Don’t Lose Muscle Mass When You Have Chronic Back Pain

Sarcopenia—losing muscle mass—and back pain tend to go hand-in-hand. Our expert has tips for keeping your body fit and your back healthy in your 20s, 30s, 40s, 50s and beyond.

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Although the term might sound like a serious medical diagnosis (or a 1970s cover band), "sarcopenia" is actually a condition that most, if not all, of us will have at some point, according to Neel Anand, MD, professor of orthopedic surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles.

SarcopeniaHere's what you can do--no matter your age--to prevent losing muscle as you get older."Sarcopenia is just a fancy word for muscle wasting, and it's a very common part of growing older," he says. "As we age, our muscle tone naturally decreases. But that doesn't mean there aren't strategies you can employ that help you maintain that muscle mass. And you shouldn't wait until you're older, either. Prevention can really be key."

Muscle Wasting and Back Pain

One of the most notable effects of aging is the loss of muscle mass, which brings a lower degree of strength and function, according to research on how muscle tissue changes with aging. Muscle mass decreases between 3 to 8 percent per decade after age 30, and the decline speeds up after age 60, becoming one of the main contributors to mobility loss and disability.

That's because with less muscle strength, people are at increased risk of falls and injury, and they're also more prone to gaining fat—a body composition shift that may play a role in issues like spinal stenosis and degenerative disc disease . Since bone density also decreases with age, this increases the risk of mobility issues, especially if arthritis or osteoporosis are present, and less activity could exacerbate existing back pain.

For example, a 2020 study in Spine looked at clinical features of sarcopenia in patients with lumbar spinal stenosis. Researchers recruited 178 participants, of which 35 had sarcopenia. In that group, there was a higher degree of severe low back pain, limited physical function, and lower bone mineral density than those without sarcopenia.

That's not the only research to make the connection. A study in Osteoporosis and Sarcopenia also found that chronic low back pain in elderly participants was significantly associated with sarcopenia, even when they had adequate bone mineral density.

Preventing Sarcopenia

Although sarcopenia is often considered an effect of reaching your later decades, Dr. Anand emphasizes that it can affect people at younger ages, too, particularly those who are more sedentary and may be overweight or obese.

"There is a ripple effect, which can happen even in your 30s, where you have reduced activity and you may start putting more weight on as a result, and that makes you even less active," he says. "When you don't use your muscles, they begin to atrophy. The phrase 'use it or lose it' isn't just for those over age 60."

Fortunately, he adds, that loss can be reversible to some degree. There are several tactics that can help build muscle mass back up and help prevent sarcopenia as you age. Here are some top strategies to consider:

  • Strength training. In order to grow, muscles need a certain degree of stress, followed by recovery. Anand suggests a low-impact training program that can be done at least two to three days per week.
  • General activity. Many people might think of exercise only in a training format, but being active means staying mobile as much as possible, says Anand. That can include everything from gardening and housework to parking at the far end of the lot when shopping in order to get more steps into your day.
  • Protein. According to the Society for Sarcopenia, Cachexia, and Wasting, older adults in particular are at risk of low protein intake, despite the connections between protein consumption and muscle mass. In part, this is because they don't synthesize amino acids as effectively as younger people, which is why the society suggests whey protein specifically, since it creates and maintains a high concentration of amino acids in the blood. Other protein choices include Greek yogurt, peanut butter, eggs, nuts and seeds, and beans, as well as lean animal proteins.

Lift Those Weights—But Choose Wisely

Although sarcopenia prevention—which can come with better back health as well—is important for every age group, Anand says it's particularly crucial for those who are seeing accelerated muscle mass loss, such as those over 50 years old and especially after age 60.

That's when focusing on strength training, done on a regular basis, can significantly slow the rate of sarcopenia, according to Dr. Anand. But don't invest in heavy weights.

"The mistake many older people make with their training is thinking they have to lift heavy, and do fewer reps with more weight, when the opposite is true," he says. "You want more reps with lighter weight."

For example, he suggests, it's better to do 20 reps with a 5-pound weight rather than 5 reps with a 20-pound weight, even though the total amount of weight lifted would be the same in both cases. Dr. Anand says this approach is beneficial because it creates less load on the bones and joints, and allows older people to do more sessions per week, keeping them more active overall.

He also advises his patients with sarcopenia, and especially with lumbar stenosis, to do other exercises that challenge the muscles but don't introduce additional pressure on the joints. That includes walking in a swimming pool, cycling, Pilates, and yoga. He also suggests adding bodyweight exercises like pushups, squats, and wall slides.

"Your focus should be on activity you can progress slowly, and gives you tone without injury risk," he says. "That's why the high-rep strength training works really well, and it's especially good for your back. Muscle tone is maintained by activity and that's essential for older people but it's actually vital for everyone. Keep moving, and make it a routine, and you'll be less affected by stenosis and back pain as you age."

 

Updated on: 09/29/20
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Neel Anand, MD
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