The Weekend Warrior
The Aging Athlete
The days of being 60-years-old and being told to slow it down, you don’t need to do the things you used to do, are over. Society has changed and older individuals are staying active or retiring and becoming more physically active and therefore need the responsibility of their physician of any field to understand that and be sympathetic or in some cases empathetic to the problems they are having. Whether there would be a 73-year-old who leads a swing band, a 68-year-old golfer or tennis player, or a 72-year-old who continues to like to golf. Studies have found that patients 76 and older recover more slowly than younger patients after most surgery. However, after a year after the surgery, they notice the improvement they felt in pain and relief matched that of the younger patients. Staying healthier into the old age means that older patients want facelifts, other cosmetic surgery and surgical procedures to prolong their active lifestyle without pain and disability. For that reason, total joint replacements, whether that be hip or knee, and arthroscopic procedures are necessary to keep our older population going.
Many of the techniques that we use, particularly in the shoulder and elbow, but more importantly in the shoulder, were designed for our younger athletes, our throwers, to be minimally invasive. We had started with arthroscopic surgery of the shoulder in the early eighties as a diagnostic tool and have progressed to the point of not only being able to evaluate lesions such as the labrum, the capsule, the rotator cuff and bone spurs, but we are able to treat them. We are able to take, through arthroscopic means to the shoulder, things that were only able to be diagnosed arthroscopically and then had an open incision procedure to perform, we can now perform all arthroscopically. The irony of this is that the younger patients that it was designed for, overhead throwers or extensive elite athletes, have benefited from this, however it’s our older population that I believe we’ll be able to save and help with less invasion, less risk for complication and a higher success rate of a surgical procedure to get them back and active.
As you age, one of the terms that you hear a lot is the rotator cuff. Rotator cuff of the muscles that surround the shoulder joint are what gives it its strength and ability to lift your arm over your head, to comb your hair, to lift a tennis racket, to pull Tylenol from the top shelve of the medicine cabinet. As you age, many people develop problems with the rotator cuff; whether that’s just inflammation what we call impingement from bone spurs and bursitis of the shoulder from overuse to partial tears to full thickness tears of the rotator cuff. For years the term rotator cuff tear in our population of patients 45-50 years and older was just a horrible thought of pain, discomfort, disability and never able to get back to the level of activity that you previously had before the injury. Now with arthroscopic means, the use of an MRI for evaluation, physical examination and arthroscopic diagnosis, as well as arthroscopic treatment we can actually fix the rotator cuff with minimally invasive techniques that will cause less tissue destruction and the outcomes and findings a number of years after surgery has allowed our patients to continue on with their active normal lifestyle that they had prior to injury.
Rather than telling a 55-year-old woman to stop playing tennis because she has a torn rotator cuff, as was done in previous years or succumb to an open procedure that would have an incision that was 4 or 5 cm long would split and cause muscle destruction to repair the rotator cuff with a chance of a significant amount of pain and still being unable to play, we are now able through less invasive techniques to look through 1 cm or less incisions, define the rotator cuff tear and repair it. It is that type of means with an excessive physical therapy program that allows these athletes in the sixth decade of life and beyond to continue their sport, continue their active healthy lifestyle because as studies have shown these are the patients that are going to, as they stay healthy, continue on and live longer than ever before.
Certainly, these changes of technology occur also in the knee with less invasive techniques, total joint replacements, partial joint replacements, as well as in the hip and the elbow, but the shoulder is where we have made our greatest arthroscopic advances over the last fifteen years. We are able to take through these incisions and repair the labral capsular structures, rotator cuff, bone spurring or early arthritic changes to keep our athletes healthy.
However, I think as important as our technological changes has been the change of attitudes in the physicians that are providing care for these older athletes. As we grew and went through school and learned that as you become older you should become sedate, less active and understand that your older and not be able to do the things you used to do, I think we are understanding that an active person lives longer, keeps their blood pressure down, their body weight down and has a potential to live a longer healthier lifestyle and in the role of sports medicine with the aging athlete to allow them to enjoy life and do the things that they had done as a younger individual. Maybe not as quick, maybe not as long lasting, but certainly able to go out and jog, walk, run, play tennis, golf or badminton or bowl; the things that they have enjoyed doing all the way as they were growing up. This mindset of physicians and an aggressive approach to sports medicine and treating our older athletes with the mindset of continuing them on the field or on the court like we would our younger athletes, I think is a breath of fresh air for our older individuals and we need to treat them like that not only in our initial visits, our continued visits, physical therapy and our continual involvement with wanting to allow them to do what they want to do to enjoy their life, either to take the pressure and stress off work, to lose weight or just an overall involvement with a team sport and enjoyment for the social activity.
As we progress on with new technology, our dimension and mindset should be for the older athlete to keep them healthy and active. With the highly public athlete being more publicized and more worthy of newspaper and print, it’s our older athletes that will continue to give us as practitioners enjoyment and practicing our trade and keeping people, healthy and active.