Hey ,

Two weeks ago, I shared a short blip about menopause and frozen shoulder syndrome. That information generated a lot of interest (and questions!). So today, I want to expand on that topic and talk about MSM—the musculoskeletal syndrome of menopause.

Before I get into the thick of it, I want to express my gratitude to all scientists who have advanced research on women's health. I'm also infinitely grateful to every woman who pushed against social norms to create an environment where conversations about menopause are no longer taboo. 

Now, over the estrogen, muscles and bones...

What is MSM?

The musculoskeletal syndrome of menopause (MSM) is a constellation of symptoms that affects the musculoskeletal system—muscles, bones, joints, tendons, and ligaments—due to hormonal changes during menopause. This syndrome is increasingly recognized as a significant contributor to pain and reduced mobility in menopausal women.

The primary driver of MSM is the drop in estrogen levels during menopause. This hormonal shift leads to increased inflammation, accelerated muscle and bone loss, reduced muscle repair and collagen synthesis.

Up to 71% of all women experience musculoskeletal symptoms during menopause, with 25% reporting severe pain.

Key Symptoms Of MSM:

Joint Pain and Inflammation:

• Estrogen has anti-inflammatory properties, and its decline can lead to joint pain, stiffness, and inflammation.
• Commonly affected areas include shoulders, knees, hips, and hands.

Loss of Muscle Mass (Sarcopenia):

• Estrogen supports muscle strength and repair; its reduction accelerates muscle loss.
• Symptoms include decreased muscle strength, endurance, poor balance, and an increased risk of falls.

Bone Loss (Osteoporosis):

• Estrogen helps maintain bone density by slowing bone breakdown. Its decline increases the risk of osteoporosis and fractures, especially in the spine, hips, and wrists.

Reduced Flexibility and Mobility:

• Tendons and ligaments lose elasticity due to decreased collagen content.
• Conditions like frozen shoulder or tendonitis may develop.

To sum it all up, in the words of Claire Callaghan, B. PTy, MSc, a physiotherapist with a passion for women's health,

"Estrogen positively affects connective tissue health. That includes ligaments, tendons, and fascia (the thin casing of connective tissue surrounding your muscles). As the estrogen declines, our ability to regenerate these tissues may be affected …we often see women presenting with more things like Achilles issues, hip pain, and plantar fasciitis issues in midlife," she says. 

What now?

The pinball effect: this is when all the wear and tear we've accumulated over the years finally adds up, as do imbalances and bad habits.

Our mobility begins to break down, and once it does, so does our functional movement. A lack of mobility in one place, like your shoulder, can have a pinball effect as your body compensates, causing pain in a completely different and seemingly unrelated place.

What's next?

Having a good physiotherapist on your team is essential to success, but it is not the whole solution. Cause let's be frank: having an adjustment once a week is not going to change the state of your tissues and bones.

The truth is that what you do every day has more impact on your health than any practitioner ever can. Now is the time to prioritize your self-care with a capital "P."

Prioritize movement:

Roll Out the Kinks: You want to roll out any kinks, knots, and stubborn spots restricting your movement. The goal is to break up adhesions and scar tissue within the muscle and fascia to reduce stiffness and tension and increase blood flow.  

In classes, we use a variety of therapy balls - some bigger, some smaller, some softer, some harder - to work out the knots and adhesions in the soft tissues.

If you press so hard that you have to hold your breath, you're going too deep and triggering your fight-or-flight response, which will only exacerbate the problem.

Over time, the goal is for these massage sessions to be minimally uncomfortable. That means your tissues are operating with healthy mobility and don't perceive a threat when they're under tension.

This also should ease joint pain because the muscles around those joints are no longer under dysfunctional amounts of tension.

Sneak in Short Walks: Many of us sit at desks, in cars, in meetings, and on the couches for much of the day. That's bad for your health, as well as your mobility.

The lymphatic system is where our body accumulates much of the metabolic waste. But unlike our circulatory system, which is in constant motion thanks to the heart, the lymphatic system is powered by our skeletal muscles. 

You can really only take out the trash by moving your muscles. We need to move to pump the lymphatic wastes out. That's one of the many reasons health experts implore you to stand up and move around at least once an hour.

Walking is an excellent healing exercise. It helps decongest your lymphatic system, stretch your muscles, and lubricate joints. Sneak in short walks throughout the day whenever possible.

Add in Resistance: Strength and resistance training helps to mitigate some of the negative effects of hormonal changes, and helps to maintain muscle mass and bone density. Pick your tool: resistance bands, weight, and even water (pool!) all count!

Address Pelvic Health: This is crucial. There are a number of significant hormonal and physiological changes that affect the pelvic floor muscles during perimenopause and menopause. These changes can lead to a huge range of issues that impact our quality of life (ya, you know what I'm talking about). Pelvic health is where a good physiotherapist (emphasize "good"!) can make a difference.

Get Down on the Ground: Kids and young people readily plop down on the floor, kneeling, legs crossed, like a pretzel, and/or in all sorts of configurations. 

We stop doing that in adulthood, and then it gets progressively harder to get down on the floor and back up again because unless you do yoga or other mat exercises regularly, you're rarely, if ever, taking your body through that full range of motion of dropping all the way to the floor in a controlled manner. That's really important - and can help pelvic floor health, amongst many other things.

With warmth and gratitude,