ATC 286: Do Older Athletes Get Injured More? How To Stay Resilient As You Age

May 10, 2019

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Intro:

  • Lucho’s new man crush is the climber, Alex Honnold. Check out the documentary Free Solo!
  • Key takeaway: repetition is essential in conquering fear.

Sean:

Re-Building a 50 y/o To Be Fit-For-Life

I’m a nearly 49 year old endurance athlete with a history of multi-day adventure races, paddling events, rogaines (orienteering), and ultra running.  (Lucho coached me through Leadville and other events including a few 24 hour runs.)

The past 6-8 months have been a bit rough, 1st with sacrum / groin issues which the MRI showed as a stress reaction in the pubic bone, and now with a torn ulna collateral ligament (thumb) which required surgery to re-attach it.  The former has meant no running since November 2018, though I was able to walk a lot, hike some, swim, spin, and do strength training. (Mtn biking tended to inflame the sacrum.) Now, with the thumb situation, upper body strength work is for the most part out (I may be able to get away with some core work), and can probably do some leg work.  (LEG EXTENSIONS HERE I COME!) Any kind of serious cardio is out for at least 4 weeks due to the sweat factor making the cast a bit nasty. So I’m leaning towards taking a decent break there, hoping the groin/sacrum issues finally have a chance to heal anyway.

All that said, as an endurance athlete fast approaching 50, how would you rebuild me into a true grandmaster badass?  🙂 Goals these days are less about traditional ultra runs (though I won’t count them out), but more like solo long adventures (famous runs like SCAR, a 72 mile self supported run on the Appalachian Trail), “strange format” races such as last man standing, off road ironman (hey, I said I’d do an ironman when I was 12, and have yet to do it!), Rogaines (24 hours of orienteering), etc.  I can’t rule out doing some multi-day paddling and biking events, too. And I still want to thru-hike the AT, and I do get out for a couple of multi-day backpacking trips every year.

So in general, a wide swath of endurance pursuits lay ahead of me in my 50s, 60’s, and 70s.  I’m now viewing this extended time off from running and now a shorter window of no cardio as a break — a break in hindsight I should have taken long before.  And when I come back, I want to be stronger and more fit than ever! What would that journey look like if you are starting from near ground zero? (I know my nearly 30 years of endurance pursuits means I have a lifetime base that has not gone away.)

The coaches say:

  • Look into getting a removable, workout-friendly cast.
  • Look at this as an opportunity; you’ve learned what your limits are, so in the future you’ll be more paranoid and not get injured again.
  • These kind of injuries don’t just suddenly appear. There are warning signs that you need to pay attention to and deal with before a full blown injury happens.
  • You need to look at what you’re doing outside of endurance activity to build up your body. Diet and adequate recovery are crucial.
  • Honor what your body can realistically do. Consider going from Ironman to Olympic distance and/or letting go of time goals.
  • Invest in a sturdy and significant strength training program.
  • The worst thing you can do for a tendon injury is to rest it. You need to safely rehab that modality (find a good PT to help you do that).
  • Consider investing in a rowing machine.
  • Perhaps reconsider your speed goals on through hikes/runs. Going slower allows you to absorb the beauty of the trails and landscape.

Craig:

Over 40 & Suddenly Getting Injured More

Hello my endurance friends. I started running at age 18.  I made it to age 40 without any major injury and rarely stretched or did any mobility/strength work (other than the beach muscles).  Then I got a sacral stress fracture. The PT’s told me I was very, very stiff (usually they said I was the stiffest person they’d ever met- yay me! First Place!!!!)  So I diligently did mobility work, stretched and did specific leg strength work for years.

Now it has been 6 years of that type of work and I get injured ALL THE TIME!  I haven’t ramped up my mileage or thrown in speed work too soon, in fact I haven’t even attempted speed work since I seem to get a soft tissue injury every 3-5 weeks.  ANd I don’t rush back to training when I do get these injuries. I take all the time needed until I don’t feel anything in that area to start running again.

So I guess my question is; how come?

I go back to not doing all that work since it doesn’t seem to help (answer is no)?

Am I doing it wrong (answer is, it depends- love that one)?

Or should I keep doing what I am doing as I am actually doing things right, I would have probably gotten injured way, way worse had I continued to not do any of that work and kept running.  The cumulative miles have actually caught up to me and I need to do so much work to reverse the poor training habits of the past.

Side note- 2 of my older friends never do any of the strength/mobility/stretching and they are never injured.  I know each person is different and it may catch up to them, but it doesn’t seem right (sorry that was more of a vent than a question)

The coaches say:

  • This is a mechanical issue: look at feet and hips first.
    • Consult a kinesthesiologist to check your run form.
    • You might need ART to help with stiffness.
  • The weight training you’re doing might not be right for your specific needs.
  • As with the previous question, beware of resting tendons. These require intentional stimulation to learn how to recover.
  • Stiffness is often a precursor to injury. It’s especially obvious in the posterior chain, which makes it difficult to get in the right position for a fluid swim/bike/run.
    • Dynamic stretching is key to fixing this, NOT static stretching!
    • Lifestyle outside of your training is a huge culprit here. Be wary of sitting all day for work.
    • Ultimately, it doesn’t sound like the mobility you were doing was working. Time to reconsider. Mix up the mobility work!
  • An anti-inflammatory diet will be key. Also, incorporate collagen.
  • Take a step back from endurance and really focus on a strength program that will build you back up. See Dan John’s Even Easier Strength program

Research Notes:

Musculoskeletal injury in the masters runners.

  • Surveyed 2,886 runners doing Hood to Coast running relay, of which 34% were masters runners.
  • The injury rate for the entire population was 46%. Significantly more masters runners were injured than younger runners (P<0.05). More masters runners suffered multiple injuries than younger runners (P<0.001). Significantly more masters runners were male, had 7 or more years of running experience, run more than 30 miles/wk, 6 or more times/week and wear orthotics than younger runners (P<0.001). The knee and foot were the most common locations of injury for both groups. The prevalence of soft-tissue-type injuries to the calf, achilles, and hamstrings was greater in masters runners than their younger counterparts (P<0.001). Younger runners suffered more knee and leg injuries than masters runners (P<0.005). Running more times/wk increased the risk of injury for both groups.

Impact of age, performance and athletic event on injury rates in master athletics – First results from an ongoing prospective study

  • Assess incidence and types of injuries during the 2012 European Veteran Athletics Championships as a function of age, performance and athletic discipline.
  • 3,154 athletes surveyed, average age 53.
  • Results suggest that the rate of injuries in master athletes is rather low and not higher than that reported for younger athletes. However, larger studies in the future will be needed to corroborate this first study in the field.
  • The hypothesis that the incidence of injuries is a function of age and age-graded performance cannot be supported while the hypothesis that the incidence of injuries depends on the athletic discipline can be supported.

Acute and overuse injuries correlated to hours of training in master running athletes.

  • 291 elite runners (average age 42 +/- 9 years) who ran an average of 20 mpw +/- 17 miles.
  • Achilles tendinopathy was the predominant injury followed by anterior knee pain and shin splints.
  • At some time, 56.6% of the athletes had an Achilles tendon overuse injury, 46.4% anterior knee pain, 35.7% shin splints, and 12.7% had plantar fasciitis.

The Prevalence and Risks of Injury for Masters Athletes: Current Findings

  • Collectively, the result of this review clearly show that there is not enough evidence to support a notion that overall injury risk increases with advancing age. 
  • The origin of the aging increases athletes injury risk may stem from a “weekend warrior” subset of the Master’s population who are, in fact, at a high risk of injury, but have inappropriately blamed their aliments on an easy scapegoat. The weekend warrior is an amateur athlete that devotes a limited proportion of their time to exercise training, but who expect to perform at higher levels than are likely capable. Due to multiple competing responsibilities (family life, work, household upkeep, pets, multiple hobbies, etc….) these individuals are not able to devote enough time to training. When high performance exercise stresses are imposed during, for example: an irregularly heavy training day or competition day, injuries are sustained. The underlying deficits in strength, flexibility and/or aerobic fitness that are the actually the root cause of sustained sports injuries, not the Masters athlete’s age.

The Mature Athlete: Aging Tendon and Ligament

  • With increasing age, these tissues are subject to vascular and compositional changes that alter their mechanotransduction, biology, healing capacity, and biomechanical function.
  • A trend toward decreased blood flow with increasing patient age.
  • Ligaments and tendons degenerate with age.
  • Based on the theory that excessive loading of tendons during vigorous physical activity is the main stimulation for degeneration of the extracellular tendon matrix, several studies have looked at in vitro analyses of strain patterns and extrinsic factors that induce tendinopathy. Overstimulation in vitro of tendon cells increases inflammatory cytokines and degenerative enzymes.

Effect of strength training on human patella tendon mechanical properties of older individuals.

  • Strength training (two series of 10 repetitions at 80 % of five-repetition maximum) was performed three times per week for 14 weeks using leg extension and leg press exercises.
  • This study shows for the first time that strength training in old age increases the stiffness and Young’s modulus of human tendons. This may reduce the risk of tendon injury in old age and has implications for contractile force production and the rapid execution of motor tasks.

Physical activity-related injuries in older adults: a scoping review.

  • The population of interest was adults (both males and females) over the age of 65 years, participating in exercise, leisure-time, or sport-type physical activities; 43 articles included. 
  • The current literature does not suggest that older adults are at an increased risk of injury from participation in physical activities.

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