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Musculoskeletal Disorders in Menopausal Women

Musculoskeletal Disorders in Menopausal Women

8 May 2024

Menopause causes a deficiency in oestrogen which can result in an increased risk of cardiovascular disease, cancer, cognitive decline, chronic obstructive pulmonary disease, diabetes, metabolic syndrome, depression, sleep disturbances, vasomotor symptoms, migraines and musculoskeletal disorders. The most common musculoskeletal disorders in menopausal women are osteoporosis, sarcopenia and osteoarthritis (Dijk et.al, 2015).

During the menopausal transition, there is an increase of muscle degeneration which can progress to sarcopenia. The decrease in oestrogen and testosterone leads to ‘neuromuscular junction insufficiency, myofiber loss, mitochondrial dysfunction’ (Buckinx and Aubertin-Leheudre, 2022) and reduced muscle regeneration.  These physiological changes increase fat deposits in muscle and increase the difficulty in achieving hypertrophy and maintaining muscle mass (Buckinx and Aubertin-Leheudre, 2022). The prevalence of osteoporosis in menopausal women is extremely high, as more than two million women have osteoporosis in England and Wales. After the menopause, prevalence rises with age from approximately 2% at 50 years to more than 25% at 80 years’ (Peto and Allaby, 2013) This is likely due to the osteoclastic resorption activity increases and the osteoblastic activity decreases, resulting in more bone being absorbed than being formed (Ji and Yu, 2015).

There is an abundance of research illustrating the impact menopause has on osteoporosis and sarcopenia, however there is limited evidence on the impact of osteoarthritis on musculoskeletal disorders (Watt, 2018). However, Richmond et. al found oestrogen receptors in articular cartilage which potentially demonstrates a relationship between oestrogen and articular cartilage health. Zhang et al. discovered that oestrogen has a positive impact on cartilage. These studies illustrate there is relationship between oestrogen and cartilage however unable to identify an explanation for the clinical significance (Hame and Alexander, 2013). Lower back pain (LBP) is also more common in postmenopausal women than men who are within the same age group. This is most likely due to oestrogen deficiency causing postmenopausal women to have increased prevalence of disc degeneration; therefore, resulting in increased risk of spondylolisthesis and facet joint osteoarthritis. Also due to higher rates of osteoporosis in postmenopausal women, osteoporosis related spine fracture, especially at thoracolumbar junction, can cause LBP (Wang, 2017).

There is a wealth of research showing the importance of menopausal women participating in exercise to reduce the risk of musculoskeletal disorders and prevent the worsening of symptoms (Grindler et. al 2015). For example, Mendoza et. al found that exercise reduces osteoarticular pain in postmenopausal women with fibromyalgia or breast cancer (Mendoza et. al, 2016). Research suggests a combination of high impact exercises and weight training is optimal to increase muscle mass and bone density, alongside medical intervention such as hormone replacement therapy and supplementation. Metcalfe et .al found the combination of adding calcium, hormone replacement therapy and weight bearing movement increases bone mass density and muscle strength for post- menopausal women. The weight bearing movements included stair climber or stepping alongside resistance training and balance exercises to reduce the risk of osteoporosis, sarcopenia and fractures (Metcalfe et. al, 2001). Hettchen et. al 2021 also demonstrated the positive impact exercise has on early postmenopausal women with osteopenia or osteoporosis and disorders related to menopausal transition. The exercise regime included a combination of high intensity training, jumping sequences and velocity resistance training (Hettchen et. al 2021).  The evidence illustrates the importance of physical activity for menopausal women, however more research is required to see the impact menopause has on other musculoskeletal disorders.

Reference List

 

Woman jogging outdoors in a teal top
Lower Back Pain and Pelvic Floor Dysfunction

Lower Back Pain and Pelvic Floor Dysfunction

3 April 2024

Lower back pain (LBP) is the most prevalent musculoskeletal injury, as approximately 80% of the population will experience LBP in their lifetime (Arab et. al 2010). Transverse abdominus activation is often prescribed for LBP however pelvic floor muscle (PFM) is not always incorporated into treatment. PFM aids in supporting the abdominopelvic organs and there is an abundance of research on the role of the PFM in urinary and fecal incontinence. Nevertheless, it is important to remember the PFM role in lumbar and pelvic stability and intra-abdominal pressure (Mohseni-Bandepi et. al 2011). Research illustrates that the combination of pelvic floor exercise alongside routine treatment can provide significant pain relief in LBP compared to routine treatment alone (Bi et. al, 2013), demonstrating the importance of PFM exercises.

The link between LBP and PFM helps to provide insight into the correlation between LBP and pelvic floor dysfunction (PFD). PFD is an umbrella term to describe weakness, poor endurance and hypertonicity of the PFM which can impact incontinence, prolapses and pelvic pain. Dufour et al. found that 95% of women with LBP had PFD, ‘71% of the participants had pelvic floor muscle tenderness, 66% had pelvic floor weakness and 41% were found to have a pelvic organ prolapse’(Dufour et. al 2018), further highlighting the importance of incorporating PFM in treatment. Arab et al. also examined PFD in women with and without LBP. The results show PFD in participants with LBP compared to those without. This is valuable for health care participants when assessment and treating LBP (Arab et. al 2010). It is also important to recognize PFD in pregnancy-related lower back pain (PLBP). Pool-Goudzwaard et. al discovered ‘52% of PLBP, significantly more than in the healthy control group’ (Pool-Goudzwaard et. al,2005) and promote addressing both LBP and PFD during pregnancy.

There are a variety of methods to help activate, strengthen and relax the pelvic floor in order to aid recovery in PFD.  Kegels or reverse Kegels are often prescribed to promote awareness and strengthen PFM (Torgenu et. Al 2021). Transverse abdominus contraction has also been shown to help activate and strengthen PFM. Sapsford et al. found ‘that abdominals contract in response to a pelvic floor contraction command and that the pelvic floor contracts in response to both a “hollowing” and “bracing” abdominal command’(Mohseni-Bandepi et. al 2011), therefore proving the PFM can be activated by engaging the abdominals. Hypopressive exercises (HE) have also shown to aid recovery from PFD. HEs lowers the intra-abdominal pressure which enables an involuntary contraction of the PFM and transverse abdominus. Navarro-Brazález et. al suggests the combination of HEs and pelvic floor muscle training improves PFM strength and quality of life for patients with PFD (Navarro-Brazález et. al 2020).

Reference List

 

  • Arab, A.M., Behbahani, R.B., Lorestani, L. and Azari, A. (2010). Assessment of pelvic floor muscle function in women with and without low back pain using transabdominal ultrasound. Manual Therapy, 15(3), pp.235–239. doi:https://doi.org/10.1016/j.math.2009.12.005.

  • Bi, X., Zhao, J., Zhao, L., Liu, Z., Zhang, J., Sun, D., Song, L. and Xia, Y. (2013). Pelvic floor muscle exercise for chronic low back pain. Journal of International Medical Research, 41(1), pp.146–152. doi:https://doi.org/10.1177/0300060513475383.

  • Dufour, S., Vandyken, B., Forget, M.-J. and Vandyken, C. (2018). Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study. Musculoskeletal Science and Practice, 34, pp.47–53. doi:https://doi.org/10.1016/j.msksp.2017.12.001.

  • Mohseni-Bandpei, M.A., Rahmani, N., Behtash, H. and Karimloo, M. (2011). The effect of pelvic floor muscle exercise on women with chronic non-specific low back pain. Journal of Bodywork and Movement Therapies, 15(1), pp.75–81. doi:https://doi.org/10.1016/j.jbmt.2009.12.001.

  • Navarro-Brazález, B., Prieto-Gómez, V., Prieto-Merino, D., Sánchez-Sánchez, B., McLean, L. and Torres-Lacomba, M. (2020). Effectiveness of Hypopressive Exercises in Women with Pelvic Floor Dysfunction: A Randomised Controlled Trial. Journal of Clinical Medicine, 9(4), p.1149. doi:https://doi.org/10.3390/jcm9041149.

  • Pool-Goudzwaard, A.L., Slieker ten Hove, M.C.P.H., Vierhout, M.E., Mulder, Paul.H., Pool, J.J.M., Snijders, C.J. and Stoeckart, R. (2005). Relations between pregnancy-related low back pain, pelvic floor activity and pelvic floor dysfunction. International Urogynecology Journal, [online] 16(6), pp.468–474. doi:https://doi.org/10.1007/s00192-005-1292-7.

  • Torgbenu, E.L., Aimakhu, C.O. and Morhe, E.K.S. (2020). Effect of Kegel Exercises on Pelvic Floor Muscle Disorders in Prenatal and Postnatal Women – A Literature Review. Current Women’s Health Reviews, 16. doi:https://doi.org/10.2174/1573404816999200930161059.

Woman performing a single-leg balance exercise indoors

Osteoporosis prevention and management

Osteoporosis prevention and management

8 February 2024

Osteoporosis is a common condition characterised by a reduction in bone density and quality, leading to an increased  risk of fractures. As per the Royal Orthopaedic Society, risk factors for developing Osteoporosis include; smoking, too much alcohol and low body weight. We also know the females, particularly post menopausal females, are at higher risk of being diagnosed.

Recent research has suggested that resistance training can be highly beneficial for individuals with osteoporosis (Zhang et. al 2022). (3)

Resistance training involves placing stress on bones, which stimulates bone remodelling and increases bone density. This can help counteract the bone loss associated with osteoporosis, making bones stronger and more resistant to fractures. Resistance training targets not only bones but also muscles. Strengthening muscles can improve balance, stability, and coordination, which are important for reducing the risk of falls and fractures, particularly in older adults with osteoporosis. Regular resistance training has numerous other health benefits, including improved cardiovascular health, better insulin sensitivity, and enhanced mood and well-being. These benefits contribute to overall better health and may indirectly help in managing osteoporosis.

The LIFTMOR trial 2017 (2) shows that targeting large multi joint strength exercises is an effective way of enhancing – or at least limiting a reduction in bone density. Through the use of 4 fundamental exercises; deadlifts, overhead presses, back squats and a chin up landing drill, positive results were shown.

The frequency of resistance training for individuals with osteoporosis can vary depending on factors such as your current fitness level, overall health, and goals. However, general recommendations suggest aiming for resistance training exercises at least 2-3 times per week with a day of rest between sessions to allow for muscle recovery. This frequency was also tested and shown to be efficacious and superior to previous programs for enhancing bone at clinically relevant sites, as well as stature and functional performance of relevance to falls in postmenopausal women with low to very low bone mass. (Watson et al 2017) (2)

Another important component in the management and prevention of Osteoporosis is nutrition (Garach et. al 2020). (1). The correct nutritional changes to your diet can support bone health, especially when combined with resistance training. Some key components to consider include:

  • Calcium: Adequate calcium intake is essential for maintaining bone health. Good dietary sources of calcium include dairy products (such as milk, yogurt, and cheese), leafy green vegetables (such as kale and broccoli), tofu, almonds, and fortified foods (such as fortified plant-based milk alternatives and breakfast cereals). Aim for the recommended daily intake of calcium, which varies depending on age and sex.
  • Vitamin D: Vitamin D helps the body absorb calcium and plays a crucial role in bone health. Sources of vitamin D include sunlight exposure, fatty fish (such as salmon and mackerel), fortified foods (such as fortified dairy products and cereals), and supplements. Consider getting your vitamin D levels tested and talk to your healthcare provider about supplementation if necessary.
  • Protein: Protein is important for maintaining muscle mass and supporting bone health. Include sources of lean protein in your diet, such as poultry, fish, beans, lentils, tofu, eggs, and dairy products. 
  • Magnesium: Magnesium is involved in bone formation and metabolism. Good dietary sources of magnesium include nuts, seeds, whole grains, leafy green vegetables, and dairy products. 
  • Vitamin K: Vitamin K plays a role in bone metabolism and may help reduce the risk of fractures. Include foods rich in vitamin K, such as leafy green vegetables (such as kale, spinach, and Swiss chard), broccoli, Brussels sprouts, and fermented foods in your diet. Limit Sodium and Caffeine: High sodium intake can increase calcium excretion in the urine, potentially weakening bones. Limit your intake of high-sodium processed foods and try to minimize added salt in your diet. Excessive caffeine intake may also negatively impact calcium absorption, so moderate your consumption of caffeinated beverages. 
  • Maintain a Healthy Weight: Being underweight can increase the risk of osteoporosis and fractures. Aim for a balanced diet that supports a healthy weight and includes a variety of nutrient-rich foods.

We are proud to be able to assist all of our patients at Opus who require assistance in the prevention or management of osteoporosis through a full MDT approach including our Sports Medicine physician – Dr Porter, physiotherapy team and nutritionist. Through our expertise we are able to implement the important points made above into the patient’s package of care.

Reference List

 

  • Muñoz-Garach, A., García-Fontana, B. and Muñoz-Torres, M. (2020). Nutrients and Dietary Patterns Related to Osteoporosis. Nutrients, [online] 12(7), p.1986. doi:https://doi.org/10.3390/nu12071986.
  • Sl, W., Bk, W., Lj, W., At, H., Sa, H. and Br, B. (2018). High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. [online] Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. Available at: https://pubmed.ncbi.nlm.nih.gov/28975661/.
  • Zhang, L., Zheng, Y.-L., Wang, R., Wang, X.-Q. and Zhang, H. (2022). Exercise for osteoporosis: A literature review of pathology and mechanism. Frontiers in Immunology, 13. doi:https://doi.org/10.3389/fimmu.2022.1005665.
Athlete performing a sprint drill against a wall outdoors