You’ve heard the old exercise-related adage over and over again: “No pain, no gain.” Well, if you’re over the age of 40, no pain is actually a good thing. In fact, the presence of pain after a workout session or a day enjoying your favorite sports activity can actually be symptomatic of a real problem, and you may be facing an injury that could derail your established exercise regimen or your overall athletic performance.“Pain is not normal,” says Brian Harley, DPM, FACFAS, foot and ankle surgeon with Village Podiatry Centers. “Pain can be a good indicator that you are pushing [yourself] too hard, and it usually does not go away on its own.”
Why is this fact particularly important for people over 40 to remember? Because if you find yourself in pain, your body may be trying to tell you something. According to Jason M. Bongi, DC, with Atlanta Spine and Sport, “Being over 40 means that our bodies have had more years of wear and tear and have become susceptible to the repetitive stress that can cause injury.” While you may feel strong and ready to take on any physical activity, your bones, muscles and joints could be more delicate than you realize. As Reginald Mason, MD, chief of medical subspecialties for Kaiser Permanente of Georgia, notes, “As we age, our musculoskeletal system—bones, joints, tendons, ligaments and muscles—changes in that we gradually lose muscle mass and the connective tissues—tendons, ligaments, cartilage and other support structures—lose some of the flexibility and resilience that is present when we are young.”
And in addition to the loss of elasticity and resilience, Jeffrey J. Kovacic, MD, orthopedic surgeon and sports medicine specialist with Orthopedic Surgery & Sports Medicine Center, reveals that low bone density conditions such as osteopenia and osteoporosis can further complicate matters.
Of course, at any age, there is a myriad of injuries that your body can sustain. However, for those who have reached the 40-year mark, there are several afflictions that are especially common. Here, Atlanta-area sports medicine experts and medical specialists pinpoint those exercise- and sports-related injuries and offer valuable information about treatment options, as well as important tips for preventing injuries in the future. We’ll start at the top ...
Common Injury #1: Rotator Cuff Strain or Tear
The rotator cuff is a supporting structure of the shoulder that consists of the muscles and tendons that attach the arm to the shoulder joint. Spero G. Karas, MD, associate professor of orthopaedics and director of the Emory Sports Medicine Fellowship Program, explains that “the rotator cuff is particularly prone to injury because as the tendon grows weaker with age, its ability to absorb energy and generate force are diminished.” Therefore, anything from tennis and golf to lifting weights can cause a serious strain or tear to the area, according to the faculty of the Sport Health Science Department at Life University (John Downes, DC; Deloss Brubaker, EdD., ATC; and Catherine Faust, PhD.).
Mason reveals, “Interestingly, shoulder and upper back injuries respond very well initially to rest, typically for at least two weeks, followed by a gradual return to activity. Ultimately, though, muscle strengthening and stretching will help to prevent the injury from returning.” Kovacic adds that the application of ice and taking anti-inflammatory medication can also be beneficial. Of course, some injuries do require professional evaluation by a sports medicine specialist or a chiropractor, who can order x-rays and develop an appropriate physical therapy program. In some cases, says James B. Labus, PA-C, clinical manager of the Northside Hospital Spine Center, cortisone injections can be administered, and surgery is rarely needed.
Scott A. Barbour, MD, orthopaedic surgeon and sports medicine specialist with DeKalb Medical, notes that the key to prevention is in strengthening the rotator cuff. “Try to build up the strength of the rotator cuff and neck muscles through appropriate exercise to help stabilize the shoulder joint and neck,” he says. “If you are involved in activities that involve repetitive overhead movements, try to take frequent breaks. In addition, always warm up before engaging in any sports, learn proper form and be sure that you are maintaining proper posture.”
Common Injury #2: Tennis Elbow
Just like the shoulder, the elbow is prone to injury from exercises or sports that require quick, repetitive actions, which place a great deal of stress on the tendon at the outer border of the elbow—an area that can lose its elasticity over time. For this reason, according to D. Hodari Brooks, MD, orthopaedic surgeon with Pinnacle Orthopaedics, lateral epicondylitis, otherwise known as tennis elbow, is very common. The condition is marked by pain, tenderness and soreness of the lateral or outside tendons that attach the forearm to the elbow, making such everyday activities as gripping and lifting difficult. Yet, while it is associated with tennis, Brooks says, “One does not have to play tennis to get it.” In fact, any racquet sport or even golf can result in tennis elbow.
Treatment of tennis elbow “begins with rest, activity modification, ice and anti-inflammatory medication,” Kovacic says. “Some injuries require splinting and professional evaluation, including x-rays.” Rehabilitation focusing on physical therapy also is a helpful tool for long-term recovery.
To ensure that you don’t overstress the elbow (or any other part of the body, for that matter) and keep it in tip-top shape, Barbour recommends engaging in a varied exercise regimen that includes 2 to 5 days per week of resistance training, while incorporating cardiovascular training and regular stretching. In fact, stretching is critical. Brooks believes that “there is no substitute for proper stretching both prior to and after completion of an activity to help prevent this injury.” Kovacic also advises individuals to use appropriate equipment and correct sports mechanics, which will help alleviate pressure on the elbow and fend off injury.
Common Injury #3: Low Back Pain
Labus reports than 80 percent of Americans experience low back pain. A large percentage of those individuals may have that pain because of their exercise- and sports-related activities, especially if they have a general lack of flexibility and increase their activity rapidly. The reason is simple: “The lower back is a fulcrum (pivot) for all activity taking place, handling the vector forces from the upper and lower body,” says Robert R. Pruni, MD, certified chiropractic sports physician, Level II rehab diplomate and certified personal trainer with Lilburn Sports & Family Wellness. “Sports that are non-contact still place an incredible amount of force on the lower lumbar spine from quick, repetitive movements.” And the swelling, pain and numbness associated with a low back injury—often referred to as sciatica when it involves the sciatic nerve, which begins in the lower back and runs through the buttock—can be quite debilitating.
The first course of action is to stop the activity that’s causing the pain. “Stop the activity until the swelling and pain subsides,” Pruni maintains. “When the pain is manageable, play can continue with bracing.” Additional options include anti-inflammatory medications, cortisone injections, physical therapy and chiropractic care, according to Labus, who also notes that in about 20 percent of cases of sciatica, surgery is required
Downes, Brubaker and Faust propose working with an exercise science professional who has experience with fitness training to construct a conditioning program that is paced for your goals and begins from a realistic starting point, allowing you to slowly fortify your back muscles. Bongi also suggests participating in classes such as yoga and Pilates, which will increase your flexibility and strengthen your core muscles. Once you have a good program in place, don’t forget to warm up before physical activity. “Warm up prior to any activity, even cleaning the garage,” Labus suggests, “as back pain can come on even with non-athletic activity.”
Common Injury #4: Knee Strain, Sprain or Tear
While the leg in general is susceptible to injury, the knee appears to present a particularly large risk when it comes to getting hurt. “Many sports, particularly those played on hard surfaces, can cause knee pain, especially in older adults,” Mason says. According to Downes, Brubaker and Faust, knee injuries also are caused by exercises and sports that call for sudden stops and change of direction. The stress placed on the knee can lead to strains, sprains and meniscus tears.
As with many other injuries, recuperating from a knee strain or sprain begins with some simple measures, such as rest, activity modification, icing and the administering of anti-inflammatory medications, Kovacic states. Downes, Brubaker and Faust add that strains and sprains also can be managed with conservative treatments such as physical therapy and stretching exercises. If there is a tear, however, surgery may be needed for a full recovery.
Injuries like this can be prevented through proper balance, kinetic chain corrections and stabilization, Downes, Brubaker and Foust explain. Interestingly, your nutrition can make a big difference as well. As Barbour notes, “You cannot prevent all injuries, but regular exercise, appropriate bracing and a balanced diet will be effective in many cases.” It also is extremely important to not push yourself too hard upon returning to normal activity after a knee—or any—injury. “Many injuries take 6 to 12 weeks to heal,” says Steven B. Wertheim, MD, co-president of Resurgens Orthopaedics. “You must be patient and not go back too soon or the injuries can become chronic.”
Common Injury #5: Achilles Tendinitis
According to Mason, runners, basketball players and workout enthusiasts who place a lot of stress on their ankles are all too familiar with the potential for Achilles tendon injuries. Located at the back of the lower leg, the Achilles tendon is the band of tissue that connects your calf muscles to your heel bone. Achilles tendinitis occurs from overuse, and symptoms include mild aching or pain, swelling, tenderness or stiffness in the lower part of the leg. If not treated in a timely manner, Brooks observes that the tendon can actually tear or rupture; this development causes sudden, severe pain and an inability to put weight on your foot.
“Treatment depends on the cause, so always seek a proper diagnosis from a qualified physician,” says Barbour, who adds that an injury such as tendinitis can be treated with bracing, injections and physical therapy. Wertheim also notes that rehabilitation exercises and physical therapy can be helpful when dealing with an Achilles tendon inflammation. Of course, if the tendon tears or ruptures, he explains that surgery is really the only course of action.
Barbour points to bracing as a particularly effective method for preventing Achilles injuries, while Wertheim recommends “a regular conditioning program of stretching, aerobic conditioning and strengthening.” Harley also suggests that appropriate footwear can give you another level of protection from a wide array of foot and ankle afflictions. “Proper equipment, especially shoe gear, is important as well,” he says. “Sport-specific shoes are vital. Don’t use one shoe for all of your activities. Use a running shoe for running, tennis shoes for tennis and so on.” And, Harley concludes, if you are attempting a new sport or exercise program, be sure to engage in proper conditioning to prepare your body and gradually increase the intensity of your workout or play “so your body has a chance to get used to the added stress."
Expert Q & A
Q: I haven’t been active for quite a while, but I want to start exercising and playing sports regularly. What do I need to do to make sure that I avoid injury?
Answers from Atlanta’s experts:
“Keep your expectations realistic and make obtainable goals. Gradually work toward them at a comfortable pace, and your body will thank you for it.” –Brian Harley, DPM, FACFAS, Village Podiatry Centers
“The best advice is to hire a professional. A certified personal trainer or a certified fitness trainer, which are available at most local gym chains, will be able to assess and advise you on form, how much weight, how many reps and how many sets you should do and create a realistic program based upon your goals.” –Robert R. Pruni, MD, Lilburn Sports Family & Wellness
“Avoid strenuous programs such as running or jogging when you are first beginning a program. For the first few months, build up the length and intensity of activity gradually and make sure that you warm up appropriately. Walking and/or swimming are great ways to get started.” –Scott A. Barbour, MD, DeKalb Medical
“Depending on your age and current state of health, you should consult your general physician to make sure you’re capable of starting any type of regimen. Next, I always say, ‘Slow and steady wins the race.’ There is no rush, and you don’t need to make up for lost time by overdoing it.” –Jason M. Bongi, DC, Atlanta Spine and Sport
Q: I’m pretty active and exercise regularly. Is there something I need to keep in mind to prevent injuries?
Answers from Atlanta’s experts:
“Do not overtrain. Overuse injuries are very common. Listen to pain and fatigue and do not push it too hard too fast.” –Jeffrey J. Kovacic, MD, Orthopedic Surgery & Sports Medicine Center
“Evaluate the mechanics of the activity [you are doing]. Sometimes incorrect [technique] can lead to injury. Also, discuss the sport with a pro, a trainer or a physical therapist.” –James B. Labus, PA-C, Northside Hospital Spine Center
“Continue to perform activities as long as you are not experiencing problems. The problems usually appear when you change your routine and/or overload an area that was not ready for that amount of stress.” –John Downes, DC; Deloss Brubaker, Ed.D., ATC; Catherine Faust, Ph.D., Sport Health Science Department, Life Universit
“To maintain your level of fitness, I recommend cross training. Your body will get used to certain exercises, so every so often try new ones. Work outside your comfort zone, and it will not only increase your performance, but will also significantly decrease the boredom that comes with the same old routine.” –Brian Harley, DPM, FACFAS, Village Podiatry Centers
“It is important to remember to train your body—not your ego. It is difficult to distinguish what is working to your peak potential and what is overtraining.” –Robert R. Pruni, MD, Lilburn Sports Family & Wellness
"While exercising or playing your favorite sport, always hydrate yourself properly. This simple act can keep your muscles, tendons and ligaments in good condition and will help you avoid a wide array of injuries." –Jason M. Bongi, DC, Atlanta Spine and Sport
“A good warm up prior to activity will help avoid injury. I instruct all my athletes to break a sweat prior to starting their activity. This maximizes blood flow to the muscle and activates the muscle so it can generate more force and resist injury.”—Spero G. Karas, MD, Emory Sports Medicine Fellowship Program
“It is imperative to stay active after 40. You are not a pro athlete, so start slowly, regularly stretch (not just on the days of the activity) and get help with the proper form. Focus on conditioning and flexibility—not on the amount of weight lifted.”—James B. Labus, PA-C, Northside Hospital Spine Center
“Injuries should be evaluated by your physician, but if an injury such as a strain or sprain occurs [use the] four-part approach known as RICE: Rest, Ice, Compression and Elevation. Through this process, people can help themselves.” —Scott A. Barbour, MD, orthopaedic surgeon and sports medicine specialist with DeKalb Medical