Stay In The Play: Aging and Sports MedicIne

 “Taking one step back to focus on rehabilitation instead of your sport will allow you to take 10 steps forward much sooner.”

— Mo Mortazavi, M.D., of Sports Medicine, Rehabilitation and Concussions Center (SPARCC) 

“It is very important to keep your core strong, practice balance and develop a good sense of your body in space.”

— Todd J. Tucker, M.D., of Tucson Orthopaedic Institute

Good news! Today’s adults, particularly those of retirement age, exercise and play more recreational sports compared to previous generations.

--Photography by James Patrick

“Twenty years ago, it was uncommon to see a 70-year-old playing tennis and working out regularly,” says Todd J. Tucker, M.D., a sports medicine specialist with Tucson Orthopaedic Institute. “Today that is completely normal. This is a great change to health habits.”

However, active people often get injured from recreational sports, which are concerns that also are increasingly seen in older adults by Tucson health professionals.
“Osteoarthritis affects all of us as we get older,” says Thomas Coury, D.O., of Desert Sky Spine & Sports, “so the aches and pains of athletic activity are somewhat amplified as we age.”

Sports Injuries

Each year, nearly 8.6 million people in the United States see a health professional for a sports or recreational injury, according to the Centers for Disease Control and Prevention.
About 1.2 million are 45 years and older, while another 1.8 million are between 25 and 44 years old, according to the report from November 2016, “Sports- and Recreation-related Injury Episodes in the United States, 2011-2014.”

General exercise — including aerobics, weight training and running — causes the most injuries among patients 25 years and older, the report says.

That’s followed by recreational sports: racquet sports, golf, bowling, fishing, hunting, hiking and mountain climbing, among them.

Rounding out the top five sports and recreational activities that lead people over age 25 to see health professionals are basketball, pedal cycling and water sports.

In Tucson, health professionals deal with lots of wear-and-tear injuries, which include tendinitis, joint and muscle sprains and strains, tendon tears, osteoarthritis and stress fractures.

Doctors mention seeing plenty of herniated disks, sciatica, meniscus tears, runner’s knee, shin splints, shoulder rotator cuff problems and anterior cruciate ligament (ACL) injuries.

“Overuse injuries are very common,” observes Mo Mortazavi, M.D., a physician at Sports Medicine, Rehabilitation and Concussions Center (SPARCC).

Playing Hurt

Weekend and amateur athletes can count on some level of soreness after any activity they may not regularly do or train for.

Muscle soreness can easily be treated with over-the-counter pain relievers such as acetaminophen, aspirin, naproxen or ibuprofen. Minor aches usually will respond to the RICE treatment — rest, ice, compression and elevation.

A. Reid Bullock, M.D., of the Pain Institute of Southern Arizona has had success with turmeric to reduce pain. “A capsule of 1,000 mg of turmeric and black pepper to increase absorption, when given twice a day, “is about as effective as 600 mg of ibuprofen.”

Even constant soreness and pain may not be cause for concern. “I want patients to push through a little bit of pain,” explains Emil H. Annabi, M.D., of Pima Pain Center. “I want them to be as active as possible.”
Dr. Bullock similarly counsels his patients. “If what you’re doing hurts as you’re doing it, and a little bit afterward, it’s OK.”

But doctors also caution not to ignore what can truly be an injury. “An individual who experiences consistent discomfort while participating in sporting activities should be evaluated,” advises Robert Chiarello, M.D., a podiatrist with Desert Hills Podiatric Associates.

Soreness may actually be an injury if pain disturbs sleep, affects everyday function, is consistently in one spot of your body or isn’t getting better with improved technique, rest or medication. Swelling is another sign.

Dr. Mortazavi lists several “red flags” for a trip to the physician: joint instability, numbness, tingling, discoloration, motor weakness and severe pain.

Figuring out where you are injured isn’t always simple.

For the most part, you’ll know when you’ve suffered an acute injury. You’ll have great pain from “significant mechanical injuries,” such as ligament, labrum and cartilage tears.

However, adds Dr. Tucker, recreational athletes can have a meniscus or rotator cuff tear and have no symptoms.

Dr. Coury explains that neck and low-back injuries “will radiate pain to the shoulder and hip, convincing patients they have injury to those joints when it is actually related to the spine.”

Getting Relief

Dr. Tucker, an orthopaedic surgeon, believes surgery works best for structural problems that affect joint function. “Surgical repair or reconstruction of the damaged tissue will give the patient the highest chance of getting back to sports activity. But most injuries from recreational sports don’t need surgery. I probably operate on 20 percent of patients I see.”

Local physicians believe that prescription painkillers are basically ineffective for healing sports injuries since they merely mask pain rather than solve the problem.

“We’re not trying to kill pain,” says Derrick Burnett, M.D., with Pima Pain Center. “We’re trying to make them live with it while we try to reach a better goal.”

That goal — getting back to playing — depends a lot on physical therapy, which aims to correct bad body movement.

Physical therapy on the body aims to “try to get it functioning with as little pain and as much strength as possible,” says Bob Androff, PT, ScD, of Arizona Physical Therapy P.C.

“What we’re really doing is retraining and reeducating” the injured area, the physical therapist says. “We’re retraining the movement.”

Massage can restructure tissue to its proper function. Strength training is designed to allow the muscles to move without pain. Stretching is about keeping a joint in its correct position.

It’s not a quick process and requires a commitment to doing hundreds of exercise repetitions, both with the physical therapist and at home, Androff cautions. “We want you to go from gentle movement to back to what you were doing,” he says.

Tucson health professionals mention many other ways to reduce the symptoms of an overuse injury and relieve pain. They include yoga, meditation, acupuncture, massage, pilates, chiropractic and TENS (transcutaneous electrical nerve stimulation).

Osteopathic manipulation goes beyond spinal adjustments found in chiropractic. It includes massage, isometrics (where the muscle is held in a static contraction) and tissue relaxation, says Dr. Coury.
Take it slowly when recovering from injury, says Dr. Mortazavi. “Sports modification — we use that all of the time,” he says. Play, but not intensely.

Tucson health professionals say two new therapies could increase treatment options.

Platelet-rich plasma (PRP) is created from the patient’s own blood. A patient’s plasma is infused with a high concentration of platelets, which have growth factors that heal injuries, and then injected directly to the injured site.

Dr. Bullock was the first PRP patient at his practice. “I was going to have shoulder surgery and had to be off for three months,” he recalls. Instead, PRP therapy kept him out of the operating room and on the job. He says now he feels “90 percent better.”

Another therapy consists of injecting stem cells from a patient’s bone marrow into the injured site. The hope is that the cells transform to replace the cells that were injured.

The U.S. Food and Drug Administration does not regulate PRP therapy and hasn’t approved stem cell therapy for injuries. They are not covered by insurance. Both have shown promise in clinical use and study.

Play Smarter

When deciding to play a sport, Dr. Coury suggests you go with what you know.

“One recommendation I have for new retirees is to return to sports they loved doing when they were younger,” he says. “There is something to be said about muscle memory.”

If it’s been a while since you’ve done an individual sport, work up to it. “Start with five minutes every week,” suggests Dr. Annabi, “and add to that to build up stamina.”

Participating in a recreational sport is good exercise. But health professionals insist that your body be ready to play safely.

“It is very important to keep our core strong, practice balance and develop a good sense of our body in space,” says Dr. Tucker.

Make sure your strength and coordination match your sport, says Dr. Coury, and hire a coach to help you. “(They) contribute to the health and well-being of the athlete in terms of avoiding injury, but also increase performance.”

Androff urges people who have gone through physical therapy to continue their exercises and therapies to maintain stability.

Utilizing gear that’s specifically designed for your needs helps. Take shoes, for instance. “Use of proper orthotics and shoe gear are important in maintaining proper biomechanics,” says Dr. Chiarello, “and providing an artificial fat pad for comfort and shock absorption.”

He says over-the-counter orthotics are fine for common foot concerns and prescription orthotics can correct special issues.

Androff suggests working with a trainer or physical therapist on the best way to apply elastic therapeutic tape. Kinesio Tape and Rock Tape are two brands. Some athletes believe they help them play better.

No matter at what age you’re playing a sport, warm up and stretch before the activity, stay hydrated throughout, cool down and stretch when you’re done and eat appropriately to regain energy.

You can successfully play sports as long as you recognize it won’t be the same as when you were younger. Change how you play a sport to avoid injury or persistent pain, several doctors suggest. Play fewer holes of golf at one time. Instead of competing in a game, practice technique. Don’t play for long periods of time. TL