02 February 2018
Women often don’t realise that musculoskeletal issues in the menopause are extremely common. They can affect a woman’s balance, core stability, reflexes, flexibility and cause discomfort but what can be done to ease the pain and can you help yourself as you grow older?
Professor Cathy Speed, Consultant in Rheumatology, Sport and Exercise medicine at Progress, The Cambridge Centre for Health and Performance, tells us more about why this is and how best to deal with it.
Some forms of arthritis appear at the menopause due to changes in hormones and joint muscle pains are extremely common at this time, and can be severe. Soft tissue injuries such as Achilles, plantar fasciitis and shoulder pain are also common and often need intensive treatment. Fatigue and mood swings are an added burden, but exercise can help with all this.
Recovery from sport/training takes longer at this time of life and physical training needs to be adapted to account for increased bone loss and changes in muscle function, as well as increased susceptibility to injury. Strength training, balance work and weight bearing exercises are all very important. The amount of bone lost depends on genetics, physical activity, nutrition and other diseases that may be present.
However, reducing some of the negative effects of the menopause can be addressed even from an early age, with a holistic approach to health and exercise. This allows development and maintenance of bone health and muscle strength and balance, all of which decline as we get older.
The early years
Women generally have more lax joints and soft tissues and poorer balance and control which means they are more susceptible to ankle sprains, Achilles injuries etc – this can be true lifelong, but especially up until 30 years of age. The risk can be reduced by preventative training, peak bone mass is achieved mostly by the age of 20, so building bone through activities that involve running, jumping and building muscle are important during these years. Calcium and vitamins dip in these years too so it is important to maintain a healthy diet.
Reduced peak bone mass can be caused by inactivity, illness, poor diet, genetics, delayed menarche (eg in intensively training athletes/gymnasts). Whilst exercise is generally good, some very talented sporting children may also end up doing too much – as everyone wants them in their team! Children's bodies need some rest time to recover, adapt and grow. Growing pains are not uncommon but beware of low levels of vitamin D and other possible causes.
Pre-menopausal women (over 20 years old)
This tends to be a busy time for women with hectic lives, stressful work and the responsibilities of children. However, physical activity should still be undertaken regularly to maintain bone and muscle mass. Strength training three times a week and daily load bearing physical activity is ideal - equivalent to at least an hour of brisk walking a day, so include physical activity in your daily routine. Walk to and from work if you can, be active in breaks and lunchtime and include physical activity in your social life. Make friends though activities you enjoy.
Too intensive training and poor nutrition can lead to menstrual dysfunction, weight loss and bone loss as may be seen with endurance athletes. It is important to strike a balance. In pregnancy be sure to maintain exercise, but take note of the guidelines and ensure good nutrition, especially calcium intake. Joints remain lax through and after breastfeeding – so there is a higher injury risk at this time. Pregnancy, lifting and carrying small children also increases the incidence of back and sacroiliac pain. Preventative core work such as in pilates, yoga’s focus on strength, flexibility and breathing, as well as the Alexander technique, for addressing the pain of postural habits, can all help. But this needs to be in conjunction with managing diet and weight - no amount of exercise will compensate for a bad diet.
The fabulous 40s and beyond
At this time arthritis from injuries earlier in life or other causes can begin to appear. In their 40s, many women are trying to deal with lack of fitness and weight gain after neglecting themselves whilst raising young children and working etc. The later fitness and weight is addressed, the harder it becomes. It is more difficult to build muscle, regain balance, and get used to intense exercise, sweating and high heart rates. Some want to return to doing sports they used to be competitive in - great but get fit first!
'Masters' sports are the fastest growing age group in terms of participation and competition so there are still plenty of opportunities to channel competitive spirits during and after the menopause. Many women turn to HIIT (High Intensity Interval Training) and bootcamps which are great, but you need to be fit enough to do it without injury. Many go to pilates and find it ineffective - which may be because they are not being taught correctly - and some find it boring. If so, find other ways of working on your core strength, flexibility and mobility through a core programme or fast types of yoga like Ashtanga.
The first symptoms of the menopause can be fatigue and aches and pains. It is always important to seek advice on these symptoms, as there are many other causes. When other conditions have been excluded then focusing on holistic approaches is important in the first instance.
For many, going through the menopause isn’t easy but you can help yourself by maintaining a healthy diet and finding the right exercise regime to help you through it. Other treatments for symptoms can be pursued through your GP or a specialist.
About the consultant
Professor Speed is a Consultant in Rheumatology, Sport & Exercise Medicine. She is Senior Physician at the English Institute of Sport and Chief Medical Office of GB Badminton, Chief Medical officer to Middlesex County Cricket and the Academy at the Lords Ground, London, UK. She is Professor of Sports Medicine at the University of St Mark and St John, Plymouth.
She is Clinical Director of the Centre for Human Performance, Cambridge and is Lead Physician at the Fortius Clinic London. She is an Appraiser for the Faculty of Sport & Exercise Medicine, UK.
She has a very active role in teaching, research and education in the fields of Sport and Exercise Medicine and Rheumatology. She has been Senior Research Associate and Isaac Newton Teaching Fellow in the Department of Medicine, University of Cambridge.
Roles have included Physician at a number of Olympic and Commonwealth Games and Chief Medical Officer to Team GB Holding Camp for the Beijing Olympic Games.
Her clinical interests include bone health in young people, soft tissue injuries, arthritis and the use of exercise in chronic diseases. Her clinical practice blends her expertise in rheumatology and sports medicine and she applies a holistic philosophy in the management of all of her patients, young and old.
She not only manages elite Team GB athletes but patients of all ages with arthritis and complex pain, bone and soft tissue conditions.
To find out more contact: Progress - The Cambridge Centre for Health and Performance, Conqueror House, Vision Park, Chivers Way, Histon, Cambridge, CB24 9ZR
T: 01223 200580 E: firstname.lastname@example.org