Advice for the Aging Athlete
While age is a
relative thing -- the 60-year-old tennis player may be in better shape than the 20-year-old couch potato -- time takes its
toll on the human body in terms of physical changes. After age 30, humans’ start losing muscle mass and after age 40,
bone mass declines. Tendons, which connect muscles to bone, and ligaments, which hold joints together, become less elastic
and are easier to tear. These changes and others affect our ability to enjoy sports, as we grow older.
Some of the sports that people
do today, such as snowboarding and extreme skiing, put even more stress on the body. The human body is not designed to perform
many activities, including traditional sports. A professional baseball pitcher rotates his arm at a velocity of about 7000
degrees per second at one point in the pitching motion. That's equivalent to rotating your arm all the way around 20 times
in a second. When a pitcher lets go of the ball, it's like someone is pulling his arm out of its socket. Because our bodies
were not designed to withstand the stresses of some sports, professional and amateur alike, participation can cause physical
damage.
The most common sports injuries are ankle sprains, shoulder and rotator cuff problems, shin splints, Achilles tendonitis,
pain in the front of the knee, elbow problems and low back pain.
Fortunately, the body is very good at repairing
itself, but as we age, that too changes and the body takes longer to recover. You need to decrease the repetitive impact to
your body, particularly your joints, to continue to enjoy the game with fewer aches and pains. How you perform your sport
makes a difference in how your body adapts to it when you age. Modify your sport as you can. Switch from singles tennis to
doubles, from running to bicycling, or from advanced ski hills to the more basic slopes. You may not be able to play three
times a week anymore because that doesn't give the body enough time to repair itself.
In the meantime, work on your flexibility and
strength. As company physician for the Milwaukee Ballet, I've found that ballet dancers have a low injury rate because
they have such incredible flexibility and strength. Stretching to increase flexibility and lifting weights to build strength
makes you a better athlete and makes the body a better shock absorber. By conditioning and increasing muscle mass, the body
is able to better absorb repetitive impacts. Using a heavy weight with fewer repetitions (about 12) will build more muscle
mass, but also may cause injury. Using lighter weights and about 30 repetitions per exercise is safer and still provides improved
strength. Lifting weights damages muscle, but when it is rebuilt, it is stronger than before. You may be able to lift two
to three times a week and still play sports and allow your body a chance to heal.
Cardiovascular fitness is important, too, as heart disease is
one of the major causes of death. In order to exercise the heart, you must raise the heart rate with exercise. For the greatest
cardiovascular benefit, exercise three to five days a week, 20 minutes a day, to get your heart rate between 60 and 80% of
your maximum. Calculate your maximum heart rate by subtracting your age from 220. Cardiovascular exercise should involve the
legs (running, walking, tennis, bicycling, stairmaster, etc.) because legs have large muscles and require a lot of blood to
work.
Research has shown that several short exercise sessions, such as climbing stairs, during the course of the day have the
same effect as one long bout in lowering triglycerides or blood fats.
Some aging athletes are concerned
that playing sports will make their arthritis worse. Arthritis is a natural condition that affects the surface coating of
bones in our joints. Each of us has a genetic predisposition that helps determine when our joints will wear out. While a serious
joint injury may affect that timetable, moderate exercise will not. You may feel more symptoms from exercise, but it will
not cause additional damage. In fact, some studies show that exercise reduces pain in arthritis sufferers.
Warming up, stretching
and anti-inflammatory treatments like ibuprofen pills or cortisone or Supartz injections may help relieve symptoms but won't
slow down the natural progression of arthritis. Nutritional supplements like glucosamine and chondroitin may also reduce symptoms.
They are not miracle cures and we do not understand how they work yet.
Surgery, of course, is the
last treatment option for aging athletes. Joint replacement surgery is generally very successful with minimal risks. But artificial
hip and knee joints have a life span of about 15 years. And while cartilage replacement surgery is sometimes possible in younger
athletes who have otherwise healthy joint surfaces, it is not an option for older athletes with more wear and tear on their
joints.
Finally, where back pain is concerned, it's a part of nearly every person's life at some time and may be caused
by muscles, nerves, bones or discs. And often when we speak of "throwing out our back," we have sprained one of
several small joints in the lower back. Strengthening the abdominal muscles with crunches -- modified sit-ups -- will help
prevent most back pain.
For a free copy of the Froedtert & Medical College Sports Medicine Center's
stretching guide, please call 414-805-7100.
William G. Raasch, MD
Associate Professor of Orthopaedic Surgery
Director
of the Division of Sports Medicine
Medical College of Wisconsin and Froedtert Hospital
Common injuries
in older athletes
Running
Most
common runners' injuries have one thing in coming; too much running causes them. This becomes more and more true as we
age.6 Common over-exercise injuries in older runners include back pain, bursitis, stress fracture,
hamstring injury, problems with the kneecap, shin splints, Achilles tendonitis, heel pain, Morton's neuroma (a nerve disorder
in the foot), calluses, bunions and a host of other leg and foot problems. Short of surgery, the best treatments for most
of these conditions include rest, orthotics, non-steroidal anti-inflammatory drugs or other pain medications, and physical
therapy. For some runners, a difference in the length of the legs plays a role in many of these conditions; this can be corrected
with orthotics. All runners should use shoes with good mid-sole cushioning and should change shoes every 250 to 500 miles.7 Grass, dirt and wooden tracks
are less stressful to the body and are particularly recommended for older runners.
Older
runners are also far more susceptible to fall-related injuries. Often, the reason is deteriorating balance; in this situation,
it is a good idea to add balance exercises to the workout regimen.
Swimming
Swimmer's shoulder,
which is caused by repeated rubbing of the rotator cuff muscles against the acromion, a bone in the shoulder, occurs in 60%
of competitive swimmers.8 An upper arm strap may relieve some of the pain caused by this condition.
Older swimmers are more likely to suffer rotator cuff rupture than younger swimmers. Another injury more common in the older
athlete is rupture of the long bicipital tendon. Both of these injuries require surgical repair. Older swimmers should avoid
using hand paddles; these increase the risk of impingement syndromes. All older swimmers, except those with certain knee conditions,
can use fins.
Cycling
Older cyclists are more likely to suffer from compressive or inflammatory syndromes, most often involving
nerve problems in the upper part of the body. These are mostly caused by over-exercise. Other cycling injuries that are common
in older people include upper limb fractures (in particular the wrist, forearm, and collar bone), shoulder dislocations, sprains,
lacerations and abrasions. Using the correct seat height, wearing padded gloves, and not resting on the hands while riding
can help cyclists avoid most overuse injuries. Using a padded seat and padded cycling shorts can help urethritis, or inflammation
of the urethra, and saddle pressure sores. Incorrect rider position is a very common contributing factor to overuse injuries.
Golf
Common overuse injuries in golfers include rotator cuff (shoulder) problems, cervical (neck)
disc or osteoarthritic problems, lower back pain and epicondylitis (golfer's or tennis elbow). Wrist pain is
common in older golfers, because of continual extension and twisting of the wrist during the golf swing. Many of these problems
can be avoided simply by appropriately warming up the body before starting and by doing stretching exercises. Muscle strengthening exercises, particularly of the back muscles,
are also key to preventing and treating golf injuries. When overuse injuries occur, doctors normally prescribe rest and pain medication. It can also be a good
idea for an older golfer to give his body a break by moving for a time from the golf course and the driving range to the putting
green.
Conclusion
There
is no question that older athletes are more prone than younger athletes to a range of sports injuries. This is no reason,
however, for older people to avoid physical activity. Most sports injuries can be prevented or
treated with a combination of preparation, targeted exercise and conditioning, and common sense. Almost all studies suggest
that active, but not excessive, enjoyment of a variety of sports and exercise can give older people both a better and a longer
life.
References
1. Morley JE, Reese SS. Clinical implications of the aging heart. Am J Med 86:77-86,
1989.
2. Hood S, Northcote RJ. Cardiac assessment of veteran endurance athletes: a 12-year follow-up study. Br J Sports
Med 33:239, 1999.
3. Seto JL, Brewater CE. Musculoskeletal conditioning of the older athlete. Clin Sports Med 10:401,
1991.
4. Morley JE, Unterman TG. Hormonal fountains of youth. J Lab Clin Med 135:364-366, 2000.
5. Hubert HB,
Fries JF. Predictors of physical disability after 50: six year longitudinal study in a runners club and a university population.
Ann Epidemiol 4:285, 1994.
6. Brunet ME, Cook SD, Brinker MR, Dickinson JA. A survey of running injuries in 1505 competitive
and recreational runners. J Sports Med Phys Fitness 30:307, 1990.
7. Richardson AB, Miller JW. Swimming in the older
athlete. Clin Sports Med 10:301, 1991.
