Ask the Expert: Sports Safety and the Aging Adult
Dr. Kurt Schluntz
Today’s seniors are more active than ever before. For some older adults, however, more activity also means an increased risk of injury. Board certified orthopaedic surgeon Kurt Schluntz, M.D., offers advice to help you stay healthy and injury-free. Questions were submitted by the public via Suburban Hospital’s Facebook page and through email.
What are the most common sports injuries you see in active older patients?
As people have stayed active longer, we are seeing more injuries to knees and shoulders. The most common knee injury is a meniscal tear, which is a tear in the knee’s cartilage. With shoulders, we see rotator cuff injuries, which result from repetitive overhead motions.
Can some of these injuries be avoided and, if so, how?
One example of injuries that can be avoided involves weightlifting. There are safe ways to lift weights and ways that lead to more injuries. We see the most problems with aggressive lifting like the military press, which involves lifting weights over the head. The aging shoulder just doesn’t tolerate that very well. Strength training must be done carefully and under appropriate guidance. What works great at age 22 doesn’t work later in life. You can break down tendon tissue, which really doesn’t heal, or get micro-tears, which cause pain and swelling.
Before you begin a weight-training program, get expert advice. That said, I have patients who have knee or shoulder pain that was caused by a training program that is too aggressive. Personal trainers need to tailor their exercise programs to the age of the individual.
If you begin a training program and you develop pain, that’s not normal. It shouldn’t hurt if you have a healthy joint and you are doing the activity correctly. An orthopedic surgeon can help delineate which activities are good for you and which ones are actually hurting you.
What is the best way for an active senior to warm up prior to exercising and to cool down after exercising?
It’s very important to loosen up before you begin any activity. That can be as simple as a couple of minutes of gentle stretching and then performing your activity at a slightly lower level for the first few minutes. If you’re going to play tennis, get on your exercise bike for two or three minutes to loosen up your muscles. Or take a short walk around the tennis court.
There isn’t a lot of good data that shows that cooling down makes that much of a difference when it comes to preventing injuries, although it’s a good idea not to go from 60 to zero suddenly. It’s more important to do some gentle stretches on the front end. Note that aggressive stretching is actually bad for you, however. If you overstretch muscles before use, you risk hurting them.
I hear about the dangers of being a “weekend warrior.” What does this mean to an aging adult?
The weekend warrior is the individual who sits around all week and then tries to run eight miles on Saturday. That’s when you get injuries. All muscles and tendons will function best if they get a routine amount of work. After long periods of inactivity, the muscles get weaker and tighter, so when you overdo it on the weekend they get angry. To avoid this, do small things during the week. You don’t need a full hour of exercise five days per week. Just walking or riding an exercise bike for 25 minutes every other day will allow you to be more aggressive on the weekend.
I walk daily. Are there any additional activities I should add to my routine to stay strong and healthy?
Walking is helpful for your heart and the muscles of the lower extremities and it’s one of the easiest things you can do on a regular basis. But it’s not enough. You occasionally need to get your heart rate up higher than what you would get on a walk and you should be doing something to keep your upper extremity muscles strong as well.
A gentle strength-training routine is a good addition to your walking routine, but it’s important to learn how to do it. Whether that means getting a personal trainer, going to a class at the gym, or going online to watch a video, you need someone telling you what’s safe to do. If you have a significant problem with a joint, you should first be evaluated by someone who can figure out what the joint issue is and then send you with appropriate instructions to a physical therapist or a trainer.
Are certain sports more likely to cause injury as we age?
Basketball is the big “no-no” after the age of 50. It’s very hard on the knees and tendons. People who try to continue playing basketball are the ones who are coming in with early arthritis of the knee, torn menisci, ACL tears, and Achilles tendon ruptures. Soccer after the age of 60 also causes major knee issues.
People who run every day tend to have the most trouble with overuse injuries. Think of baseball pitchers. They don’t pitch a game every night but every fourth to fifth night. They need that much time in between to recover. As runners age, I generally recommend that they run every other day. Give those muscles and joints a chance to recover. If they want to do something every day, they should cross-train. If they run one day, then use an exercise bike the next day, or swim. The key is to stay fit without overuse.
Are there activities that I must reconsider as I age and why?
Tennis, skiing, swimming, cycling, even basic running are all fine. After the age of 65 or 70, however, think about slowing down. For example, excessive tennis – playing more than a couple of times per week – can lead to rotator cuff issues.
If you have early arthritis, you still need to keep your muscles strong. Strong muscles act like shock absorbers so you have less pain in your joints. Just find a way to strengthen those muscles without hurting the joint in the process. Heavy impact exercises like running and jumping activities are not great for those with an arthritic joint; they should be avoided. Deep squats and lunges are also hard on the knee joint.
As patients age, it’s a good idea to switch over to lower-impact exercises. The big three for the lower extremities are swimming, water aerobics, and using an exercise bike. All three encourage muscles and tendons to get stronger without overstressing any one particular joint.
Is there any adaptive equipment that I should consider using to reduce my chance of injury?
There really is no role for bracing in advance of an injury. For someone who does not currently have a problem with a joint, there’s no evidence that bracing actually changes anything.
If I continue to participate in my favorite activities, are there any symptoms I should watch for and what should I do if I notice these symptoms?
First, it’s always important to tailor your activities to your individual situation. For example, if you have an arthritic knee but your arthritis is under your knee cap, an exercise bike will aggravate your knee cap but walking won’t. Those who have arthritis in the main weight-bearing part of the knee will have trouble walking but they won’t have any trouble on an exercise bike.
Next, think about what is a natural aging phenomenon. A little achiness a day after an activity or not quite having the stamina that you had before, that’s normal and you can work on that by slowly and carefully increasing your training. If you are a little achy, back off what you’re doing and gently stretch. Give it a week to see if things improve. If, however, you are experiencing significant pain, loss of motion or swelling that is stopping you from doing an activity, you need to see your orthopedic surgeon.
About Dr. Kurt Schluntz
Dr. Kurt Schluntz graduated from Harvard University and received his orthopaedic surgery training at the Harvard Combined Orthopaedic Program. He completed a sports medicine fellowship at the American Sports Medicine Institute. His sports training focused on the treatment of athletic injuries to the knee, shoulder, and elbow. A diplomate of the American Board of Orthopaedic Surgery and a fellow of the American Board of Orthopaedic Surgeons, his main areas of interest are sports medicine and arthroscopic surgery of the knee and shoulder, as well as joint replacement surgery of the knee. Learn more about Dr. Schluntz by visiting www.orthobethesda.com.
Dr. Schluntz’s office
10215 Fernwood Road, Suite 506
Bethesda, Maryland 20817