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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!