Strategies for Aging Well   (2009)

The Familiar Advice

Anyone who has been paying attention knows the modern script for optimizing one's health and longevity, which includes specific recommendations for diet, exercise, and alcohol and tobacco use.  Tending to one's levels of stress, intellectual stimulation, and social connection are also getting more emphasis in maintaining wellbeing. Blending adherence to the latest advice with a bit of good luck will likely increase the length of your quality years.

However following the good advice and having better "numbers" doesn't necessarily result in being comfortable in your body or moving with ease and confidence during those extended quality years. From my vantage point of age 58, I can see that both comfort and confidence become more elusive with age and that they require additional, secondary strategies to retain them. 

For my aging-well program, my secondary strategies have 4 aspects. The first aspect involves placing a heavy emphasis on strength and flexibility. By hyping-up one's strength and flexibility, one should be able to access the additional potential gained by tending to the modern guidelines for optimal health. My second level, after strength and flexibility, involves focusing on more mechanical details like posture, gaze, balance, and vision correction--all elements that help one move vigorously, confidently, and comfortably. Next, is the use of massage therapy to optimize one's flexibility, capability, and comfort. And my final aspect is the philosophical or mindset level where "No" is questioned and play is cultivated to support one's sense of wellbeing and confidence.

I:  Strength & Flexibility Are Key

Increase Your Strength

Why

As I look at my aging process and that of those around me, it seems that building and maintaining strength is the single most important secondary strategy one can implement to age with a sense of physical wellbeing. Good muscle strength makes one sturdier and less injury prone, makes one capable of a wider range of activities, helps one's endurance, and facilitates weight management.

A significant portion of balance issues in the elderly have to do with a lack of strength, so if you keep your strength up your balance will be better and you are less likely to fall. If you fall and you are strong, you are less likely to get hurt. I fell hundreds of times in my 40's while learning to do inverted poises like headstands in yoga classes and when struggling with ill-suited cleats on my new road bike. "Wham!" "Bang!" over and over again to the floor and the pavement and yet I rarely hurt myself beyond a bruise.

I have suffered 2 serious injuries from falling in the last 10 years: a head injury from a bike collision and a shoulder dislocation from slipping on a steep hill while walking. My overall strength is what probably meant that the worst injury from my bike collision was to my brain as my shoulder and arm healed well and I didn't break any bones. And we are guessing that it was my better-than-average strength that limited the damage associated with my shoulder dislocation and that contributed to my relatively rapid recovery.

Aside from blunting issues related to falling, being strong helps your entire body. Strong muscles around the ankle, knee, and shoulder joints protects them from injury. Strong back and abdominal muscles protect your back from injury and spares your discs from excessive wear. And having generally good strength makes you sturdier and more resilient from unexpected bumps, stumbles, slams, and twists.

Maintaining your general strength will make you more successful with new and old activities and therefore you are more likely to do them, which helps you keep active and retain your strength. And getting that positive feedback that comes with being successful with activities enhances one's overall sense of wellbeing.

Being strong means that you have good muscle mass and the more muscle you have, the more calories you burn with a given activity. That in turn lets you eat more than the less active person and not gain weight.

Being strong, especially for women, can help one feel less vulnerable in general. Feeling increasingly defeated by the effort involved in pushing open doors, carrying groceries, and moving a chair erodes one's sense of wellbeing. As I've watched my mother age, I've seen how "heavy" is steadily been redefined: now in her 90's, she is unhappily acutely sensitive to the relative weights of coffee cups.

How

How you build and maintain strength doesn't matter much, the important thing is to do it and to keep it up.  And there are of course endless ways to develop and maintain your strength. Target activities that are readily accessible so you'll do them regularly and make sure that as many muscle groups are strengthened as possible.

The bulky power muscles, like those in your arms and legs, respond well to doing repetitions. The smaller postural muscles, like those in your torso and neck, do their work by being in isometric contraction and so are best strengthened isometrically. That means that abdominal strengthening exercises that are held rather than done as sets of rep's are more effective for strengthening the muscles in the way they are used.

I believe that having a large buffet of exercises and exercise modes to choose from is the best strategy for building strength. Resistance training using weights, your body weight, or stretchy bands is very efficient but tends to be boring. Cardiovascular workouts, like running and cycling, efficiently strengthen a relatively small number of muscles but aren't complete enough strength-building workouts to leave it at that. Sports are a great for strengthening because they are entertaining, but again leave out important muscles and may strengthen the body asymmetrically, as is the case with golf and tennis. So, mixing it up is the way to go to keep your training interesting and to challenge the largest number of muscles.

Demanding careers and then aging tend to narrow our activities so that the utilization of our muscles isn't as  balanced as when we were younger. The expression "If you don't use it, you lose it" applies to your entire body.

If you resort to throwing your shoulder into the effort of opening heavy doors, then your arms get weaker and weaker. If you use an electric canner opener instead of a manual one, then using the manual one gets harder. If jumping drops out of your repertoire of movements, the unpleasant sensations the next time you jump will convince you not to do it again. So, as you think about revitalizing your strength-building program, think more broadly than you ever have before and weave a variety of strengthening activities into your lifestyle. Be creative about adding activities like jumping rope, trying out a neighborhood Par Fitness Course, or going for a swim at your local public pool a few times a year to challenge neglected muscles.

 Surprisingly, a muscle only strengthens in the specific range it is exercised, so doing 100 push-ups halfway doesn't strengthen the muscle fibers needed in the second half of the motion. Likewise, cycling on a mountain bike strengthens a slightly different mix of muscle fibers than does pedaling a road bike. Especially as we age, it's crucial to use as many muscles as possible through the fullest range of motion as possible to maintain optimal strength.

Even knowing about this range specificity issue in conditioning muscle fibers, I continue to be surprised at just how true it is and how it involves all parts of the body. When we did a particularly long Via Ferrata hike in Italy that involved a lot of rock climbing, we were startled that even our toes were pooped at the end of the day. Earlier this year I was taken aback that systematic strengthening of my tongue and cheek muscles was enough to reduce my snoring and breathing disruptions when sleeping. And both men and women benefit from the Kegel-type muscles contractions of the perineal area. From head to toe, we need to tone and strengthening our muscles so be aggressive about introducing new movements into your routine to make new demands on your muscles as you just never know when you'll need one of those neglected muscle groups.

Flexibility

Why & How

For me, maintaining general strength is the most important secondary strategy in aging well and balancing one's strength with flexibility is a close second.  Being able to swivel your neck makes you a safer driver; being able to squat is invaluable as a traveler; good back flexibility makes sleeping easier; and being able to reach high makes that upper cupboard space useful. (And one man I know found that his golf game improved so much from doing yoga that his greens partners begged him to share his new secret.)

Many older people can't raise their arms higher than is needed to comb their hair so keeping reaching for the plates high in the cupboard and the hat on the closet shelf. Squat, bend, twist, wiggle--do all of those things that kids do without thinking about it until you can too.

Yoga, Pilates, and Tai Chi are just some of the systems available to invite you to bend and reach in ways you might not think to do so. These programs can also help you learn which parts of your body need special attention. I have a short list of muscles that either need to be stretched daily or need to at least be evaluated daily so that their shortening doesn't create pain.

Amazingly, sitting or standing can create the same pattern of tightness in hamstring muscles (back of the thigh) as occurs in runners, so don't think that exercise or strengthening is the only risk factor for reduced flexibility.

Like strength work, I think most stretching work can be done on one's own, but the input of a trained eye can be helpful. Especially with flexibility work, it's good to occasionally have someone else evaluate your symmetry and technic. We all have side to side imbalances and we tend to reinforce those imbalances when we stretch. Having another person scrutinizing the details of your stretches can entirely change your experience of them because your body will naturally try to avoid stretching the tight places.

Medications

It's rarely discussed, but medications can affect one's flexibility. Estrogen in the form of hormone replacement therapy can increase or restore much of some women's lost flexibility. And in some women, estrogen replacement can reduce the aching muscles and joints that sometimes accompanies menopause. In contrast, hormone replacement in men in the form of testosterone usually decreases flexibility. Vitamin D supplementation may reduce aches and pains in those with low circulating levels of the substance. Ciprofloxacin, an antibiotic, can increase the risk of Achilles tendon rupture. Those are the medications that I'm familiar with than can affect muscle flexibility, comfort, and vulnerability though I'm sure the list is much longer.

No Pain, No Gain?

I generally disapprove of the "No pain, no gain" mindset and yet how true it is all depends upon an individual's definition of pain. I think some people over read unfamiliar sensations and label them all as pain and then inappropriately avoid experiencing the sensations. At the other extreme, some athletes believe in pressing through pain until the brain stops registering it as information and then deal with the damage done at a later time. And just to make it more confusing, if one doesn't feel any sensation from a training activity then it is likely to be labeled as useless and not repeated.

My intense experience as a yoga practitioner exposed me to a previously unimagined range of sensations, a few that rapidly leapt past pain to feel like near-death experiences. Curiously, my worst yoga-related injuries were repetitive-use or over-use injuries and not caused by these highly sensational, one-time events.

Through the array of new sensations that the practice of yoga generated in me, I feel like I developed a refined sense about the boundary between sensation and pain in my body. I know that boundary well, whether I arrive at the boundary through my own activities or those induced by a medical/dental procedure. And I use that knowledge of my own boundary between pain and sensation to guide me in work-outs and in more challenging situations like self-directed rehabilitation from a dislocated shoulder. I push to reap the gains of an activity but I listen carefully to the feedback from my body so as not to push so much as to cause damage.

Everyone benefits from developing their own refined sense of the boundary between pain and sensation to manage their strength and flexibility work. That sensitivity, that awareness as to where to draw the line, is usually developed by trial and error (and with the help of a few injuries along the way) though sports professionals can provide helpful of guidance.

Knowing when to push and when not to is critical for effective strength and CV building as they both require moving beyond the comfort zone to train, to condition. If the workout doesn't cause some amount of distress, then it likely isn't accomplishing much. The same is true for flexibility work. Increasing one's flexibility usually causes some distress, OK--maybe agony, but it shouldn't be damaging. One has to learn how to play one's own edge, to push the strength/flexibility edge out beyond the comfort zone but stop before crossing the line into the injury zone.

Pain is a good teacher but it is for you to elegantly manage the lessons learned and you do that by developing a refined sense about your boundary between pain and sensation.

II:  Putting It Into Motion:  Posture, Gaze, Balance, Vision & Walking Technics

My "Ah-Ha" Moment with Hiking

It was when we took a break from our bikes in 2006 and started hiking in the Alps that I decided that hiking, especially with a little scrambling on rocks mixed in, was the best sport for maintaining my body-confidence as I aged. The uneven terrain; the irregular pattern of stepping up, over, or down; the variation in surface textures; and the stream of potential obstacles puts one's strength and flexibility work to use in a big way and it was fun. Hiking on challenging terrain underscored the importance of the next level of skills for maintaining body comfort and confidence after strength and flexibility, which includes elements like posture, balance, and walking technic.

Posture

I'm an avid believer in the importance of good posture both in sitting and standing even though I struggle daily with countering my bad postural habits. But it's a battle worth fighting even if it isn't decisively won and good posture pays big dividends by sustaining your endurance when hiking or walking.

To me, good posture means aligning your bones so you have optimal biomechanics throughout your body and minimize the unnecessary stresses on the joints and soft tissues. Good posture can extend the comfortable lifetime of your back and other joints by lining up the forces so that they go through your body in the most advantageous and sparing way. Good posture may help prevent developing sometimes-painful compensating structures like bone spurs. And good posture in the daytime may help you sleep better because you should have fewer overworked muscles in vulnerable areas like your neck and low back.

Checking his alignment on a corner.

Once or twice a day, check your static posture by backing up to a protruding wall corner, like in a doorway or a post. Let your heels stay out from the wall about 2" and rest your buttocks on either side of the corner. Your upper back should touch the corner though not your low back. Now keep your gaze on the horizon and your chin level to the floor as you invite your head to drift back to touch the corner too. For many people, the head will be 2-4" or more from the wall, though you'll need a helper to judge that. Don't force your head back, but invite it back a little farther as your flexibility work progresses.

Explore your posture in a dynamic position, as when walking, by ratcheting your gaze up off the ground and onto the horizon. Notice if your breastbone lifted along the way. If not, use your mind to give it a nudge up and out. Roll your shoulders open so you are broader across the chest and anchor that position by drawing your shoulder blades down your back. Try lifting your spine up off of your pelvis so the pelvis is more free to roll with each step. Let your arms hang comfortably and rather than swing them forward, then think about emphasizing a push-back with them.

 Flexibility classes or stretching exercises are great ways to keep your posture options open. Massage can also be a huge help in releasing shortened muscles so you have more positions available in selecting a healthier and more sustainable posture.

Disciplining Your Gaze

If you haven't already, it's time to break that habit of looking at your feet when you walk. Looking at your feet is terrible for your posture and puts excess strain on your neck and back, as well as other areas less likely to complain. Looking at your feet when you walk may increase your confidence in the moment but it's a loser as a long term strategy.

Even on rough surfaces you don't need to look at your feet.

People usually look at their feet because they are afraid of tripping and falling but looking at your feet actually increases the likelihood that you'll fall forward. We tend to go where we look and if you look at the ground right in front of you, you are likely to end up there. If you lift your gaze up, you are more likely to stay upright.

When walking, practice moving your gaze onto the horizon. Switch from looking at your feet as a habit to it being a back-up strategy in difficult situations. Instead, look ahead, scanning the sidewalk, road, or path for obstacles and then trust your mind and feet to remember what you saw. You may need to discipline your mind to be more attentive, to see farther ahead, and remember longer, but you can do it.  If you find yourself stumbling or anxious when using this horizon-oriented gaze, gain some extra confidence for the transition by using a hand railing, a pair of walking sticks, or the arm of a friend.

Reserve looking at your feet for when it matters.

My husband and I amazed ourselves and enhanced our self-confidence by hiking for a few minutes at a time with our eyes closed. We first tried it on a steep, uphill, rocky trail, which was a bit ambitious but the other person served as helper and held the walker's arm and gave verbal instructions as to variations in the surfaces. We also have played a similar game without arm support and only verbal guidance on top of rock walls and on outdoor stairways. It's absolutely amazing how well one can do without seeing--much of walking has to do with confidence and closing your eyes now and then may actually improve your confidence as it did ours. 

Balance

Tuning-up one's balance skills is an easy way to increase one's confidence with their moving body. I periodically find a line, either painted or a crack in pavers, and walk 10 or 20 paces with my eyes closed. A relatively smooth, level surface away from traffic is a sensible choice. I've also done this on narrow foot bridges with my hands softly held out from my sides so that if I get close to the railing I'll feel it on my fingertips before slamming into it with my body.

Walking on the tops of low curbs, like on a balance beam, is another way to challenge one's balance in an entertaining way. Start by looking a bit forward of your feet and moving slowly, then gradually lift your gaze and pick-up speed. Some outdoor Parcourse fitness courses will have a low log or beam on which to refine your balance skills. I'm amazed at how much my balance improves in 10 minutes of play on a beam.

Another easy way to work with your balance is to practice standing on 1 foot. First work with your eyes open, then give it a whirl with your eyes closed. You can slip this exercise into your day while waiting for a "Walk" light to turn green. These exercises work on your proprioception--the neurological side of balance--as well as strengthens those little muscles that help support the ankle.

Vision Correction

I am a big fan of progressive lenses for improving my confidence in navigating the obstacles of the world and it's especially true when hiking. I need major vision correction for reading and about half as much for distance vision. I switched to progressives in my early 40's as my bifocal lenses left me in a panic when hopping on an escalator as at one point neither of the 2 bifocal lens was the proper correction for placing my feet on the moving steps. It was a terrible feeling to suddenly be afraid of riding escalators. Progressives solved the problem as they gave me a continuous range of correction even as my eyes deteriorated on the way to a new pair of lenses.

Years ago I was told that adjusting to progressives gets harder as you age, which spurred me to try them sooner rather than later. Don't give up easily if you have trouble getting used to them. I've worn progressives for years and even changing brands can sometimes require a couple of weeks adjustment time, but it's worth it. I appreciate that as my need for increased correction creeps in, that they give me a bigger working range than bi- or tri-focals and keep my confidence high when my body is in motion.

Walking Technic

If you find yourself stumbling a lot, check-out your walking technic. Make sure you are heel striking when on level terrain, rolling through the length of your foot, and then pushing off with your toes. Insist that your foot action be active and resist the temptation of drifting towards the foot-shuffling so common in the elderly.

If attending to your foot action doesn't reduce your stumbling, perhaps it's time to put a touch more muscle into your walk by bending your knees a tad more so that your feet lift a little higher off the ground. Also practice lifting your toes ever so slightly when you walk. The combination of lifting your toes a little higher and lifting your feet a little more will dramatically reduce the number of obstacles that you scuff when walking on rough surfaces and reduce the risk of tripping. If your feet and legs resist the effort, get their attention by going for a walk in a pair of hiking or snow boots that demand greater clearance.

When walking on gritty or gravely paths, feel and listen for how much rock is spitting out from under your shoes. In my experience, a minimum amount of surface disruption is a sign of efficient and secure walking. When I start kicking up the surface, I am usually loosing traction. On level trails disturbing the path surface is unnecessarily fatiguing; on steep terrain the loss of traction could take you down.

When walking, keep your weight forward on your feet. If you drift back on your heels you are more likely to fall backwards. Let your walking have the slightest 'falling forward' quality while keeping your gaze and breastbone lifted. Break into a bit of a run for even a few seconds to remind your body of this controlled, falling-forward position. When walking on less-stable surfaces, retain this walking posture and avoid shifting into the comma-shaped position so common in the elderly and too-cool adolescents. 

Putting Some Spring Back into Your Step

Reviving the Spring

The steep Alpine descents when hiking underscored for me how little spring I had in my legs, especially around my knees. My muscles were flexible and well stretched, but they lacked the spring-like quality that they once had and that I could see many others on the trail still enjoyed.

The lack of springiness was down right dangerous for me. When I placed my foot on a steep descent, my leg muscles felt like they locked into a fixed position, and then if a rock or grit caused my foot to slide in the slightest, I'd lose my balance. My leg muscles seemed to lack the shock-absorbing and fine-tuning ability that they once had. Using a telescoping trekking pole in front of me was a huge help as it gave me a way to catch myself and restore my balance on challenging downhills.

I assumed that this diminished resilience in my legs was yet another 'age-related disability' creeping in, perhaps accentuated by hormonal changes which can also affect muscles and joints. My search for online guidance was fruitless until catching the end of a mountain racing event on Italian TV put a different spin on my inquiry. "Mountain racing technique" and not "age-related stiffness" were the key words that revealed the secrets I longed to know. It instantly became clear that it was my carefully cultivated running style of old--that of meticulously heel striking to protect my vulnerable knees--that was killing my legs (and perhaps always had) when I hiked downhill.

The mountain racing website sections that discussed the hazards and pitfalls of racing down steep slopes with heel striking precisely described the aches, pains, and patterns of soreness that I had had since we started hiking the high mountains in 2006. I wasn't running but the extreme steepness of the grades we were on was sufficient to trigger exactly the same over-use symptoms in my less-trained body as the elite trail runners experienced. I was thrilled to discover that instead of a marker for becoming decrepit, my pains were caused by using inappropriate technique. I abhor being wrong but I'd so much rather be wrong and 'fixable' than creaky and unstable.

Unfortunately this break-through in understanding came after we left the Dolomites, the ultimate outdoor laboratory for developing my downhill technic, but I immediately began training for 2010. And we still had a week of hiking in Austria ahead of us, though the slopes wouldn't be as consistently steep and rocky as in the Dolomites.

Before discovering that my foot placement technic was what was killing me, I'd begun a campaign that I had hoped would convince my muscles to retrieve a bit of their lost resiliency. This new campaign still looked sound, it only needed a slight modification after reading about mountain running.

My plan to add a little running motion on the trails when hiking still made sense, with the addition of focusing on mid-sole/ball-of-the-foot striking instead of heel striking. The revival of a little rope jumping also seemed like it was still a good plan as it would condition my lower leg muscles to taking more of this ball-of-the-foot impact that was in my future. And the resumption of training by descending stairs 2-at-a-time also looked appropriate because, like jumping rope, the activity would continue to habituate my legs to absorbing the shock of harsh descents without heel contact.

I was beginning to understand that only when walking on level surfaces is the right foot technic clear, and that still seems to be the heel-strike and roll-through-the-foot. (Back home in the winter, my sports massage therapist disagreed. In his opinion, heel striking had nothing to recommend it at anytime. And so began another journey....)  On uphills or downhills, especially if they were steep, some other pattern of foot strike is likely better and exactly what is best varies with the specific traction issues. On extremely steep grades, up or down, ball of the foot striking or a flat foot plant is likely best. But the key seems to be to use the feedback from the strain in the muscles around the knees, especially in the quads, and more subtle aches like in the low back, to determine the optimal foot-strike strategy for the given terrain.

A steep, dangerous situation calls for an exaggerated stance.

Stability on the steeper grades also demands an exaggerated posture or stance like that of a skier, with more flexion at the hips so the buttocks provide ballast for a more forward chest.  Just how exaggerated your response should be varies with the risk and consequences of falling as well as the footing issues.

Back-Up Strategy: The Hips

The new information about foot-strike seemed like it was going to allow me to eliminate most of my extreme soreness and lack of springiness on the trails. But before finding that tip, I'd put a back-up plan in place for reducing my problems, which was programming my hips to take some of the shock when descending. I have a tendency to have rather locked hips when I walk. Like my leg muscles, my hip muscles are well stretched out, but they aren't in the habit of participating in the recommended rolling of the pelvis when I walk. Like the leg training exercises I'd started, working on my hip mobility also still seemed like a good supporting strategy for putting more resiliency into my lower body when hiking.

Consider checking out your hips to see if you can get more shock-absorption from them as I know I'm not alone in having less-than fluid hips. Start by standing in place, bending your right knee and noting if your right hip moves forward and down as the left hip rolls back and up. Alternate bending one knee and then the other and noticing if the hips are rocking and rolling in response. If not, nudge them to create this rolling motion.

Walking up or down stairs in another easy way to feel if your hips rock and roll with each step and to practice by exaggerating the motion. Then progress to the sidewalk and the trails, making sure that the rolling motion stays active. I'm hoping that cultivating this action will give me a little more chance at fine-tuning my balance on the trails and increase my confidence as it should give me more shock absorption with each foot plant and perhaps it will solve some problems for you too.

Advanced Walking Technic: Trail Running

While in the northern Italian Alps in 2009 I again marveled at the occasional person, usually a lean 30-something male, that was extremely sure-footed on the very difficult trails. We felt like we were taking our lives in our hands as we cautiously picked our way down a steep, loose-rock descent with the aid of a trekking pole and these dudes would go running by us. Yes, they had the strength and bravado of youth on their side that I had long ago lost and all that testosterone coursing through them that I'd never known, but I still wanted to do what they could do. I wanted to have even some of their ease and speed and confidence even if they thought I was old enough to be their granny.

After being blasted by 3 of these 2-legged mountain goats in 1 week, I set-out to up my game and it didn't take long to crack the code. Instead of carefully placing one's feet in the uncertain terrain, the trick seemed to be to switch to unhesitatingly quick-stepping and letting the mind-body deal with the balance and instability consequences created by the indiscretion of the feet.

The process seemed to be an advanced form of the lesson of not looking at one's feet. In not looking at your feet you instead rely on the brain to remember the scan of the terrain the eyes made a few seconds before. With practice, the conversation between the brain and feet gets more refined and one gains confidence in the process. The eyes have a new expanded role and become scanners of the path and the bigger world. Being a mountain goat meant relying even less upon knowing what you stepped on and relying more on automatically compensating for the results.

On these difficult mountain descents, looking at the feet becomes essential for me, though I trust with practice my gaze won't be as riveting as it is while I am learning the new technic. But speed can be gained by simultaneously seeing the footing situation and having the feet and brain adjust for it as the foot makes contact with the terrain. Seeing and stepping becomes a concurrent, rather than a sequential, process. Taking small steps with the feet a little wider apart than normal also adds some stability to this more rapid stepping regime.

It was an edgy game to play, a daring change in strategy to make. My "intermediate solution" was to move off of the steep trails littered with loose rock and to move on to the steep trails with fixed obstacles, like projecting rocks and tree roots. I used 2 trekking poles instead of one and pushed myself to trot down the trail rather than place-and-pause with each foot. "Go for it" was the mantra as a pushed myself to double my usual speed. I'd also pause periodically to let my brain rest from the new demands placed upon it in the first 45 minute training session.

This was the transformative moment, this was when the paradigm shifted for me. From this point all that lay between me and my 'mountain goat achievement badge' was to practice on progressively less stable surfaces. I might not ever be as fast as the guys that inspired me, but at least I'd kicked myself into a higher orbit, into a higher level of performance, that would both increase my confidence and my strength.

I started working on this more reckless approach to steep descents before reading online about foot plant issues in mountain running and of course, abandoning my heel strike or heel contact on steep descends will only enhance my chances for success with trail running.

Needless to say, combining my efforts to increase my strength and flexibility with refining more subtle body issues like posture and balance have been extremely rewarding as we added hiking to our repertoire. The demands of Alpine hiking coaxed me to delve into more subtle details of gait and stance, all of which have vastly improved my confidence in moving my body in difficult terrain. No doubt these explorations and accomplishments will counter some of the 'age-related disabilities' that are creeping into my world.

III. Using Massage to Adapt to Changes

Injury Repair & Prevention

For me there is no substitute for receiving massage in maintaining comfort in my body and confidence in my movement. I very hesitantly began receiving massage as a limping runner in my mid-30's. My new LMT (licensed massage therapist) fixed 1 lame leg in the first 1-hr session and the other leg in the second and I have been a regular consumer of sports massage ever since.

My massage therapist however considered his work most important for injury prevention and over the years, I've come to believe him as keeping the tissues in tip-top health means they are less likely to be injured. It's hard for me to imagine that there is anyone who wouldn't benefit from regular massage work as it is a great adjunct to stretching for maintaining flexibility and symmetry and to prevent injuries. 

Isolating An Injury

One of the clear benefits of regular massage is keeping your tissues healthy. To me that means keeping the little knots and spasms at bay, keeping good circulation throughout your tissues, and aiding in one's overall symmetry. When the tissues have a high level of health (not just tone or strength), then if one does become injured, the injury remains isolated. If I overdo and injure one muscle, only that muscle is affected. If my tissues weren't so healthy an injury would be the perfect trigger for a whole cascade of muscles in borderline health to go into spasm, creating a much large injury area. Having good circulation to the tissues also sets one up for more rapid healing and less pain if there is an injury.

Partner Massage for Injury Recovery

My full or partial shoulder dislocation in 2009 at age 58 radicalized my thinking about the importance of massage to the point of now believing that every person should have a partner with whom to exchange some targeted massage work. Of course, that is simplest if you have a partner you live with who can be coaxed into learning to give a bit of massage. A reliable, nearby friend would be an alternative. Relying on self-administered massage helps, though has limitations.

At the beginning of the second month of my shoulder dislocation recovery I began having a lot of muscle spasms which significantly interfered with my sleep. A bit of research on the internet suggested that this was very common and in others like me, became a major problem in coping with the injury. I would awaken multiple times in the night with spasms in my shoulder or upper arm that would take 15 minutes or more to calm enough for me to return to sleep until the next wave hit. (It was apparently a healing phase that had to be endured as the brain remapped its knowledge of the injured shoulder joint rather than being related to injury to the muscles.)

In response to these painful spasms, my husband began giving me 15 minute shoulder and neck massages at bedtime and on my worst nights he would do a few more minutes in the middle of the night. I would have been in absolute chaos from the sleep deprivation had he not been capable and willing to do this work. Had we been at home instead of traveling overseas, I would have been making weekly visits to my LMT for help but even that might not been enough to help with my sleep between sessions.

Every few days the muscles needing the most attention from the dislocation changed and my husband would chase them down, starting with the muscles just under the edge of the shoulder blade, then he'd move on to the traps of the top of the shoulder, and then he'd advance to the shoulder joint itself and into my upper arm. I probably had some tears in my biceps muscles of my upper arm and so they needed constant attention through the 4th month of my healing process. I considered my husband's daily massage work to be pivotal in managing my recovery from the dislocation.

Self-Care Massage

Dealing with my shoulder dislocation was an extreme situation, but we both regularly use self-massage and sometimes exchanged massage for keeping our aging bodies active. I've learned which muscles to 'smooth out' daily in my thighs to keep my knees happy and my husband has learned how to dig down and find the little neck muscles that play havoc with my comfort. I occasionally work on his back muscles when things get out of whack for him. And together we brainstorm as to how and where to find the right spot to sooth our latest ache or pain.

A couple of times a month when we are cyclotourists abroad we'll  call a halt to our riding for a few minutes so one or the other of us can work out a muscle spasm that's just gotten going. Knowing what to listen for and then what to do has meant that we have ridden for 9-10 months a year for almost 10 years and we've each only had 1 show-stopping injury.

Learning How to Massage

Intrigued by the healing powers of massage when training for my one-and-only marathon crippled me so I could barely walk, I eventually took a number of classes at our local massage school. I began with the anatomy class and then took several of the professional-level, hands-on massage classes. That experience plus both my husband and I being regular recipients of sports massage, was all it took for us to be able to work on each other.

We still receive professional work when at home a few months each year and occasionally pick-up a massage when we can overseas. We've also asked our LMT for specific remedies for ourselves or each other and scanned a couple of professional articles on specific techniques into our laptop.

Our overseas traveling lifestyle has given us a huge payoff for the investment in learning how to massage--a bigger investment than most couples will want to make. But anything is better than nothing, so consider beginning by taking a non-professional massage class that will teach the basics. Like almost everything, confidence is a huge part of one's effectiveness. A little bit of knowledge about how to use your hands and a lot of confidence that what you do will help is all it takes. Surprisingly, knowing the anatomy isn't as important as courage.

IV:  Mindsets for Expanding Your Physical Interface: Rejecting "No" & Playing More

Keep Your Physical World From Prematurely Shrinking: Reject an Unqualified "No"

For Example

A health care professional telling you "Don't ever do...." is likely over-simplifying to make his/her life easier without taking into account that it is diminishing yours. In my early 50's a young physician looking at my new knee cyst said "Don't ever do squats." Fortunately I knew enough about bodies out in the real world to know that that was terrible advice: in saying that she was accelerating my aging-related disabilities. If you stop squatting, then you can't squat when you need to without injuring yourself because you've become weak, inflexible, and unpracticed.

I do squats as part of my daily wellness routine as I believe that they are critical to maintaining my mobility (and they are a great counter to the limited range of motion involved with cycling). What is one to do when confronted with a less-than clean squat toilet when traveling--one where you really don't want to touch the walls or floor with your hands for support? What if you are out walking and want to sit on a low rock or wall for a rest and then get up without going on to your hands and knees? How are you going to get on the floor when you need to if you can't squat? What if you are in an emergency situation and need to stoop, crawl, and scamper to escape? Squatting may not come up in your daily life but the need to squat does eventually come up for most people and they sure complain about it if they have lost access to that position.

That being said, it is important to squat properly so as not to injure one's knees and a yoga teacher, physical therapist, or personal trainer can guide you. The key is keeping your knees from rolling as they need to stay aligned with your active feet to prevent the unbalanced forces torquing your knees. Often people let the arches in their feet collapse when they squat and this invites the knees to roll inward, which isn't good. But of course it is easier to say "Don't squat" than to teach how to do it well.

And A Few More....

In college when my more significant knee problems first presented themselves, the doctor told me not to go up stairs anymore. What kind of advice is that to give a 20-year-old? In hindsight, I needed to do more activities like going up stairs to bulk up my quads to solve my knee problems, not less.

Rather than say "No" to me when in my 40's a podiatrist told me that people with foot problems like mine usually swam rather than cycle or run, which were my 2 sports at the time. At least he didn't say "No". I would have appreciated more guidance in successfully pursuing my sports but he did put diagnostic labels on my challenges which helped me find my own solutions over the years so I could both run and cycle.

I cringed when my mother who was in her early 90's at the time said "They say we aren't supposed to lift weights" which I considered absolute nonsense. Of course she should be lifting weights; of course she was lifting weights. Every time she lifted herself out of a chair, every time she lifted up a glass to her mouth she was lifting weights. Too bad the staff at her residential community weren't more willing and able to guide their residents in a broader range of activities to make them stronger rather than facilitate their increasing disability by discouraging them from strength building.

When You Are Told "No"

Sometimes taking "No" for an answer might be the right thing to do, but I am not quick to accept unqualified "No's" when it comes to my body so find out why you aren't suppose to do an activity and for how long. Is there an intermediate solution, an intermediate strategy? Is there a progression you can work towards so as to safely do the forbidden?  One's world, one's capabilities shrink too quickly if you blindly accept every bit of constricting advice. Usually there is a way to work around limitations, to keep your world from shrinking, to retain your confidence in your body, if you press for the inconvenient details.

Revert to Your Childhood (Or someone else's if it looks better.)

Years ago I read a book called "Boundaries, No Boundaries". In it the author took the  provocative position that first one must develop firm boundaries and once that is accomplished, the boundaries should be dropped. To a point, I like his model: that first one does/learns/masters and then you move beyond the confines. The tricky point is that letting go of the useful structure can be moving forward, not backwards.

I think the same notion applies to childhood and aging. Many childish behaviors have to be tamed or dropped to excel in school and to become a successful member of multiple communities. Behaviors like being loud, impulsive, playful, spontaneous, curious, self-gratifying, and impatient must be reigned in to be welcomed in western societies. But there is a point in our later years when we should let some of those constraints drop away so as to become more childlike again--we should let go of the boundaries.

The childish behaviors of impulsiveness, playfulness, and spontaneity are good things to re-explore.  I watch children at play to remind myself of how I used to move my body and of what I should retrieve. Walking on the tops of retaining walls and then jumping down off of them is something I've started doing again after watching kids. These activities are good balance training and the jarring from jumping down is good bone-strengthening work too--and besides, it's fun. 

Take a cue from the opportunities at playgrounds and play: take a fling on a swing, slide down a slide, hang from the bars, and explore any other equipment that is sturdy enough for an adult to use to rediscover forgotten motions in your body. Run and skip now and then to change the muscles habituated to more sedate walking. Buy a ball and kick it, throw it, bounce it, and place it on the floor and roll your back over it.

Try moving your body like a child--maybe even mimic a few at a playground. Be curious: look, touch, ask, experiment with new things. Run, jump, skip, jump rope, walk backwards, hop on 1 leg and rediscover your body. Push back the artificial boundaries constraining your body's movement to gain more confidence in its abilities.

Being a proper adult means not being nosy, but at some point it stifles our curiosity. Curiosity is one of those childlike behaviors that should be revived as we age to keep expanding aspects of our worlds as aging-related effects are making are making our worlds smaller in other ways.

When boarding a tour bus in Malta in 2009 I was horrified at the dull, static quality as I scanned all the older people before me. I realized that part of their distinctive 'old look' was because they weren't looking around, they weren't curious--they were being proper and waiting patiently. A few months later I found myself chatting with an Italian woman on a train who turned out to be 80. I later realized that part of why she didn't look her age (unlike her husband who did) was because she was looking, seeing, noticing, and then engaging. She was curious; she actively responded to the stimulation in her environment (me)  in a more child-like way instead of being passive like a proper adult.

Of course do retain the wise aspects of your year's of experience, like keeping your fingers and objects on the ground out of your mouth, but trying letting go of the 'proper' things you learned that were of benefit to others and a detriment to you. Expanding your world beyond the boundaries established decades ago can do amazing things for living more fully in your body and for your self-confidence.