Sports Medicine: Just the Facts

CHAPTER 97 • THE GERIATRIC ATHLETE 569

1. Management begins with making a pathoanatomic
   diagnosis. Examine the entire region in question.
   In addition any patterns of muscle imbalance and
   structural malalignment need to be evaluated.


2. Control inflammation to allow injured tissues to
   repair and heal. This includes a period of rest or
   activity modification, ice and compression, eleva-
   tion of effected extremity, and finally strategies to
   prevent further injury. Medications such as ace-
   tominophen or nonsteroidal anti-inflammatory
   agents may be used to manage pain. Use of steroid
   is controversial.


3. Promote healing through site-specific rehabilita-
   tive exercises and cardiovascular conditioning.
   This will increase the proliferation of vascular ele-
   ments and fibroblasts that create collagen deposi-
   tion and maturation in injured tissue.


4. Begin sport specific rehabilitative exercises when
   pain free range of motion is achieved and strength
   and endurance test indicate a return to a preinjury
   state.


5. Control abuse by educating the older athlete that
   more is not always better and that overtraining pre-
   cipitates fatigue, decreases performance, and
   increases the probability of injury. Emphasis
   should be placed on a gradual increase in workload
   and training cycles. Use of bracing and taping can
   control balance and counter-forces especially
   during rehabilitation and early resumption of
   sports activity.
   •For older athletes remember that when using any
   medication “start low and go slow.” Using 1/3 to 1/2
   the recommended dosing is always a good starting
   point as is reviewing all other medications for poten-
   tial drug–drug interactions.

• The older athlete will take longer to heal. Start reha-
  bilitation early and expect the duration of treatment to
  be twice as long for an athlete of 60 years or more
  than for a 20-year-old athlete and three times as long
  for those older than 75.

PROMOTING LIFESTYLE PHYSICAL
ACTIVITY IN OLDER ADULTS (Christman
and Andersen, 2000; Evans, 1999)

• Encourage all older adults to participate in physical
  activity. The explanation for promoting this change
  should include the overall benefits of exercise as well
  as the potential risks of engaging in exercise, with
  emphasis on the benefits that the individual will gain.
  (Table 97-2).


• Obtain a detailed exercise history to include the
  patient’s lifelong pattern of activities and interests;

activity level in the past 2–3 months to determine a

current baseline; concerns and perceived barriers

regarding exercise including issues regarding per-

ceived lack of time, unsafe environment, cardiovascu-

lar risks, and limitations of existing chronic diseases;

level of interest and motivation for exercise; and

social preferences regarding exercise (Christman and

Andersen, 2000).

• The discussion should be documented with a recom-
  mendation by the American Heart Association for an
  informed consent for exercise training to be place in
  the patient’s record (Fletcher et al, 2001). A detailed
  history of cardiovascular risk factors and disease is a
  must.
  •A physical examination should be performed with
  emphasis on the following:
  
  
  1. The cardiopulmonary systems
  
  
  2. Any limiting conditions including visual or mus-
     culoskeletal impairments
  
  
  3. Evaluate the strength of the quadriceps and ankle.
     An elderly patient should be able to generate
     enough force to generate 50% of his or her body
     weight. Physical therapy is indicated for strength-
     ening if weakness is perceived in these muscle
     groups.
  
  
  4. Flexibility of the hips and ankles should be evalu-
     ated as well as sensory testing on the plantar sur-
     face and dorsum of the feet.
  
  
  5. The feet, lower legs, knees, thighs, and trunk
     should be inspected for deformities and joint pain
     in an attempt to prescribe the right exercise to min-
     imize pain and discomfort.
  
  
  
  


• The American College of Sports Medicine recom-
  mends stress testing for any older adult who intends to
  begin a vigorous exercise program such as strenuous
  cycling or running (American College of Sports
  Medicine, 2000).
  
  
  1. Conditions that are absolute and relative con-
     traindications to exercise stress testing or embark-
     ing on an exercise program should be evaluated
     (Fletcher et al, 2001).
  
  
  
  


• Finally an exercise prescription should be written on a
  prescription pad to strengthen the endorsement for
  increased physical activity. The prescription should
  include frequency, intensity, type, and time of exercise
  (Will, Demko, and George, 1996).


• It is important to start low and go slow especially if
  the older adult has been relatively sedentary.
  
  
  1. It is more important to get the older adult doing
     any physical activity than to prescribe something
     that is unattainable.
  
  
  2. The health of older adults may be better served if
     they perform a little more exercise or activity than
     the previous week, attempting to incorporate the