Healthy Aging: Musculoskeletal System

Our health and wellness are key to our developing our resilience and maintaining our independence.

In this series of articles about aging, I focus on some of the common complaints associated with aging and offer lifestyle and herb recommendations that may help prevent these issues as well as support our aging bodies. Lifestyle factors are always the starting point for overall wellness, but my research revealed that they are critical to assisting the aging process. 

Starting any kind of herbal protocol should be discussed with a health practitioner who is knowledgeable about both botanical medicine and aging bodies. Our digestive and circulatory systems work slower and sometimes less effectively, and this can affect how herbs are used by our systems. Potential herb-drug interactions should always be researched before using any herb therapeutically while taking pharmaceutical drugs. 

Our health and wellness are key to developing our resilience and maintaining our independence. It’s never too late to start a daily habit of exercise but if it’s been a while since you exercised regularly, you may want to check with your health provider about any restrictions. 

Musculoskeletal Health: Osteoporosis 

As we age, the risk for bone fractures and osteoporosis increases significantly, especially for post-menopausal women. Estrogen is essential for bone health, ensuring that calcium is absorbed into the bones. Estrogen declines after menopause and bones can quickly become porous, putting older women at a higher risk for hip fractures and bone breaks. Hip fractures can be life-changing because many people can no longer live on their own even after recovering from one.

Osteoporosis is a major factor in the disability of older women. It’s called a silent disease because it’s gradual and painless with no symptoms to diagnose. There are risk factors that include being an older woman, a family history of diagnosed osteoporosis, and rheumatoid arthritis. Lifestyle factors like smoking, alcohol, insufficient exercise, poor nutrition, and low dietary intake of calcium can significantly increase the risks of decreased bone density.

Osteoporosis-related fractures most commonly occur in the hip, wrist, or spine.
Osteoporosis-related fractures most commonly occur in the hip, wrist, or spine. (Image: Wikimedia Commons)

Bone Density Tests 

Some physicians automatically recommend a bone density test for all post-menopausal women every couple of years, and if there is evidence of minimal bone loss (called osteopenia), prescribe an expensive drug that can include unpleasant side effects. The American Board of Internal Medicine (ABIM) created a campaign called Choosing Wisely which provides advice for patients and practitioners to make decisions about patient care for bone loss. It provides facts and guidelines to discuss with your physician whether a bone density test is appropriate for you.

Prevention remains the best strategy for reducing osteoporosis. Incorporating healthy and nutritious foods, daily exercise, and regularly drinking herbal infusions and bone broths are the first steps for building and sustaining bone density.

Caution: If you have been diagnosed with osteoporosis, check with your health practitioner about the types of movement you should avoid. The Mayo Clinic provides some basic information on exercise limitations.

Lifestyle Suggestions for Supporting Bone Health

  • Don’t wait to start nourishing your bones: the younger you start, the better.
  • Daily sessions of weight-bearing exercise like walking, hiking, stair-stepping, tennis, and dancing are essential to building and maintaining strong bones (see my caution above).
  • Yoga and certain martial arts utilize your weight for strength-building in specific areas of the body (see my caution above).
  • Recommended daily amounts of calcium in your diet depend on your age and sex. Review this check sheet for details. Eat more brassicas, leafy greens, nuts, seeds, whole grains, and beans. Dairy products are rich in calcium but not easily absorbed so do not rely on dairy as your sole source of calcium.
  • Recommended daily amounts of magnesium through diet and supplements depend on age and sex. Review this check sheet for details.
  • Smoking, alcohol, soda pop, excessive salt, caffeine, and certain medications can contribute to bone density loss.
  • Increase the daily amount of healthy protein. Recent research suggests that older women benefit from higher levels of healthy protein.
  • Increased intake of phytoestrogens may help with both reducing bone loss and building new bone.
Healthy diets support bone health
Healthy diets support bone health. (Photo by D. Gold Unsplash)

Using Herbs For Bone Health

Some studies suggest that phytoestrogens could help bone loss in aging women.7 Weekly nourishing herbal infusions are one easy way to incorporate bone-building minerals and phytoestrogens. 

What’s a nourishing herbal infusion?

A nourishing herbal infusion is a tea made with nutrient-dense herbs. Infusions are steeped for 4-24 hours to extract minerals and vitamins from the herbs. Infusions are typically made with one ounce of herbs in a quart jar or French press, topped with hot water, and covered and steeped for at least four hours. The herbs below are ideal for nourishing infusions. I drink a nettle infusion 1-2x a week: 1 oz dried nettle leaves + a small handful of dried oatstraw + a pinch of mint, steeped in a quart of hot water.

  • Alfalfa: Contains both minerals and phytoestrogens (research for side effects and drug interactions before use)
  • Horsetail: All about the silica!
  • Nettle: calcium-dense with magnesium, potassium, and iron
  • Oatstraw: High levels of calcium, magnesium, and silica
  • Red Clover: Lower levels of minerals but contains phytoestrogens

Musculoskeletal Health: Osteoarthritis

Osteoarthritis (also known as a degenerative joint disease) is the most common type of the 100 types of joint inflammation. Thirty-three percent of Americans over the age of 65 are afflicted with osteoarthritis. Typically related to the aging process, the wear and tear on our bodies, and for some, old athletic injuries or physical trauma, the occurrence of osteoarthritis is also influenced by sex, genetics, ethnicity, and lifestyles.

The effects of arthritis vary widely from occasional flare-ups to debilitating chronic pain. It affects both large and small joints in the body but is life-changing when it affects large weight-bearing joints like the hips, back and knees. It’s considered the number one disability in the United States, and it contributes to additional health problems because the pain reduces physical activity.

Symptoms of osteoarthritis include:

  • Soreness and tenderness
  • Stiffness, especially after sitting or sleeping
  • Redness and warmth
  • Swelling caused by inflamed tissues
  • Bony proliferations on knuckles, causing them to look knobby
  • Lost range of motion
  • Poor sleep due to pain

Modern medicine usually recommends the standard pharmaceutical treatment: acetaminophen for pain and aspirin, ibuprofen, and naproxen for pain and inflammation. This protocol can help with the occasional flare-up, but osteoarthritis has a tendency to worsen with age, especially if lifestyle factors are not altered. 

In addition, there are side effects with over-the-counter (OTC) drugs, especially if taken daily: acetaminophen can cause problems with the liver, and nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen can create chronic digestive problems. 

As pain increases, some people choose prescribed pain medication which often results in less physical activity. Research indicates that regular exercise and movement reduce pain and improve function. Losing extra weight is especially helpful for OA in the knee joints.

Diagnosing the type of arthritis is an important first step; the symptoms can be similar for several different joint inflammation diseases, but the causes and treatment can differ. 

Lifestyle Suggestions for Reducing Osteoarthritis Pain

As common as osteoarthritis is, the medical community does not fully understand how to prevent or cure it, but has identified specific lifestyle behaviors to help delay and reduce its painful effects:

  • Healthy diet
  • Daily exercise & stretching
  • Maintain healthy weight
  • Ensure adequate sleep and rest
  • Strengthen muscles around joints for added support
  • Avoid excessive repetitive movements

Some natural remedies for arthritis include applying heat to stimulate circulation and using cold to reduce inflammation and numb pain. 

One of the benefits of herbal remedies is there are generally no adverse side effects. Another benefit is that there are a variety of herbs and applications to consider. 

Herbs for Topical Applications 

External use of herbs for pain and inflammation is generally safe but users should be watchful of any reactions and stop use if they become present. These herbs can be infused with carrier oils and made into salves for topical application.

  • Arnica: Arnica is used for topical (only) pain relief and as an anti-inflammatory and can be made or purchased as a topical cream or gel. Several studies have found it effective for pain in the hands and knees. Avoid using it on open wounds or cuts.
  • Cayenne:  Capsaicin, a major constituent of cayenne peppers, blocks substance P, which sends the message of pain to the brain. It can help with pain relief associated with sore muscles & joints. Commercially made capsaicin topical creams are widely available but cayenne salve is easy to make. 
  • St. John’s Wort: A powerful plant that helps with nerve pain, and inflammation. Learn more at my Medicinal Herb Profile: St. John’s Wort.
  • Willow Bark: Willow bark contains salicin and has been used for thousands of years for multiple purposes. As the precursor to manufactured aspirin, it can be used topically to relieve arthritic pain. Commercial willow liniments can be purchased, but they are easy to make. 

SJW & Cayenne Salve for Pain

This salve is useful for aches and pains, inflammation, nerve pain, and soreness associated with arthritis and overuse of muscles. It gets a lot of use in my home. This recipe is adapted from Alchemy of Herbs by Rosalee de la Foret.

To make: In a double boiler set-up, put 1/2 cup of St. John’s Wort infused oil. Add 1-2 tablespoons of cayenne pepper and if available, 1-2 tablespoons of arnica or cottonwood-infused oil. Heat until warm, then cool and repeat this cycle throughout the day. Strain the oil with a thick layer of cheesecloth. Slowly melt 1/2 ounce of beeswax in the double boiler and add the strained infused herbal oil until thoroughly mixed. Pour into a container and allow to completely cool & harden. Be cautious when applying with hands; wash them thoroughly with soap. Cayenne salve will sting if rubbed in sensitive areas!

Herbs for Internal Uses 

Always do ample research and check with your health practitioner before ingesting herbs for medicinal purposes. These herbs can be taken as food or extracts.

  • Ashwagandha: This amazing plant can offer multiple benefits to people with arthritis. Regular use can help calm the nervous system, support restful sleep, soothe pain, and reduce inflammation.
  • Stinging Nettle: Taken as an extract, nettle can reduce inflammation.
  • Turmeric: This current “super” herb actually has a long history of use for a variety of conditions. Curcumin, a major constituent in turmeric, decreases both pain and inflammation and has been used for chronic joint problems. 

The Natural Loss of Muscle Mass

As we age, muscle mass decreases. Adults will lose 3%-5% of muscle mass per decade. The decline increases to 1%-2% per year after age 50. Muscles help us with our balance and bone strength throughout our life span.

The largest muscle in the human body is the gluteus maximus (and its two companion muscles, the medius, and the minimus) which reside behind the hips. Many of us spend a lot of time sitting on our glutes! The glutes are responsible for keeping our bodies upright and for most of our lower body movement including climbing stairs, getting out of chairs, and pushing a wheelbarrow around the garden.

Gluteus maximus is the largest muscle in the body. (Wikimedia Commons)

The quadriceps are another large group of muscles that also help us to perform everyday functions like walking, squatting, and maintaining balance. Located in the front of the upper leg, these muscles can stop you in your tracks if they are injured.

Squats and lunges are excellent exercises to strengthen these muscles. The way you perform them is more important than the speed. The American Council on Exercise has an exercise database that provides photos and specific instructions on performing a wide range of exercises.

A great way to get started is to start the 30-Day-Squat Challenge which takes only a few minutes each day and helps develop the beginning of an exercise habit.

Don’t Forget to Stretch Your Muscles

Stretching our muscles is often overlooked or given just a few minutes in exercise classes. Research shows that daily stretching, especially of the lower body, is key to maintaining flexibility. Yoga and pilates incorporate stretching but I have found that 10 minutes of dedicated stretching on a daily basis not only helps maintain my flexibility but also helps prevent muscle aches.

Done on a regular basis, many yoga poses help maintain muscle tone, and improve balance and flexibility.
Done on regular basis, many yoga poses help maintain muscle tone, and improve balance and flexibility.

Flexibility and Balance for Older Adults

One of the most important mobility changes of aging is the loss of muscle mass and strength which reduces flexibility. It affects our ability to move efficiently, reduces our stamina, and sets the stage for accidents, falls, and broken bones.  

“The decline of skeletal muscle tissue with age is one of the most important causes of functional loss of independence in older adults. Maintaining skeletal muscle function throughout the lifespan is a prerequisite for good health and independent living. Physical activity represents one of the most effective preventive agents for muscle decay in aging.”

Simona Ultimo 1Giorgio Zauli 1Alberto M Martelli 2Marco Vitale 3 4James A McCubrey 5Silvano Capitani 1Luca M Neri

Many of us have heard or seen the commercial where an older woman is lying on the floor after falling and uses a special communication device to ask for help because she “has fallen and can’t get up.” While an injury could be the reason why an elderly person can’t move after falling, many sedentary elders no longer have the strength in their upper arms or legs to move their bodies off the floor.

A recent study published in the British Journal of Sports Medicine that measured older people’s ability to balance on one leg for ten seconds as an important factor related to the reduced risk of falling. Can you stand unassisted on one leg for ten seconds? Learn more here.

Lifestyle Recommendations For Supporting Our Balance

A daily exercise program that combines strength/resistance training, endurance (aerobic), balance, and flexibility is the key to maintaining flexibility and balance as we age. Our ability to balance is a complex set of factors, but building core strength, daily stretching of our hamstrings and calves, maintaining strong ankles, and practicing balance movements every day will greatly increase our ability to balance. Here’s a list of simple balance activities that can be practiced every day.

Get Started!

Starting a home exercise routine is about starting a habit and often the hardest part is getting on the mat and just doing it. You don’t need expensive equipment (many people end up not using home exercise equipment). I recommend these basics:

  • a small amount of space to stand and lie on your back
  • a yoga mat
  • hand weights (start with 2 lbs and plan to work your way up to at least 5 lbs each
  • a pillow (for sitting on and in my case to support my head and neck when doing floor exercises)
  • access to a wall
  • a computer
The basics needed for developing a home exercise program.
The basics needed for developing a home exercise program.
Photo credit: E. kloppen@unsplash

There are many online exercise and yoga channels on youtube but I have found the most success with these two:

Yoga with Adrienne – She offers an abundance of free videos on youtube but also has an affordable membership program that includes many more instructional videos.

SeniorShape Fitness – After years of trying to keep up with instructors thirty years younger than me, I was thrilled to discover this youtube channel. She offers cardio, pilates, yoga, strength building, barre, dancing, and even kickboxing. Her routines are perfect for older adults and those new to exercise.

The Benefits of Massage

Lastly, let’s talk about massage. Not the occasional 60-minute high-end spa with soft music, candles, and mellow massage – though these certainly have their place – but rather, massage as physical therapy. Each month, I schedule a 90-minute massage and each visit is customized to whatever hurts at the moment, which is usually some part of my back. It can be downright painful at times!

The Mayo Clinic has identified the following physical benefits of massage therapy:

  • Improved circulation
  • Decreased muscle stiffness
  • Decreased joint inflammation
  • Better quality of sleep
  • Quicker recovery between workouts
  • Improved flexibility
  • Less pain and soreness
  • Strengthened immune response


“Multiple Chronic Conditions in the United States –” Accessed March 25, 2019.

Levy, Susan. “The Most Common Age-Related Medical Issues.” August 30, 2018. Accessed March 25, 2019.

Adib-Hajbaghery, Mohsen, and Seyedeh Nesa Mousavi. “The Effects of Chamomile Extract on Sleep Quality among Elderly People: A Clinical Trial.” Complementary Therapies in Medicine 35 (2017): 109-14. doi:10.1016/j.ctim.2017.09.010.

Hip Fractures Among Older Adults | Home and Recreational Safety | CDC Injury Center.” Centers for Disease Control and Prevention. Accessed March 29, 2019.

“Who’s at Risk?” Who’s at Risk? | International Osteoporosis Foundation. Accessed March 29, 2019.

Shen, Chwan-Li, Vera Von Bergen, Ming-Chien Chyu, Marjorie R. Jenkins, Huanbiao Mo, Chung-Hwan Chen, and In-Sook Kwun. “Fruits and Dietary Phytochemicals in Bone Protection.” Nutrition Research 32, no. 12 (2012): 897-910. doi:10.1016/j.nutres.2012.09.018.

Qureshi, Shoeb, Abdullahforaih Al-Anazi, Viquarfatima Qureshi, and Khalida Javaid. “Preventive Effects of Phytoestrogens against Postmenopausal Osteoporosis as Compared to the Available Therapeutic Choices: An Overview.” Journal of Natural Science, Biology and Medicine 2, no. 2 (2011): 154. doi:10.4103/0976-9668.92322.

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