OLDER ATHLETES (contributed by Mark Pitcairn-Knowles, Osteopath at Springbank Clinic)

You may be aware that I really enjoy competitive sport – particularly running and contributing towards a team score.  However, the (unfortunate!) realisation that I am now simply not fast enough to be of any help to the team at Tonbridge Athletics Club (TAC) led me to explore the opportunities of running in Masters events (five-year age categories for runners over 35 years old), preferably as a team.   At Masters events you do come across some athletes who appear to defy the aging process when it comes to speed, but they are in the minority.    Like many people, in my head I do not feel that I am any different from when I was 21 years old.  Of course my body knows that this is a delusion, but can I defy this process? What is it that actually happens to our body to affect our speed as we get older and what can we do to minimise it?

‘Wear and tear’ is a common diagnosis from your GP if you present with a sore joint, but what contributes to a joint becoming worn and what does this mean?
Use, mechanics, genetics and injury are the four main components which contribute to wear and tear. 

Articular cartilage is the smooth, ‘Teflon-like’ covering of the joint surfaces of the bone.  This does regenerate but does so more slowly with age and is susceptible to damage.  The expression “bone on bone” is used when the articular cartilage has worn away to expose the bony surface.  

Meniscal cartilage refers to the two semi-circles of cartilage in the knee which act as a guide for the movement of the femur on the tibia, also providing a protective role to the joint surface.  These can be torn – particularly with weight bearing twisting movements – but for most of us the meniscus will naturally become ‘frayed’ over the years.   Pain on the inside of the knee is often due to direct damage to the meniscus.   Bone will sometimes form in response to trauma to ligaments or tendons, resulting in Osteophytes (bony projections or spurs that form along joint margins) which will often reduce the function of a joint. 

As an Osteopath I am frequently asked if running is bad for your joints:  There is no simple answer to this but clearly there are many benefits to being active, both physiologically and mentally.  Cardiovascular benefits are obvious, as are the weight control benefits to joints, the CVS system and the endocrine system.

Our minds cannot function well if our bodies are not fit and healthy. Those people who love running or other sport become fed up and difficult if they are injured and they do not want to hear that they must stop exercising (even though some injuries do need rest!) 

There has been a huge increase in the numbers of middle aged and older runners in this area due to the competitiveness and success of local athletics clubs such as TAC and Sevenoaks AC, but also businesses such as Shona’s Runners (Shona Campbell runs a group in Sevenoaks which focuses on the benefits to mental health that running can give), MoJo’s runners,  Sevenoaks Ladies Joggers and Oaks Blokes, all catering for beginner runners who lack confidence, offering a social environment without the competitive element.  

Through the numbers of runners who are new to the sport we have also seen an increase in the number of patients who have presented with injuries that are quite specific to someone starting running absolutely from scratch.  Starting a new activity, whatever it is, may well cause physical issues.  Running is by nature a very repetitive sport and muscles need to build up strength to be able to do the same thing over and over again without becoming damaged.   If a muscle is weak and tired, control of the movement it is trying to make is lost and the result will be damage to the tendons that attach the muscle to the bone, particularly as the tendons lose their elasticity with age.    It is therefore wise to combine starting to run with some strength training and stretching, perhaps even for several weeks before starting to run, aiming at the Gluteal, Quadriceps, Hamstrings, core and lower leg muscles. Wearing the correct shoes is also important and professional advice should be sought on this from experienced retailers such as ‘Up and Running’ and ‘Bat and Ball Sports’. 

If you have taken up running because you would like to lose weight, it may be a better idea to first make dietary changes combined with starting to walk dynamically or cross training before progressing to running.   Landing on your leg when running increases the “Vertical Ground Reaction Force” compared to walking by approximately two and a half times.   The level of this force depends on the length of time your leg is in contact with the ground.  Someone with a stiff straight knee action will have a shorter contact time with the ground and therefore a higher impact force than someone who bends their knee more, spreading the force over a longer impact time.   Listening to your foot strike sound is helpful – quieter feet suggest less energy going into potentially damaging ground reaction force involved with the impact, but more into forward propulsion.   We need the energy to propel us forwards, not just upwards.   It is noticeable when watching top class runners that their heads bob up and down much less than runners further back in the field.  Leaning forward from the ankles helps with this, with your foot strike being under your body, pushing you forward.
Speed walking only marginally increases vertical reaction force so is a good place to start if weight loss is a major factor.

THE FACTS:  The following facts for Masters/Veteran runners are a reality and you should be aware that injuries occur due to a musculoskeletal overload.  The following will influence this:

SARCOPENIA: This is the process in which we lose muscle mass as we age.   A sedentary person will lose 8% of muscle mass between the age of 40-50, then 15% after the age of 75.   The muscle changes nature as type II, fast twitch fibres are lost, hence we lose speed and reaction which is more important to sprinters and throwers.  Type I fibres, related to endurance events, decline less with aging. According to a study undertaken in 2011, with appropriate training it is possible to maintain muscle bulk.

ELASTICITY: Tendons and Ligaments lose their elasticity, hence the increase in low energy injuries/ruptures.   This is also combined with an increase in determination that comes with middle and late age.   Stretching is vital to try to avoid this as it keeps the load off the tendons by giving more length to the muscle belly.

BONE DENSITY: Density and strength of bones will decline, however weight bearing activity helps to reduce the rate of this loss.   This will have more of an impact the later in life you start your activity.

VO2 MAX:  This is the ability of the body to use oxygen which declines with age.   It is the combination of taking the oxygen into the body via the lungs, transporting it to the muscles and how the muscles then use it.   As you get older your maximum heart rate reduces (roughly 220 bpm minus your age) and as a result of your heart beating slower your cardiac output will be less, hence blood passes around the body at a slower rate, in turn delivering oxygen more slowly.   The heart is a muscle, so exercising it maintains it.  Lung capacity also reduces with age: There is thought to be a 1.5% yearly reduction in VO2 max between the ages of 35 and 55.    However, exercise and training can reduce this loss by up to 50%.    Maintaining VO2 max is important for endurance events.  The positive news is that the ability of our muscles to utilise the oxygen that they receive is well maintained as we get older, which assists with endurance events.  

USE IT OR LOSE IT:   Or perhaps this should be, the more you use it the slower you will lose it.   

Training smarter not harder is important for older athletes in order to maximise improvement, reduce chances of injury and reduce the losses described above.

Recovery periods following higher intensity training need to be longer.    Intense training will cause minor damage to tissue, which in turn needs about 24 hours to recover before the benefit is produced:  This period becomes longer with age.  Training again to an intense level while still in the recovery period will prevent the positive benefits from taking place.   Cross-training will allow parts of the body to recover while still progressing general fitness or other muscle groups.   Remember, maintaining muscle bulk is a continual challenge.

Always recognise when you are not well, or if a niggle would benefit from missing a session.

Personally, I found the temptation to train harder and more frequently when I have had a good race hard to resist, particularly when I see younger athletes out running the next day.   If you have a good performance it shows that your training is working so make any increase in frequency or intensity of training gradual.

INJURY: Injuries tend to fall into the following categories: Overuse, muscle strain, tendinopathies or degenerative joint disease.   There will always be a reason:

Overuse: This can result in bony stress fractures/reactions.   Mechanics need to be looked at and balanced with frequency of use.   Recovery time is crucial for all tissue.

Degenerative joint disease: This will often be a reflection on the history of the joint, i.e. previous injuries which may have affected the function of the joint or perhaps another adjacent joint.   The articular cartilage is a smooth covering of the bony surface that reduces friction.  This can be damaged through one-off trauma or by repetitive wear.   One-off traumas which cause a hole in the cartilage may be repaired using stem cell technology, cartilage plugs or by ‘micro-fracturing’ – creating a blood clot in the hole which contains stem cells and will form a repair tissue (not actual cartilage but something more fibrous).  This has varying success rates, but over time it tends to breakdown, so load management is important.   If a joint, such as an ankle, has been damaged and results in loss of mobility, then further joint damage may occur at the knee or hip as these joints may be required to adapt their function to allow activity to continue.    If the damage is too widespread then joint replacement may be required.

With any joint degeneration, managed movement is the key to slowing the deterioration.   A mixture of passive and active exercises help to maintain synovial fluid within the joint (produced in response to movement of the membranes) and strength of the muscles to control movement.

Muscle strains: These can be avoided by careful warm up and slow progression when building activities.   Avoiding sudden changes to the type of activity you do, for example, a distance runner switching to long jump without training for it!   Also having good judgement of when tightness is simply tightness, ie. will ease with exercise or when it is a minor muscle tear that will deteriorate with continued exercise.

Fascia strain/tear:  These injuries are often very sudden and sharp – feeling like you have ‘pulled a muscle’.  Fascia is the connective tissue that covers and intermingles with our muscles and viscera, helping to hold us together!   Over the past few years it has had more attention as a source of injury and pain.    The coloured tapes that are often seen on athletes and go by several names are a Myofascial tape, the role of which is not to stabilize but to stimulate receptors under the skin by lifting it.  Injuries to the fascia will often occur “mid-range” so, not like in a muscle when stretching and contracting but perhaps when turning suddenly.  It is a connective tissue and therefore has a relatively poor blood supply so will be slightly slower to repair than muscle tissue.

Tendinopathies: This is when the tendon is diseased and is thickened from the inside rather than inflamed around the outside.   There is normally a build up before an activity which aggravates the condition and causes pain.  Management of your training schedule as mentioned earlier is the way to avoid this. Typical symptoms are acute pain on walking after resting.  Advice from one of the Osteopaths at Springbank clinic will be required to ensure there are no clear mechanical issues or to involve treatment for the muscles of the calf.

Anaemia or low Iron Levels:  The act of long distance running can cause damage to red blood cells through repetitive percussion on the ground or within the viscera when they are shaken during activity.  Sufficient levels of iron are important to maintain healthy red blood cells which carry oxygen around the body. Good dietary sources of iron are green leafy vegetables such as spinach and kale, pulses, brown rice and nuts.  There may, however, be a more systemic reason for anaemia – for example, intestinal blood loss or lack of ability to form red blood cells – and it is important to rule out any of these in the first instance.  

KEYS TO TRAINING
Warm-up carefully by slowly increasing the stress on the tendons.  This increases synovial fluid within the joint, therefore feeling looser.   Sprinters in particular do not want to stretch excessively before an event in order to maintain recoil for explosive response.

Avoid sudden changes to training routines, activity, intensity or volume

Always make time for a good warm down as stretching post activity is crucial.