Muscle Loss with Ageing

The loss of muscle as we age is sadly a normal part of the ageing process it is called Sarcopenia. Sarcopenia literally means “lack of flesh.”  It occurs when the break down of muscle “catabolism” exceeds the laying down of muscle “anabolism.” It is expected that one after the age of 30, you begin to lose as much as 3% to 5% per decade.  However, the rate of muscle loss happens most around the age of 75 years. Less muscle means greater weakness and less mobility, both of which may increase your risk of falls and fractures.

Four factors have been identified that increase sarcopenia:

  1. Inactivity.

  2. Poor diet

  3. Inflammation

  4. Hormonal Changes


This is particularly prominent with immobility due to illness or injury but a slow decline in physical activity will also have an impact.  The immobility increases the muscle loss. The muscle loss then makes activity more difficult resulting in a reduction of activity and further muscle loss 0- a vicious cycle to avoid.

The Answer -  Maintain an active lifestyle - The old expression of “Use it or Lose it” is true.  This does not have to be sport and formal gym going but could be gardening, shopping or housework.  However the three most important types of exercise to fight sarcopenia are:

Resistance Work - This promotes the release of chemicals to build muscles (anabolism).  The introduction of a graduated exercise program including resisted exercise can really help.

Walking - A gentle weight bearing and muscle building activity.

Fitness Training - To improve aerobic aerobic capacity.

Poor diet

A poor diet insufficient in calories, and in particular protein, the building block for muscle,will result in weight loss and further muscle loss.  A loss of appetite is common with ageing and, without meaning to, a reduced calorie intake it can occur.  

The Answer - Aim for a balanced healthy diet with sufficient protein and calorie intake.  Discussing your diet with your GP or a dietitian can prove very useful if you have concerns.


Links have been found between chronic inflammation and sarcopenia.  Inflammation promotes the catabolic processes (breaking down of muscle) and decreases the anabolic processes (building up of muscle).   The inflammation may be as a result of a systemic condition or a musculoskeletal problem such as arthritis.  

The Answer - Your GP should be able to manage any systemic inflammatory problems and a physiotherapist can help reduce inflammatory reactions to musculoskeletal problems.

Hormonal changes

The normal falls in testosterone and oestrogen levels due to the ageing process are proven to be a major contributor to sarcopenia.  There is unfortunately nothing one can do to prevent this normal hormonal drop. However, if you are demonstrating sarcopenia at a younger age,  hormone replacement therapy can be considered. This would be something to discuss with your GP.

In Conclusion.

The loss of muscle bulk is part of the normal ageing process and if left unchecked can play a significant role in loss of mobility and independence.  However, some simple changes to lifestyle can not only decrease the rate of muscle loss can actually rebuild the muscle. If you would like to discuss any part of this paper or plan a graduated exercise programme please give Victoria a call.

Warm UP for Tennis

The evenings are drawing out and the days are getting bright and sunny so it must be tennis season. Tennis is a wonderful sport and recreational hobby but one that can be very demanding and, rather more frequently than most people would like, ends up with a trip to see the physiotherapist.  Bjorn Borg describes the game as “a thousand little sprints”. In an effort to avoid injury and keep playing all summer the inclusion of some simple warm up exercises can really help.

The warm up for tennis can be split into four sections.:

  1. Cardiovascular and general warm up.

  2. Stretching and release of tight muscles.

  3. Muscular activation.

  4. Shadowing and knock around.

1. Cardiovascular and general warm up.

This is very important as it primes the body for the game.  It gets the heart rate up and the blood flowing. The easiest way is to spend 10 mins slowly increasing your activity with:

  • Jogging around the court.

  • Side skips back and forth along the baseline.

  • Running from the base line to the net and back - start with straight lines and then move to diagonal runs changing the angles of direction. Slowly increase the pace.

  • Hops and Jumps along the baseline.

Try not to rush this stage it's important to give the body a chance to get ready for action.

2. Stretching and release of tight muscles.

Research suggest that dynamic stretches are more efficient and effective at releasing tight muscles, therefore I suggest a dynamic programme to stretch the whole body.

I suggest you move the length of the court completing each of the exercises 1-4.

1. Walking lunges with a rotation of  the body to the opposite side at the same time (i.e. as you lunge left knee forward rotate body to the right knee the hips facing forward).

2 .Side stepping with squats taking the arms up the side meeting above your head as you move - half way down the court turnaround so you lead with both the left and the right leg.

3. Alternating knee to chest bringing the opposite elbow to the knee and  then heel to bottom squeezing the arms straight behind you.

4 .Kicking each leg up in front of you and swinging the opposite arm for balance.

5. Standing up on tip toes and then sink to a squat - keep the feet facing forward and the middle of the knee cap over the second toe as you squat. Repeat x 15

6. Cross arms across the chest and rotate the trunk smoothly from right to left - keeping hips facing the front - Repeat x 5

7. Roll downs - Stand with feet parallel.  Exhale and nod the head and roll the spine down bone by bone. If you feel tension in the back of the thighs (hamstrings) bend the knees so you can continue to roll. Inhale at the bottom of the movement and exhale as you uncurl up. Repeat x 4

8.  Hand on your bottom and standing tall lean back to extend the spine.  Repeat x 4

9. Roll the shoulder back and forth.  Repeat x 5

10. Shrug the shoulders and drop.  Repeat x 5

11. Take each arm out in front of you and

A: Palm up stretch the wrist with the fingers down with the other hand. Repeat x 2

B: Palm down stretch wrist with the fingers down with the other hand. Repeat x 2

12. Think tall and rotate the head right / left / up / down / ear to right shoulder / ear to left shoulder. Repeat x 2 each.

With the above exercises please do not try too hard or force the movement - keep steady and relaxed - you do not want to over- stretch any muscles.

Muscle activation:

This is very difficult to write and advise on in a general post but this is the time to focus your attention on any areas of weakness specific to you. Most people have muscle imbalances and spending a few minutes awakening the less active muscles is useful.  If you have specific concerns re muscle imbalance and the need for muscle activation exercises Victoria can offer some guidance on this.

Shadowing and gentle knock around:

Now you should be warmed up it’s time to get the brain ready for tennis.  Tennis requires a complex neuromuscular activation. It is vital to “prime” the brain ready for the task. You don’t want to be part way through the first set before the brain realises what it is supposed to be doing. The easiest way to do this is Shadowing. Shadowing mimics the movements involvement in the game - forehand, backhand, volley, smash and serve… alternate these movements for 2 - 3 minute slowly increasing the intensity so you brain is ready for action.  If you watch the top players they often spend quite some time on this activity before starting to play.

Finally, a gentle knock around with your partner for 1 -2 minutes and you should be set to PLAY.

The above programme is given as a suggested warm up but should you have any specific concerns or injures you should seek the advice of a doctor or physiotherapist before starting the exercises.  

If you would like to discuss your concerns with Victoria please do not hesitate to email or telephone ThamesPhysio.


In recent years the practice of acupuncture has become very much more mainstream, however, I am still often asked what does it do and how does it works?

So I thought I would try and answer a few questions:

  • What is Acupuncture?

  • How does it work?

  • What can acupuncture help with and what is the evidence?

  • Is it safe and are there any risks?

What is Acupuncture?

Acupuncture is the insertion of fine needles into the body at specific points along recorded channels called meridians.  Acupuncture is based on traditional Chinese medicine principles with records dating back to 1000BC. The body is designed to be  in balance - homeostasis- and injury can upset this balance. Acupuncture supports the body to regain this balance.

How does it work?

As the acupuncture needle enters the tissues there is an increase in circulation to the area. This will cause release of chemicals to modulate inflammation.  The needles also stimulate the release of endorphins and oxytocin, these chemical relieve stress and reduce pain.  Acupuncture enhances the release of melatonin promoting good sleep and encourages a sense of well-being by stimulating the release of serotonin. Acupuncture also stimulates nerve fibres to inhibit pain signals and helps to reduce levels of discomfort in the body.

So what can acupuncture help with and is there evidence to support its use?

There is a large body of scientific research emerging to prove the effectiveness of acupuncture.   The AACP (Acupuncture Association of Chartered Physiotherapists)  have produced a chart to demonstrate how acupuncture can help and shows some of the extensive evidence available.


Is Acupuncture Safe?

Acupuncture is a very safe procedure when carried out by fully qualified professionals.   Victoria at ThamesPhysio is fully trained in Acupuncture and has been practising the technique since 2002.  Victoria is a member of the AACP - which means she has completed a recognised accredited course and kept her knowledge up to date with regular courses.  The needles used are sterile and single use only and are disposed of by incineration.

Acupuncture needles are the very thin between 0.2mm and 0.4 mm and are thus much smaller than an injection needle, so having acupuncture does not feel the same as having an injection.

Any side effects tend to be mild and short-lived. They may include: fatigue, feeling light headed, bruising, localised bleeding or soreness or redness or mottling of the skin around the needle sites. If you continue to feel tired after a treatment, it is recommended that you do not drive or operate machinery.  

Can anyone have Acupuncture?

There are a few contraindications, or restrictions, to the use of acupuncture and Victoria  would discuss these with you if acupuncture would be an appropriate adjunct to your physiotherapy.  

The AACP have released an interesting video diary of a patient who received acupuncture as part of her physiotherapy management of sciatica.

Kirsty, a 25 year old graphic designer, has been suffering with Sciatica since the age of 19. She has previously been prescribed pain-killers and anti-inflammatory drugs by a GP but neither provided long-term management of her pain. Her video diary follows her six sessions of acupuncture with physiotherapy.

If you would like to discuss acupuncture and its possible use for your problems please contact Victoria at ThamesPhysio.

Heat or Ice?

A frequently asked question is

“Should I use heat or ice?”

I tend to give the answer that if the problem is acute or sharp in nature Ice is usually the answer but if the problem is more chronic in nature, dull and achy the answer is usually heat. However I thought it might be useful to explore the benefits of heat and Ice.


The application of heat to an area:

  • Increases blood flow - this has brings with it oxygen and proteins to the area.   This aids the healing of the injury.

  • Stimulates the sensory receptors in the skin - this can decrease the transmission of pain signals to the brain which can help to alleviate pain.

  • Promotes tissue flexibility - this allows more freedom of movement and can aid the restoration of mobility.


The application of ice to an area:

  • Decreases blood flow to the area - this can prevent swelling and further injury. However inflammation is part of the healing process so there is debate on whether ice application may slow down the healing process.  I believe the use of ice in the first 48 hours has benefits in preventing secondary tissue damage due to excessive swelling. However, after the 48 hours ice can be used more sparingly to allow a level of inflammation to occur to allow the natural healing process to progress but still control pain.

  • Stimulates the sensory receptors in the skin - as with heat application ice can slow down the transmission of pain signals to the brain and can help alleviate pain.

Ice must not be used for longer than 20 mins per application - prolonged ice use has the opposite intended effect and causing the body to go into protection mode and push blood to the area to prevent cold damage.


Heat and Ice are cheap and easy to access - I do not believe there is any great added benefit to using expensive heat or ice pads when a hot water bottle and bag of peas can do the job.  Care must be taken to avoid the risk of a heat or ice burn, this is especially important to consider if the skin sensation of the patient is compromised.

Ice should not be applied directly to the skin but though a damp tea towel and heat through a cotton towel.