The Aging Athlete and Back Problems

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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.  
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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.  
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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 hamstrings which
cross 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 and 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.  
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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.
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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.
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.
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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.
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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.
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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.
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g-athlete-and-back-problems/lstl1