How often, during the course of my day, do I deal with the consequences, many as there are, of the “A” word. Do you know which word I’m talking about? Everyone should. Especially since we all succumb to its effects. Dust-to-dust, we all must shuffle off this mortal coil. Father Time has a tendency to wreak havoc on the human body. The “A” word stands for aging.

In the course of a normal day, I see a variety of conditions. From infectious disease (fungal nails!) to neurology (diabetic neuropathy), many different categories of problems are encountered in a typical day. Still, I think of my practice as being largely orthopedic. Every structure you can think of is eroded, damaged, degraded, by the passage of time. The same holds true for the human body, and many of the people who cross my door are suffering the consequences of aging on the human musculoskeletal system, with its brittle bones and weakened muscles.

Aging is a function of being here, on Earth, subjected to the laws of entropy as we are. Chronologically, aging starts at birth and ends at death. It’s what happens along the way that is so interesting, and so variable. How each of us changes as the years pass, experiencing the ravages of time, is dependent on a multitude of factors. Genetics is an obvious one. Still, we are a long way from understanding how it all works, the process of aging.

Obviously, the musculoskeletal system is hugely affected by aging. Time has a predictable effect on ligament and tendon, joints and bones. From about 30 and on, the density of bones begins decreasing. This loss of bone occurs at an increasing rate in women after menopause. This results in more fractures since thinner bones are more fragile, more likely to break. Stress fractures of the feet are more common as bones thin.

Aging results in many changes to our joints.  Many suffer with some sort of painful joint problem, and the cost of treatment for these problems runs a staggering sum. Osteoarthritis, as common as it is, is still misunderstood by many. It is not a systemic, blood-borne condition but the result of chemical changes occurring to specific components of a joint, the cartilage proteoglycans. These are specialized chemicals that provide this tissue with its unique characteristics. It is amazingly resilient and friction-free when the two surfaces match appropriately.

But poor joint mechanics may cause sufficient stress to the joint surfaces that, over time, degenerative changes occur to the cartilage. in some people, the surfaces of the joint do not slide as well over each other as they used to. Pain and disability are too often the result. But these are problems that take time to develop, although symptoms may not be experienced initially. Indeed, time takes its toll. Yet, people will often remark on how strange that they never had this problem before. In my mind, the answer is simple: they have never been this age before!

Some deviation from normal anatomy will usually cause stress to various soft tissue structures. But, when we are filled with the vitality of youth, an over-worked tendon will be pain-free. Our bodies are so much better able to deal with these types of stressors, and the inflammation that may develop, when we are young. But with age comes a host of changes, including a loss of muscle tissue. The rate and amount of muscle changes seem to be a function of genetics. Muscle changes can begin as early as the 20s in men and in the 40s in women. The muscle fibers shrink. Muscle tissue is replaced more slowly. 

The loss of muscle is a process called sarcopenia. It typically progresses throughout life. The amount of muscle tissue, as well as the number and size of muscle fibers, decreases with time. The result of sarcopenia is a gradual loss of muscle mass and strength. This loss of muscle strength places increased stress on various joints (such as the knees) and may predispose a person to arthritis or falling. Fortunately, the loss in muscle mass and strength can partially be overcome or at least significantly delayed by a program of regular exercise.

As to the subject of aging and our appearance, I won’t even touch on that one. Needless to say, skin care can only go so far. What is far more interesting is how different cultures handle aging and the aged.  

The environment in which we live can favor health or be harmful to it. It can potentially increase our exposure to various health risks, like air pollution or gang violence. Our living environment also has a tremendous influence over our access to quality health and social care and the opportunities that aging brings. So many of these physical changes take time, occurring slowly, insidiously. Yet the symptoms that lead to awareness, of what is a long-standing condition, may not manifest themselves for years.

Exercise is one of the best ways to slow or prevent problems with the muscles, joints, and bones. Some sort of exercise program, which should include both resistance training and cardiovascular work, can help you maintain strength, balance, and flexibility. Exercise will help keep the bones strong and blood vessels open. Healthy aging is about developing the habits and routines that promote optimal health.

You can’t choose your parents, meaning genetics are a factor which is out of your control. But your lifestyle choices, these are thing that you are opting to do. The diseases of lifestyle, heart disease, diabetes, and stroke, are major killers of adults today. These diseases are well known to be the result of dietary and activity choices, at least in part. Time will cause many changes, some of which are inescapable. As seniors, how well we optimize our abilities, our activity levels, our mobility, is influenced by many things, including how we treated our body years ago. In the big picture, over the years, some of these factors are under our control. The passage of time, obviously, is not.


Conway McLean, DPM