Autumn 2018 - Muscle management

Sarcopenia, the loss of skeletal muscle mass, strength and function with age, is widely recognised as a major clinical problem for older people that is associated with serious health consequences in terms of frailty, disability, morbidity and mortality, as well as high health care costs. Recent diagnostic algorithms have provided a systematic approach to case-finding. This article reviews the epidemiology and pathogenesis of sarcopenia and presents an overview of comprehensive geriatric assessment (CGA) as a multidisciplinary-based approach to the assessment, management and follow up for the older patient.

For years it has been assumed that muscle wasting was an inevitable part of growing older, but John Starbrook, who at 87 completed the 2018 London Marathon is, together with several other masters athletes, forcing us to reconsider this view. While the media is full of how sedentary lifestyles and poor nutrition are making our youth ill, the research also seems to suggest that it may be an important factor influencing how our neuromuscular systems age.

Pain that radiates from the neck down the arm, or from the back down the leg, is a common presentation in clinical practice. However, despite the importance of standardisation in physiotherapy practice, there exists an abundance of terms to describe such symptoms, that may not only be confusing to patients, but may worry them unduly if explanations imply that their body is vulnerable or damaged. Therefore, communicating a diagnosis to the patient in a way that is honest, reassuring and empowering is very important. This article also aims to clarify these terms, explain the pathophysiology behind them, consider their limitations in light of recent developments in pain science.

There are more years lived with musculoskeletal (MSK) disability than any other long- term condition. The aim of this article is to present a case study that reflects some of the challenges in translating the multitude of evidence into clinical practice and the context of the individual with multi-morbidity.

It is universally accepted within society that activity, i.e. exercise that raises physical stress on the body, is important for overall health. However, the suggestion of exercise to the person living with persistent musculoskeletal pain can be a daunting one. The unpredictability and unpleasantness of musculoskeletal pain following exercise for the person living with long- term pain can be unsettling and finding the right dosage can be challenging for the practising clinician. This article aims to critically appraise the evidence with the intention of providing a clinical rationale for reasoning exercise dosage for people living with persistent musculoskeletal pain.