Aging
athletes require tailored exercise regimen to
avoid overuse injuries
ROSEMONT, Ill., Oct. 3 /PRNewswire/
-- Research shows that many of the so-called physiologic effects of
aging may be related to the increasingly sedentary lifestyle that
typically accompanies old age. Regular exercise can slow down or
even reverse many of the "physiologic" consequences of aging.
Estimates cite that one-quarter of the U.S. population will be over
age 55 by the year 2010. With the growing trend of exercise adoption
among baby boomers and beyond -- coupled with the fact that older
athletes are more susceptible to chronic and overuse injuries than
their younger counterparts -- the number of Americans with
musculoskeletal problems is positioned to reach an all-time high.
According to a study published in the October 2005 issue of the
Journal of the American Academy of Orthopaedic Surgeons, proper
diagnosis and treatment of musculoskeletal problems in aging
athletes will help active older adults maintain function and safely
return to sports via individually-tailored exercise programs.
Age-related declines in muscle
function have the greatest impact on older athletes' functional
capacity, as discussed in "Orthopaedic Care of the Aging Athlete," a
study by American Academy of Orthopaedic Surgeons members Andrew L.
Chen, MD, MS; Simon C. Mears, MD, PhD; and Richard J. Hawkins, MD.
Besides losing muscle and bone mass with age, tendons and ligaments
lose elasticity and are more prone to wear and tear injuries.
Age-associated declines in hearing, memory, balance, motor skills,
sensation, proprioception and cognition further affect athletic
participation. Because of these changes, low-impact, endurance
sports are often better suited to older athletes, although many
choose to pursue high-impact activities, such as skiing. With
regular, intensive muscle training, aging athletes -- well into
their 80s -- can minimize or reverse age-related declines in muscle
mass.
The most common injuries among
aging athletes are chronic, overuse injuries such as muscle strains
and tendinitis. These types of injuries result from a decrease in
musculoskeletal flexibility and participation in endurance sports --
such as long-distance running -- which promote muscle fatigue and
predisposition to injury. "Chronic and overuse injuries account for
approximately 70 percent of injuries in veteran athletes age 60 and
older, whereas only 41 percent of younger athletes -- ages 21-25 --
are affected by these same injuries," explained Dr. Chen, the
study's lead author and attending orthopaedic surgeon in Littleton,
NH. "Because these injuries are related to repetitive activity in
the presence of degenerative changes, they often result in prolonged
disability."
Shoulder injuries are also
frequent among older athletes. One of the common causes of prolonged
shoulder pain, weakness, and disability is a torn rotator cuff.
Rotator cuff repair can be very successful in physically active
older patients, with up to 94 percent of patients over 65 years old
reporting satisfactory results. After repair, up to 80 percent of
patients are able to return to athletics at their pre-injury
activity level.
Because the majority of older
athletes have been physically active since a very young age, they
are especially vulnerable to osteoarthritis (OA, or "wear-and-tear"
arthritis), which leads to joint pain and stiffness. Despite the
popularity of nutritional supplements like creatine, and the use of
"anti- aging" agents such as androgens or growth hormones, the
researchers concluded that these supplements have not definitively
been shown to enhance performance in athletes who train regularly
and maintain a well-balanced diet. They emphasized that further
investigation is needed from both a safety and efficacy standpoint
before these substances can be widely recommended. The supplements
glucosamine and chondroitin sulfate have been shown to improve
osteoarthritis symptoms in some patients. Exercise and weight
control are essential in the prevention and treatment of
osteoarthritis, especially of the knee, hip and ankle joints.
A newer therapeutic treatment
called viscosupplementation has well-established success in treating
OA of the knee, and may be a viable option for the aging athlete.
Viscosupplementation is an injection of a preparation of hyaluronic
acid -- a naturally occurring substance in joint fluid -- into the
knee joint, which acts as a lubricant so bones can move smoothly
over each other and absorb shocks from joint loads. In addition,
such injections have also been shown to have analgesic and
anti-inflammatory effects similar to ibuprofen, and may jump-start
the body's own production of hyaluronic acid. For athletes with
early-stage OA, arthroscopic surgery may relieve mechanical symptoms
of locking and catching related to cartilage (meniscus) tears.
Patients with smaller, defined areas of cartilage damage may benefit
from microfracture surgery. Typically performed arthroscopically on
an outpatient basis, the microfracture procedure involves
stimulation of the bone marrow to release cells that can cause
cartilage defects to heal. Recent studies have reported a 75 percent
improvement at three-to-five-year follow-up in individuals that have
undergone this procedure. Most notably, microfracture surgery is a
single, minimally invasive procedure that does not preclude or
interfere with possible future surgery.
Realignment surgery (osteotomy)
may be of benefit to patients with arthritis limited to only part of
the knee. Osteotomy is ideally suited for physiologically younger
patients who wish to remain extremely active. In cases of advanced
degenerative changes, total joint replacement is often recommended.
However, total joint replacement presents a unique challenge in the
older athlete, as the goal of the procedure is not merely pain
relief, but also to allow return to functional activities. Despite
continued improvements in implant technology, what limits
postoperative activities is implant fixation to the body. Because
the procedure provides patients with pain relief and mobility --
allowing them to return to many activities they enjoy -- older
athletes often place undue stresses on the implant. Patients who
have undergone hip replacement have additional activity constraints
due to risk of implant dislocation. Most patients with artificial
joints can remain physically active, as long as they adhere to
certain restrictions as recommended by their orthopaedic surgeon.
Because the success of functional
recovery and return to athletic activity depends on the older
patient's ability to physically or mentally comply with a given
treatment plan, it is essential that physicians individualize
conditioning or rehabilitative regimens based on each patient's
known physical or cognitive limitations. "Physical fitness and
injury prevention programs geared toward active seniors will
continue to grow in demand," added Dr. Chen. "While it's never too
late in life to start exercising, it's best to consult with a
physician before beginning any intense exercise program, as
sedentary older adults who begin intensive training programs -- as
opposed to gradually adopting an exercise routine -- are at
increased risk for cardiovascular problems as well as
musculoskeletal conditions."
An orthopaedic surgeon is a
physician with extensive training in the diagnosis and nonsurgical
as well as surgical treatment of the musculoskeletal system
including bones, joints, ligaments, tendons, and nerves.
The Journal of the American
Academy of Orthopaedic Surgeons (JAAOS) is a publication of the
28,000-member American Academy of Orthopaedic Surgeons (
http://www.aaos.org/ ) or (
http://www.orthoinfo.org/ ), a
not-for-profit organization that provides education programs for
orthopaedic surgeons, allied health professionals and the public. An
advocate for improved patient care, the Academy is participating in
the Bone and Joint Decade (
http://www.usbjd.org/ ), the
global initiative in the years 2002-2011 to raise awareness of
musculoskeletal health, stimulate research, and improve people's
quality of life. President Bush has declared the years 2002-2011
National Bone and Joint Decade in support of these objectives. The
AAOS will celebrate its 75th Anniversary at our 2008 Annual Meeting
in San Francisco. Visit
http://www.aaos.org/75years and
be a part of our history!
avoid overuse injuries