Category Archives: Flexibility

Are My Joint Issues Due to Being Active, Normal Aging, or Diabetes?

Sheri DHHS 30th climbing side viewLiving with diabetes often leads me to wonder if what I’m experiencing—particularly when it’s an irritated joint or an overuse injury—is a consequence of being a regularly physically active person, getting older, or having diabetes, or some combination of those. Which one of these is causing my joint issues? Is it possible to know? I will attempt to answer these questions based on my deeper dive into the published research.

Personally, I have managed to avoid most overuse injuries (such as joint tendinitis) related to physical activity by engaging in cross-training and doing different activities on varying days, and this strategy worked well for me for over 25 years. Of late, though, I have started experiencing chronic overuse injuries (or sometimes just short-term joint irritation) that appear to arise not from most of my usual activities, but more from unusual ones—such as hand-scrubbing my house to get it ready to sell (dominant shoulder joint irritation), tamping down my front yard with a hand compactor (alternate shoulder joint pain that lasted for several years and recurs occasionally), driving a car for several hours in traffic after not driving far often (ankle joint tendinitis of some sort that took months to fully resolve), and random aches and pains in joints that come and go on any given day and may only last a few days at most.

Yes, I’m getting older (aren’t we all?), having successfully passed the half-century mark. I’ve also been living with type 1 diabetes for nearly 50 years (diagnosed at age four in 1968). My A1Cs are in recommended ranges (usually near 6.0%) and have been good ever since I got my first blood glucose meter in 1986 (after going 18 years with nothing but urine testing). I still have blood glucose fluctuations while trying to manage food, exercise, stress, occasional lack of sleep, hormonal variations, illness, and other usual factors that impact my daily levels. So, are my own occasional joint issues the result of being an active person (exercising daily for decades), normal aging, or long-standing diabetes (despite being in relatively good control for the past 30+ years)?

Are overuse injuries more likely to occur due to diabetes or aging? Overuse injuries from participation in athletic endeavors (even just walking) are more common in people with diabetes, likely due to changes in joint structures when exposed to hyperglycemia over time (1). But aging also increases the incidence of overuse injuries when exercisers are older (2). For instance, in one study 70% of the injuries in older exercisers (over 60 years) were overuse injuries, but accounted for only 41% of injuries in younger adults (early 20s).

Is it due to inflammation related to aging or to diabetes? Aging lab rats have overuse activity changes to the structure of their tendons related to inflammation that may make them more prone to injury (3), but when it comes to humans, the research is unclear whether inflammation is involved (4). In one review (5), “prolonged systemic, low-grade inflammation and impaired insulin sensitivity act as a risk factor for a failed healing response after an acute tendon insult and predispose to the development of chronic overuse tendinopathies.” Perhaps, then, in people with diabetes, joint structures do not respond as well to or repair as quickly after activities (6).

Others have argued that low-level, systemic inflammation is not involved in changes to tendons that may lead to injury (4). People with diabetes have some structural joint changes that may or may not be related to diabetes duration or type, although poorer blood glucose management has been associated with higher levels of systemic inflammation (1). Fit, active adults with type 1 diabetes with good blood glucose control exhibit more inflammatory markers in response to exercise, but appear to recover normally (7). If someone has had “good” control for many years, does that lower the chance that their overuse injuries are diabetes-related? I’m quickly raising more questions than I can answer!

Other joint issues like frozen shoulder, carpal tunnel syndrome, and trigger finger are more common in people with diabetes, and structural changes to tendons may occur in people with diabetes (8). On the other hand, my non-diabetic, aging (mid-50s), reasonably active neighbor has had two frozen shoulders in recent years that clearly have nothing to do with diabetes or blood glucose management. I’ve also known people with diabetes who are active that develop a frozen shoulder, but others who get this condition are sedentary, suggesting that such joint issues are not consistently related to diabetes or habitual physical activity.

In short, if you are reading this in hopes of finding out whether joint pains and overuse injuries are more related to being active, aging, or diabetes, you are about to be sorely disappointed because I am unable to determine that based on available research. That said, it is likely that getting older (and not springing back as quickly) contributes to the rise in overuse injuries with aging, but that just means that everyone will have to find ways to be active that do not aggravate any existing issues. The best policy still is to vary your activities, try not to overdo or act like you’re still twenty, and rest appropriately and take time off when necessary to recover from injuries. Given we’re all aging and a significant number of us will be developing diabetes in our later years (if we don’t have it already), it is a topic ripe with possibility for future research.

                                                                                                                                                           

References cited:

  1. Abate M, Schiavone C, Salini V, Andia I: Management of limited joint mobility in diabetic patients. Diabetes Metab Syndr Obes 2013;6:197-207
  2. Kannus P, Niittymaki S, Jarvinen M, Lehto M: Sports injuries in elderly athletes: a three-year prospective, controlled study. Age Ageing 1989;18:263-270.
  3. Kietrys DM, Barr-Gillespie AE, Amin M, Wade CK, Popoff SN, Barbe MF: Aging contributes to inflammation in upper extremity tendons and declines in forelimb agility in a rat model of upper extremity overuse. PLoS One 2012;7:e46954. doi: 46910.41371/journal.pone.0046954.
  4. Kjaer M, Bayer ML, Eliasson P, Heinemeier KM: What is the impact of inflammation on the critical interplay between mechanical signaling and biochemical changes in tendon matrix? 1985) 2013;115:879-883. doi: 810.1152/japplphysiol.00120.02013.
  5. Del Buono A, Battery L, Denaro V, Maccauro G, Maffulli N: Tendinopathy and inflammation: some truths. Int J Immunopathol Pharmacol 2011;24:45-50.
  6. Battery L, Maffulli N: Inflammation in overuse tendon injuries. Sports Med Arthrosc 2011;19:213-217. doi: 210.1097/JSA.1090b1013e31820e31826a31892.
  7. West DJ, Campbell MD, Gonzalez JT, Walker M, Stevenson EJ, Ahmed FW, Wijaya S, Shaw JA, Weaver JU: The inflammation, vascular repair and injury responses to exercise in fit males with and without Type 1 diabetes: an observational study. Cardiovasc Diabetol 2015;14:71
  8. de Jonge S, Rozenberg R, Vieyra B, Stam HJ, Aanstoot HJ, Weinans H, van Schie HT, Praet SF: Achilles tendons in people with type 2 diabetes show mildly compromised structure: an ultrasound tissue characterisation study. Br J Sports Med 2015;49:995-999. doi: 910.1136/bjsports-2014-093696.
Advertisements

Do Balance and Flexibility Training to Stay Younger

Chelsea Brown (T1D) dancingMaintaining your balance is important during almost all physical activities, and your ability to balance may diminish as you age. Research has shown, however, that loss of strength in your hips, knees, and ankles has a lot to do with your diminishing ability to balance, which means that it can be enhanced with specific exercises to strengthen those muscles. While core exercises can help with balance, other muscles are critical as well and should be worked with balance exercises. Specifically, the most important muscles for good balance are the ones that lift your legs to the side, the ones that lift your toes, and the ones that keep you moving forward. The primary “abductor” that lifts your legs to the side is a gluteal (buttocks) muscle, the gluteus medius; the main toe lifter is the tibialis anterior, on the front of your shins; and the primary muscle for maintaining forward movement is the gastrocnemius in your calves.

It’s easy to lose your balance when you’re standing or walking. Your head, trunk, and arms constitute two-thirds of your whole body weight, but with every step you take, that weight is carried and supported mainly by the hip muscles of your stationary leg. If these muscles are weak, they will allow you to tilt to the side, and if you slip when you’re already tilted, you’ll likely fall down. You can prevent this from happening, though. Side leg raises are the best exercise to strengthen the abductor muscles of the upper thigh. Toe raises (listed as an additional balance exercise, below) can be done anytime, either sitting or standing, with one leg held out in front of you, to improve your toe-lifting ability. In addition, the calf raise will strengthen the toe flexor muscles that keep you moving forward. Try to balance on your toes during that exercise for optimal balance improvement.

Additional Balance Exercises

These exercises will help you improve your balance, so do them as often as you like. If you need to, hold on to or brace your hand against a table, chair, wall, or other sturdy object when you begin. As you progress, first use only one fingertip, and then try to do them without any support – as long as you have something sturdy nearby to hold on to should you become unsteady.

  • Toe raises: Standing with your hand on the back of a chair or against a wall, straighten one leg so that your foot is off the floor in front of you and flex your ankle to point your toes up at the ceiling. Hold this position for as long as you can; relax; and repeat several times before switching to the other leg.
  • Stork stands: Stand on one foot for a minute, and then switch to the other one. You can practice doing this exercise anytime you are standing.
  • Line walks: Take a step forward by positioning your heel in a straight line just in front of the toes of the opposite foot. As you take each additional step, the heel of your front foot and the toes of your back one should be barely or almost touching.
  • Sit/stand exercise: Practice standing up and sitting down without using your hands or arms for support or balance.

Flexibility Moves to Set You Free

Flexibility exercises in their simplest form stretch and elongate muscles. Good flexibility is as important a part of fitness as stamina. Muscles must be strong, but they also have to be long (as opposed to contracted) to work optimally. In fact, stretching can do a lot more for your figure than aerobic exercise, because flexibility work results in a supple, toned, and streamlined body. Moreover, the benefits of greater flexibility may go beyond the physical to include stress reduction and promotion of a greater sense of well-being. Exercise disciplines that incorporate stretching with breath control and meditation include yoga, tai chi, and Pilates.

In creating your flexibility workouts and completing them a minimum of two to three times a week, it’s again important to include stretches for all of the major muscle groups in your body. You will regain some of your flexibility by stretching regularly, although your gains may be ultimately limited by your genetic makeup, diabetes control, arthritis, and other variables. Nonetheless, my own research found that all people with type 2 diabetes experience flexibility gains by doing just eight weeks of stretching of their major upper- and lower-body muscles thrice weekly in conjunction with a moderate resistance training program.

Flexibility Training “Do’s” and “Don’ts”

Do:

  • Use a full range of motion around joints when stretching.
  • Complete at least one stretch per major muscle group, optimally holding each stretch for 15 to 30 seconds.
  • Stretch all parts of your body two to three days per week.
  • Complete equal stretching exercises on both sides of your body or a joint.
  • Breathe deeply during all stretches to relax your muscles more.

Don’t:

  • Bounce during stretches, as doing so can cause muscle tears and joint injuries.
  • Forget to stretch opposing muscle groups equally (e.g., quads and hamstrings).
  • Stretch to the point of causing sharp pain or intense discomfort.
  • Continue with a stretch if you feel a sharp or immediate pain in any joint or muscle.
  • Hold your breath or strain while stretching.

To get the maximum benefit, perform each stretch slowly. Doing the exercises correctly, with good form, is much more important than doing them quickly. To have any lasting effect on the muscle being stretched, you need to hold the stretch for at least 10 seconds to start. The more regularly you stretch, the better you become at judging how far to take your body. Aim to increase the duration of your stretches, so that you are eventually able to hold them for up to 30 seconds, the point at which muscles optimally start to lengthen. Also, be sure to stretch both sides of your body equally, as well as opposing muscles on both sides of a joint (such as biceps and triceps on the upper arm).