Dr. Nicholas Cappello

Have you  ever bumped your elbow and felt an electric shock sensation down your arm into your hand (hitting your “funny bone”), you did not hit a bone you hit the ulnar nerve..

The ulnar nerve extends down the arm, across the elbow, and into the hand. It provides sensation to the little and ring fingers and activates many of the small muscles in the hand. You can actually feel this nerve as it passes behind the elbow and through a tight tunnel (the cubital tunnel) at the inside of the elbow.

An injury to the elbow such as a dislocation or fracture can tear or inflame the ulnar nerve. The inflamed nerve can swell and become trapped in the  tunnel it travels in to get around the elbow.. Thus  its name, ulnar nerve entrapment. It is often also called cubital tunnel syndrome.

Prolonged pressure on the nerve against the bone and  constant rubbing can damage the nerve’s protective covering (myelin sheath) . Gradually, the muscles of the hand start to weaken, so that it becomes difficult to open a jar or grasp a tool.

Signs

Although the problem is in the elbow area, most symptoms occur in the hand and fingers because the ulnar nerve controls movement and sensation there. Both sensory and motor skills are affected. Symptoms include:

• Tenderness along the inside of the elbow.
• Tingling and numbness in little and ring fingers (especially at night).
• Numbness in your hand when the elbow is bent, such as when you drive or hold a telephone.
• Difficulty with hand coordination (such as when typing or playing a musical instrument).
• Decreased grip and pinch strength; muscle weakness.
• Pain along the inside border of the shoulder blade.

If you experience any of these symptoms, contact a physician. Early diagnosis and treatment is essential to controlling symptoms.

Diagnosing the problem

A physician can use several methods to diagnose ulnar nerve entrapment. Your own description of the symptoms is a primary source of information. If you’ve experienced a fall, blow or other injury to the elbow, the physician may request an X-ray. The physician may also apply pressure around the nerve to see if pain or tingling results, check to see if the hand muscles are atrophying, or do an electrical stimulation test to see how well the nerve conducts sensory information.

Who’s at risk

• Anyone who falls on or injures their elbow
• People whose jobs involve excessive bending of the elbow (typists or data entry operators, drivers)
• Diabetics
• People with arthritis or thyroid problems
• Alcoholics

Nonoperative (conservative) treatment

• Keep the elbow as straight as possible. A straight elbow puts less pressure on the ulnar nerve.
• Avoid crossing your arms across your chest.
• If you frequently use the telephone, consider using a headset or cradle attachment, so you don’t have to hold the telephone to your ear with a bent elbow.
• Adjust your workspace so that you don’t have to bend your elbow more than 30 degrees and you can keep your wrist in a neutral position.
• Consider wearing a splint at night. Something as simple as a towel wrapped around the elbow can help keep it straight.
• Use elbow protectors if you play sports to avoid bumping the elbow.
• If muscle atrophy and numbness continues, corticosteroids may be used to reduce swelling and pressure.

Operative treatment

If conservative treatment is not effective and muscle strength continues to weaken, further evaluation and surgery may be needed. There are several surgical options; the most frequent type of surgery (anterior submuscular transposition) moves the nerve from behind the bone to the front of the elbow. After the surgery, treatment must focus on maximizing the use of the hand and arm through physical therapy. This process can take several months.

This is one of the most frequent complaints I hear.

Feet are the most used and abused parts of the human body, the average American walks 115,000 miles – the equivalent of more than four times around the world – in a lifetime. With each step, minor abnormalities in foot structures or shoes that don’t fit right, or both, can result in such ailments as corns, calluses, bunions and hammer toes. An estimated 87 percent of Americans suffer from a foot problem.

The constant introduction of foot-distorting shoe styles for women and the fitness craze that has millions of American feet jogging, running, dancing and jumping have greatly swelled the ranks of podiatric and orthopedic patients. In addition, disorders like diabetes, obesity and circulatory abnormalities predispose their victims to foot problems that require professional attention.

Those who try to cope with foot problems on their own often throw good money after bad with purchases of inappropriate over-thecounter medications and appliances. In some cases, self-treatment can make matters worse.

Yet many painful afflictions of the feet can be avoided entirely or their more serious consequences averted by simple preventive measures and daily attention to these usually neglected (until they hurt) parts of the anatomy. It is best to wear shoes that have low heels, well-cushioned soles and supportive arches. Shoes should be at least half an inch longer than your longest toe. Well-made sneakers and sandals are considered acceptable footwear.

Shoes and socks should be changed daily and feet cleansed once or twice a day, dried carefully and dusted with foot powder. A 10-minute soak in warm water may be the best remedy for tired feet.

Corns and Calluses. These are the most common foot complaints (though many calluses give no pain or other trouble and can be left alone). They are composed of layers of dead skin cells and result from repeated friction or pressure against parts of the foot. They represent the body’s attempt to protect sensitive tissue.

Hard corns are usually found on the tops of toes, where skin rubs against the shoe. Sometimes a corn will form on the ball of the foot beneath a callus, resulting in a sharp localized pain with each step. Corns are cone-shaped, with the tip pointing into the foot. When a shoe exerts pressure against the corn, the tip of the cone can hit sensitive underlying tissue, causing pain.

Self-treatment can be risky, since the chemicals used to soften corns also damage healthy tissue. Follow the directions carefully and limit self-treatment to five applications. People with poor circulation, such as diabetics, should seek professional help. Removal of corns with a razor blade should never be attempted. Hard corns are best prevented by protecting any rubbed area with a stickon nonmedicated corn pad or horseshoe-shaped piece of moleskin or foam rubber and by not wearing the shoes that are the culprits.

Soft corns, which are rubbery, form between toes where the bones of one toe exert pressure against the bones of its neighbor. To help prevent their formation, use lamb’s wool or cotton between toes that rub together. Once established, these corns are best treated professionally.

Calluses form over a flat surface and have no tip. They usually appear on the weight-bearing parts of the foot – the ball or heel. Each step presses the callus against underlying tissue and may cause aching, burning or tenderness. Calluses may result from the friction of loose-fitting shoes or the pressure of shoes that are too tight. Women who wear high-heeled shoes are especially vulnerable to calluses.

People with high arches are also vulnerable since the heel and ball of the foot bear all the weight. Arch supports may help to relieve the pressure and cause the callus to disappear slowly. Cushioned innersoles may also help.

Calluses can be gradually eliminated by rubbing the callused area with a pumice stone after soaking or bathing has softened the dead skin. Then apply a moisturizing lotion. Do not try to remove too much of the callus at once. Diabetics should see a professional rather than attempt self-treatment.

Bunions. These swollen, inflamed protrusions occur on the side of the foot at the joint of the big toe (a form of bursitis). A similar swelling can occur at the outside of the foot, where it’s called a bunionette. The usual cause is the persistent wearing of shoes that are too tight and short. Not surprisingly, bunions are four times more common among women, many of whom wear high-heeled, pointy-toed shoes that cause the big toe to bend inward. In some cases, bunions result from an inherited misalignment of foot bones.

Bunions cannot be self-treated and only surgery can correct the problem. However, considerable relief may be obtained through conservative measures, using devices in the shoes that change the foot’s weight balance and by wearing shields to protect the bunion from friction against the shoe. 

Hammer toes. As with bunions, this problem can result from wearing high heels or shoes that are too short. The usual victim is the second toe, which on most people is longer than the big toe. The middle joint on a hammer toe bends the wrong way, causing the segment of the toe nearest the main part of the foot to stick up. People with high arches are more prone to hammer toes. If caught in time, the problem can sometimes be remedied by splints and exercises, but a longstanding, rigid hammer toe requires surgery.

Ingrown toenails. In this misnamed condition, the nail doesn’t really grow in; rather, the surrounding soft tissue presses against the edge of a nail that has been cut too short. The big toe is most often involved. The problem is prevented by being certain to cut toenails straight across (rather than in a curve), leaving a piece of ”white” nail on either side.

If there is no evidence of infection (such as red, swollen, pussy tissue), ingrown toenails may be treated at home by forcing a tiny piece of absorbent cotton under the nail. This allows the nail to grow out without digging into sensitive soft tissue. Replace the cotton twice daily, perhaps first dipping it into an antibiotic solution.

Blisters. These commonly appear where a shoe rubs against skin that is unprotected by a corn or callus. Ease the friction with moleskin padding, wear socks and change shoes. Don’t pop blisters, since they may then become infected. If a blister breaks on its own, apply an antiseptic and keep the area covered with a sterile bandage. Remove the bandage at night to promote healing.

”Falling” arches. Feet that feel tired and achy after prolonged standing may be suffering from strained arches. Getting off your feet, soaking them in warm water and massaging them may help. If the problem occurs frequently, arch supports may be needed. In special cases these can be custom-designed, but much less expensive readymade supports help many people. The problem is often averted by wearing shoes with low heels and strong, supportive arches.

 It’s well established that the carbohydrates (sugars) that sweeten most sports drinks aid performance. They provide immediate fuel for straining muscles, keep blood-sugar levels stable and allow you to work out for a longer period of time or at a higher intensity, or both, than if you don’t swallow any extra protein as fuel.

 To date most studies have  shown that adding protein to Sports Drinks does not enhance performance. Some earlier experiments that did find athletic-performance benefits from protein-enhanced sports drinks used protein beverages that contained more calories than the carbohydrate-only versions and, as some critics pointed out, the extra calories rather than the protein, , probably provided the benefit.

What does this finding mean for those of us trying to decide on a sports drink? Buy the less expensive protein free sports drink.  As you might imagine, the folks at Gatorade have been keenly following the Carb+Pro studies. Gatorade’s recovery beverage, the Nutrition Shake, contains a C+P formulation like basically all other recovery products on the market. But the company’s traditional sports drink and its new Endurance Formula, both for consumption while you exercise, contain no protein–just carbs and electrolytes , and is less expensive.

With the recent events in Tucson, and the brain injury of Gabrielle Gifford’s  made me review this topic.

The brain is like a bowl of Jell-O if the head is shaken, the brain sloshes about in the skull. Most of the damage in car accidents results from acceleration and rotational forces, not direct blows. Someone in an accident is not necessarily fine just because he didn’t hit the windshield. In a bullet transferring its energy through brain tissue, it expands and contracts just like jell-o when shaken.

Brain injuries are often fatal, causing about 100,000 deaths a year in this country. About seven times that number of individuals suffers nonfatal head injuries severe enough to require hospitalization.

There is another, much larger, group of individuals with head injuries, however, who have been all but ignored by the public and neglected by the medical profession. These are the uncountable thousands who seemingly recover from their injuries but still suffer subtle intellectual and behavioural effects that may seriously impair their ability to work and interact normally with other people. They are the victims of what experts call a ”silent epidemic.” Some never lost consciousness and others never even suffered a direct blow to the head, yet brain damage occurred.

Brain injury symptoms include difficulties with memory, attention span, concentration and abstract thinking; emotional instability; easy fatigability; personality changes; social lethargy; impulsivity, and irritability. When unrecognized and untreated, these problems typically lead to depression, loss of self-esteem and self-confidence and disruption of family and social relationships. 

Causes and effects. Automobile accidents are by far the most common cause of head injuries, both severe and minor. Sports injuries are a growing problem, especially in activities such as boxing, football, cycling and hockey.

  Brain damage can occur even if there is no direct blow to the head. Vulnerable individuals can include a child who is violently shaken by an angry parent or someone subjected to severe jostling in an automobile accident. 

In a study involving special tests of 77 head injury patients who had been hospitalized less than 24 hours and discharged ”with normal neurological findings” showed that a third had difficulties with memory, attention span and concentration.

The hallmark symptoms of subtle brain damage that warrant further diagnosis. They include the person who sits around, loses track of things, interrupts things, has short attention span, is unable to do his former job, has difficulty maintaining family relationships and sustaining old friendships, has trouble learning new things, develops sexual problems, or thinks of himself as worthless.

Diagnosis and therapy. The usual neurological tests are not sufficiently sensitive to detect the problems that commonly afflict victims of minor head injuries. More detailed neuropsychological tests are needed to evaluate cognitive deficits, including such abilities as vigilance, information processing and problem solving. Emotional states should also be thoroughly evaluated. These tests are becoming increasingly available, primarily at major medical and rehabilitation centers. Evaluations may be done by a neurologist, neuropsychologist or rehabilitation medicine specialist.

Patients should be seen often and followed closely and the family and patient should be told what to expect and what symptoms might develop. Employers, too, should be informed about effects of the injury and advised about job changes and additional support that can make the difference between a productive employee and one who fails repeatedly.

Some patients need more specific therapy. So-called cognitive therapy is designed to improve the patient’s ability to respond to a variety of situations. Computer games are being used in many centers to improve hand-eye coordination and increase attention span.

 Brain injury, however minor it may seem, can last for years, earmarked by periodic improvements and plateaus. Although complete recovery may not always occur, most patients can learn to compensate for their limitations.

The National Head Injury Foundation is organization founded by families of head-injured patients that is dedicated to helping people understand brain injuries and find local resources for diagnosis and therapy.

Many of the local chapters have organized support groups 18A Vernon Street, Framingham, Mass. 01701 (phone: 617-879-7473

I weighed myself and was surprised to see I had put on ten pounds. I am always telling patients to loose weight, it will help with your back pain, or recovery from Surgery but I never gave them a method to follow. I will share with you my research on Diets and Dieting.

What I found out that most fad diets do not work and perhaps this is why 80 million Americans are overweight.

Most diet fads are a recycled version of a high-protein, low carbohydrate diet, first proposed in the 1860s. Since 1950, it has resurfaced as the Calories-Don’t-Count, Air Force, Mayo, Drinking Man’s, Stillman’s Quick-Weight-Loss, Atkins Diet.

Basically, fad diets make daily food decisions for the dieter who, upon returning to his or her old eating habits, nearly always regains the weight. Further, some of the quick weight-loss schemes are wholly illusory, producing mostly a loss of body water, not fat. In fact, on any diet, the initial rapid loss during the first week or two is ”primarily of fluids as the body adjusts to utilizing its stored fat.”

Even more illusory are the supposed benefits of drugs and hormones purported to assist in weight reduction. Numerous studies have shown that hormones, including thyroid, HCG and growth hormone, have no effect on weight loss. It is my experience that weight lost with pills is always regained as soon as the pills are discontinued.

No one has yet devised a weight-reducing regimen that guarantees long-term success, many factors that influence the ability to lose weight and keep it off have been identified., Diet is only a small part of success, of greater importance are the adoption of long-term goals, personal determination and discipline, and a restructuring of eating and exercise habits.

 We all know people who seem to eat alot.and never put on weight, and likewise there are those who just look at food who are overweight. Think of it this way, a Ferrari and a beetle volks wagon are side by side with their engines running, the Ferrari is burning up gas at twice the rate as the volkswagon. Our lean body with muscle rather then fat is burning calories twice as fast as a fat person. 

Fat tissue burns calories at a lower rate than lean muscle tissue, a person whose body has a high percent of fat needs fewer calories than someone of the same weight who is lean.

”Individuals with large muscular development have a basal metabolic rate from 5 to 6 percent greater than that of persons of the same height and weight, but with less muscle mass, this accounts in part for the lower caloric needs of women, who typically have a higher percentage of body fat than do men of the same height and weight. It also partly explains ”middle-aged spread,” since as people get older and more sedentary, muscle mass decreases and body fat increases, resulting in a slow weight gain unless fewer calories are consumed. Thus, a 60-year-old woman requires about 25 percent fewer calories to maintain the same weight she was at when she was 17.

Recent studies have indicated that many overweight people, after becoming fat, don’t eat more than their slender counterparts. In fact, some eat less. Differences in their caloric needs, as determined by the amount of body fat, are one reason for this surprising finding. Differences in levels of caloric expenditure are another.

 Vigorous physical activity not only burns extra calories , but it also revs up the body’s engine and increases for many hours after the activity has stopped. Therefore, the less an overweight person moves, the fewer calories needed to maintain body weight. ‘As an alternative, combining a moderate calorie cutback with increased exercise, which would also raise the bodies resting rate of burning calories.

 The benefits of exercise in weight control extend far beyond the number of calories burned during the activity. In addition to raising the BMR for up to 15 hours afterward, exercise has been shown to have an appetite-suppressing effect, to enhance self-image and to reduce feelings of tension, anxiety and depression that prompt many people to overeat. Any kind of exercise is helpful that involves prolonged movement of the body’s long muscles, as does walking, running, stair-climbing, swimming, cycling, skiing and skating.

Exercise is also crucial to maintaining muscle tissue during a weight-loss program. A Chicago study among 32 college women who were 20 percent or more overweight showed that those who jogged three times a week and followed a reduced calorie diet lost more body fat and less lean muscle tissue than those who simply dieted.

Eating Patterns have shown that fat people tend to eat fewer meals than thin ones. Many overweight people report that they regularly skip breakfast, have a skimpy lunch, if any at all, and consume most of their calories at dinner. Yet they are fatter than other people who consume more calories divided among three meals a day.

High caloric load consumed once a day – and especially at the end of the day – is more likely to go to fat than the same number of calories spread out in small meals throughout the day. A study in Prague showed that 57 percent of men who ate three or fewer meals a day were overweight, whereas only 29 percent of those who ate five or more meals a day had a weight problem.

Eating causes a temporary increase in the metabolic rate (which creates a feeling of warmth after eating); eating several small meals a day burns off more calories than one big meal.

Eating Patterns Studies have shown that fat people tend to eat fewer meals than thin ones. Many overweight people report that they regularly skip breakfast, have a skimpy lunch, if any at all, and consume most of their calories at dinner. Yet they are fatter than other people who consume more calories divided among three meals a day.

Although the evidence on this point is conflicting, a number of studies have suggested that a high caloric load consumed once a day – and especially at the end of the day – is more likely to go to fat than the same number of calories spread out in small meals throughout the day. A study in Prague showed that 57 percent of men who ate three or fewer meals a day were overweight, whereas only 29 percent of those who ate five or more meals a day had a weight problem.

Eating causes a temporary increase in the metabolic rate (which creates a feeling of warmth after eating); eating several small meals a day burns off more calories than one big meal.

In people, eating large meals has been shown to result in a larger secretion of the hormone insulin, which promotes storage of calories as fat. This mechanism would enhance survival in a feast-or-famine situation, but it produces chronic overweight in a time of continuous plenty.

The time of day meals are consumed also influences weight. In a recent study people fed one 2,000-calorie meal a day in the morning lost weight. But when the same people were fed the same meal in the evening, they lost less or even gained weight.

Contrary to what many dieters believe, most protein-rich foods provide far more calories than natural carbohydrate-rich foods such as potatoes, rice, pasta and beans, which contain little or no fat. A five-ounce baked potato has about 110 calories, less than one percent of them from fat, whereas a five-ounce steak has 500 calories, 80 percent of them from fat.

Fat is the most ”fattening” of nutrients, providing two and a quarter times more calories than an equal weight of either pure protein or carbohydrates. Fat is also used more efficiently by the body to add weight.

Unrefined complex carbohydrates (starchy foods) have distinct advantages to dieters because they are rich in indigestible fibber, Fiber provides few calories but considerable satisfaction to the consumer, he said. Fibber-rich foods like fruits, vegetables and whole grains take longer to chew and are bulky, and thus fill the stomach and small intestine before too many calories are consumed. In addition, because fibber speeds passage of foods through the digestive tract, fewer calories may be absorbed from diets rich in fibber.

It is important to teach people to restrict their eating to designated meals and snacks intended to satisfy physical, not psychological, hunger, and to increase the amount of activity in their everyday lives.

Weight-reduction groups such as Weight Watchers, TOPS (Take Off Pounds Sensibly) and Overeaters Anonymous can provide needed reinforcement for many dieters, especially for persons who tend to be passive, dependent or depressive types,

Studies of successful dieters who have been able to maintain their weight loss for many years have shown that they are more likely to have such personality factors as vanity, self-discipline, dependability and a ready willingness to accept the consequences of their own behaviour.

‘Ideal’ Weight – And Beyond

Overweight is generally defined as weighing 10 to 20 percent more than ”ideal” as defined by insurance company studies. A person who exceeds the ideal weight by 20 percent or more is considered obese. A better definition would account for the proportion of the body that is muscle and the proportion that is fat. A 250-pound football player with 12 percent body fat would weigh more than ideal but would not be overweight or ”fat” in a medical sense, whereas a sedentary man of the same weight with 30 percent body fat would be obese.

With this information you are now prepared to lose those pounds…

My Own Back Pain Story

was going to pick up my dogs leech, and I bent over, and I couldn’t stand up again. Nothing brought it on. I wanted to laugh, but I was hurting so much I also wanted to cry. And I didn’t want anybody to see me because I thought people would say, “What kind of Orthopaedic Surgeon is he, anyway?”

I was hoping I could get the dog, get out of the park and back to my car and just get better. I could barely get back to my car. I went from meter to meter to get back, and I could barely breathe it was hurting so much. I drove home and lay down on the couch, and then realized I need to get up and keep going, because that’s what I tell all my patients. I used ice, took a couple of aspirin and said to my wife, “I need to go for a walk.” She said, “You can’t even move,” and I said, “I know, but it has to be.”

I spent a week that way, and I did get over it. I’ve had several recurrences, and it always takes five to seven days to get over it, no matter what I do. I think I have some aging of the joints and discs in my back, and I think when I just move a certain way it causes the muscles to go into spasm.

In order to prevent recurrences I keep up my elliptical trainer to stay in good condition. I think aerobic conditioning is extremely important. I do at least 20 minutes, and when I’m feeling good, up to an hour. I think that’s incredibly important to keeping my episodes short and not as bad.

The point is, I live by my own suggestions, and I think for most people they can work. The people I operate on don’t have that ability to get better. In those 2 to 3 percent of cases, surgery can be a fantastic alternative.

 Probably the most common causes of back pain are just — what’s the best word? — life’s events. People often go through life doing just what they normally do, and one-third of them on any given day will experience back pain. It’s the second most common complaint after upper respiratory infections in the United States. Most times it’s not related to work. There are some work-related risk factors like heavy lifting, twisting, or being exposed to vibrations, like a jack-hammer operator or a truck driver is., and in our country, obviously, obesity is a problem. But even people who aren’t exposed to these risk factors are subject to back pain.

Usually, 95 to 98 percent of the time, it will get better by itself without any intervention. But that’s not the American way. We’ve built an incredible medical structure. People think, “I shouldn’t have to suffer for one day — there must be a pill or surgery that can help me.” I agree with how they feel, but certainly there’s over a 90 percent chance most people will get better with no intervention. That’s an important message. People will say, “Well, what am I supposed to do when I can’t walk or go to work?” Well, having surgery is going to keep you out of work. F Most people know it will take a week to 10 days to feel better after getting the common cold just transfer that to your back pain.

Why don’t we have that same approach to backaches? Stay active. Take aspirin or other over-the-counter drugs.

  The best treatment for straightforward back pain without a specific diagnosis is reactivating yourself to what you normally do as fast as possible.  That means if you’re normally a runner, you try to go running. If you’re a walker, get back to walking. If you’re not an exerciser, then you don’t all of a sudden go out and become one. Then I’d avoid heat — I’d use ice. I would use over-the-counter meds like aspirin or acetaminophen. I would avoid narcotics except in extreme cases. I would avoid bending or twisting during acute phase.

With an aging population we are likely to see more spine conditions — not the typical back pain you see in younger people, but conditions related to the degenerative process. Over age 65, you start seeing hip and knee problems and also back problems. In older people, it’s most commonly related to spinal stenosis, a narrowing of the spinal canal . As the population ages, we are more likely to see more of that and to see more fractures of the spine related to that. We’ll see more hip fractures and more complicated ones than we used to see, and more spinal problems and more complicated spinal problems as people live longer.

This quote by Betty Davis does not have to be your Mantra
We all know  people who stay active longer and look younger then their age.
It’s no secret that our bodies change as we age. Some changes are obvious, while others are more subtle.

Many people age comfortably and remain active, alert, and vibrant throughout their lives. Their physiologic age may be quite younger than their chronological age.

Others may experience the effects of osteoporosis and osteoarthritis, which can gradually diminish their abilities to participate fully in activities.

Knowing what to expect and taking steps to counterbalance the effects of aging can help you maintain a young spirit and an independent life. A healthy diet, regular exercise program, and positive attitude can help delay the onset and slow the progression of many age-related changes.

Aging Muscles:

• As muscles age, they begin to shrink and lose mass. This is a natural process, but a sedentary lifestyle can accelerate it.
• The number and size of muscle fibers also decrease. Thus, it takes muscles longer to respond in our 50s than they did in our 20s.
• The water content of tendons, the cord-like tissues that attach muscles to bones, decreases as we age. This makes the tissues stiffer and less able to tolerate stress.
• Handgrip strength decreases, making it more difficult to accomplish routine activities such as opening a jar or turning a key.
• The heart muscle becomes less able to propel large quantities of blood quickly to the body. We tire more quickly and take longer to recover.
• The body’s metabolic rate (how quickly the body converts food into energy) slows. This can lead to obesity and an increase in “bad” cholesterol levels.

Throughout life, bones constantly change through a process of absorption and formation called “remodeling.” As we age, the balance between bone absorption and bone formation changes, resulting in a loss of bone tissue.

• The mineral content of bones decreases, so that bones become less dense and more fragile.
• As bones lose mass, osteoporosis develops, affecting both women and men. In the spine, osteoporosis can lead to crush fractures of the vertebrae, resulting in a “dowager’s hump.” Osteoporosis is also responsible for almost all hip fractures in older men and women.
• The chemistry of cartilage, which provides cushioning between bones, changes. With less water content, the cartilage becomes more susceptible to stress. As cartilage degenerates, arthritis can develop.
• Ligaments, connective tissues between bones, become less elastic, reducing flexibility.

Aging Joints

• Joint motion becomes more restricted and flexibility decreases with age because of changes in tendons and ligaments.
• As the cushioning cartilage begins to break down from a lifetime of use, joints become inflamed and arthritic.

Counteracting the Effects of Aging

• Many of the changes in our musculoskeletal system result more from disuse than from simple aging. Less than 10 percent of Americans participate in regular exercise, and the most sedentary group is older than 50 years of age.
• Stretching is an excellent way to help maintain joint flexibility. Weight training can increase muscle mass and strength, enabling people to continue their daily routine activities without maximal exertion. Even moderate amounts of physical activity can reduce your risk of developing high blood pressure, heart disease, and some forms of cancer.
• Long-term regular exercises may slow the loss of muscle mass and prevent age-associated increases in body fat. Exercise also helps maintain the body’s response time, as well as its ability to deliver and use oxygen efficiently. Just 30 minutes of moderate activity, incorporated into your daily routine, can provide health benefits.
• An exercise program doesn’t have to be strenuous to be effective. Walking, square dancing, swimming, and bicycling are all recommended activities for maintaining fitness as we age.
• The 30 minutes of moderate activity can be broken up into shorter periods. For example, you might spend 15 minutes working in the garden in the morning and 15 minutes walking in the afternoon. It all adds up.
• But if you have never attempted an exercise program before, be sure to see your doctor before starting one now