Pushing the Limit
Locals defy age in a quest to stay fit and active, though the risk of serious injury lingers
by Bill Donahue

“Do not go gentle into that good night,” the poet Dylan Thomas once wrote. Taking his words to heart, an increasing number of Americans approaching 40 or older are spitting in death’s eye by engaging in contact sports, triathlons, endurance races, etc., and their bodies risk paying a hefty price because of it.

“Although there are a lot of benefits for people who remain active, they also face a constellation of potential injuries,” says Benjamin Chu, M.D., a physician with Chalfont-based OrthopaediCare, a private group of surgeons on staff at the Abington, Lansdale and Warminster campuses of Abington Health. “The biggest risks are the overuse type of injuries—typically, muscle inflammation, tendonitis and muscle pulls and strains.”

The risk of suffering these kinds of injuries as a result of participating in high-impact sports and other activities increases with age, especially in men and women past the age of 35. For example, tendon problems are more common in 40- to 60-year-olds than any other age group, according to published medical reports, while the incidence of rotator-cuff injuries and back problems also accelerates with age.

“One of the common overuse problems we see is tennis elbow, where a group of muscles in the forearm becomes inflamed and painful,” Dr. Chu adds. “It’s curable, but if it goes untreated it can impact quality of life, disrupt sleep, which nobody enjoys, and limit your productivity at work. … There are a lot of hidden costs to those types of overuse problems.”

Dr. Chu sees such injuries spike in the springtime and early summer, after people who have been “cooped up” for too long try to do too much too soon, without the necessary preparation. He calls it “weekend warrior syndrome.”

“Not everyone has the flexibility they once had, and, naturally, over time the muscles get stiffer,” he says. “A lot of people spend time building up strength and endurance but not flexibility. As a result they develop some of these overuse problems.

“It’s like trying to bench press 200 pounds; the proper way is to start off with a little bit and work your way up gradually,” he continues. “There should be a progression of building strength and flexibility, starting with less aggressive stretching exercises. … It’s not easy to figure out on your own, because not everyone is the same. Probably the thing I recommend most in treatment is working with a personal trainer or physical therapist and spending some one-on-one time to learn how to gain that flexibility with guidance from a professional.”

Why It Happens
As the body ages, the protein in one’s connective tissue no longer works as effectively as it used to, making the muscles more susceptible to injury. Also, some people fall into the trap of thinking they can perform at the same level as over-40 athletes—the ageless former Flyer Jaromir Jagr, for example, or former Phillies pitcher Jamie Moyer—who still compete at a high level.

“It’s a fact of life that we have a finite amount of time to use our bodies, and the more sports we play the quicker we wear out,” says Dennis McHugh, D.O., chief of orthopedics for Mercy Suburban Hospital in East Norriton. “You don’t see what [athletes] go through when they are not playing. [The late PGA golfer] Payne Stewart used to say, ‘I wish people could follow me around to see what I go through.’ By the time he hit a golf ball he’d already been in the exercise area for three to four hours. The people [who stay in the game after 40] are staying conditioned 365 days a year.” 

Dr. McHugh is seeing injuries spike—“I see them nonstop, all day every day,” he says—in adults ages 35 to 60. Although the majority of “feast and famine” injuries are male, sports injuries are by no means an exclusively male issue.

“More people are health conscious and staying fit and active,” he adds, “but when people get to be 35 or 45, work and life and kids get in the way, and then we store all our energy up till the weekend and then go crazy.”

As many as 80 percent of Dr. McHugh’s patients over the age of 40 seek relief from what he refers to as “the bane of all orthopedists,” otherwise known as pain in the lower back. Besides counseling patients about improved posture, weight reduction and making work stations more ergonomic, he’s a “zealot” about stretching protocols, including yoga.

“When we don’t listen to the body, which does talk to us, what we’re doing is causing damage,” says Dr. McHugh. “When I talk to my weekend warriors, I say, ‘If you have physical pain, you need to stop,’ but a lot of times they don’t and it causes strains, sprains and tears. Also, when the muscles are just not stretched out, there’s no good blood flow, and they fatigue easily. … People don’t warm up, and they say, ‘When I was 20 I didn’t need to do it,’ and then they reach the ultimate limit of what they can do, which accounts for pain and fatigability.”

Although the risk of injury recurrence tends to run high, it can be extremely low if properly treated. Sometimes the simplest remedies, such as icing the affected area, are the most effective. Even so, science continues to find new and minimally invasive ways to mend the bent and broken. A relatively recent advancement is an orthobiologic treatment known as PRP, short for platelet-rich plasma, which contains enriched plasma cells to accelerate the healing process. Typically, PRP is injected into an injury site—a surgically repaired shoulder, say, or an injured elbow, which lacks sufficient blood supply needed to promote healing.

Dr. McHugh has seen some patients treated with PRP reduce inflammation and pain, sometimes trimming their healing time by as much as a third. “I have yet to do it on a patient that hasn’t had a benefit from it, but I think there are variables where the jury is still out on it,” he says. (Likewise, Dr. Chu refers to the research he’s seen on PRP as “somewhat mixed.”) Even so, PRP appears to be one way to create “more resilient” scar tissue, though ultimately success may depend on whether the patient adheres to the prescribed protocol for treatment.
Once an injury does occur, some patients worry about the risk of re-injury. Yet patients have it within their power to prevent “lightning from striking twice,” according to Dr. McHugh.

“I recommend stretching and spending half an hour three times a week on some sort of endurance exercise to keep muscles around [the injured area] strong,” he says. “Our main goal is preventative, and prevention is done through education. … One thing I express to patients is to know your body and understand what over-the-age-of-35 sports entail. Stay active on a consistent basis, and make sure you listen to your body.”