Sports Medicine: Just the Facts

CHAPTER 97 • THE GERIATRIC ATHLETE 567

1. Insidious changes occur over time in sedentary
   populations leading to a loss of physical capacity
   and an increased perception of effort at submaxi-
   mal work (exercise). This leads many adults to
   avoid exercise, exacerbating age related declines
   secondary to disuse of biological systems
   (Figure 97-1).


2. Moderate- to high-intensity activity is a means by
   which the functional/physiologic losses associated
   with aging may be altered.

THE AGING MUSCULOSKELETAL
SYSTEM (Buckwalter, Heckman, and
Petrie, 2003)

• Age-associated musculoskeletal changes play an
  important role in injuries sustained by the older
  adults.
  
  
  1. Bone mass and strength decrease dramatically with
     aging. Losses in cortical bone (from increased
     porosity and endosteal absorption) and cancellous
     bone (from decreased number of trabeculae) leads
     to an increasing incidence of vertebral body and
     long-bone fractures after the age of 50. Women are
     proportionally more affected than men.
  
  
  2. Muscle mass decreases in the size and number of
     cells resulting in decreased strength.
  
  
  3. Articular cartilage undergoes degenerative changes
     secondary to a decrease in chondrocyte function.
     Fraying of articular surfaces, decreased tensile
     stiffness, fatigue resistance, and overall thickness
     leads to degenerative processes and to the develop-
     ment of osteoarthritis.
     4.Intervertebral discs demonstrate dramatic changes
     especially in the central region of the disc. The
  
  
  
  

firm fibrous plate develops fissures and cracks

that extend centrally with aging leading to disc

compression and to the age-related loss of spine

height. Changes in proteoglycan, water, and

nutrition to the disc lead to disc herniation and

changes in disc shape and volume. Stiffness, back

and neck pain, loss of mobility, spinal stenosis,

and degeneration of the joint facets are common

to the aging spinal cord.

5. Tendons, ligaments, and joint capsules are com-
   posed of dense fibrous tissues. Degenerative
   changes in these tissues lead to low-energy ruptures
   of the rotator cuff, long head of the biceps, and
   patellar and Achilles tendons. These tendon and lig-
   amentous ruptures appear to be caused by progres-
   sive decline in tensile stiffness and an ultimate load
   to failure with aging.

FACTORS AFFECTING THE AGING

MASTER ATHLETE (Mengelkock et al, 1997;

Wiswell et al, 2001; Maharam et al, 1999;

Rogers et al, 1990; Pollock et al, 1987; 1997)

• Changes associated with the normal aging process are
  also found in the master athletes (those older than 40).


• The master athlete continues to maintain muscle mass
  but it is dependent on strength training and training
  volume. Table 97-4 outlines changes normally seen
  with aging and compensatory changes of the master
  athlete.


• The master athlete is more prone to acute and overuse
  injuries secondary to slower rates of healing and
  recovery and lower compliance with rehabilitation.


• The master athlete appears to slow down secondary to
  a decrease in training intensity, time, and motivation
  as compared to younger competitive athletes.

COMMON INJURIES IN PHYSICALLY

ACTIVE OLDER ADULTS AND

ATHLETES (Kannus et al, 1989; Menard

and Stanish, 1989; Kallinen and Markku,

1995; Kallinen and Alen, 1994)

• Injuries account for the sixth leading cause of death in
  older adults, typically from a fall in a frail older indi-
  vidual. Most injuries are related to speed of move-
  ment. For women 8 to 21% and in men 9 to 35% of all
  injuries are related to sports activity (Table 97-5).


• Acute injuries are common in older adults who partic-
  ipate in physical activities that demand a high amount
  of coordination, balance, and reaction times. These
  sports include ball games, skiing, and gymnastics.

FIG. 97-1 Schema of exercise avoidance.