If you lead an active lifestyle in London, such as training for marathons or Hyrox on weekends and working to improve your personal best at the gym during the week, you likely rely on your body’s consistency. However, during the menopausal transition, you may notice changes. Recovery from exercise may take longer, or you may develop persistent hip discomfort that was not present before.
At Movement Perfected, we see these changes frequently. Menopause is not only a hormonal shift but also a significant adjustment for your musculoskeletal system. Our goal is to help you adapt your movement so you can continue to perform at your best.
1. What is Happening in Your Body?
While hot flushes and sleep changes are common symptoms of menopause, as physiotherapists, we focus on underlying changes. The decline in oestrogen is the primary driver here.
Oestrogen is a powerhouse for your bones and soft tissues. It regulates bone formation and supports tendon resilience. During menopause, many women experience increased joint stiffness and slower recovery from intense exercise.
2. Common problems you may experience:
Decreased Bone Density and Why Walking Isn’t Enough
One of the most common things we hear in our Marylebone clinic is: “I’m active, I get my 10,000 steps in, so my bones should be fine.”
While we love that you’re moving, recent research suggests that “habitual loading” (basically your daily walking and general activity) might not be enough to stop the decline in bone mineral density during the menopausal transition.
Our bones require mechanical load to stay strong. This is the kind of stress that comes from lifting heavier weights or medium-to-high intensity impacts. Studies show that higher-impact activities, such as very brisk walking or light jumping, have a much stronger link to improved hip and leg bone density than lower-intensity movement. Essentially, if we want to protect your skeleton, we have to challenge it.
Pain on the outside of the hip and Menopausal Tendons
Are you experiencing a dull, persistent ache on the outside of your hip? This is often Greater Trochanteric Pain Syndrome (GTPS), and it’s significantly more common in postmenopausal women.
Because tendons are sensitive to oestrogen, the drop in hormones can make the gluteal tendons less tolerant of certain loads. The good news? It is highly manageable. We focus on three main areas:
• Education: Small changes matter. We often find clients are inadvertently “compressing” their tendons by crossing their legs at their desk or standing with their weight shifted to one side.
• Load Management: The solution is not to stop you from moving; we just change the way you move to avoid irritating the area.
• Hormonal Support: For some women, Menopausal Hormone Therapy (MHT) can help, alongside Physiotherapy strategies for tendon pain, particularly when combined with targeted exercise.
The Morning Knee Stiffness
If your knees feel painful, stiff and heavy when you first get out of bed, you might be dealing with the early stages of osteoarthritis.
In our clinics, we focus on progressive resistance training to manage this. During the menopausal transition, you may need higher mechanical strains like those from weight training to actually trigger a bone-building response. Additionally, intensive aquatic training is also a brilliant tool for easing short-term stiffness, and it is just as effective as land-based strength work is for improving pain and physical function.
3. What a Menopause Assessment Includes
• The Hormonal Timeline: Where are you in your transition? This helps us gauge how “reactive” your bones and tendons might be.
•Impact Tolerance: We assess how your body handles load. Can you jump? Can you hop? Can you squat with weight?
• Gait and Biomechanics: We assess how you walk and run to determine if you are placing any extra stress on your joints.
• Bone Density History: If you’ve had a DXA scan, we’ll review it to tailor your protocol specifically to the areas that need it most.
4. Common Mistakes We See
• Doing “Light Weights for Toning”: During menopause, your muscles and bones need heavy (but safe) resistance to maintain their mass. Light weights often don’t provide enough strain to trigger bone growth.
• The “Rest and Wait” Approach: If your hip or knee hurts, resting until it “goes away” usually leads to more stiffness and muscle loss. We recommend the “modify and continue” approach.
• Ignoring Nutrition: Movement is the architect, but nutrition is the builder. We often discuss protein and calcium intake alongside your exercise plan and refer to expert Dietitians in the field where necessary.
5. When to Ask for Help
You don’t need to be in agony to see a physio. In fact, the best time to see us is when you first notice your body isn’t responding to exercise the way it used to. Specifically, seek help if:
• You have hip pain that makes sleeping on your side impossible.
• Your joints feel stiff for more than half an hour in the morning.
• You’ve been told you have “thinning bones” and you’re scared to lift weights.
• You want to start a high-impact sport (like padel or running) but aren’t sure if your body is ready.
6. Long-Term Strategy
Menopause isn’t a temporary state; it’s the beginning of a new chapter in your life. Our goal is to help you build a body that is “future-proof.”
This means a mix of Clinical Pilates for joint mobility and core control, combined with strength and impact training to keep your bones dense and your tendons resilient. It’s about moving with intention and backing your movement with the latest science.
At Movement Perfected, we’re here to ensure that your transition through menopause is one of empowerment, not limitation.
7. FAQ
Q: I’ve been told I have Osteopenia. Should I stop running?
A: Actually, quite the opposite! Controlled impact is generally good for bones. However, we would assess your technique to ensure you aren’t overloading specific areas, and we might suggest incorporating some heavy resistance training to supplement the running.
Q: How often do I need to do “impact” training to help my bones?
A: Consistency is key. The research suggests that medium-to-high intensity impacts are most effective when they are a regular part of your week. We usually aim for 2-3 sessions that include some form of “loading” or impact.
Q: Does Clinical Pilates help with bone density?
A: Clinical Pilates is incredible for joint health, balance, and muscle tone. However, for bone density specifically, we usually need to add “weight-bearing” and “impact” elements to the Pilates repertoire to get the best results for your bones.
