The Aging Athlete and Back Problems

1. The Aging Athlete and Back Problems John Nordt, III, M.D. Whether we are middle aged, an aging athlete, natural athlete or someone involved in a masters program like swimming or track, we as individuals who are still exercising over the age of 30 are falling into a category that I am calling the "aging athlete". The aging athlete has numerous different problems than those experienced by the young adolescent at the high school and college level. Back pain and back problems are related to many factors, some of which become more difficult to deal with as we get older. Many of us have experienced a hiatus in our exercise program due to professional responsibility and education goals. We usually return to the active physical fitness that we know; commonly that which we did in our late teens and early twenties, and this is the limit of our experience in attempting to deal with athletic activities. Our exercise program needs to change and be modified. Unbeknownst to us, our bodies have changed and have become a bit less tolerant, muscles less flexible, bones are softer and ligaments are not as strong. These factors all play a part inproblems with the back as they develop with related exercise programs. There are five points that I am going to deal with today: Flexibility of musculature Weak spinal extensors Weak abdominal muscles or spinal flexors Degenerative facets Disk disease Flexibility of Musculature      The first problem is that of flexibility. The muscle is made up of connective as well as muscle contractile tissue. With inactivity this connective tissue eventually tightens ina more permanent fashion than the inactive muscle fibers over five to ten years of time. Stretching this connective tissue is more difficult than actually stretching the muscle fibers themselves. This explains why flexibility is more difficult to obtain. In the simple act of bending over to touch ones toes with the knees completely strraight, one bends at two hinge points. The first at the waist, approximately the middle of the lumbar spine. Flexibility of the waist is very important and depends upon motion of the lumbar spine, and the limitation of the muscle in the lower back. The other area requiring flexibility is the hip, a second hinge point that also allows us to reach over and touch the floor. The limiting factor of this flexibility point is the hamstringswhich cross

2. behind the hip joint and limit flexion of the hip. Most people have difficulty bending over and touching their toes because of loss of flexibility of these hamstrings. This in turn places more stress ans strain on the muscles and the joints of the lower back, causing back pain and muscle tearing. A simple act of stretching the hamstrings by propping the foot up on a suitable chair or fence or rock wall with the knee in extension will stretch the hamstrings out. This reduces the stress and strain on the lower back. If one generates too much pain with stretching the hamstrings, the muscle will go into spasms and be counter productive towards your ultimate goal. Therefore, pain is not necessary, but a gradual stretching just to the limits of beginning pain is optimal. When one sees an athlete bouncing trying to stretch these muscles, this is actually detrimental and not helpful. Weak Spinal Extensors The second topic causing back pain is spinal weakness. This, is easy to correct. The spinal extensors of the lower back support the lumbar spine and become weaker as we become more sedentary and less active. The lumbar spine, as it settles backward into what we call a hyperextended position, puts more weight on the joints in the back part of the spine as the muscles become weaker, therefore the spine settles into a more stable position, demanding less muscle stabilization. When lifting boxes or crates or moving from one aprtment or house to another the muscles can become excessivelystrained manifesting as acute sharp and dull pain in the lower back. This is usually the seen the next day, not in the night of injury. Anti-inflammatory medications and muscle relaxants help to treat these acute problems. When the soreness is gone, a strengthening program can be instituted based on exercises of back extension, to strengthen these muscles. Running and swimming can also help as a more advanced program. Weak Abdominal Muscles The third topic of back pain in the middle aged individual is weak abdominal muscles. We have all seen the T.V. commercials and humorous instances where people have a rather large protuberant abdomen. This is due to weakness of the abdominal muscles. This allows the abdominal contents to sag forward, and actually puts more weight on the lumbar spine, preventing any support from the front.

3. The abdominal muscles normally act, when in good condition, as a very supportive brace to the abdominal contents. In turn this supports the lumbar spine. This anterior support, is a great help to supporting the back. the weaker the muscles become, the greater the difficulty the back muscles have, supporting the entire back. A simple sit up, partial or complete with the knees bent is the best exercise to reduce this problem. Degenerative Facets Fourthly, the small joints that attach each vertebral body to the next are called facets. These facets can become degenerative because of wear and tear of the lumbar spine, secondary to accidents or because of congenital abnormaliies. The normal weare and tear process also generates what we call "early generative arthritis" which may or may not be evident on the x- ray. The small facets on either side of each vertebrae at each level are about the size of a quarter and two of these at each level support all the weight of ones back when standing upright, in extension. Excessive twisting motions, such as playing tennis, jumping motions, playoing basketball and running long distances, which produce a hyperextension of the lumbat spine, and load these facets, irritating a degenerative lower back. The sedentary individual, who at age 45 decides to exercise and has not done anythng since age 25 will experience a loosening of a rather stiff joint and consequently irritate the linings of this joint. This inflammation then causes pain with motion and subsequest restriction of activity. These problems are responsive to anti- inflammatory medications and weight loss. Restriction of activity such as previouslymentioned, is recommended until the symptoms have passed, and conditioning has been going on for four to six weeks.

4. If no structural problem exists then a gradual return to the desired exercise is recommended. We should have no restrictions of athletic activity based on back problems, if we treat ourselves correctly. Disc Disease The last and least common cause of back problems is disc disease. Disc Disease takes on two basic forms, that of discogenic disease and herniated lumbar disc. Discogenic disease is related to a degeneration of the pulpy central shock absorbent mass of the tissue within the discs itself. This provides the cushioning effect between the vertebrae. As this material becomes less pliable, it tends to compress and cause increase motion at the level of the disc. This is not a herniated discbut causes excessive slippageof the vertebraeformward and backward with loss of the support of the disc itself. One could just imagine how this affects the joints in the back of the vertebral body and the stress that it places on those joints that may already have some degenerative arthritis. Degenerative discogenic disease is very treatable and is reognizeable occasionally with sophisticated test as well as x-rays. The treatable aspect of this includes all of what has been mentioned earlier such as physical therapy programs, bed rest and anti-inflammatory medications. Discogenic disease ooes not cause leg pain but causes primarily back pain precipitated by twisting motions and lifting motions. Reversal of this condition is very important. The other aspect of disc disease is herniated lumbar disc, which are fairlyclassically presented in 95% of people. The hallmarks of this is a precipitating incident, usually lifting, bending, stooping or a fall. This precipitates leg pain which is greater than the back pain and constitutes pressure on a nerve rootfrom a portion of the pulpy disc material extruding out against the nerve root. This causes symptoms of a sensory or weakness change. The herniated lumbar disc presents itself in different fashions. Seven or eight out of ten people are usually treated with bed rest, anti-inflammatory medications and a physical fitness programs. Occassionally surgery is necessary after all other methods or treatments are exhausted. It appears that people who have herniated lumbar discs may have a slight predisposition to a herniated disc at another level if they continue a vigorous exercise program. Those risks should be made known to the individual.