 By Dr. Cathy Utzschneider
This is the third in a series of interviews with Dr Wright, orthopaedic surgeon at the University of Pittsburgh School of Medicine’s Center for Sports Medicine, and director there of P.R.I.M.A, the Performance and Research Initiative for Masters Athletes.
In this interview Vonya answers more questions about injuries, aging, and advances in orthopaedic surgery.
Dr. VonyaWright You mentioned in the last interview that various forms of tendonitis including Achilles tendonitis and iliotibial band syndrome are among the most common preventable injuries among masters runners. For what kinds of common injuries are surgeries least likely to be successful?
Even in the masters athlete there may come a time when the pain and dysfunction in their hips and knees, due to arthritis, is too painful to deal with on a daily basIs and limits their function. Hip and knee replacement is often offered.
People have the misconception that replacing your worn out joints with metal ones means that your sporting days are over. This is not the case at all! I tell my patients that “Hip and knee replacements are a license for mobility!” meaning that they can help athletes and sedentary folks alike stay mobile and get their lives back.
During the 2005 Senior Olympics, held In Pittsburgh, PA, there were many athletes with joint replacement who had qualified for the national games by placing 1st or 2nd in their state games.
The only sport I don’t recommend after joint replacement is running as this kind of consistent pounding may wear out the poly lining of the new joint faster (given that you pound your knees with five to seven times your body weight and your hips with three to five times your weight with each step).
When my masters athletes have arthritis that has progressed past the mild stage to the moderate or even severe stage and they are not sufficiently debilitated to want knee replacement I often tell them that this is another reason they should mix up their sports and do multi-sport events. For runners I suggest triathlon. They can still complete at a high level and do less overall running.
What are the chances of returning to competitive running after having had meniscal surgery?
I perform mensical surgery for people with primarily mechanical symptoms including popping, clicking, locking. People with these symptoms have a great chance of returning to their sports in a short time after surgery. I always educate them about the importance of quadricep, hip and core strength to the knee.
People don’t realize that we are a kinetic chain from our big toes to our backs and having one segment out of whack can throw off the mechanics of the joint above or below the injury. That is why my rehabilitation protocols include not only knee rehab but hip and core strengthening as well as balance training.
Is it true that tendons and ligaments have a more difficult time healing than bones in masters athletes?
Yes. Bone is a constantly remodeling structure with a constant blood supply. Tendons and ligaments have a limited blood supply so they heal with scar. Bone will heal back to healthy bone. Tendon and ligament will heal with scar. This is actually the case no matter what your age and is not just a problem with masters athletes.
What advances in orthopedic surgery should masters runners be aware of?
We are in the midst of a biological revolution. We will soon — in five to ten years – be able to create musculoskeletal tissue for use on patients. Now our choice is using self or cadaver tissue (which most people would rather not use).
Top of Page What other studies are you conducting now?
We did a bone density study on 600 athletes at the 2005 Senior Olympics. We found that not only do female masters and senior athletes maintain their bone density at a higher level than the general sedentary population but that this was true even in the oldest (>70-80 year old) athletes.
We also documented that while all exercise is important for bone health, impact sports were better for aging bone than non-impact. Basically, doing no exercise is bad for your bone, swimming is good but walking, running, tennis, etc. are better.
While we found many of the same things to be true in men, it was interesting to see that in the oldest male competitors there was a higher level of low bone density than we anticipated. This points towards the importance of MEN paying attention to their bone health….osteoporosis is not only a disease of aging women but is a problem for men that is too commonly overlooked.
Now I am doing an MRI study on lean muscle mass on elite master athletes. We know, from a large NIH study called Health ABC, that the quadriceps (remember the keys to the knees) become largely infiltrated with fat by the time sedentary people reach 70 years old.
What this translates to is weakness going up and down stairs, getting out of chairs, falls, etc. and can add significantly to the reasons why fully one-third of people become disabled as they age.
This disability is a huge problem for the individual but also for us as a society…. what are we going to do with 77 million baby boomers, the oldest of whom is now 62, if fully one-third become disabled? How are we going to care for them? We have to find ways to keep the boomers on their feet as they age.
One way to look at aging is to look at the best examples of musculoskeletal aging, the masters athlete, and see what is going right with them so we can try and outline a course for the general population to take. My study is looking at the muscle strength, cellular muscle characteristics, body composition and thigh lean muscle in masters athletes from age 40 to 80 to determine the effect of intense exercise on these parameters.
While we expect to learn many things from this study about aging muscle I hope to gain enough information to be able to recommend specific muscle sparing exercise training for everyone as we age.
This is a fabulous time to be aging because with purposeful training focused on your specific weaknesses and designed to prevent repetitive injuries we can continue to compete for many years past our expectations.
My PRIMA Athlete program is focused on taking you to the next level no matter what your age. For the recreational athlete I have captured the conversations I have with my patients every day in a book called Fitness After 40: How to stay strong at any age! that is currently available for pre-order on Amazon.com.
The future is bright and your best may be yet to come….Now get back on the road!
Dr. Vonda Wright can be reached through her website.
Cathy Utzschneider Ed.D. (human movement), M.B.A., professor of goal setting and competitive performance, Boston College; coach, Liberty Athletic Club, MOVE and Women-Running-Together.com.
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This article was originally printed in National Masters News.
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