief try taking a magnesium supplement or soaking the painful area in Epsom salts, which contain magnesium sulfate. These are effective natural pain relievers as magnesium relaxes muscles and nerve endings while also helping bones to mineralize, making them stronger.

To a certain extent bone deterioration and resulting joint pain is unavoidable, as natural processes weaken them with age. Nonetheless, there are steps that can be taken to keep bones as strong as possible, reducing joint pain to a minimum.