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Injuries, aging and menopause

Is it true that injuries, aging and menopause do not generally mix well?

One could say that the human body comes into the world perfectly equipped with innate, or non-specific defenses, since these defenses are part of our anatomy.  As we age, we tend to diminish our physical activities sometimes for fear of injury and the consequences of poor recovery that will affect our quality of life in the long term.  It is quite normal to feel this way because injuries, aging and menopause do not generally mix well.

We may suffer an injury at any time.  A foot that is not properly placed on a step can turn into a fall; the position of our foot can be due to our vision that is no longer as good, or to a lack of coordination or proprioception.

Neuromuscular control reaches its peak in mid-adolescence.  Skeletal muscles are richly vascularized but as they age, they become fibrous, loose strength and atrophy; however, this process can be slowed if an appropriate exercise program is followed.

The immune system’s ability to recognize foreign substances is determined generically.  However, the nervous system also plays a role, and research in psycho-neuroimmunology (the study of the relationship between the brain and the immune system) has begun to provide answers.  Thus, we now know that the immune response is indeed weakened in people who are depressed or under great stress, for example, those who are grieving the loss of a loved one.

From a certain age, the effectiveness of the immune system begins to decrease, so its ability to fight infection and repair injuries.

What Happens When You Hurt Yourself

We break a bone, tear a muscle, dislocate a joint, etc. We automatically experience inflammation in this part of our body.  Inflammation means protection: inflammation is a natural and protective process resulting from an aggression (allergy, infection, injury…) and which can sometimes become harmful when it is the victim of a dysfunction. Inflammation is a first-line defence mechanism against aggression. Its objective is to recognize, destroy and eliminate all substances that are foreign to it.

The image below illustrates the inflammatory reaction caused by a thorn in the skin. Immune cells flow in and the reaction site swells and blushes.

La réaction à la blessure par de l'inflammation

What Happens During an Inflammatory Reaction??

The detection of the aggression by the body leads to a massive arrival of immune cells at the site of the injury. To do this, the blood vessels in the area dilate and the immune cells in place produce molecules that activate and attract their congeners based on the identified threat. This is what causes the redness, swelling, pain and heat often present at the site of inflammation.

Our body protects itself and puts everything in place to repair itself.  On the other hand, if our immune system is deficient, the healing may take longer and not necessarily be complete.

degeneration of tissue

People who have adequate nutrition and good circulation and do not suffer too many injuries or infections, tissues function effectively until mid-adulthood.  Then, with age, the epithelia thin and weaken them.  The amount of collagen in the body decreases as a result, tissue repair becomes less effective and bone, mucilage and nerve tissue gradually atrophy.  These phenomena are partly due to a decrease in circulatory efficiency that reduces the supply of nutrients to tissues, but in some cases they are related to diet.

Indeed, the elderly who have restricted budgets to purchase quality food items and those who have difficulty chewing most often consume soft foods that are low in protein and vitamins.  Consequently, they harm the integrity of their tissues.

Injuries and Menopause

Is There An Impact Of The Decrease In Estrogen On The Regeneration Of Tissue

In the research Effect of estrogens on musculoskeletal performance and risk of injury (Frontiers in Physiology) published in early 2019, the question about the effects of estrogen decline on tissues in women is fairly well answered.

Estrogen has a dramatic effect on musculoskeletal function. Beyond the known relationship between estrogen and bone, it directly affects the structure and function of other musculoskeletal tissues such as muscle, tendon and ligament. In these other musculoskeletal tissues, estrogen improves muscle mass and strength and increases the collagen content of connective tissues. However, unlike bones and muscles where estrogen improves function, in tendons and ligaments, estrogen reduces stiffness, which directly affects performance and injury rates. High levels of estrogen can decrease power and performance and make women more prone to catastrophic ligament damage.

The Role Of Estrogen On tissue

Beyond its role as a sex hormone, estrogen plays an important role in the development, maturation and aging of extra-gonadic tissues such as bones, muscles and connective tissues.

Estrogen receptors are present in all musculoskeletal tissues, including muscles, ligaments and tendons.

In postmenopausal women, higher rates of muscle protein synthesis and degradation have been observed than in pre-menopausal men and women. Although higher rates of protein renewal can be expected to improve muscle quality, these women still experience a rapid decrease in muscle mass and strength, and are therefore more vulnerable to age-related fragility.

In the musculoskeletal system, tendons and ligaments function as connective tissues between bone and muscle and between bone and bone, respectively. Since a ligament, such as the ACL (Anterior Crucial Ligament) in the knee, shows a direct relationship between laxity and rupture, a stiffer ligament is preferable to maintain joint stability and prevent injury. Because of its role in connecting an elastic muscle to a rigid bone, a more rigid tendon is not always beneficial. In terms of performance, a rigid tendon transmits the force produced by a muscle to the bone more quickly, which can improve performance. However, when a tendon becomes too rigid, it produces a concentration of tension in the muscle. This means that more of the tension (stretching) produced during a given movement is concentrated in the muscle that is connected to a rigid tendon than a muscle attached to an elastic tendon.

Maximizing Musculoskeletal Function in Menopausal Women

Given the sometimes confusing data on the role of estrogen in musculoskeletal function, the question many active women ask themselves is: Based on our current knowledge, what recommendations can be made to maximize musculoskeletal function?  We are talking about a normal level activity and not high performance level athletes.

In postmenopausal women, the strategy is less clear. In this population, hormone replacement therapy improves muscle mass and function by improving muscle repair and response to diet and exercise. Bone mass and bone function are also improved by HRT. The problem is that long-term use of HRT is associated with a decrease in tendon cross-sectional area, especially in an active population. The result can be a larger and stronger muscle that pulls on a small brittle tendon that is in turn connected to a more rigid bone. This would result in an increased inadequacy of impedance, differences in stiffness between connected tissues, which can produce deformation concentrations and promote injury.

However, not taking HRT would accelerate sarcopenia and osteoporosis. Therefore, to date, data suggest that hormone replacement therapy is beneficial for musculoskeletal function in postmenopausal women, but great care must be taken to maximize tendon function. What is really lacking for these women is a way to achieve the positive effects of estrogen on muscle and bone repair and anabolic load and nutrition reactions without the long-term negative effects on the tendon. Phytoestrogens can give hope, but much remains to be done to establish the effectiveness of these natural products.

The Dramatic Effect On Musculoskeletal Function

It is clear that estrogen has a dramatic effect on musculoskeletal function. In the past, much of the research has focused on the close relationship between estrogen and bone. However, recently, the effect of estrogen on other musculoskeletal tissues such as muscles, tendons and ligaments has been the subject of further research. These studies clearly show that estrogen improves muscle proteostasis and increases the collagen content of tendons; however, the benefits on bones and muscles are at the expense of the stiffness of connective tissue. From an evolutionary perspective, this makes sense, as more laxer joints and better repair after injury would facilitate healthy delivery and recovery.

However, as more women participate in sport, it is clear that these physiological effects of estrogen contribute to decreased power and performance and make women more prone to catastrophic ligament damage. In order to promote women’s participation in an active lifestyle throughout their lives, further research is needed to determine how nutrition, training and hormonal manipulation can be used to promote optimal performance at any age.  For the full study HERE.

The Psychological Connection to Injuries

As mentioned above, it is now known that the immune response is weakened in depressed or highly stressed people.

Could we say that women in the phase of hormonal change are more stressed?

If the individual is more stressed, it is obvious that his immune response will be affected and so will healing.

The Scars

I distinguish scars in two categories: superficial or physical or apparent and psychological.

The apparent scars are what they are, you can see them; a scar on the knee, on the wrist, etc.

On the other hand, psychological or emotional scars are much more difficult to perceive and especially to heal.  Often associated with post-traumatic shock, these scars have a much greater effect on our lives than we can imagine.

In the following example, I explain the emotional – psychological impact on the healing of an injury:

First we have a woman who is involved in a car accident; her vehicle is hit on the passenger’s side, the impact is violent enough to cause an injury to her right arm, simple fracture of the Radius bone.  This is followed by a visit to the hospital with immobilization of the limb for a few weeks, short rehabilitation and life goes on in less than a year. She was alone in the vehicle at the time of the incident.

In our second situation; we have a woman who is involved in a car accident; her vehicle is hit on the passenger’s side, the impact is violent enough to cause an injury to her right arm, simple fracture of the Radius bone.

Then follows a visit to the hospital with immobilization of the member for several weeks, rehabilitation of several weeks and his life will no longer be the same, she has suffered a permanent loss of mobility of the limb. She was accompanied by her four-year-old grandson sitting on the back seat at the time of the tragedy.  The boy was well secured in his child-seat, but the broken glass shards caused superficial injuries to his face and the accident caused a fit of hysteria in the child.  The woman constantly sees the child’s bloody face and also hears his cries in her head.

I think you understand the nuance between the two incidents and also understand the difference in the recovery process of the two victims.

Louise Therrien ND

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Other source : Anatomie et physiologie humaine, 3ieme édition Elaine N. Marie

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