Photo: istockphoto/Arne Trautmann

Aging does not have to be painful. In fact, it is possible to remain energetic and pain-free for life. The good news is that with some dedication and effort, you have control over how you feel and how to increase your energy.

How does age affect our ability to maintain good health without pain? The connective tissue loses elasticity, microtrauma produces tightness, the joints tend to produce less synovial fluid, and we have a tendency to become less active due to other priorities like raising children and having careers.

What can we do to maintain a healthy, vibrant life without injury or poor posture? Even though there are steps one must take to maintain health and well-being, it is not as daunting as it may seem because of the immense amount of information available in magazines, on the Internet, or on television. In this article I will provide information to help simplify and reduce the stress of keeping fit.


To maintain wellness and prevent injury, there are several fitness categories to address. These categories include posture, flexibility, strength, aerobic capacity, and diet. Let’s take a look at how these five categories of health can help maintain wellness and prevent injury:

  1. Posture: Were you ever told to sit up straight when you were young? Were you ever given a reason for this besides the fact it makes you look better? Well, there are health reasons for good posture as well. Most neck, back, or nerve pain conditions I see are due to poor posture when sitting or bending. When trauma causes the pain to develop initially, poor posture prolongs or prevents normal healing.

    To understand the importance of posture, one must understand the mechanism that causes spine pain or referred pain from neck to arm or back to leg. According to Robin McKenzie, who developed the McKenzie Method, the disc is the “root of all evil” when it comes to spinal conditions. The disc is made up of two parts: the ligaments (annulus fibrosis) that connect the vertebrae (spinal bones), and the softer cartilage in the middle (nucleus pulposis) that moves in the opposite direction from how we move.

    This opposite movement of the nucleus allows for spinal mobility between a stack of flat bones. However, when we bend forward and/or slouch thousands of times per day without stretching our spine in the opposite direction, we develop micro tears in the ligaments, which over time progress into a bulging disc. In order to keep the nucleus in place and avoid overstretching of the supporting ligaments, maintaining a neutral position for sitting and bending is crucial.

    Two steps are recommended for posture maintenance. The first is to use a lumbar roll or support at your waistline any time when sitting more than 5 minutes. The second step is to keep your chest elevated when sitting or bending. This requires using your legs to squat every time you bend. If squatting becomes a habit when bending, then you won’t be tempted to get into the habit of bending forward at the waist, and you can prevent many of the back problems people develop from poor posture or bending. After injuring my back three times from bending improperly, I can speak from personal experience on this one.

  2. Photo: istockphoto/Eliza Snow

  3. Flexibility: Some conditions that cause pain are due to shortened tissue, which includes muscle, ligament, and tendon. These conditions are called dysfunction, and they develop from lack of stretching after activity or injury. Heavy lifting or repetitive activity causes microtearing, which scars, then develops tightness when not stretching often enough. Dysfunction can also develop over time from lack of full joint or muscle range of motion.

    Stretching lengthens muscles and joint structures to maintain or regain the full motion of a joint or muscle. This lengthening of the tissue helps to prevent injury when stretching prior to activity, and prevents developing tightness from scarring after activity or exercise. Therefore, the optimal way to maintain flexibility is to stretch before and after exertion or physical activity. Yoga classes are also a great way to maintain health through flexibility.

    In the case of painful restriction to joint movement or excessive muscle tightness, stretching the tight or restricted motion up to six times per day is recommended as long as the condition does not worsen during or after the stretch. If you have a tight joint or muscle and are unsure of how to stretch to recover the mobility, then seeing a physical therapist is recommended to help you determine the best stretching routine for your condition.

  4. Strength: The most common question I am asked regarding strength is, “Why is it important to do strengthening when I already work hard lifting at work or at home?” There are several reasons why strengthening is important, whether we are active or sedentary. When we perform activity, most of the time we are moving in a limited range of movement for each joint and muscle involved in the activity. Second, only a portion of our muscle groups are used while performing functional activities, which creates a muscular imbalance across the joints.

    Therefore, strengthening is important to maintain strength and flexibility in the muscles through their full range of movement. Formal strengthening incorporates opposing muscle groups across the joint, which reduces joint stress. By strengthening through the full muscle motion and working muscle groups that stabilize the joints during activity, we can reduce the risk of injury when performing new or routine functional activities.

    When seeing a client with a joint or muscle restriction in physical therapy, the first step is to regain the range of motion. However, if we do not follow the range of motion gain with strengthening to develop muscle balance across the joint, then the joint can become reinjured, starting the process over again.

    When performing strengthening exercises, the recommended frequency is no more than every 48 hours. Each exercise should be repeated for two to three sets of eight to 12 repetitions, two to three times a week. Be sure strengthening exercises are performed for opposite (antagonist) muscle groups at each joint (ie, biceps curls, and triceps extension for the elbow). Examples of strengthening include use of free weights, resistive bands, exercise balls, and Pilates.

  5. Aerobic exercise: Do you find yourself getting out of breath or taking more frequent breaks when climbing stairs or hiking? Decreased endurance or getting out of breath is common when we are less active as we get busy with work or life commitments and obligations. It is normal to become out of breath during the first few minutes of exercise, as the aerobic system takes several minutes to kick in for efficient use of oxygen.

    By maintaining good posture, increasing muscle strength, and improving flexibility, one can enhance the likelihood of living a longer, more energetic and pain-free life.

    Photo: istockphoto/Fred Goldstein

    Benefits of aerobic conditioning include improved cellular oxygenation, increased number and size of blood vessels, increased heart muscle strength, improved energy for activity, improved sexual performance, and a general sense of well-being due to release of endorphins that act as natural antidepressants.

    Aerobic exercise is probably the easiest type of exercise to incorporate in a routine. One does not need a gym to perform aerobic conditioning. Some examples of aerobic activity that can easily be included into your routine include fast walking, jogging, cycling, tennis, and most outdoor recreation. To make activity aerobic, keep the pace steady or fast enough to get your heart rate to 70% of maximum for at least 15 to 20 minutes, a minimum of three times a week. To determine your exercise heart rate, take 220, subtract your age, and multiply by .7 (70%).

  6. Diet: When most of us think of diet, we think of omission of certain foods we love to eat. Since people have a difficult time living without the foods they love, this is the most common reason why most diets fail. What if instead we viewed “diet” as the inclusion of nutrient-dense, whole foods that help us reach our personal level of optimal health.

    Why is diet important? First, you need to understand what your body needs before you can understand the principles of eating. Your body needs protein for muscle and cell development or regeneration. Proteins in the form of antibodies also help fight infection, and, in the form of hormones they regulate metabolism and other vital body functions. You need vitamins and minerals to help with absorption and to allow the body to function properly, including metabolism, digestion, growth, vitality, and the production of hormones. Water is necessary to keep the cells hydrated, move nutrients to the cells, lubricate joints, and eliminate cell waste and toxins. Carbohydrates are necessary for muscle and brain energy. And fats are necessary for longer-term energy for the absorption of fatsoluble vitamins, and tissue protection, and as the building blocks for cell membranes and hormones. The focus should be on the types and variety of fats we eat, not how much or how little fat we might consume.


So how do you determine how much of each food group to eat every day? That is going to be different for everyone; however, following four easy steps helps to put your diet into perspective.

Photo: istockphoto/Arne Trautmann

  1. Every time you think of something to drink, go for water; not a soft drink, coffee, juice, or other dehydrating drinks. You should work up to a daily intake of water (in ounces) equal to half of your body weight.
  2. Increase the variety and number of servings of vegetables and fruits. Be creative! Include leftover vegetables with your breakfast egg. Have a piece of fruit instead of a mid-morning bagel or doughnut. Fill your dinner plate with vegetables and salad. Substitute pasta, rice, and potatoes with an alternative grain such as quinoa or millet.
  3. Decrease the number of servings per week of processed or fast foods.
  4. Consume high-quality proteins, such as organic, free-range eggs, grass-fed meats, and deep-sea fish.

For optimal dietary intake specific to your needs, I recommend seeing a naturopathic physician, nutritional therapist, or other knowledgeable health care practitioner regarding diet or use of supplements. Such a practitioner will be able to provide safe guidelines to support you on your personal journey toward wellness.

In summary, to help reverse the effects of aging and reduce the chance of injury, it is important to maintain good posture, muscle strength (balancing muscles across the joints), aerobic capacity, and stretching, and to eat nutrient-dense whole foods. It is important to set a plan of action incorporating these principles into your self-care practices.

If you would like help with establishing a fitness program for your specific needs, contact your local physical therapist for an evaluation of your fitness condition.

Live well and enjoy a pain-free life!

Author’s Note: Thank you, Lee Ann Petrie, NTP, for editing the diet section of this article.

Ted Ellquist, PT, owns and operates Back in Action Physical Therapy (, Portland, Ore. For more information, contact .