INJURY PREVENTION AND TREATMENT OF THE SENIOR ATHLETE

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Luke Watkins
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1 INJURY PREVENTION AND TREATMENT OF THE SENIOR ATHLETE Course Overview This course will expand on findings from the Senior Athlete Fitness Exam (SAFE) in National Senior Games athletes. Content will review: typical injuries, risk factors and evidence-based treatment in this unique and growing population. Becca Jordre, PT, DPT, GCS, CEEAA, Cert MDT MN PHYSICAL THERAPY ASSOCIATION 2015 SPRING CONFERENCE Objectives By the end of this 2-hour session participants will: 1. Report awareness of typical injury trends in senior athletes. 2. Recognize key risk factors for injury in senior athletes. 3. Report awareness of current evidence-based treatment trends unique to senior athletes. 4. Discuss case scenarios and apply course content to create sample treatment plans. Prevalence of Senior Athletes Approximately 10,000 athletes participate in National Senior Games events biennially Master s Level Competition is growing Inactivity by Age Sport participation by generation 1

2 Cardiovascular Changes with Aging VO2Max Heart Rate Stroke volume Cardiac Output Blood Pressure Arteriovenous Oxygen Differential Peripheral Vascular Resistance Baroreceptor Sensitivity Orthostatic tolerance Vessel Compliance Pulmonary Changes with Aging Lung Compliance Conducting tubules Alveoli Skeletal muscle Ribcage Impairments in lung defense Spine Musculoskeletal Changes with Aging Cartilage Neurological Changes with Aging Functional changes Joints Anatomical changes Connective Tissue Physiological changes Skeletal Muscle Bone The Senior Athlete Response to Aging 1. Cardiovascular 2. Pulmonary 3. Musculoskeletal 4. Neurological The Senior Athlete Response to Aging 2

3 PHYSICAL DEMANDS Extended duration Quick bursts of activity GOLFERS Upright posture Balance Strength Flexibility Cardiorespiratory Endurance Common Injuries Back Shoulder Elbows Sport-Specific Recommendations Skill Training Strength Training Flexibility Training Regular warm up Wrists Sport-Specific Recommendations Shoulder pain Scap stabilization program Rotator cuff strengthening Modify stroke to a flatter swing plane to reduce impingement Back Pain Strengthen Abdominals Increase lead hip IR Increase lumbar extension Correct swing (don t overroate) SWIMMING 3

4 PHYSICAL DEMANDS Repetitive UE use Frequent practice (5-7x/week, twice daily) Cardiovascular Endurance Non-Weight Bearing Common Injuries 40-91% have shoulder pain Glenohumeral laxity Rotator cuff lesions Biceps lesions Impingement Sport Specific Recommendations Cross Training/reduce exposure Core endurance training Strength Training Pec Stretching Posterior Shoulder Stretching TENNIS PLAYERS No clear prevention program exists. PHYSICAL DEMANDS Overhead hitting Impact Endurance Speed Balance Common Injuries Achilles rupture Medial gastroc tear Meniscal tears (medial or post horn) Rotator Cuff Rutpure/Tendonitis Degenerative change in knees Lateral epicondylitis Back Pain 4

5 Sport-Specific Recommendations Increase strength training Abs Increase Flexibility Gastroc/soleus Adductors Hamstrings Lumbar Spine Shoulder Include warm up prior to play Rotator Cuff Pathology Full or Partial Thickness Tear Prevalence by Age Age Prevalence % % % Pain vs. Intensity PHYSICAL DEMANDS Repetition Impact Endurance RUNNERS Common Injuries 46% injury rate Increased incidence with age Multiple injuries were not uncommon Calf* Hamstrings* Knee Foot TRIATHLETES *more common in older runners 5

6 Physical Demands Repetition Impact Duration Accidents Sport-Specific Recommendations Strength Training Intensity of Cardiovascular Training Cross-training Warm up Stretching Balance Training Strength GLOBAL RECOMMENDATIONS Strength training may be more critical in older athletes Key areas Frequency Duration Intensity Mode Core Cardiovascular Training Intensity Time Mode Duration Flexibility Problem Areas Consider the sport Mode Timing 6

7 Posture Trends Balance Consider underlying variables Hx 78 yo retired college professor Running history: ½ marathon at 72 CASE STUDY 78 yo Female Runner Medical history Osteopenia Bil frozen shoulder DDD per MRI (2014) Current Status Pain in bil LE R>L Pain in LE (right hamstring) and back with running or fast walking Limited participating in some fitness classes Starting Exercise Late in Life Cardiac Risk Factors Hypercholesterolemia Hypertension Smoking Diabetes Family history of CAD Starting Exercise Late in Life OA is not a reason to limit exercise Evidence supports exercise and dynamic movement Avoid pain Avoid joint trauma *if several then suggest a cardiac stress test *low risk, no screening *more likely to need screening with diabetes 7

8 Benefits of Staying In the Game Morbidity Mortality Strength Balance/Falls Flexibility As a group.still waiting to plateau. References Baker AB, Tang YQ. Aging performance for masters records in athletics, swimming, rowing, cycling, triathlon, and weightlifting. Exp Aging Res. 2010;36(4): Brumitt J, Meira EP, En Gilpin H, Brunette M. Comprehensive strength training program for a recreational senior golfer 11-months after a rotator cuff repair. Int J Sports Phys Ther. 2011;6(4): Cann AP, Vandervoort AA, Lindsay DM. Optimizing the benefits versus risks of golf participation by older people. J Geriatr Phys Ther. 2005;28(3): Leach RE, Abramowitz A. The senior tennis player. Clin Sports Med. 1991;10(2): McCrory JL, Salacinski AJ, Hunt SE, Greenspan SL. Thigh muscle strength in senior athletes and healthy controls. J Strength Cond Res. 2009;23(9): McKean KA, Manson NA, Stanish WD. Musculoskeletal injury in the masters runners. Clin J Sport Med Mar;16(2): McMahon PJ, Prasad A, Francis KA. What is the prevalence of senior-athlete rotator cuff injuries and are they associated with pain and dysfunction? Clin Orthop Relat Res. 2014;472(8): Physical Activity Council 2014 Participation Report. Accessed April 2, Tate A, Turner GN, Knab SE, Jorgensen C, Strittmatter A, Michener LA. Risk factors associated with shoulder pain and disability across the lifespan of competitive swimmers. J Athl Train. 2012;47(2): Vandervoort AA. Potential benefits of warm-up for neuromuscular performance of older athletes. Exerc Sport Sci Rev. 2009;37(2):60-5. Vignon E, Valat JP, Rossignol M, et al. Osteoarthritis of the knee and hip and activity: a systematic international review and synthesis (OASIS). Joint Bone Spine. 2006;73(4): Willick S, Akau CK, Harrast MA, Storm SA, Finnoff JT. Sports and performing arts medicine: 5. Special populations. PMR. 2009;1(3 Suppl):S Wright VJ, Perricelli BC. Age-related rates of decline in performance among elite senior athletes. Am J Sports Med. 2008;36(3):

THE OLDER TENNIS AND GOLF ATHLETE: INJURY MANAGEMENT AND PREVENTION

THE OLDER TENNIS AND GOLF ATHLETE: INJURY MANAGEMENT AND PREVENTION William Micheo, MD Professor and Chairman Physical Medicine, Rehabilitation, and Sports Medicine Department University of Puerto Rico