Changes in Musculoskeletal Biomechanics with Aging and their Implications for Mobility and Fall Risk

Sarah Carlos^*
*Correspondence: Sarah Carlos, Department of Biomedical Sciences, University of Leeds, Leeds LS2 9JT, UK, Email:

Keywords

Musculoskeletal biomechanics • Mobility • Muscle strength • Gait mechanics • Bone density • Biomechanical changes

Introduction

Aging is a natural and inevitable process that brings about various physiological changes in the human body. Among these changes, alterations in musculoskeletal biomechanics play a crucial role in determining the mobility and fall risk of older adults. Understanding how these biomechanical changes occur and their implications is essential for developing effective strategies to promote healthy aging and improve quality of life in older populations. Musculoskeletal biomechanics in young adults can refer to as delving into the changes that occur with aging, it is important to establish a baseline understanding of musculoskeletal biomechanics in young adults. In young individuals, musculoskeletal biomechanics contribute to efficient movement, stability, and overall physical function. Key aspects include muscle strength, coordination, joint mechanics, and bone health, all of which support mobility and balance [1]. Some biomechanical changes with aging are muscle changes, bone changes such as decreased bone mineral density and changes in joint mechanics, neuromuscular changes, implications for mobility such as alterations in muscle activation patterns, implications for balance control and Mobility, Changes in Gait Parameters and Gait Stability, Balance and Postural Stability. Aging is an inevitable and complex process that affects every system in the human body, including the musculoskeletal system. Musculoskeletal biomechanics, encompassing the study of how bones, muscles, tendons, and ligaments interact to produce movement and maintain stability, undergo significant changes with advancing age. These changes not only impact mobility and physical function but also contribute to an increased risk of falls among older adults. Understanding the biomechanical alterations that occur with aging and their implications is crucial for developing effective strategies to promote healthy aging and improve quality of life in elderly populations.

Literature Review

To appreciate the changes that occur with aging, it is essential first to understand the baseline characteristics of musculoskeletal biomechanics in young adults. In young individuals, musculoskeletal biomechanics contribute to efficient movement, stability, and overall physical function. This includes the coordination of muscle groups to produce movement, the integrity and elasticity of tendons and ligaments, and the structural integrity of bones. Muscle strength, which is crucial for everyday activities such as walking, lifting, and maintaining balance, is typically at its peak during young adulthood. This strength allows for efficient movements and contributes to overall stability and mobility. One of the most significant changes in the musculoskeletal system with aging is the progressive loss of muscle mass, a phenomenon known as sarcopenia. Sarcopenia begins in middle adulthood and accelerates with advancing age, leading to a gradual decline in muscle size and strength. The loss of muscle mass is accompanied by changes in muscle fibre composition, with a shift from fast-twitch (type II) to slow-twitch (type I) muscle fibres. This shift contributes to a decline in muscle power and endurance, affecting the ability to perform activities that require strength and stamina. Muscle quality also deteriorates with age, characterized by an increase in intramuscular fat infiltration and connective tissue deposition within muscle fibres. These changes, collectively referred to as myosteatosis and fibrosis, impair muscle contractility and elasticity, further compromising muscle function. As a result, older adults often experience reduced muscle strength and endurance, making everyday tasks such as climbing stairs, carrying groceries, or rising from a chair more challenging [2].

Aging also affects bone health and integrity, which are integral components of musculoskeletal biomechanics. Bone mass peaks in early adulthood and gradually declines thereafter, resulting in decreased bone mineral density (BMD) and increased susceptibility to fractures. This age-related bone loss, known as osteopenia and osteoporosis, affects cortical (compact) and trabecular (spongy) bone tissues, compromising skeletal strength and durability. Changes in joint mechanics also contribute to altered biomechanics with aging. Articular cartilage, which provides cushioning and smooth joint movement, undergoes structural changes with age, including thinning and decreased elasticity. These alterations can lead to joint stiffness, pain, and reduced range of motion, impacting mobility and physical function. Older adults may experience joint degeneration and osteoarthritis, conditions characterized by cartilage breakdown and inflammation within the joints, further exacerbating biomechanical impairments [3]. Neuromuscular function plays a critical role in coordinating muscle activation and movement control. With aging, there is a decline in neuromuscular efficiency, characterized by slower nerve conduction velocities and reduced motor unit recruitment. This age-related decline in neuromuscular function contributes to altered muscle activation patterns and coordination during movement. Older adults may exhibit delayed muscle responses, decreased muscle coordination, and impaired balance control, factors that increase the risk of falls and impact overall mobility. The biomechanical changes associated with aging have profound implications for mobility and physical function in older adults. Mobility encompasses the ability to move independently and perform activities of daily living (ADLs) efficiently and safely. Changes in musculoskeletal biomechanics, including muscle weakness, joint stiffness, and impaired balance, can significantly impact mobility in several ways.

Gait, or walking pattern, is a fundamental aspect of mobility that relies on coordinated movements of the lower extremities, trunk, and upper limbs. Aging-related biomechanical changes, such as reduced muscle strength and altered joint mechanics, can alter gait mechanics in older adults. Common changes include decreased stride length, slower walking speed, increased double support time (both feet on the ground simultaneously), and variability in step length and width. These alterations in gait parameters contribute to reduced gait efficiency and stability, increasing the risk of falls and compromising mobility [4]. Maintaining balance and postural stability is essential for performing daily activities, such as standing, walking, and reaching. Biomechanical changes associated with aging, including muscle weakness, joint stiffness, and impaired proprioception (awareness of body position in space), can compromise balance control mechanisms. Older adults may experience difficulties in maintaining balance during static (standing still) and dynamic (walking, turning) activities. Changes in postural stability characterized by increased sway and reduced ability to correct balance disturbances, further contribute to fall risk in this population. Falls are a significant health concern among older adults and can have serious consequences, including injuries, hospitalizations, and decreased quality of life. Understanding the biomechanical factors that contribute to fall risk is essential for developing effective fall prevention strategies [5].

Discussion

Several biomechanical factors contribute to increased fall risk in older adults such as; Muscle weakness like decreased muscle strength, particularly in the lower extremities, reduces the ability to stabilize joints and generate sufficient force during activities such as walking or rising from a chair. Weakness in the muscles responsible for maintaining postural stability (e.g., core muscles) further increases fall risk. Altered gait mechanics, such as reduced stride length and increased variability, compromise gait stability and increase the likelihood of tripping or stumbling. Impaired balance control, characterized by decreased ability to maintain a steady posture and respond to balance disturbances, further elevates fall risk. Osteoporosis and age-related bone loss increase the risk of fractures following a fall. Reduced bone mineral density compromises skeletal integrity, making bones more susceptible to fractures, particularly in the hips, spine, and wrists.

Reducing fall risk in older adults requires a multifaceted approach that addresses biomechanical, environmental, and behavioral factors. Evidence-based strategies include; Strength training exercises that target major muscle groups (e.g., quadriceps, gluteal muscles) improve muscle strength, power, and endurance, enhancing mobility and reducing fall risk. Balance and coordination exercises, such as tai chi or yoga, improve postural stability and proprioception, contributing to better balance control and reduced fall risk. Home safety assessments and modifications, such as removing trip hazards, installing grab bars in bathrooms, and improving lighting, create a safer environment for older adults and reduce the risk of falls. The use of assistive devices, such as canes, walkers, and orthotic devices (e.g., ankle-foot orthoses), provides support and enhances mobility, particularly for individuals with balance impairments or gait abnormalities. Reviewing and managing medications that may cause dizziness, drowsiness, or orthostatic hypotension (a drop in blood pressure upon standing) can reduce fall risk associated with medication side effects. Regular vision checks and appropriate footwear, such as supportive shoes with non-slip soles, improve sensory input and stability during walking and standing activities.

Understanding the biomechanical changes associated with aging enables healthcare professionals to implement targeted interventions that optimize musculoskeletal health and reduce fall risk in older adults.

Rehabilitation programs tailored to address age-related biomechanical changes can improve functional outcomes and quality of life in older adults. Key components of rehabilitation strategies include, Strength Training Program such as Progressive resistance exercises that target specific muscle groups (e.g., leg press, calf raises) improve muscle strength and endurance, enhancing mobility and reducing fall risk. Balance training exercises, such as standing on one leg or performing tandem stance exercises, challenge postural control and improve balance reactions. Gait rehabilitation programs focus on improving walking mechanics, stride length, and gait symmetry through targeted exercises and gait retraining techniques. Functional mobility exercises simulate activities of daily living (e.g., sit-to-stand transitions, stair climbing) to improve overall physical function and independence. The use of assistive devices and technological innovations can enhance mobility and safety for older adults with musculoskeletal impairments: Ankle-foot orthoses provide external support and stability, particularly for individuals with foot drop or ankle instability, improving gait mechanics and reducing fall risk. Technological innovations such as Wearable devices and sensors, such as accelerometers and gyroscopes, monitor mobility patterns and provide real-time feedback on gait parameters and balance control. Virtual reality and augmented reality technologies offer immersive environments for balance training and gait rehabilitation.

Continued research in musculoskeletal biomechanics and aging is essential for advancing our understanding of age-related changes and developing innovative interventions to enhance mobility and reduce fall risk in older adults. Computational models and simulations can predict musculoskeletal changes with aging and evaluate the effectiveness of interventions in improving mobility outcomes.Genetic and molecular research exploring genetic predispositions and molecular mechanisms underlying musculoskeletal aging may uncover novel therapeutic targets for age-related conditions, such as sarcopenia and osteoporosis. Addressing barriers to translating biomechanical research findings into clinical practice and community settings is critical for optimizing the delivery and uptake of evidence-based interventions. Long-term studies tracking biomechanical changes over time in diverse populations are essential for understanding individual variability and identifying early biomarkers of musculoskeletal decline [6].

Conclusion

In conclusion, aging is accompanied by significant changes in musculoskeletal biomechanics that impact mobility, physical function, and fall risk in older adults. Understanding these biomechanical changes, including muscle weakness, joint stiffness, and impaired balance control, is essential for developing effective strategies to promote healthy aging and reduce the burden of falls. By implementing evidence-based interventions, such as exercise programs, environmental modifications, and assistive technologies, healthcare professionals can enhance musculoskeletal health, improve mobility outcomes, and ultimately, enhance the quality of life for older adults.

Acknowledgement

None.

Conflict of Interest

None.

References

1. Stubbs, Brendon, Tarik T. Binnekade, Andy Soundy and Pat Schofield, et al. "Are older adults with chronic musculoskeletal pain less active than older adults without pain? A systematic review and meta-analysis." Pain Med 14 (2013): 1316-1331.

Google Scholar, Crossref, Indexed at

2. Lee, Sang Yeoup, Hye Soon Park, Dae Jung Kim and Jee Hye Han, et al. "Appropriate waist circumference cutoff points for central obesity in Korean adults." Diabetes Res Clin Pract 75 (2007): 72-80.

Google Scholar, Crossref, Indexed at

3. Blyth, Fiona M. and Naomi Noguchi. "Chronic musculoskeletal pain and its impact on older people." Best Pract Res Clin Rheumatol 31 (2017): 160-168.

Google Scholar, Crossref, Indexed at

4. Yanardag, Mehmet, Tülay Tarsuslu Şimşek and Fisun Yanardag. "Exploring the relationship of pain, balance, gait function, and quality of life in older adults with hip and knee pain." Pain Manag Nurs 22 (2021): 503-508.

Google Scholar, Crossref, Indexed at

5. Veronese, Nicola, Emanuele Cereda, Marco Solmi and S. A. Fowler, et al. "Inverse relationship between body mass index and mortality in older nursing home residents: a meta‐analysis of 19,538 elderly subjects." Obes Rev 16 (2015): 1001-1015.

Google Scholar, Crossref, Indexed at

6. Zhou, Huan‐Huan, Yuxiao Liao, Zhao Peng and Fang Liu, et al. "Association of muscle wasting with mortality risk among adults: A systematic review and meta‐analysis of prospective studies." J Cachexia Sarcopenia Muscle 14 (2023): 1596-1612.

Google Scholar, Crossref, Indexed at