How to Age Gracefully

Longevity is something I think about in the clinic on a daily basis. I’ve seen patients as young as their 40’s where “everything is falling apart” after a series of unfortunate accidents have caused their health to start spiraling out of control. I’ve also seen patients in their 80’s who are still lifting weights 3 times a week and golfing most days with maybe just a little chronic low back pain. I’m sure we would all like to live like the second example and not the first. 

There are several so-called “silver bullets” or principles of longevity that I think we can all benefit from on our journey into old age; eating plenty of fruits, vegetables, and whole grains; staying limber; keeping a strong core are a few examples. Today I want to step back and examine some of the concepts that lead us to becoming injured and aging poorly and talk about what we can do to make sure we’re planting the seeds of a long and healthy life now. As the ancient Chinese proverb goes, “Dig the well before you’re thirsty.”

Workload versus Work Capacity

A basic concept I’m often reminded of when treating patients in the clinic is that injury occurs when workload exceeds work capacity. This is true for injuries related to chronic, daily stressors or acute, sudden accidents. Learning how to properly manage workload and increase work capacity throughout our life is one of the keys to having a long healthspan and not just a long lifespan. Let’s look more closely at a few different examples:

One type of patient I treat at the clinic is an office worker. Specifically, they work for a tech company, 60 hours every week, they sit for 10-12 hours a day and often work weekends. They also haven’t exercised in 15 years. The workload experienced by this patient’s body is related to being in a less than perfectly ergonomic position all day long. Sitting with slumped shoulders, leaning on their forearms, head hanging forward as they analyze another line of code. The workload is not great if it were only for a moment here and there, but over time it begins to add up. Add to that the fact that their work capacity is diminished due to not exercising for so many years and it’s no surprise that everything in and around their spine is slowly being crushed into a less than ideal position and causing pain.

A second type of patient I treat has been an athlete their entire life. They got a scholarship to a prestigious college to play their favorite sport and after they graduated they played professionally for a time. One day, while training, they jumped in the air and as they came down another player moved under them causing them to land on an awkwardly outstretched leg, rupturing their ACL in the process. In this case, the workload is extreme and even though their body is well trained and they’ve developed an extreme work capacity relative to the average person, it is still too much too quickly.

Oftentimes the patients that I treat in the clinic aren’t clearly from the first or second category, but are more a blend of the two. Someone who works too much in an unergonomic position and likes to exercise on the weekends or whenever they get a chance, but also might train with poor posture or form. This third type would benefit from seeing someone like me or a trained coach who can analyze how they move and point out where the flaws and weaknesses arise before they start to break down and develop an injury.

In all of these examples increasing work capacity and decreasing workload would save the patient a tremendous amount of unnecessary suffering. To decrease workload, the patient who works too much could have an ergonomics assessment of their workstation and switch to a sit-stand table. To increase work capacity they could start Pilates to help them strengthen their core and improve their posture or start physical therapy or what we call PACE (postural assessment corrective exercises) with us. For the elite athlete, maybe if they had done more heavy squats during their career their ACL would have been better conditioned and could have withstood the force of their fall. Of course, not falling in the first place would have been the best course of action for the athlete, but being a collegiate or professional athlete often requires taking on a lot of unforeseen risk.

So how do we Age Gracefully?

Myosatellite cells help muscles to regenerate after we exercise. As we age the number of myosatellite cells in the body decreases. This eventually leads to a chronic decrease in work capacity making us more and more vulnerable to becoming injured even with a relatively light workload. The only way to offset this gradual decline is to continue to move and exercise. The key is to continue to move and exercise in a way that doesn’t exceed work capacity so we minimize the number of injuries as much as possible along the way.

If something is hurting we must learn how to continue moving and challenging ourselves while we rehab the injury. For instance, if a knee is hurting from running you can take up aqua jogging while rehabbing the knee. If a shoulder is hurting from pressing, you can focus on leg exercises or modify the upper body exercises so you’re mostly pulling. Innovate, modify, rehabilitate, but never give up.

One of the biggest mistakes I see in the clinic comes from patients who get injured and then completely stop doing whatever it was that caused the injury. Maybe they were lifting weights and they injured their back and so they stopped lifting forever. Injuries are always bound to happen, but if every time an injury occurs the patient stops doing that particular thing eventually they will have “painted themself into a corner”, so-to-speak. Eventually there’s nothing they can do because everything hurts (or might hurt). They become sedentary and they begin to age much more quickly as their muscles atrophy and become stiff, they lose coordination, and their bones lose density. An extreme example of this is a patient who had become so frail that even sitting down incorrectly caused another compression fracture in her spine (yes, this is a real patient and she was only barely 70). 

The Daoists say all life is Yin and Yang in close harmony. Yin, workload, Yang, work capacity. Yang, continuing to move and challenge our bodies, Yin, knowing when to listen to our bodies and be sensitive to when they need to take a break or rest before they get injured. The real key to longevity is learning how to develop a healthy relationship with your body. What I mean is, knowing what your body is typically capable of and then being able to adjust your expectations from moment to moment based on how well you’ve slept, how well you’ve been eating, how consistent your training has been, and how you feel right now in this moment. If we could all master learning how to listen so that we can rest when appropriate and push hard when appropriate we could all live to be healthy and strong into old age.