Sports Medicine: Just the Facts

Falls, slips, and strains accounted for the majority of

these injuries.

• Inflammatory overuse injuries (muscle strain) are
  common especially to the back and lower extremity.
  
  
  1. Strength/power athletes (track and field, sprinters,
     throwers, power lifters, tennis players) tend to have
     more injuries of the upper extremities than
     endurance athletes.
  
  
  2. The knee, ankle, and foot account for 39% of all
     injuries with joint and muscle injuries more
     common in endurance athletes and muscle and
     tendon/tendon insertion injuries more common in
     power/strength athletes.
  
  
  
  


• There is a higher risk of spontaneous, low energy tears
  to the rotator cuff, Achilles tendon (peaks in 4th
  decade), patellar tendon, and medial meniscus.
  Although not frequently seen, stress fractures of the
  lower extremity have been found in runners and
  marchers (Carpintero et al, 1997).
  
  
  • There is no evidence supporting high intensity/high
    load physical activities promoting degenerative arthri-
    tis. Trauma to a joint (hip, knee, ankle) prior surgery,
    poor alignment, inadequate muscle strength and obe-
    sity are more correlated with the development of
    osteoarthritis. (Buckwalter and Lane, 1997)
  
  
  • Injuries more commonly occur during competition
    than during training especially for soccer, football
    players, and recreational athletes (Murphy, Connolly,
    and Beynnon, 2003).
  
  
  
  

DIAGNOSIS AND MANAGEMENT

(Epperly; O’Connor et al, 2003)

• Although acute injuries account for a greater number
  of injuries they are treated as overuse injuries. These
  injuries may be compounded by osteoarthritis of
  the knee, hip, wrist, and thumb as well as bursitis of
  the hip and back and Achilles and rotator cuff ten-
  donitis.


• The diagnosis and management of most injuries
  involves obtaining a good history and performing an
  adequate examination. Most elderly athletes do not
  report injuries immediately, taking a wait and see
  approach. This usually means the acute injury must be
  treated as if it were chronic (Kallinen and Markku,
  1995; Epperly).
  •A step-wise approach to management as advocated by
  O’Connor et al (2003) allows the older adult to go
  back to full physical activity.

568 SECTION 7 • SPECIAL POPULATIONS

TABLE 97-4 Physiologic Adaptation of Master Athletes

FUNCTIONAL COMPARTMENT AGE-RELATED CHANGE COMPETITIVE MASTER ATHLETE

Muscle Decreased strength Maintain type 1 and 2 muscle fibers
Reduction in muscle area/mass Mass dependent on strength training
Loss of type 1 (slow-twitch and type 2 (fast twitch Performance dependent on training volume
muscle fibers) (time and distance)

Cardiovascular ↓Cardiac output Lower resting heart rate
↓stroke volume Higher systolic blood pressure
↓maximal heart rate (10 beats/min/decade) Decreased decline in HRmas
↓aerobic capacity (VO2max) (4–7 beats/min/decade)

Bone ↓Bone mineral density ↓Bone mineral density

Aerobic Capacity (VO2max) ≈10% per decade after age 25 ≈5% per decade after age 25

Performance Between ages 20–30 near maximal speed ↓Speed
and performance ↓Strength
↓Overall performance

Nutrition ↓Energy requirement (↓lean body mass; ↑protein (1.00–1.25 g/kg)
↓physical activity) Supplement Vitamins D, B 6 , B 12 , E, C, Folate
Calcium 1,000–1,500 mg/day
Iron 18 mg/day

Water ↓Thirst mechanism Weigh in before and after workout; replace
↑Output by kidneys weight loss with 2 cups of water for each
pound lost; Monitor color of urine

Table 97-5 Common Injuries in Older Athletes

Tendinitis
Patellofemoral Pain Syndrome
Muscle strain
Ligament strain
Plantar fasciitis
Metatarsalgia
Meniscal injuries
Degenerative disc disease
Bursitis
Rotator cuff tear
Subachromial impingement
Achilles tendon tear