The physio’s guide to injury recovery when you’re over 65

Poor Sir Richard Branson. The bearded billionaire doesn’t appear to have much luck when it comes to transport. The latest drama came about last week when he came tumbling down to earth with a crash after a cycling accident in the British Virgin Islands.

Sir Richard, 73, posted a photograph on his Instagram account of the bloody aftermath.

“Took quite a big tumble while cycling in Virgin Gorda a little while ago. I hit a pothole and crashed hard, resulting in another haematoma on my hip and a nasty cut elbow, but amazingly nothing broken,” he told his followers.

Sir Richard was lucky to walk away with cuts and bruises. A significant fall for many over-70s can be life changing. Indeed, falls are the most common cause of injury-related deaths in people over the age of 75. No wonder then that a survey commissioned by Age UK recently found that millions of older people are worried about falling over, with 4.3 million (36 per cent) saying it topped their list of concerns.

Sam Bowden, the director and clinical lead physiotherapist at Head2Toe Physio Clinic in Surrey explains: “A third of all cases of life-threatening trauma in England and Wales among over the 60s are people who have fallen from a standing or sitting height. Falls in people over 60 are now the most common major trauma seen in hospitals. The problem is that we have an ageing population that is doing more activity, which is good, but they are more likely to fall over for a range of reasons.”

The propensity towards bone fractures is a result of two physiological factors. Bones tend to become less dense with age, described as osteopenia and, in a more severe form, osteoporosis. The risk factors are lack of exercise, eating disorders, high dose steroid use, anti-oestrogen medication, menopause and heavy smoking and drink. 

The second factor is sarcopenia, which is loss of muscle mass. This typically starts in middle age and is more common in the over-60s. This leads to loss of strength. Inactivity and poor diet are contributing factors and symptoms include weakness, declining stamina, difficulty with everyday activity such as climbing stairs and poor balance.

But, as super-fit silver fox Sir Richard, who brushed off his injuries understands, decline and injury in older age isn’t inevitable.

Bowden continues: “The physio community buzz-phrase du jour is ‘progressive loading’. Essentially the body adapts to the loads placed on it, so if you do that slowly and progressively your body will adapt to bear more load, that doesn’t matter if its muscle, bone, or cartilage. Resistance strength training can be used to reverse muscle loss or at least maintain muscle, and maintain or improve bone density, if it comes with a healthy diet with enough protein and calcium. You can’t go wrong getting strong.”

Prevention is frequently cited as the best treatment for injuries in older age. Age UK, for example, recommends exercising to improve balance and muscle strength.

Fraser Smith, a personal trainer and founder of Vive Fitness says a holistic approach offers the best protection: “Whole body mobility is important to make sure all joints function as they should, because as soon as one joint starts to stiffen up you can quickly get issues on either side of it. It’s about keeping the joints mobile, making sure you use them properly and keeping the supporting muscles strong.”

The good news, then, is that while injury risks tend to increase with age, protecting against them doesn’t have to be rocket science.

At risk body-parts for the over sixties

Hips 

Pop singer Shakira famously sang “hips don’t lie” and, if you are one of the 8.5 million people in the UK who report joint pain, your hips are probably saying: “Ouch!”

Causes of hip pain vary among the elderly but common causes are osteoarthritis and fractures due to falls.

Smith also points out that post-menopausal women are at greater risk of fractures.

“The menopause potentially leads to dramatic drops in bone density,” he says. “To help mitigate the effects it would help to do load bearing exercises throughout your life to ensure that when you hit menopause your bones are strong enough to withstand the possible degradation.”

Treatment for hip fractures will be medical at first, followed by rehab focused on building strength and mobility. Physio exercises typically include knee lifts, external hip rotations, heel-to-buttock stretches, steps up and down stairs and hip bridges.

Elbows 

According to the charity Versus Arthritis, most elbow pain comes from strained or inflamed soft tissues such as tendons and can be treated with over-the-counter painkillers and rest.

“It’s important not to rest for too long as lack of movement causes your joint to stiffen and the muscles around your elbow to weaken, which increases the chance that you’ll have further symptoms,” the charity warns.

Bowen explains that tennis and golfer’s elbow are common complaints.

“These are described as tendinopathies and are related to the increased likelihood in age that tendons have degenerated, and muscles weakened. The way we used to get people better, with ice, massage, acupuncture and possibly ultrasound are out of vogue because they are not shown to change the outcome. Now the focus is on progressive loading exercises.”

For tennis elbow this typically includes stretching the affected arm across a tabletop with the wrist and hand over the edge. Holding a weight, allow the wrist to drop then slowly lift it up.

Neck

“Neck injuries can be linked to bad posture of the thoracic spine, which are the vertebrae between the base of the neck and the mid to lower back,” explains Smith. “Long-term weakness or lack of use can lead to the common kyphotic hunch, in turn causing upper back and neck muscles to be overused and tighten. This causes a lack of mobility in your back, neck and shoulders. Poor mobility and overused muscles increase your risk of developing neck and shoulder injuries because the body is not functioning how it should.”

To help alleviate these issues, he recommends gentle yoga and Pilates-style mobility exercises that target your thoracic mobility, such as ‘child’s pose’ (kneeling with knees wider than hips, dropping chest to floor and reaching forward with arms), ‘cat-cow’ (on all-fours alternate between arching back and looking towards your belly button and curving your back and looking up) and ‘open books’ with a comfortable head support (lay on your side and rotate until your chest is facing the ceiling, whilst keeping your lower body still). For severe cases he recommends consulting a professional to assess and guide you specific to your needs.

Lower back

Back pain is the largest single cause of disability in the UK, with lower back pain alone accounting for 11 per cent of the total disability of the UK population. Referrals for spinal surgery are increasing year on year. A 2023 Lancet article described lower back pain as a “global epidemic” made worse by more people working from home.

According to WHO, prevalence increases with age.

“One of the main causes is that you try and do the same tasks you did when you were younger, but you are now a bit less mobile and not as strong, so you end up using your back more, as you lean over to lift something, rather than using your legs and glutes, which is a double problem because your back is weaker to begin with and you are asking it to take extra load, so your injury risk jumps up,” says Smith.

Again, prevention is the best policy and for those unlucky enough to suffer back injury, once the problem has been properly assessed and the acute phase has been treated with painkillers and anti-inflammatory, recovery can be helped by strengthening the core muscles with basic exercises such as planks, side planks and glute bridges.

Knees 

Knees pain usually manifests as arthritis in older age and while there is no cure, there are measures that can help.

Exercise to build muscle and bone in the leg is recommended. And it doesn’t have to mean going to the gym. Dancing and jogging are also good ways to build strength.  

“Our job as physios should not be to make exercising harder than it should be,” says Bowden. “Any resistance that can be added, from body weight to resistance bands, to weight machines and dumbbells and barbells.”

Recovery exercises for knee injuries typically include the following:

1. Lie on your back, bend your hip and knee as far as you can, then relax. If the pain goes immediately, go a little further with the next bend until you feel a stretch that stays, then relax and repeat, increasing mobility each time. 

2.  Lie down with your legs relaxed. Tighten the muscle on the front of your thighs by stretching your leg away from you then push your leg down and hold for five seconds. Relax and repeat.

3. Lie on your back with a small rolled-up towel under the affected knee. Straighten your knee, pushing the back of your thigh onto the towel and lift your heel as high as you can without lifting your knee.