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Posted on: May 31, 2006

Keeping It Together

What to do when things get out of joint

By Mark L. Fuerst
CTW Features

New joint treatments offer more options today than ever before for active individuals, specifically for baby boomers who may have been injured and want to bounce back to weekend warrior status.

"Most fitness-related injuries, and even osteoarthritis of the joints, can be treated and controlled with rest, medications and other noninvasive interventions," says sports medicine specialist Dr. Kevin Plancher, associate clinical professor of orthopedic surgery at Albert Einstein College of Medicine in New York City. "Since the more we use our joints the more quickly they wear out, active boomers are more likely to need joint therapy sooner rather than later."

The days of doctors recommending no exercise if you feel joint pain are long gone. Now with proper rehabilitation and precautions, doctors attempt to get you back to moving your joints as quickly as possible.

"We know that exercise may enable you to perform at a high physical level into your 70s and 80s, and may help many organ systems as well as your ability to think," Dr. Plancher says.

However, people over 40 who have been weekend warriors often find it difficult to change their exercise patterns.

"You can't ignore the signs and symptoms of joint wear and tear," Plancher says.

If you've had knee pain for several years and continue to run regularly, you may be setting yourself up for a knee replacement. A little preventive maintenance might allow your knee joint to normalize without going through a big procedure.

As we get older, we need to listen to our bodies even more, says Dr. Allan Levy, co-author of "Sports Injury Handbook" (John Wiley, 1993) and team physician with the New York Giants.

"Your body will tell when you are abusing it and when you should begin to back off," says Dr. Levy. To keep joints lubricated, Levy suggests taking 10-20 minutes to warm up before sports and another 10-20 minutes afterward.

For aging boomers, most joint-related injuries are sport-specific. An easy adjustment in equipment is often the simple answer to prevent recurring joint pain. A runner with foot, knee or hip pain who has put in a lot of mileage may need orthotics (custom-made shoe inserts) because the foot becomes flatter as we get older, Plancher says. A tennis player whose knees hurt from years of playing on hard courts should switch to softer Har-Tru courts.

Many people put their joints at risk while working out.

"Simple refinements or substitutions can offer the same results without the risks," Plancher says. Doing leg extensions with weight on the ankle can severely stress the knee joint. One-third knee bends with elastic cords for resistance can build up the quadriceps muscle (front on the thigh) more safely. A military press on a flat bench with elbows locked at full extension may cause a shoulder impingement. The same exercise on an inclined bench with elbows slightly bent spares the shoulder and works the same chest muscles. Similarly, a pull down should be done with a narrow, not a wide grip, and the bar pulled down in front of you, not behind your neck, to protect your shoulders.

"At the first sign of joint pain, many people fear they need surgery," Plancher says. "But there are many measures you can take to reduce joint pain before surgery. For example, you may be able to receive glucosamine injections into the knee for up to two years, and this may help you to return to a sport or activity."

Glucosamine is a substance the body makes to lubricate the cartilage in joints. However, as we get older, glucosamine production slows and cartilage can harden, making joints less mobile. Many people with osteoarthritis take daily pills or drinks containing glucosamine and another joint-lubricating agent, chondroitin, to control their joint pain.

If you do need more pain relief, there are a host of minimally invasive surgical options that can get you back to your previous level of activity with very little recovery time.

Arthroscopic surgery of the knee, shoulder, hip and elbow have become commonplace. "If you tear a knee ligament skiing, and you are an active 42-year-old, you should have it repaired surgically," Plancher says. With proper physical therapy, you could be back skiing, or playing basketball, tennis or soccer, within two months

A torn rotator cuff used to mean the end of weekend tennis matches. But improved rehabilitation programs and much better surgery now make this a routine procedure. Again, with proper physical therapy, you could be back swinging a tennis racket in 12 weeks, or swinging a golf club in eight weeks.

"With the advent of MRI, we know what the inside of the joint looks like so we can confirm the diagnosis," Plancher says. "By providing a complete road map of the joint, MRI tells us whether someone needs conservative treatment and rehabilitation or surgery."

And even if your joints degenerate to the point of needing replacement, there are new technologies and techniques available, from shatter-resistant, long-wearing ceramic hips to partial knee-replacement procedures. If you have a total knee replacement, you can still consider skiing and playing singles tennis. Even those who receive an artificial shoulder can play tennis.

"Most joint injuries are bad chapters in our lives, but when treated appropriately can get you back in the game," according to Plancher.

Join the Party: Exercises to Keep You Moving

To protect your joints from injury, here are six exercises recommended by Dr. Plancher, two each for the shoulder, hip and knee. For each exercise, use a sports cord or elastic band – available at sporting goods stores, department stores or pharmacies – to provide resistance. For each exercise, do two to three sets of 10-20 repetitions.

HIP

Standing Hip Extension

Attach a sports cord to a closed door at waist level. Stand facing the door and loop the other end of the sports cord around your right ankle. Tighten your abdominal muscles and keep your back straight. Slowly move your right leg backward at your hip, keeping your right knee straight and your trunk still. Slowly return to the starting position. Repeat on the other side.

Standing Hip Adduction

Attach a sports cord to a closed door at waist level. With your left hip facing the door, loop the other end of the sports cord around your right ankle. Keeping your hips straight and your trunk still, move your right leg out to the side. Slowly return to the starting position. Repeat on the other side.

Knee

Single Knee Bends

Hold on to both handles of the sports cord and stand on the cord with your right foot. With your knees slightly bent, pull both handles to your waist. Place your left big toe on the floor behind you for balance. Slowly bend your right knee 4 inches to 5 inches, 1 second down, 1 second up. Keep your back straight and never fully extend your right knee. Repeat with the other side.

Seated Hamstring

Carpet Drags

Attach a sports cord to a closed door at knee level. Sit facing the door and loop the sports cord around your right ankle. Scoot away from the door to create tension. Keep tension on the cord and pull your toes along the carpet toward the chair, lifting your right heel. Lift your right foot and return to the starting position. Repeat with the other side.

SHOULDER

Internal Rotation

Attach a sports cord into the door jamb at waist level. Stand with your right shoulder facing the closed door, about 1 arms’ length away. Hold one end of the cord with your right hand, elbow bent at 90 degrees, and hold the other end of the cord with your left hand just below your belly button. With your right hand, pull the cord away from the door and across your body, keeping your thumb pointed up and right elbow tucked at your side. Repeat with the other side.

External Rotation

Attach a sports cord into the door jamb at waist level. Stand with your right shoulder facing the closed door, about 1 arms’ length away. Hold one end of the cord with your left hand over your right hip, elbow bent at 90 degrees. Hold the other end of the cord with your right hand by your side on the outside of your right thigh. With your left hand, pull the cord outward as if opening a door and across your body, keeping your thumb pointed up and left elbow tucked at your side. Repeat on the other side.