There are some things they just can’t teach you in school. You have to learn from experience.

The chiropractic education I got (from New York Chiropractic College in the late 1970’s) was thorough as far as it went. They couldn’t have crammed much more into those four years.

Of course we learned the distinction between acute and chronic conditions, studied many aspects of the aging process, and mastered a variety of manual therapy techniques so that we’d always have an appropriate option ready to use regardless of the age or health status of a patient.

But in the years since, as I’ve aged and the average age of my patients has increased, too, I’ve learned much more about the different ways a doctor of chiropractic has to care for individuals as they progress through their fifties, sixties, seventies, and beyond.

Here are some of the lessons I’ve learned:

Traumatic injuries versus long term wear and tear

An athletic guy in his thirties can all too easily tear one of his rotator cuff tendons throwing a baseball or swinging a tennis racket. The condition is painful and impairs the ability to move the shoulder. Surgical repair is an option, and the results are typically favorable.

In contrast, if you’re over sixty you could have a tear in a rotator cuff tendon and not even realize it. You might have little or no pain and no noticeable functional impairment. Oftentimes the condition doesn’t even require treatment, and when it does, surgical repair is rarely the first option.

Despite the fact that they’re given the same name, a rotator cuff tear (for example) is an almost completely different diagnostic entity in an older person as compared to a younger person.

The human organism is resourceful. Even as long-term wear and tear begins to affect you, a complex web of adaptations often allows you to continue functioning in those ways that are most meaningful to you.

Loss of elastic tissue function

Flexibility and elasticity are two different properties of your muscular and skeletal systems. Flexibility is a measure of how far you can move your joints and stretch your muscles. Elasticity refers to how readily the body snaps back to its starting position once it’s been stretched.

If your exercise program includes regular activities that expand your range of motion, you can maintain flexibility throughout life. But no matter what program of healthy living, nutrition, or exercise you adopt, it’s nearly impossible to prevent loss of tissue elasticity as you age.

Loss of tissue elasticity is the reason that older athletes, no matter how strong their muscles are, can’t get as much power into their tennis forehand or golf swing. When a younger athlete winds up for a stroke, she’s storing energy in her connective tissues. As she follows through with the swing, her connective tissues spring back, releasing that stored energy and delivering more power to the racket or club head.

The passive energy-storage-and-rebound effect happens to a much lesser degree in an older athlete.

Loss of elasticity is one of the reasons that older people have to move into and out of body positions more gradually. For instance, when you bend forward, you stretch the intervertebral discs of the low back. When a younger person straightens up again, those discs snap back into line. But the discs of an older person have lost their elasticity and can’t snap back – instead, they ooze back into place. That takes longer. If you move too quickly, a fragment of your disc can get pinched.

Longer healing time

Healing takes time. In an older person, it takes more time. That’s because the body systems responsible for healing – digestion, endocrine function, enzyme activity, among others – all become more sluggish as we age.

To some degree, you can fight back with better nutrition, regular balanced exercise, maintaining healthy intestinal flora, massage to improve circulation, and other health measures.

Loss of brain quickness and its effect on movement

As you age, your nerve responses slow down. That puts you at a disadvantage when it comes to quickly answering question on Jeopardy. But it also makes your movement responses slower.

Slowing down of nerve response time is one of the main reasons seniors are at risk of losing their balance and falling.

Changing expectations

With younger patients, my goal (in general) is to find out what their problem is and fix it. But for an older person, the purpose becomes more one of managing a combination of longer term problems. Fortunately, people of every age can improve their health and fitness.

Sense of humor

A sense of humor gives a health boost to anyone, young or old. But for an older person, taking an irreverent view of life isn’t optional, it’s essential.