Caroline Freedman is a personal trainer and expert in TRX Sports Medicine Suspension Training. While many of the symptoms of menopause are repeated each October by health and fitness companies as part of Menopause Awareness Month, one of the lesser-discussed issues affecting many women is the loss of bone mass, potentially leading to osteoporosis and even scoliosis.
M&F Hers spoke to the London-based fitness coach to find out how all women can hope for better health outcomes through exercise at this challenging time in their lives. Freedman also has a wealth of personal experience in this area: she suffered from scoliosis at a young age, and her daughter also wore a splint to straighten her spine. It's no wonder, then, that her life and work were the driving force behind writing the Scoliosis Handbook. The popular PT is now 56 years old and is passionate about maintaining bone mass, muscle tone and fitness to reduce the negative effects of perimenopause. Also pay attention to the suggested exercises at the end of this article.
Would you agree that bone loss associated with menopause may not be as well known as other symptoms such as hormonal changes, hot flashes and bad moods? How important is it for women to understand that it's common to develop osteoporosis as a result of menopause?
I agree that bone quality loss is not that well known. Osteoporosis is often associated with something that only comes with old age, and women are not as aware that this aging of bones can begin at menopause.
As women age around 50, estrogen levels deteriorate, putting them at risk for osteoporosis and osteoarthritis, which can result from menopause. Osteoporosis causes thin and brittle bones, this can lead to osteoarthritis which causes swollen and painful joints. Additionally, a lack of estrogen leads to dehydration in the joints due to the body's inability to hold fluid, which causes uric acid to build up and trigger inflammation. The drop in such a vital hormone can also lead to weight gain, which is not only annoying but, depending on the amount, can also put a strain on the joints.
Research shows that up to 20% of bone loss can occur around menopause and osteoporosis affects approximately 1 in 10 women over the age of 60 worldwide. Therefore, it is important that women understand the importance of protecting their bones as they enter menopause. Using weights and performing weight-bearing exercises has been shown to increase bone density.
How does bone quality loss begin to show to us?
I've seen several new personal training clients in their 50s and friends complaining about joint pain and back pain that they didn't previously have problems with. In many cases, this is due to reduced bone density, which causes osteoporosis. When women reach perimenopause, many complain that their bones and joints start to hurt. This is generally worse when they wake up or sit still for long periods of time, and it lasts into menopause.
As we age, the joints and discs in the lumbar region (lower part of the spine) begin to break down. The discs can protrude and eventually slip, which can cause scoliosis. There are two ways that menopausal women can suffer from degenerative scoliosis. The first are those who are diagnosed with scoliosis at an earlier age and whose curvature progresses during menopause. The second case is where it develops later in life, which can be triggered by menopause. Scoliosis is a lateral curvature of the spine in an S-shape of more than 10 degrees. It can affect any age from prenatal (congenital), young children (early onset) and teenagers (idiopathic in adolescents) if the scoliosis has progressed through puberty/growth into adulthood. But it is also observed in women going through menopause.
Physically, the first thing women might notice is pain on one side of their body. This is because the spine rotates and pulls the lateral muscles across the rib cage. As the curvature progresses, over time this can lead to neck pain, headaches, and eventually central and lower back pain. Pain is known to cause fatigue and along with all of our hormonal changes this only adds to the feeling of exhaustion. Women may also notice that they don't look as symmetrical and one shoulder may jut forward, raising the scapula. This causes the clothes to hang differently, and often people can't figure out why.
As someone who suffered from scoliosis from a young age and had multiple surgeries to correct it, how does exercise help with bone disease?
I started exercising when I was 14 and started strength training when I was 18. I don't lift heavy weights because lighter weights with higher reps are more beneficial for building muscle while avoiding strain - with a spinal condition like mine. If I'm not moving at least three times a week, I'm in pain and my joints and muscles become stiff. Exercise has literally been my savior throughout my scoliosis journey, both physically to improve my posture and to keep my bones strong and muscle tone. When training customers, the prevention of osteoporosis is always the priority for me.
They encourage women to try strength training and yoga too. How do they complement each other?
Strength training has been shown to increase bone density, and yoga is great for improving flexibility and balance. With both methods, depending on the exercise, you can also use your own body weight, which increases bone quality. The combination of strength training and yoga will therefore complement each other and produce positive results.
Another benefit is an increase in endorphins, this leads to improved mental health and can benefit mood swings, a common symptom in many women suffering from hormone imbalances due to menopause.
What small steps could women take to start increasing their bone and muscle density?
Start running and introduce a really short stress and weight training program into your day. Even if you only start with 15-20 minutes at a time to avoid the pressure of the "hour-long workout". Many women are too confident to hit the gym, but they can always find a beginner class online or swap weights for household items like reusable water bottles.
When women suffer from joint pain, how can they relieve it?
For instant relief, I find that a hot shower or bath as soon as I wake up is an essential way to start the day, and that's what I recommend to my clients. Heat warms up our muscles and joints and helps relax our body. Also, starting the day with enough fluids helps prevent joint inflammation.
Caroline Freedman's Recommended Exercises for Menopause Warriors
The repetitions and sets of the following exercises are determined by your fitness level. If you're just starting out, try each exercise for 1-3 sets of 4-5 reps. Start with a weight you are comfortable with. Over time, increase the weight in small increments and add more reps and sets.