I’m an over-50s physio – the five midlife aches you should never ignore

‘There’s a deeply embedded cultural narrative that says pain, stiffness and declining function are inevitable parts of getting older,” says Will Harlow, a physiotherapist specialising in treating the over-50s. “They’re not. They’re common, yes – but common and inevitable are very different things.”

Mid-lifers misunderstanding this is something he sees “every single week” in clinic. “The problem is when people write off pain or restriction as ‘just ageing’, they then stop moving, stop loading the affected area, and often start compensating around it – favouring one leg, avoiding bending, stopping activities they love.”

The effects of which spiral quickly. “What might have been resolved with six weeks of targeted exercise instead becomes a year of worsening stiffness, reduced confidence and a growing list of things they ‘can’t do’ any more.”

In his new book, Independence for Life, Harlow focuses on five “problem areas” which come up time and time again in his practice: the back, neck and shoulders, hips, knees and feet.

“They’re all load-bearing or high-use regions, absorbing enormous forces across a lifetime,” he explains. “And they’re the areas most affected by the age-related, changes such as reduced muscle mass and changes in connective tissues.” But, he adds, he chose to focus on these “because they’re all areas where the research overwhelmingly shows they respond to exercise – meaning these are issues you can do something meaningful about”.

Here, Harlow shares everything you need to know about each of the problem areas, and what you can do to fix them for good.

Back pain

“Back pain is almost universal – around 80 per cent of adults will experience a significant episode at some point in their lives – but it is also one of the most mismanaged conditions in medicine.

“The key thing to understand is this: pain does not equal damage. In fact, there is very poor correlation between what scans show and what people actually feel. We know from large studies that a significant proportion of people with bulging discs, ‘wear and tear’, and degenerative changes on MRI have no pain at all.

“What actually matters is restoring movement, building stability and gradually exposing the body to progressive strengthening. Bed rest – which was the medical approach for decades – is actively harmful because the spine needs movement to heal.

“For anyone managing back pain, my core advice is to keep moving, don’t fear the pain and start building strength in the muscles that support the spine. Specifically, the stabilisers around the spine – the glutes and core especially.

“My go-to exercise recommendation for the back is called toe taps. It looks deceptively simple but is extraordinarily effective at building the deep spinal stabilisers without loading the spine. Lie on your back, knees bent to 90 degrees. Slowly lift one leg, then the other, keeping your lower back pressed into the ground throughout. Then slowly drop one leg down until your toe touches the ground, then bring it back up. Return and repeat on the other side. Done correctly, this trains the pattern of bracing that transfers directly to everyday activities – getting up from a chair, lifting shopping, walking up stairs.

“For anyone with chronic back pain, I’d strongly recommend a physiotherapy assessment before any exercise programme. Not all back pain is the same, and there is no perfect exercise for everyone, so a precise diagnosis shapes the most effective treatment.”

Neck and shoulders

“As a population, we have more neck and shoulder pain than ever. Sustained ‘forward head’ posture – from screens, phones, driving – puts a cumulative load on the neck and the muscles of the upper back and shoulders. For every inch the head moves forward from its natural position, the effective load on the neck approximately doubles. Most people’s heads are two to three inches forward of where they should be.

“What I see clinically is the downstream effect: tight neck muscles causing headaches, compressed facet joints [small joints in the spine] causing neck stiffness and referred pain into the arms, and chronically overloaded upper trapezius muscles that feel permanently knotted. None of this is just because of age, and all of it is addressable.

“The key thing to understand is that the solution is not to endlessly stretch and massage these areas – though that can provide temporary relief. The solution is to strengthen the muscles that are chronically weak: the deep neck flexors, the lower trapezius, and the serratus anterior [one of the muscles controlling your shoulder blade]. These muscles are effectively ‘switched off’ in most people and need to be deliberately retrained.

“My top exercise for neck pain is the chin tuck, which is probably the simplest and most evidence-backed intervention for pain in this region. Standing or sitting, gently draw your chin straight back, creating a ‘double chin’ position. Hold for five seconds, release, repeat 10 times. This directly activates the deep neck flexors and counteracts the forward head pattern. Pair this with wall angels – standing against a wall, arms in a goalpost position, slowly sliding them up and down while keeping your back and arms in contact with the wall – and you have a powerful postural reset.”

Hips

“Hip pain in over-50s falls into two broad categories: true hip joint pathology – usually osteoarthritis – and equally common but frequently misdiagnosed soft tissue problems, particularly gluteal tendinopathy, which is sometimes known as bursitis. The two require quite different management, which is why a proper assessment matters enormously.

“But what almost everyone with hip pain shares, regardless of diagnosis, is weakness and underuse of the gluteal muscles. The glutes are the largest and most powerful muscle group in the body, and they are almost universally underpowered in adults who sit a lot. Weak glutes shift load onto the hip joint itself, onto the iliotibial band [a thick band of tissue along the outside of the thigh], and onto the lower back. So strengthening the glutes is foundational for almost any hip presentation.

“People are often told to rest hip pain, particularly when a diagnosis of osteoarthritis or tendinopathy is made. This is frequently the worst advice they can receive. The hip joint – and the tendons around it – respond positively to appropriate loading. Tendon problems need progressive loading to stimulate tissue healing. Rest allows symptoms to settle temporarily, but the underlying capacity never improves, and symptoms return the moment activity resumes.

“One of my top exercises for hip health is the single-leg glute bridge. Lying on your back with knees bent, lift one foot off the floor and drive your hips upward through the heel, squeezing the glute at the top. This isolates the gluteus maximus, and the single-leg component adds an element of stability training. Start with three sets of 10 on each side and progress by increasing the range of motion and eventually adding load. The two-footed bridge – keeping both feet on the floor as you drive your hips upwards – is a good substitute for anyone who can’t do the single-leg version.

“Anyone with significant hip pain should also be evaluated for hip mobility – specifically rotation, which is often severely restricted with early hip arthritis – because restoring mobility and strength together produces far better outcomes than either in isolation.”

Knees

“Knee pain is what I probably see more than any other in our practice, and it is also the one where patients have been most poorly served by the traditional medical advice to rest it, take anti-inflammatories and avoid what hurts. That approach manages symptoms. It does not address the underlying cause, and it doesn’t build the strength the knee needs to function well long-term.

“The fundamental thing to understand about knee pain is that the knee joint is like a middle-manager – it gets problems from both above and below. It sits between the hip above and the foot below, and its health is heavily determined by what happens at those two joints. Weak hips create a collapsing inward at the knee, and poor ankle mobility forces the knee to compensate in ways it wasn’t designed for. This is why treating only the knee so often produces mediocre results.

“The good news is that the evidence base for knee arthritis – which affects around one in five adults over 45 – is now clear: exercise is the most effective intervention available, outperforming both pain medication and knee replacement in quality-of-life outcomes for most patients.

“My go-to exercise for knees is the sit-to-stand. Find a sturdy chair, then get up without using your hands. Then, take four seconds to return to the chair and repeat 10 times. This strengthens the quads that sit above the knee and the glutes at the back of the hip.

“I also recommend step-ups onto a sturdy surface for those who can manage them: slow, controlled, single-leg loading that builds quad and glute strength without excessive compressive force on the knee joint.”

Feet and ankles

“Feet and ankles are the most underappreciated region in the whole system, and the consequences of ignoring them affects the entire chain. The foot is a complex structure of 26 bones, 33 joints and over 20 muscles – and it is the only part of the body in constant contact with the ground. What happens there shapes everything above it.

“The two things I see most commonly are plantar fasciitis – a painful condition at the base of the heel that can make the first steps of the morning genuinely agonising – and ankle joint problems, often the legacy of old sprains that were never properly rehabilitated. Both respond very well to physiotherapy but are highly neglected because people either assume they’ll resolve on their own or wear orthotics [supports or braces] as a permanent fix rather than addressing the weakness.

“The intrinsic muscles of the foot – the small muscles inside the foot itself – are almost universally weak in anyone who has spent decades in supportive footwear. The arch of the foot is a dynamic structure designed to load and spring back. When these muscles are weak, the arch collapses, the plantar fascia is overloaded, and every step transmits abnormal forces up into the ankle, knee and hip.

“The most important exercise I prescribe for foot health is the short foot exercise. Sitting or standing, try to shorten the foot from toe to heel – creating an arch without curling the toes. This activates the intrinsic foot muscles directly and is the foundation of any serious foot rehabilitation programme.

“For plantar fasciitis specifically, the evidence strongly supports calf raises done on the edge of a step – both double-leg and single-leg – performed slowly with a three-second lowering phase. This progressively loads the plantar fascia, calf and Achilles tendon, stimulating tissue healing that helps to resolve the condition effectively.

“Going barefoot on varied surfaces when safe to do so, also provides the stimulation the foot needs to restore its natural function, though make sure to build up gradually. The foot was designed to move and most of us have spent a lifetime preventing it from doing exactly that.”

‘Independence for Life’ by Will Harlow is out now (Hay House, £18.99)