A Stiffened Body and a Diminished One

A Stiffened Body and a Diminished One

I often hear that the first steps in the morning are awkward. It is the same sentence, but ask a few more questions and it splits in two.

One person says it loosens up soon after a little walking. Another says the legs actually lose strength the more they walk. They began with the same sentence, and what is happening in the body is different. The first is the stiffened side; the second is the diminished side.

The Side That Slows by Accumulation

The connective tissue filling the space between muscle and joint accumulates the years as they are. The account of sugar attaching to protein and bridging fibre to fibre I have set out separately. Tissue joined that way takes longer to return to its original length after stretching, and the water it holds decreases a little at a time.

Posture is added to this. A joint long folded in one direction sets to that length. In the consulting room we call this contracture.

This body still has its strength. It is only that the first few steps are awkward, and movement loosens it. Especially on rising from sleep, or standing after sitting a long time.

The Side That Diminishes From Disuse

Muscle remains in proportion to use. A few weeks of less use shrinks it noticeably, and with age the same amount of movement no longer maintains what it used to. This state, in which muscle decreases and strength falls with it, is called sarcopenia.

This body is fine at first. The trouble appears as it is used. Strength drains partway up the stairs, on the way home from the shops. And diminished muscle cannot hold the joint, so "it hurts" often comes out before "I have no strength."

What Is Needed Is Opposite

Why this distinction matters is that what the two bodies need is opposite.

For the stiffened side, topping something up changes little. What this body needs is not material but moving often, a little at a time, to shorten the time it takes to come back.

Approach the diminished side the same way and it is injured. Forcing stretch and pressure on a joint that lacks the strength to hold itself damages the area. For this body, loading it as much as it can carry and adding strength to the building side comes first.

And the two commonly arrive in the same body together. The knee is stiff so one walks less; walking less, the leg diminishes; diminished, it hurts more. So rather than settling which of the two it is, I look at which of them is ahead right now.

What I Ask

So I ask when it is awkward before I ask how much it hurts. After how many steps does it loosen? At about which floor does strength drain on the stairs? Is the afternoon better than the morning? These answers separate the two branches quite well. Body composition and imaging show how much muscle there is and how the joint is shaped, but they are not built to measure how long that tissue takes to stretch and return.

I do not use the same herbal medicine for the two bodies either. Which is ahead changes what I ask first. For the stiffened side I ask how much that area is moved in a day; for the diminished side I ask whether what is eaten is actually being digested and absorbed.

However, if one leg suddenly swells and hurts, if the weakness comes on one side only, or if you buckle while walking, that may be a different matter from this story and it is better to be seen first.

Inside the words "my body is not what it was" are two different things: what has slowed by accumulating, and what has diminished from disuse.

I take this fork as welcome news. Both have something that can be worked on, and it means the places to work on are different. The force that springs back slows; it does not vanish. And diminished muscle comes back as long as building and taking down are still turning together.

Because the two bodies need different things, sorting out which one it is changes what there is to do today.