Effects of Ageing on Joints
Original Editor - Wendy Walker
- 1 Introduction
- 2 Age-related Changes in Connective Tissue
- 3 Age-related Changes in Bone
- 4 Age-related Changes in Cartilage
- 5 Range of Movement
- 6 Physiotherapy
- 7 References
Alterations in circulating humoral factors (hormones, cytokines, growth factors) that occur in ageing, coupled with built in cellular senescence (loss of a cell's power of division and growth) exaggerated by a slower turnover of many connective tissue cell populations, and the age-associated alterations in matrix molecule cross-linking, predispose the elderly to altered connective tissue biology. This decreased proliferation and altered control of apoptosis (programmed cell death) causes a decrease in effective maintenance of tissue homeostasis.
- Increased stiffness
- Decreased strength
- Reduction in water content
As you age, joint movement becomes stiffer and less flexible because the amount of lubricating fluid inside your joints decreases and the cartilage becomes thinner. Ligaments also tend to shorten and lose some flexibility, making joints feel stiff.
Age in the cartilage is likely due to ageing changes in cells and tissues that make the joint more susceptible to damage and less able to maintain homeostasis ie an imbalance exists between catabolic and anabolic activity driven by local production of inflammatory mediators in the cartilage and surrounding joint tissues. There is a close relationship between chondrocyte activity and local articular environment changes due to cell senescence, followed by secretion of inflammatory mediators. The senescent secretory phenotype likely contributes to this imbalance through the increased production of cytokines and MMPs (matrix metalloproteinases) and a reduced response to growth factors. Oxidative stress appears also to play an important role in the degradation of cartilage seen in ageing with excessive ROS (reactive oxygen species ) affecting cell function.
Synovial fluid lubricates your joints for smooth movement. Healthy joints contains high amounts of high molar mass hyaluronic acid (HA) molecules in the synovial fluid giving it the required viscosity for its function as lubricant solution, which naturally cushion your joints and other tissues. With age, the size of the hyaluronic acid molecules in your joints decreases inhibiting its ability to work as effectively in support cushioning and lubrication.The video below gives an insight of the role HA plays in the joints health. Due to cellular senescence HA degrades.
Collagen is part of your connective tissue, and is found in your cartilage, ligaments, tendons and bones as well as your skin. Collagen fibers keep your skeletal system flexible, but collagen levels in the body start to decline after about age 25. These declines can cause ligaments tendons bones and cartilage to become less flexible and more brittle over time.
Age-related changes in collagen including senescence-related secretory phenotypes, chondrocytes' low reactivity to growth factors, mitochondrial dysfunction and oxidative stress, and abnormal accumulation of advanced glycation end products all lead to this altered structure and decreased functional ability in collagen in eg ligaments and tendons become stiffer and brittle. The image is of a collagen triple helix
Range of Movement
Joint range of movement (ROM) decreases with increasing age; passive and active ROM both decrease, but often within a single joint the active ROM reduces more than the passive ROM.
Reduction in ROM is not uniform, and different joints show different degrees of restricted movement, as well as different patterns of directional limitations.
Specific Joint ROM Changes
Cervical spine - extension and side flexion show the greatest reduction in ROM.
Thoracic and lumbar spine - extension is the most limited movement in older adults and rotation shows little or no age-dependent decline.
Hip - extension ROM has been shown to reduce by 20% when comparing 25 to 39 year olds to 60 to 74 year olds.
Ankle - dorsiflexion ROM is reduced with age.
Upper limb: there is less influence of age on joint ROM (compared to spine and lower limb).
The shoulder complex shows the greatest changes in the upper limb, whereas no age-associated decline in ROM of the elbow or wrist have been noted (in the absence of disease).
Exercise can prevent many age-related changes to muscles, bones and joints – and reverse these changes as well. It’s never too late to start living an active lifestyle and enjoying the benefits.
Research shows that:
Exercise can help slow the rate of bone loss and make bones stronger.
Older people can increase muscle mass and strength through muscle-strengthening activities.
Physical activity in later life may delay the progression of osteoporosis as it slows down the rate at which bone mineral density is reduced.
Weight-bearing exercise, such as walking or weight training, is the best type of exercise for maintenance of bone mass. There is a suggestion that twisting or rotational movements, where the muscle attachments pull on the bone, are also beneficial.
Older people who participate in hydrotherapy (which is not weight bearing) still experience increases in bone and muscle mass compared to sedentary older people.
Stretching also is excellent to help maintain joint flexibility.
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