How did I get so stiff?

Have you ever watched a small child pick something up from the floor?

They don't bend forward carefully, hold on to the table and make the little noise that many of us start making somewhere after fifty.

They simply squat down.

And then they stay there.

They may play on the floor, sit on their heels, crawl around, get up again and repeat the whole thing without giving any of it a second thought. Their bodies still move in the way human bodies were probably designed to move.

Animals do much the same thing.

If an animal hurts one leg, it tends to leave it alone (lifting it up) for a while and use it again when it feels ready. We humans are more sophisticated. We keep stepping on the painful leg every few minutes to see whether it still hurts.

It usually does.

So what happens to us between the child squatting happily on the floor and the sixty-five-year-old man wondering why putting on his socks has suddenly become a flexibility test?

Quite a lot.

First, we discover the chair

For the first few years of life, children move constantly and in almost every direction imaginable.

Then we send them to school.

And we teach them to sit.

They sit in the classroom. They sit while eating. They sit doing homework. Today they sit in front of computers, tablets and phones. In the West, most of us then continue into further education, which usually involves even more sitting.

Eventually we find jobs where many of us continue sitting for another thirty or forty years, sometimes in a sort of a shrimp posture.

It is hardly surprising that the body adapts.

What is interesting is that this is not inevitable.

I have spent quite a lot of time in Thailand, particularly in rural areas where some of the comforts we take for granted in the West have traditionally been less common. There you can still see surprisingly old people sitting comfortably in a deep squat while eating, talking or simply waiting.

Try joining them.

After a few minutes, many Westerners of the same age start looking for either a chair or an orthopaedic surgeon.

We were not very clever about flexibility either

Most young people are active. They run, play and participate in sports.

But when I was young, flexibility was hardly a science.

We might do a few stretches before or after training, but nobody seemed particularly interested in which structures we were stretching, why we were stretching them or whether what we were doing made much sense.

Then adolescence arrives and the body changes remarkably quickly.

Teenagers frequently complain of aches and pains, often historically thrown into that wonderful medical wastebasket called "growing pains" when doctors didn´t really have any specific diagnosis.

That description was not entirely nonsense.

During rapid growth, bones, muscles, tendons and the rest of the soft tissues do not necessarily adapt at exactly the same rate. Bones sometimes grow faster than the soft tissues can keep up.  Add intense sport to a rapidly changing body and it is hardly surprising that things sometimes begin to hurt.

I had my own experience of this.

As a teenager I was very good in the school gym and could do dive roll perfectiy.  I was rather proud of being able to do this with a fairly straight back but unfortunately as I found out later, several of my vertebrae developed the changes associated with what is called Scheuermann's disease which is common in teenage boys and reduces the backward flexion of the spine.

Those vertebrae became wedge-shaped.

Decades later, some of them are effectively fused anteriorly and several segments of my spine barely move.

So when I complain about being stiff today, I cannot blame all of it on getting older.

I started early.

Then real life takes over

For many people, organised sport gradually disappears.

Education becomes work. Work becomes career. Then come partners, children, houses, mortgages and all the other things that apparently constitute adulthood.

Some people continue doing physical work and use their bodies every day. That has advantages, although decades of heavy physical work can create its own problems. Osteoarthritis and overuse do not discriminate.

Others spend much of their working lives sitting.

And sitting has become extraordinarily easy.

We sit at work, in the car, on the sofa, at the dinner table and in front of screens. Hours pass with the hips and knees flexed, the shoulders forward and the spine in more or less the same position.

The human body is extremely good at adapting to what we ask of it.

Unfortunately, it also adapts to what we don't ask of it.

Age does have something to do with it

We cannot blame everything on chairs.

From somewhere after the age of thirty, muscle mass and strength begin a slow decline unless we do something about it. The process is gradual at first but tends to accelerate as we get older, particularly after fifty.

Bone changes too.

So do tendons, ligaments and other connective tissues. Recovery becomes slower. Hormonal changes also play a role. Old injuries that we had almost forgotten about sometimes return to remind us that they have excellent memories.

Then strength begins to decline.

Balance often follows.

And something interesting happens psychologically as well.

We become more careful.

I used to be lowered 90 feet from a rescue helicopter onto ships and mountains in my younger ears without thinking very much about it. Today I can sometimes look down from the roof of a house and think:

No. Absolutely not.

Some of that is wisdom and scared of heights

Some of it is probably balance.

The two should not be confused.

As strength, mobility and balance deteriorate, we trust our bodies less. When we trust them less, we use them less. When we use them less, they deteriorate further.

That is not a particularly good circle to get trapped in.

And then there is fascia

For most of my professional life, I thought primarily in terms of bones, joints, muscles, tendons and ligaments.

I am an orthopaedic surgeon. That is what we were trained to think about.

But there is another structure running throughout the body that has received far less attention than it deserves: fascia.

Fascia is connective tissue that surrounds and connects muscles and extends throughout much of the body, surrounding and supporting many other structures as well.

For a long time it was almost treated as wrapping material — something you cut through on the way to the interesting anatomy underneath.

We now know that the story is considerably more complicated.

Fascia is richly innervated, biologically active and involved in movement, force transmission and sensation. Changes in the fascial system may contribute to some of the stiffness and discomfort that many of us experience as we get older.

I find this particularly interesting because fascia received remarkably little attention during much of my own medical and surgical training.

I only started thinking seriously about it relatively recently.

The more I learn, the more I suspect that we have underestimated it.

But fascia deserves an article of its own.

So why the hell are we so stiff?

Because we have spent decades training ourselves to become stiff.

We stopped squatting.

We sat down.

We repeated the same movements and abandoned others.

We accumulated injuries.

We lost muscle.

Our connective tissues changed.

Our bones changed.

Our balance changed.

Our hormones changed.

And eventually we started moving less because moving had become more difficult.

None of that means that at sixty, seventy or eighty we should be able to move like the child on the floor.

Nor does it mean that every stiff joint can somehow be stretched back to youth. My wedge-shaped vertebrae are certainly not going anywhere.

But there is an enormous difference between accepting the changes that genuinely come with age and unnecessarily surrendering movement that we could still have.

Perhaps the child on the floor has something to teach us after all.

Not that we need to spend our evenings sitting in a deep squat.

Although, if you can still do it comfortably, I am slightly jealous.

But that movement is something we should keep using for as long as we possibly can.

Because the body adapts remarkably well to what we ask of it.

And, unfortunately, to what we stop asking of it too.