The Matrix

We have a real matrix in our bodies. It is called the extracellular matrix, the ECM, and it falls under the broader heading of fascia. Most people who have heard the word fascia think of the saran wrap like lining around muscles and joints. Emerging tissue biology suggests that functionally, even cartilage and bone are variations on the same fascia and ECM theme. Today I want to focus on the ECM specifically, because it has properties that almost no one outside of body work circles understands, and they shape how you age in some surprising ways.

What the ECM actually is

Three features matter for what follows.

First, the ECM has extremely high water content, up to 78 percent in a well hydrated state. It is often called mostly water, which is a simplification. The water is bound up by glycosaminoglycans and proteoglycans, the gooey ground substance that holds the whole structure together. Visually, the ECM is closer to a gel pack than to a glass of water. It flows, but slowly. One body work expert I respect calls it extracellular snot, which captures the consistency better than any textbook.

Second, the ECM is a communication system. It is densely populated with mechanoreceptors, pain receptors, vibration receptors, and proprioceptors that respond to movement, pressure, and trauma. When deformed, these receptors generate small piezoelectric signals that travel through the matrix to surrounding tissue and sometimes well beyond. It is a slow neural network parallel to the fast electrical nervous system and the chemical endocrine system. Effects play out over months. Once they take hold, they can take equally long to reverse.

Third, the ECM remembers. Postural patterns, repetitive motion, chronic dehydration, and stress all leave a footprint in the matrix. Over years, that footprint becomes structural. The most familiar visible result is posture.

Adhesions: where the matrix gets stuck

If you have ever had body work or massage, you have probably heard your therapist talk about adhesions. An adhesion is a region of the matrix where the normal smooth, slow flow has become bound. The tissues lose glide. Range of motion decreases. Pain shows up. Take it far enough and you get scar tissue. Take it further still and you get the bony remodeling we call osteoarthritis.

In theory, all of this can be reversed by removing the offending stimulus, allowing rehydration, and slowly remodeling the matrix. In practice, most people are too far down the road by the time they look at the problem, and most clinicians do not have the framework to address it. The science is still evolving.

The modern Western posture

Walk into any office. Three quarters of the people you see, regardless of age, have variations on the same postural pattern.

• Head forward of the shoulders.
• Rounded shoulders with the arms rotated inward.
• A stuck thoracic spine that does not rotate or extend well.
• Excess lordosis in the lumbar spine. The belly sits forward, the lower back curves to compensate.
• Anterior pelvic tilt. Watch the belt line drop from the back to the front.
• Externally rotated femurs even when the feet are pointed straight ahead.

The cause is primarily sitting, especially for long periods without movement and without hydration. Add in long flights, long drives, and long stretches at a screen, and the pattern locks in.

Hydration is not optional

The matrix is mostly water. Chronic dehydration thickens it. Thicker matrix forms more adhesions, particularly in regions of strain. Sit at a desk dehydrated for a year, and the low back and hips begin to feel the price. Run long distances dehydrated for a year, and you build chronic strain that becomes hard to resolve. The single most underrated daily practice in this whole picture is consistent water intake. Half your body weight in ounces is a starting target, more if you train or live in heat.

Stress thickens the matrix too

This part rarely gets discussed. Chronic sympathetic nervous system activation, the always wired, always on state that defines a lot of modern life, also drives matrix thickening. Caffeine, the constant rush, the inability to truly stop, the addiction to sleep aids that helps 50 million Americans get to bed at night, all of this signals the matrix to thicken and to lay down more of itself.

Meditation works partly through the opposite mechanism. It raises parasympathetic tone and reduces the thickening signal. The telomere literature on meditation is well documented. The matrix literature is younger but pointing in a similar direction.

About yoga and Pilates

I am going to offend some people here. Movement therapies like yoga and Pilates can absolutely help. They also frequently injure their practitioners, including the instructors, for exactly the same biomechanical reasons that injure athletes and sedentary office workers.

The problem is that most students arrive with the postural pattern described above and try to do advanced poses that require a healthy, mobile spine and well organized pelvis. Pose form gets cheated. Compensation patterns deepen. Injuries accumulate.

The honest version of yoga or Pilates instruction for the average modern adult would be roughly: we are going to spend a year on four poses, fix your breathing, fix your pelvic position, fix your thoracic mobility, and then we will progress. No one teaches that and no one pays for it, but that is what most students actually need. A good question to ask any instructor is what they do for their own body work. Most of the good ones see a body worker regularly.

How to keep your matrix healthy

• Get up and move. Long stretches of sitting are the single biggest driver of matrix dysfunction.
• Stay hydrated. Half your body weight in ounces of water daily, adjusted for training and heat.
• Fix the posture. It takes time. It is uncomfortable physically and emotionally. It is one of the highest return projects you can run in your 50s and 60s.
• Take your omega 3 fish oil. Inflammatory tone affects matrix biology.
• Meditate. Even short daily sessions move parasympathetic tone.
• Reduce excess stimulants and unnecessary stress where you can.

I have come to think that what we call degenerative arthritis is the long term collision of poor nutrition, chronic dehydration, and biomechanical posture defects that nobody addressed in time. The pieces are individually small. The cumulative effect over decades is everything.

If the goal is living to 150, it has to be a 150 that can still move. That is the whole point.

— Doc