Age Related Issues in Sports Medicine

 

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Pediatric Sport Epidemiology

Pediatric sport epidemiology is a very interesting and useful topic of study in physical therapy. As participation of the pediatric population increases in both competitive and recreational sports activities, the risk of injuries increases and the number of injuries that do occur per year climbs. As physical therapists better understand the risk for injury as related to age, gender, and type of sport, they can better prepare to care for the pediatric patient population that presents with sports injuries of various severity.

What is pediatric sports epidemiology?  Pediatric sports epidemiology is the study of how many sports injuries occur and how often they occur in children during a given year. In the pediatric population, there are many anatomical and physiological concerns that apply to this epidemiology, including immmature skeletal structures, growth plates, and growth spurts . 

Total Joint Replacements and Sport

There are approximately 500,000 total joint replacements performed each year around the world, and approximately 300,000 of those are total knee replacement performed in the United States. (Vagel, Carotenuto, & Levine, 2011). Typically, total joint replacements (TJR) are performed to relieve pain and restore the quality of life for the individual receiving the TJR. Many of these individuals receiving a TJR participated in sporting activities prior to surgery; currently it is unclear whether it is safe for these individuals to continue to participate in sports postoperatively. Carotenuto et al. (2011), found that the current research has conflicting evidence regarding participation in sports following a TJR. The concern that high impact sports will increase the need for revision due to joint loosening or wear of joint components leads many surgeons to list sporting activities as a precaution postoperatively.
According to Golant, Christoforou, Slover, and Zuckerman (2010), postoperative participation in sporting events is beneficial to the patients overall health. An active lifestyle increases an individual’s muscular strength, endurance, proprioception, cardiovascular health, balance, and coordination, decreasing the likelihood for injury and falls. Golant el al. (2010), found that patients with a TJR also benefit from physical activity, but the level of activity is controversial. Some studies promote the participation of high impact sports while others refute high impact sport participation due to the risk of revision.
Though high impact sports for patients following a TJR are controversial, most studies have found that low impact sports are recommended. Sports like walking, water aerobics, cycling, swimming, and cross-country skiing are healthy and recommended by most surgeons. Golant et al. (2010) noted that low impact sports have been found to decrease the risk for revision due to loosening when compared to more sedentary patients. Chatterji, Ashworth, Lewis, and Dobson (2004) found an increase in low impact sports participation with patients who received a total hip arthroplasty. Regardless of the level of impact a patient wishes to participate following a TJR, it is recommended the patient discusses the sport with their surgeon prior to surgery to allow the surgeon to determine the appropriate approach and type of implant to accommodate the forces imposed by the sport.

 

With the realization that those over 80 are the fastest growing age group of the entire population, it is important that this segment of people understand the health benefits of exercise. Yes, there are some undeniable and inevitable changes that come along with aging; however, evidence shows that the benefits of physical activity and training in the senior population continue to grow. These benefits include fewer falls with injury, improved muscular strength and endurance, a decreased incidence of coronary artery disease, and a lower risk of cardiovascular related mortality (Franklin, Fern, & Voytas, 2004). Senior athletes can enjoy participating in a variety of athletic or sport related activities including swimming, running marathons, golfing, playing basketball, lifting weights, cycling, tennis, etc. Based on the activity the senior athlete is training for, the training regimen should be specifically designed to produce both metabolic and physiologic adaptations aimed to improve his or her athletic performance. The American College of Sports Medicine (ACSM) recommends the following training guidelines for senior athletes:
1. Train 3-5 days per week
2. 55%-65% to 90% of maximum heart rate or 40%-50% to 85% of maximum oxygen uptake reserve
3. 20 to 60 minutes of continuous or intermittent aerobic activity
4. Any activity that engages the large muscle groups like walking, jogging, running, cycling, rowing, stair climbing, etc.
5. Perform resistance training: one set of 10-15 repetitions for major muscle groups two to three days per week
6. Perform flexibility training: stretch major muscle groups at least four times each for a minimum of two to three days per week
Even at advanced ages, it is apparent that with the implementation of regular sports training, performance levels can be maintained.

Recent Related Research (from Pubmed)

Older adults are the least physically active age group and account for the highest amount of medical cost (Nelson, Rejeski, Blair, Duncan, & Judge, 2007), which led to many studies to determine an appropriate level of exercise for adults to maintain a healthy lifestyle. The American College of Sports Medicine (ACSM, 2015) has established a guideline for a recommended level of activity for the healthy adult. The current recommendations are as follows:

Cardiorespiratory moderate intensity ≥ 30min a day 5 days a week
Vigorous exercise ≥ 20min a day 3 days a week

Resistance Exercise each major muscle group 2-3 days a week

Flexibility Exercise Maintain Joint Range of Motion 2 days a week

Neuromotor for balance, agility, & coordination 2-3 days a week
Exercise

Individuals who currently have a more sedentary lifestyle are encouraged to gradually increase the amount and level of activity to decrease the potential for overuse injury and to provide for a more enjoyable exercise experience. Nelson et al. (2007) recommends that older adults create a plan for physical activity. The plan should “reduce sedentary behavior”, “increase moderate levels of activity”, and “take a gradual step approach”(p. 1101). Research has shown physical activity to increase an individual’s overall health, decrease medical costs, and provide psychological benefits for all age groups, which has led to campaigns that encourage daily physical activity.

Resisted Sled Sprint Training vs. Non-resisted Training

In many sports, sprinting is a key to optimal performance. For this reason, Petrakos, Morin, and Egan (2015) compared the effects of resisted sled sprint training to those of non-resisted sprint training on athletes. Resisted sled sprint (RSS) training involves multiple straight-line sprints while pulling a sled, which is loaded with additional weight that is attached to the athlete by a waist harness. The authors hypothesized that RSS could provide effective benefits when performed alone or in combination with traditional or non-resisted sprint training in force production, strength, and power while sprinting. The authors found that when the RSS load was 12% to 43% of the athlete’s body mass, improvement was noted in sprint performance for trained individuals. When the load was lighter than 12%, the authors concluded that there was no benefit to RSS when compared to non-resisted sprint training. A combination of RSS and non-resisted sprint training or plyometric training may also provide benefits in improving overall sprinting acceleration when compared to non-resisted sprint training alone (Petrakos, Morin, & Egan, 2015).

References

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