On the Move

Donna Shryer, May 14, 2019

It seems like every time we hit a milestone birthday, there's a buttercream-frosted cake along with a neatly packaged adage. First it's "50 is the new 30." In another decade, you'll hear "60 is the new 40."

It’s nonsense, of course, but in a clever way these oneliners acknowledge the fact that Americans live longer, healthier, more active lives than ever before. To be specific, the 65 and over population hit 37.2 million in 2006 and 49.2 million in 2016, and it’s projected to come in around 98 million in 2060.¹

This thriving demographic has sparked attention from marketing directors to the medical community to the International Health, Racquet & Sportsclub Association (IHRSA), with the latter reporting that U.S. health club memberships hit a record-breaking high in 2017, attracting nearly 60.9 million members and increasing 2016 figures by 6.3 percent.²

As more Americans than ever sign up for the gym, more age-related aches, pains and physical obstacles are showing up, too. Preventing, managing or, in some cases, resolving these issues plays right into what massage therapists do best. Your knowledge about how different ages and longtime repetitive motion affect muscles, fasciae and bones is key to helping active-minded clients of every generation walk the healthy aging path.

“Motion is lotion,” says Judy Kapler Bishop, licensed massage therapist, M.Ed. in exercise physiology, practicing in Park City, Utah. “We all need to keep moving. It strengthens our muscles and our joints, and just as important, impacts how we feel about ourselves and interact with others,” Kapler Bishop says with strong conviction. “When I decrease someone’s pain, increase their range of motion and improve their strength, what I’m really feeling is that I just helped this person get back on a bike, take a walk, return to Tai Chi classes or do whatever it takes to participate in life. That’s my reward.”

Let’s Get Physical

Living longer is all about “healthy aging,” defined by the World Health Organization (WHO) as doing what it takes to create environments and opportunities that enable you to be and do what you value throughout life.³

WHO admits that advanced medical research, health care improvements and our medical communities’ support for physical activity play a dominant role in healthy aging’s increasing significance—but there’s also this cross-generational drive to make those “bonus” years count by initiating healthy habits sooner rather than later. According to new Mintel research, more than 55 percent of Americans report living a healthier lifestyle in 2017 as compared to 2016, and 45 percent say they made “dramatic changes to improve their health.”⁴

Staying physically active ranks high on the list of healthy living habits, whether talking to 25 year-olds working toward a healthy tomorrow, 50-year-olds looking to maintain a healthy today or 75-year-olds determined to regain some of yesterday’s strength.

The Harman Group’s Health + Wellness (H+W) 2017 report cites a deepening connection between physical and mental health. “Exercise, for instance, has moved from being a weight-loss tool to a mood and energy management strategy, giving it even more prominence in consumers’ health and wellness goals, yet even many engaged consumers struggle to prioritize it.”⁵

Yes, prioritizing opportunities to stay active can be challenging— particularly if a simple stretch or gentle workout brings cringing pain. And pinpointing where that pain originates poses another challenge—especially as we age.

Sometimes pain follows a well-defined injury or diagnosed disease, and that knowledge helps a massage therapist gain quick focus. However, pain can also creep up, maybe after a seemingly insignificant misstep that pushed tight muscles beyond their range of motion. There’s also the body’s natural aging agenda, which begins around 30. And let’s not forget about how decades spent behind a desk, bent in daylong, misaligned positions, can result in a cascade of painful consequences. Any one of these scenarios can create painful obstacles that limit activity for every age.

As Muscles Age

So why is the massage therapist’s skill, knowledge and talent instrumental in healthy aging? In short, it’s because our muscles aren’t like fine wine—they don’t improve with age. At some point in our 30s, muscles begin to lose mass and function. Massage may not be a fountain of youth, but the right therapy can enhance muscular health, improve postural holding patterns and keep clients actively headed toward healthy aging.

To begin with, the massage therapist understands why muscles lose functionality, which is in part because they can become ischemic as we age, explains Jyoti Jason-Miller, licensed massage therapist and owner/operator of Denver Sports Massage in Greenwood Village, Colorado. This, he adds, means that certain muscles are less able to supply blood to different tissue layers, which inhibits—or even prevents—a muscle’s natural recovery process after use. “This recovery aspect peaks when we’re around 28 and starts to decline from 30 onward,” Jason-Miller says. “So every decade, we lose a little more of that recovery aspect.”

As our muscles lose the ability to recover, we may find pain and other symptoms inhibit our desire as well as ability to remain physically active and strive for healthy aging. Here’s the kicker—it can be difficult to identify where and why an ache or pain originates. This can be particularly tricky as we age.

Consider these specific concerns that may call for your sharpest “Sherlock Holmes” skills to nail a healthy solution.

General discomfort. All too often people walk away from the bike path or let their gym membership lapse because working out is too taxing. These folks often declare, “I’m just too old for this.” According to the Centers for Disease Control and Prevention, this sets up a downward spiral of events: You quit due to loss of strength and stamina, but this loss is “in part caused by reduced physical activity.”⁶

In a study conducted by the National Institutes of Health, “A carefully structured, moderate physical activity program helped vulnerable older people maintain their mobility. The study shows that exercise can benefit even many frail older people.” In fact, during this 2.6-year study, the physical activity program reduced the risk of major mobility disability by 18 percent.⁷

Sharing these studies—and stressing the importance of staying active—is an essential first step. Relieving the pain is step two. If, for example, the problem is back pain, try reflexology, which appears to offer promise as a treatment in the management of lower back pain.⁸

Muscle imbalance. “Sometimes we see someone as young as 50 with their shoulders pitched forward,” Jason-Miller explains. “There could be a health issue causing the problem, but rounded shoulders can happen to some degree to almost everyone. Decades of sitting in a certain position can make the pec muscles tight, weaken the back muscles and cause an imbalance. People in their 20s sometimes experience issues between their shoulder blades from this sort of imbalance.”

Massage, Jason-Miller cautions, will help loosen tight muscles for a few days, but client self-care, such as self-massage and physical activity to restore balance between weak and strong muscles, is critical. Pinpointing exercises to strengthen and lengthen weak back muscles is outside of most massage therapists’ wheelhouse. For this reason, Jason-Miller adds, it’s a good idea to have a trainer ready to recommend—someone skilled and schooled in helping clients target muscle groups that lack strength.

Misidentified pain source. It’s not unusual for clients to misunderstand the origin of their own pain when muscle imbalance is involved, cautions Jillian Barnet, LMT, DPT, ACSM, and owner of Barnet Therapeutic Bodywork in Aspinwall, Pennsylvania. “Someone may come in and say, ‘The middle of my back is killing me! What can you do?’ But after a few minutes of palpation, I can feel that it’s their pecs that are tight, and by definition a tight muscle is a weak muscle. It may not make sense to the client, but weak pecs can create a painful imbalance with the opposing back muscles.”

Massage can help, but only if you include the weak and also the opposing muscle group.

Adapting gone wrong. As a muscle loses its ability to recover, the body adapts. However, the adaptation itself can trigger what appears to be an unrelated and painful problem, explains Donna Barnes, licensed massage therapist and owner of Whole Body Whole Soul located in Colorado Springs, Colorado. “When we’re young, muscles slide easily back into place and a simple stumble won’t likely have a lasting effect. But as we age, falling can trigger a muscle to quickly stiffen—to stabilize and protect itself from damage—but then the muscle ‘forgets’ how to move back into its original position.”

This scenario, Barnes says, can set off a chain reaction, which recently happened to her client who fell in the shower. “He didn’t break anything, but he may have strained his lower back. All we know is that he was sore the next day, so he adapted by changing his gait. Suddenly he was using different muscles to walk, and that led to hip pain.”

Once again, massaging the hip will help, but it’s also essential to work on the original damaged muscle group.

Redefining what we thought we knew. Certain diseases, such as osteoarthritis, have long been associated with the aging process—hence its nickname: wear-and-tear arthritis. Over time, though, rheumatologists have updated their opinion. First of all, it’s not impossible for 20- or 30-year-olds to be diagnosed with osteoarthritis after a joint injury or repetitive joint stress. As for aging generations, OrthoInfo, a publication of the American Academy of Orthopaedic Surgeons, notes that, “Many of the changes in our musculoskeletal system result more from disuse than from simple aging.”⁹

That opinion, by the way, includes osteoarthritis, which opens the door to a serious discussion with clients about the importance of staying active. A good place to start with these clients may be to offer a few massage sessions focused on relaxation.

While you’re at it, you might also want to share a 2017 systematic review of seven randomized controlled trials involving 352 participants with arthritis. The study reports evidence that massage therapy is superior to nonactive therapies in managing osteoarthritis and rheumatoid arthritis symptoms while also improving functional outcomes.¹⁰

Helping your client with creeping pain or tight muscles that decrease range of motion, and getting them up and active again may be top-of-mind, but first, Kapler Bishop suggests, it helps to understand your client’s bigger goal. “So often people become sedentary because something hurts—but that’s not really why they don’t exercise. In fact, they may want very much to stay active. That’s their goal,” she says.

So instead of preaching the importance of exercise, Kapler Bishop suggests talking about ways to retrain the muscles, so the client can get back to doing whatever brings them happiness and encourages healthy aging.

It also helps to ease a client’s pain by striking up a conversation seasoned with probing questions, Barnet advises. “You can work on the area in pain that brought a client to you, but if that’s not the area causing the pain, the problem will likely return,” she says. “So follow the ‘bread crumbs.’ Ask if your client spends hours sitting over a book in a chair that’s unfriendly to the neck. Do they have a sedentary job and now their hamstrings can’t activate because the muscles are too tight? Identify the root of the problem and consider how that issue spiraled into another obstacle.”

Remember Barnes’ client who fell in the shower? “I could have worked on his hip because that’s where he felt the most pain, but I wanted to help him regain his natural walk and stay active,” Barnes recalls. “I had to identify which muscle was injured when he first fell in the shower and which muscle needed help to slide back into place. By working backwards, I retrained my client’s muscles and got him walking without pain.”

Understanding Physiology

From a purely physiological standpoint, Jason-Miller explains how massage is particularly helpful as we age.

Massage breaks up muscle tension that’s creating distortion. “If my client has back pain, I not only need to loosen up the back, but I also have to stretch both hip flexors. By stretching and loosening tight flexors, the extensors get stronger. Now the client’s body begins to remember what the end range for healthy human expression feels like—and not the end range they’re used to feeling.”

You need to work opposing sides of the muscle to stimulate the flow of blood to the weaker side—thus giving that weaker muscle more ability to contract.

The rule of thumb, Jason-Miller says, is to use a slower, deeper myofascial release on the chronically tight side. On the stretch-weakened side, you want a more stimulative technique to get blood pumping. “So you’re working both sides of the body to create a more dynamic system—with muscles firing that weren’t firing before, and muscles that were over-firing now looser.” Jason-Miller sums up.

Barnet elaborates on why it’s so important to lengthen a chronically tight muscle. “Loosening a tight muscle helps your client regain range of motion. Now you set off a cascade of positive
reactions, as the muscles surrounding a joint begin to work more efficiently and safely."

Time Is on Everyone’s Side

When a client’s pain doesn’t clearly trace back to an isolated, distinct, clearly diagnosed injury or chronic disease, then a massage therapist needs to step back, consider the possibilities and help the client understand that a solution is probable, but it will likely take time—which means multiple massage appointments.

“People can develop all sorts of problems over a long period of time—and it takes time to unravel that tension and get the client back to a healthy baseline,” Jason-Miller explains.

For your more science-minded clients, you can always cite a few studies. For example, a metaanalysis of research on massage therapy for pain, conducted by Samueli Institute in 2016 and commissioned by the Massage Therapy Foundation with support from the American Massage Therapy Association, concluded that massage therapy is a viable recommendation for pain management.

The analysis reviewed 67 published studies on the impact of massage therapy on pain.¹¹ “You have to be patient,” Barnes says. “You want to coax and never force a muscle. So I tell a client right up front that I have no idea how many sessions will be needed to resolve their pain. But when I explain in layman’s terms how important it is to gently retrain a muscle to slide back into place, they get it. And when the client gives me the time we need, it’s amazing what we accomplish!”

References

1. Acl.gov. (2019). Profile of Older Americans | ACL Administration for Community Living. [online] Available at: https://acl.gov/aging-and-disability-in-america/dataand-research/profile-older-americans [Accessed 13 Feb. 2019].
2. IHRSA. (2019). The 2018 IHRSA Health Club Consumer Report. [online] Available at: https://www.ihrsa.org/publications/the-2018-ihrsa-health-club-consumerreport/ [Accessed 13 Feb. 2019].
3. World Health Organization. (2019). What is Healthy Ageing? [online] Available at: https://www.who.int/ageing/healthy-ageing/en/ [Accessed 13 Feb. 2019].
4. World Health Organization. (2019). What is Healthy Ageing? [online] Available at: https://www.who.int/ageing/healthy-ageing/en/ [Accessed 13 Feb. 2019].
5. Health + Wellness 2017. [online] The Hartman Group, Inc. Available at: http://store.hartman-group.com/health-wellness-2017/ [Accessed 13 Feb. 2019].
6. Acl.gov. (2019). Profile of Older Americans | ACL Administration for Community Living. [online] Available at: https://acl.gov/aging-and-disabilityin-america/data-and-research/profile-older-americans [Accessed 13 Feb. 2019].
7. National Institutes of Health (NIH). (2019). Physical activity program helps maintain mobility. [online] Available at: https://www.nih.gov/news-events/nih-research-matters/physical-activity-programhelps-maintain-mobility [Accessed 13 Feb. 2019].
8. Quinn, F., Hughes, C.M., Baxter, G.D. (2008). Reflexology in the management of low back pain: a pilot randomised controlled trial. Complement Ther Med. 16(1), 3-8.
9. Orthoinfo.aaos.org. (2019). Effects of Aging—Ortho- Info—AAOS. [online] Available at: https://orthoinfo.aaos.org/en/staying-healthy/effects-of-aging/ [Accessed 13 Feb. 2019].
10. Nelson L, Churilla J. Massage therapy for pain and function in patients with arthritis: a systematic review of randomized controlled trials. Am J Phys Med Rehabil 2017;96:665–72.
11. Crawford C, Boyd C, Paat C, et al. The impact of massage therapy on function in pain populations—A systematic review and meta-analysis of randomized controlled trials: Part I, patients experiencing pain in the general population. Pain Medicine, first published online: 10 May 2016. Summer 2019 43