Knee Injuries in the Older Athlete

Knee injury and pain is also quite common in the older athlete. Pain can be due to osteoarthritis of the knee joint, arthritis behind the patella (kneecap), sprain of the ligaments on the inner and outer part of the knee (medial and lateral collateral ligaments), and weakness of ligaments inside the knee (anterior and posterior cruciate ligaments).

Generally all that is needed is a good history and physical examination to determine exactly which component of the knee is injured.

There are specific tests on the knee in order to determine the strength of the ligaments. These tests are relatively painless and involve pulling the lower leg forward or backward (anterior or posterior drawer test), pressure on the inner or outer lower leg to determine weakness of the side ligaments (valgus and varus stress test), and listening for crepitus in the joints.

Once the diagnosis has been made, generally, Prolotherapy is indicated because almost all knee pain is soft tissue in origin. Prolotherapy can be quite useful in strengthening the medial and lateral collateral ligaments of the knee. It will eliminate pain on the inner and outer aspect of the knee. Tightening the ligaments surrounding the knee, along with injection of a proliferant solution into the joint of the knee, can frequently help osteo-arthritis pain. Injection of proliferant into the knee helps to tighten the joint capsule. In addition, rehabilitation may also be recommended and usually includes exercises to strengthen the muscle surrounding the knee, flexibility training of the muscles of the leg and back, and physiotherapies to help tender points in the muscles (trigger points). As a side note, one of the best exercises that improves coordination, flexibility, and proprioception, as well as muscle strength, is jump roping.

SPORTS INJURIES IN THE OLDER ATHLETE

Although activities may be helpful for cardiovascular fitness, there has been a rise in sports-related injuries. This is particularly significant for the older athlete. Previous injuries that occurred in earlier years, were of little consequence at the time, and that did not heal properly, may cause pain over the years due to the continuation of the degenerative process. Sprains and strains also occur more frequently due to the general physical condition of the older athlete and the lack of protective muscle strength of joints and ligaments.

One reason for the poorer healing ability in the older athlete is the dramatic decline in anabolic hormone levels as the athlete ages. Another reason is decrease in balance.

There are often cardiovascular reasons for this. The person might be on a blood pressure medication that affects balance, but often the reason is that an old injury never healed. For example, a previous ankle sprain that never healed completely may result in chronic ankle instability. This causes a decline in the balance due to the "feel" in the limb being less sharp. This results in frequent episodes of "giving way" in the joints during sports and daily activity, making sports injuries more likely. In many cases there are abnormalities in proprioception (the ability to receive and process stimulation from muscles, tendons, and other internal tissues) and coordination, along with changes in reaction time as the athlete ages. Abnormalities in proprioception occur because the injury has done harm to the interaction between the central nervous system and the muscle, tendons, and ligaments. This impaired proprioception can result in a sudden loss of coordination or poor technique. The end result is an increase in the likelihood of sports injuries in the older athlete. Proprioceptive changes can occur not only in the ankle but also any other previously injured joints such as the knee, shoulder, and back. This is why it is always best for the athletic injuries to be completely healed right after the time of the injury. If an athletic injury has not healed after a few months, most likely it never will. This is the time to get Prolotherapy. If Prolotherapy is done initially, the likelihood of complete healing is enhanced dramatically. Prolotherapy can always be done later, but by then there may have already been irreversible degenerative damage done to the joints.

Overuse injuries occur more frequently as the athlete ages because of a decline in the athlete's ability to heal. These injuries, due to microtrauma to connective tissues and ligaments, occur with prolonged repetitive movement of large muscle groups where pounding frequently occurs such as in running, jogging, or tennis. The sign that an overuse injury is occurring is a prolonged recovery time. It is normal to feel sore for one to two hours after a workout, but if recovery time becomes six hours, then extreme soreness the next day, an overuse injury is eminent. The best approach in this scenario is to start cross training by doing other less-pounding sports for workouts, instead of just running or jogging all the time. Fortunately, cross-country skiing, swimming, and bicycling are more forgiving in this regard. Another consideration for the older athlete is to start on a natural hormonal/nutritional program to optimize healing. It is not possible to reverse the chronological clock, but it is sure possible to reverse the biological clock. It is actually relatively easy to increase hormone levels to that of a 35 year old. Athletes who desire to be 35 years old again, go to natural medicine physicians for natural hormone replacement. Besides helping recovery times and enhancing athletic performance, the hormones improve sex drive, improve muscle strength, and therefore expand the ways in which to get exercise.

Ligament Sprain

The most common type of sports injury in the older athlete is ligament sprain. A sprain is a stretch, tear, or complete rupture of a ligament. Fortunately, complete ruptures of ligaments are much less common than partial tears of ligaments. Types of sprains are determined by degree. A first-degree sprain is a stretch or tear up to 25 percent of a ligament. A second-degree sprain is a 25 to 75 percent tear of a ligament. A third degree, or complete sprain, is a result of a complete rupture of a ligament. Prolotherapy is extremely effective on first- and second-degree sprains. Microtrauma sprains to the ligaments can occur over a period of time and are not just the result of one specific injury. Microtrauma sprains are due to accumulative trauma to the ligament due to repetitive use over time, which can further irritate the joint, resulting in worsened osteoarthritis and joint pain. In such instances, Prolotherapy is often effective at strengthening the ligaments so they can handle the microtrauma.