Why does this hurt?
That is the question a friendly store clerk told me she asks herself every morning as we talked about her co-worker, who was out with some debilitating ailment — her back, maybe? This led, as many conversations among people in their 50s do, to that run-down we do as we age. What did I do to my knee? How did I get this bruise? Are you sure I need to get out of bed … like, ever?
My new friend’s daily pain inquiry is so familiar to me and, like my Gen X peers — some of us now in our 50s — I’ve been resigned to more “Oww” than “Wow.” That’s just inevitably what happens when you get older, right?
Actually no, says Dr. Dan Chapman of Baltimore’s Chapman Physical Therapy, located across from The Rotunda shopping complex in North Baltimore. Aging is inevitable, but extreme physical decline isn’t. The key is staying active and working on your strength if you already are doing so, or getting started if you aren’t.
“It’s common, but it’s not normal,” said Chapman, 34, a doctor of physical therapy, an orthopedic clinical specialist, and certified clinical strength and conditioning specialist. “We’ve associated aging with weakness and frailty, and we’ve accepted it as normal. If Grandma has a hard time getting out of her chair, it’s normal. She’s just old.”
“Old” is a word I admittedly use a lot as of late to describe why I run slower, fall asleep earlier and decline most invitations to leave my house after 6:30 p.m. Chapman said that he sees among his patients an accepted but misguided truth that as our body ages, we slow to a stop.
“Most people are relatively active in their 20s and 30s, and some into their 40s, but then they stop being so active in their lifestyle. As that activity declines, they start to be less and less conditioned, and by their 60s and 70s they’re very deconditioned, all the way to [being] frail,” he said. “People come in with one knee hurting and say, ‘It’s just old age,’ and I say ‘So how old is your other knee?’”
This decline in activity and strength creates “a very clear pipeline” that ends in a seriously debilitating place, he said. “People do even less, because they’re afraid to go outside because they might fall or break a hip, and then they can’t live independently, and have to go to a nursing home.”
Well, that doesn’t sound fun! Chapman is on a crusade of sorts, trying to get the word out to people before they wind up in his office. And he’s backed up by the National Institutes of Health’s National Institute on Aging, which states clearly on its website that “often, inactivity is more to blame than age when older people lose the ability to do things on their own.”
So how does this happen? Chapman admits that his own medical community “has not done a good job” of explaining the connection between gaining and maintaining physical strength as early and consistently as possible and physical issues later in life. While we do lose about 2% of our physical strength each year after age 50, the key is to have gathered as much strength as possible up to that point so you have less to lose. Think of it as a health savings account — the earlier you start saving, the more you have available to spend when you get older.
Chapman referred me to the World Health Organization’s physical capacity chart, which forms the shape of a rising then gradually declining wave correlating the amount of muscle strength one gains in early life to where they end up on the spectrum of physical performance toward life’s end. “The goal in early life, in your 20s and 30s, is to get as strong as you possibly can,” Chapman explained. “Then once you reach your 40s and 50s, it’s about maintaining your strength, and once you hit your 60s, it’s about minimizing loss.”
That lowers our chance of chronic disease and pain and of a prolonged, difficult decline. “You want to live long and die fast,” he said. “That’s what we all want.”
How do you do that? Chapman said at my age, as the creaks start, the intensity of your workouts is important, as is making adjustments when we have to. For instance, I can’t run hard like I used to, but that doesn’t mean I have to slow down completely.
“Maybe it’s not that squats are bad for you, but that you might be doing them too deep. The other thing is that ‘No pain, no gain, go hard all the time, bro’ attitude. If you hurt, maybe your body is telling you something,” he said.
This reminds me of my favorite movie scene about aging, from “Rocky Balboa,” where the Italian Stallion improbably comes out of boxing retirement at 60. His old trainer pal Duke tells him that since he’s slow, arthritic and has bad knees, he’s not going to be running fast up the steps of the Philadelphia Museum of Art anymore. His only path to victory is “blunt force trauma,” or getting so strong that his punches hurt more. It’s not sleek, youthful or pretty. But it gets the job done.
You don’t have to step into the ring for maximum benefit. Chapman suggests prioritizing your lower body, “your quads and glutes, the muscles that walk us around and help us get out of a deep couch, and help us catch ourselves if we lose balance.” He likes activities like yoga, or a challenging, more than leisurely walk at a pace where you can still maintain a conversation.
If you’re trying to make sure you can talk while you exercise, it’s better to have someone along to talk to. “Socialization is so important, with the last couple of years we’ve had,” he said. “Find a way to do it with friends, wherever you feel safe. Accountability and joy comes from being with other human beings you enjoy being around. It does wonders.”