Staying fit while aging is tough. As an example, I saw a woman in the office this week who has been an athlete all her life and now that she’s in her late 40s, things are breaking down. Like many of us (including me), aging and staying fit at high levels is not always easy. Sure some of us who have never been injured and who have fantastic genes breeze past their 40s, 50s, and 60s, performing seemingly Herculean feats. However, most of us mere mortals have to constantly stay ahead of the aging curve if we want to still be athletic as we age.
As I sat in the office with her yesterday, I felt badly for this woman, as she has never gotten any concrete advice on how to stay fit while aging, so she now finds herself in a tough spot. What would I have told her if I could have met and advised her 10 years ago?
1. When things begin to go wrong in your body, listen carefully! You need to throw, “No Pain, No Gain” out the window. We all grew up with the adage, “No Pain, No Gain”. Where did this originate? According to Wikipedia it became popular with Jane Fonda’s work-out videos along with “feel the burn”. Regrettably, Jane ended up with hip and knee replacements and back problems, so you may not want to follow her advice on this issue.
Let me explain why listening to your body is key using this patient as an example. About a decade ago this woman developed bunions on her feet. She did what most women her age do, she went and found a surgeon to “fix” the problem. Regrettably, this foot problem was an “alarm bell” that should have been heeded. What was really happening? She has valgus knees (knock knees) and has always run with a gait where she had poor knee control. I’ve described in previous blogs one of the cause of bunions-issues with the how the foot strikes the ground due to poor biomechanics and the lower back. In her case her poor knee and foot control were causing her bunions. These were the first symptom and warning sign of a biomechanical pattern that wasn’t sustainable.
What could she have done back then? Start using orthotics, train her CORE muscles, get her gait analyzed, etc… More recently when she tried orthotics her feet went numb. In fact, they go numb a lot. Her calves are also always tight. Again, another warning sign, as the most likely cause of numb feet in an otherwise healthy and active middle aged woman is a pinched nerve in the back. Warning sign number two ignored.
2. Quick fixes like surgery usually aren’t the answer. I’ve blogged extensively how we have little credible scientific evidence that most modern orthopedic surgical quick fixes are doing anybody any good. For example, knee “clean up” surgeries using arthroscopy (debridement) have been shown to be no better than placebo surgeries, meniscus “repair” surgeries where parts of the meniscus are removed are no better than no surgery or physical therapy, and low back fusion often causes more problems than it fixes. Despite this, many aging athletes turn to surgery because it seems like a fix.
Using this patient as an example, by removing the bone spurs on her toe joints that were causing her bunions, they destabilized her foot. First, the term “pronation” means that the foot is rolling inwards as it strikes the ground. Those bone spurs on her big toes formed because they were needed to stabilize her foot (prevent it from rolling inwards) and were her body’s way of reacting to the extra pronation forces. In fact, the body is pretty smart, if you begin placing too much pressure on an area it will shore it up with extra bone.
So what happened long-term as a result of “fixing” her feet? The diagram above shows what happened. The excessive pronation from her destabilized feet put more “valgus” (knock knee) forces on her knees. This in turn overloaded the outside (lateral) knee compartment. What happens to a joint when one side gets too much force in an aging athlete? It gets arthritis as the cartilage wears away – it literally can’t keep up anymore with all that extra force. The current recommendation? Knee replacement – another surgical quick fix.
3. Fix the Real Cause! Sometimes figuring out what’s going wrong takes time, an area in which our ever devolving managed care, medical system continues to short change patients. Hence, quick fixes are often the suggestion “du jour”. This patient has come to us for stem cells in her knee and she may well benefit from that treatment. However, while the cause 10 years ago was a simple pronation problem, now this has grown into unstable knees that have worn down the lateral compartment cartilage. In addition, somewhere along the path to where she is today, her low back nerves became involved, shutting down key muscles in her CORE and legs, making her biomechanics worse and wrecking more havoc on her knees. What began as a small issue that could have been addressed and carefully monitored, has morphed into big problems.
The upshot? When something begins to go wrong in the middle aged athlete, instead of ignoring it and pursuing surgical quick fixes, it needs to be considered an “alarm bell” that indicates a small problem that should be fixed or it will eventually snowball into huge problem. If you use the mantra, “Listen and Fix” (i.e. listen to your body and take the time to find out what’s wrong and fix that problem) you can stay active as you age. But If you ignore small problems and pursue surgical quick fixes, those small issues become big ones. Don’t mimic Jane, “No Pain, No Gain” was only ever intended for 20 or 30 something aerobics bunnies, not aging athletes!