Prevention and Management of Common Musculoskeletal Injuries in the Aging Female Athlete

Abstract

The onset of menopause around the fourth to fifth decade causes numerous changes in the active female’s body. The alteration in sex-specific hormones, particularly a decrease in estrogen, affects both quality and quantity of bone. This mature life stage herald by the occurrence of menopause is associated with a 3% increase in bone loss per year. Therefore, one of the greatest threats to the aging female athlete is decreased bone density with the eventual development of osteoporosis. Additionally, the reduction in estrogen levels also causes a decline in muscular strength in women. However, with the proper physical training regime, particularly weightbearing plus resistance exercises, bone mass and muscular degeneration can be combated. Aging also exposes the female athlete to certain types of injuries along with increasing the time to recovery post trauma. Prevention of musculoskeletal injury is the best method to ensure that the aging female athlete can maintain an active lifestyle. Appropriate workout/conditioning programs incorporating strength, flexibility, balance, and mobility, as well as proper nutrition, are crucial in keeping the older female population healthy and active to enhance their quality of life in later years.

Chapter Review Questions with Scenario

1.1 Scenario

You are a nurse practitioner for an internist in a midsize town. Your adult patient population ranges from young adults to senior citizens. You see an array of patients with different clinical entities ranging from the simple common cold to complicated cardiopulmonary disease. One of your hobbies is playing recreational tennis in a “female over fifty” league at the YWCA. You meet with your teammates twice a week and you serve as the team captain for these female athletes. Another pastime for you is working out at a local health club three to five times a week. Your doubles tennis partner is 55 years of age and is an avid runner and climber, physically active as well. She pretty much participates in some sort of sporting activity every single day of the week. Lately, she has been frequently absent, sending in a substitute player and complaining of vague, achy shoulder, and deep knee pain. Unfortunately, before you could help her sort things out, she suffered a fall, sustained a wrist fracture on her dominant side (opposite of her involved shoulder), and finally made it to your clinic for evaluation and treatment. You have known this woman for several years, and she refuses to let anything slow her down in terms of exercise. She is extremely frustrated with her injuries and wants to heal really fast and get on with her active life again as soon as possible.

1.2 Review Questions

• 1. First of all, what pertinent questions should you ask about your patient’s medical history and what modalities should you utilize for diagnosis?

• 2. What should you advise her about the shoulder/knee complaints and wrist injury?

• 3. What other medical specialist(s) should you consult and why?

• 4. What other factors should you consider prior to sending her back to athletic activity after healing?

• 5. How soon after she heals from her injury should you allow her to return to tennis? Will you let her go back to running; how about rock climbing?

1.3 Plausible Answers

• 1. First of all, you should take a detailed history of your patient’s physiological status and physical fitness profile, including the frequency, intensity, and duration of each athletic endeavor in which she has been involved, to see if indeed she is overtrained and also, how she fell to begin with that is, was it from one of her climbs or stumbling elsewhere? Then, order radiographs of the shoulder, knee, and wrist, and a DEXA scan to evaluate her bone density because she is most likely postmenopausal.

• 2. It seems as though your partner has not allowed her body to recover, jumping from one sport to another, lending herself to be involved with risky athletic activities. Her knee pain may be coming from early degenerative changes aggravated by the excessive impact of running. On the contrary, it also appears that rock climbing and tennis may not be compatible, because both sports require repetitive overhead maneuvers that may overload the shoulder joint, causing an overuse-type impingement syndrome. As for the wrist injury, you must advise her to stop all sporting activities requiring upper extremity use. This will force her to rest her shoulder and knee as well, but have her move the surrounding joints gently so she would not get too stiff. Also make sure she institutes first-aid measures, such as the PRICE principle, which was discussed in this chapter.

• 3. You should discuss her case with your internist, then seek a consult from an orthopedic or sports medicine surgeon, especially for the fractured wrist, because she may need casting and/or surgery. She/he can address the shoulder and knee conditions as well, which most likely will need some sort of physical rehabilitation exercises. In addition, an endocrinologist should be sought out to see about the best course of medicinal or other therapy beyond calcium and vitamin D for her bone density.

• 4. After clearance from her orthopedist and more information from the endocrinologist, you should sit down with your patient and make sure she understands that most likely the wrist fracture stems from osteoporosis and that the risk of other similar skeletal injuries will increase several folds. Therefore, she should be extremely careful from now on and avoid risky-type sports.

• 5. In terms of allowing your patient to return to competitive athletic activities, she must have a pain-free ROM and good strength of both her upper and lower extremities, as documented by a physical therapist before she can even practice tennis. This may take several weeks to a few months or more. She should also modify her workouts at the gym to maximize muscular endurance, skeletal strength, and proprioception, along with cardiorespiratory capacity. In addition, she needs to perform a low-impact-type aerobic activity so as not to stress her arthritic joint or osteoporotic bone. As far as running goes, if she must, she can jog on alternate days on the treadmill so as not to overload weightbearing joints. As for rock climbing, again stress to her the importance of keeping away from activities that would increase the potential for repetitive trauma, so obviously give her an emphatic NO!

Chapter Review Questions

• 1. What are some of the musculoskeletal manifestations which occur over the years of aging?

  • (a) Hypokinesia

  • (b) Sarcopenia

  • (c) Osteoporosis

  • (d) All of the above

• 2. Age-related sarcopenia is associated with

  • (a) Decreased metabolic rate

  • (b) Decreased soft tissue flexibility

  • (c) Increased body fat

  • (d) All of the above

• 3. Kyphosis is a ___ plane deformity.

  • (a) Sagittal

  • (b) Coronal

  • (c) Horizontal

  • (d) None of the above

• 4. Osteoarthritis is first manifested in which of the following joint?

  • (a) Tibiofemoral

  • (b) Carpometacarpal

  • (c) Interphalangeal

  • (d) Metacarpophalangeal

• 5. Name some common sites of osteoporotic fractures affecting postmenopausal women.

  • (a) Spine and wrist

  • (b) Wrist and hip

  • (c) Spine, wrist, and hip

  • (d) None of the above

• 6. What are some indicators of potential osteoporotic fractures?

  • (a) 2″ loss in height

  • (b) Hip pain after falling from standing height

  • (c) Low BMI

  • (d) a and b

• 7. Which types of exercise have been found to be beneficial in older, active females?

  • (a) Bicycling, aquatic aerobics

  • (b) Skiing, rock climbing

  • (c) Dancing, jogging

  • (d) a and c

• 8. What treatment modalities have been shown to benefit musculoskeletal health in the master athlete?

  • (a) Glucosamine/chondroitin sulfate

  • (b) Fish oil supplements

  • (c) Calcium/vitamin D

  • (d) Sports supplements

• 9. ACSM and CDC recommend ___ of moderate-intensity exercise 3–7 days/week.

  • (a) 5–10 min

  • (b) 20–60 min

  • (c) 70–90 min

  • (d) 90–120 min

• 10. To maximize aerobic fitness, the target heart rate range should be ___ of maximal heart rate.

  • (a) 20–30%

  • (b) 80–100%

  • (c) 40–80%

  • (d) All of the above

Answers

• 1. d

• 2. d

• 3. a

• 4. d

• 5. c

• 6. d

• 7. d

• 8. b

• 9. b

• 10. c