sonki: Investing in health - U must read from Barrons 6/8/98
I am sending 6 sections in separate posts.
June 8, 1998 <Picture: [Barron's Online]>
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As Baby Boomers charge into middle age, a lot of them are continuing to play sports as if they were still college kids. Result: a huge increase in trips to the emergency room by the over-40 crowd. Bicycling and skiing are the most dangerous. But beware the big three country-club sports.
Baby Boomers Enter The Danger Zone
Still skiing the bumps at age 44? Watch out! --- Why so many weekend warriors end up in the hospital
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By Jonathan R. Laing
Staying in shape has become an American obsession in the 1990s, with Baby Boomers well into their 40s and 50s playing basketball, lifting weights and racing down ski slopes. But this trend has one disturbing consequence: Ever-greater numbers of weekend warriors are ending up in the hospital. In 1996, for example, more than 43,000 skiers over 40 years of age were taken to emergency rooms for treatment, up twelvefold from 1986. As the nearby illustration shows, there were also large increases in emergency-room admissions for Baby Boomers who play basketball, lift weights and golf.
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These injuries typically occur when people are trying to perform the way they did as teenagers -- or the way they see stars like Michael Jordan or Pete Sampras play on TV every week. All too often, such overly ambitious efforts result in torn muscles, blown knee joints and ruined rotator cuffs.
Even doctors aren't immune. Take Lee Newcomer, for example. As Chief Medical Officer for the HMO giant United HealthCare, the 46-year-old Newcomer has first-hand knowledge of the casualty reports from the fitness front. On top of that, he has been a fitness buff since high school, when he was twice Nebraska state cross-country champion and once state champion in the mile. Yet this didn't keep him from shearing his Achilles tendon in 1990 when he jumped to take a shot during a pickup basketball game. The tendon made a sickening pop sound, forever shattering his illusion of athletic invincibility.
''The accident was all my fault, of course, for failing to properly warm up and stretch,'' he ruefully recalls. ''I was on crutches for five months after the surgical repair, which meant that my partners at the Tulsa hospital where I then practiced had to do all my rounds. None of us was very happy about the situation.''
One of the most troubling findings on the injury front concerns women, who are now playing strenuous sports far later in life than they ever did before. Right now the world of sports medicine is buzzing about the epidemic in serious knee injuries suffered by female athletes playing high-impact sports like soccer, basketball and skiing. Growing numbers of these women have been suffering much-dreaded tears in the anterior cruciate ligament (ACL), the most important ligament controlling and stabilizing the knee and the most difficult to repair. It appears that women are three times more likely to sustain this injury than are the men who play these sports.
''We're not sure why this rash of knee injuries is occurring, but all I know is that women patients in recent years have surged to half of my sports practice,'' says Dr. Michael Dillingham, a prominent Bay Area orthopedic surgeon and team physician for the San Francisco 49ers.
None of the raft of doctors and other sports-medicine gurus Barron's consulted suggested that the risk of injury outweighed the benefits of engaging in exercise. Far from it. Typical was Dr. Herbert Haupt, a St. Louis orthopedic surgeon who has done extensive research on the aging athlete. As he points out, ''Exercise helps diminish the four most destructive problems of age -- hypertension, heart disease, arthritis and hearing loss.''
That sentiment is echoed by Dr. Thomas Upton, a Chicago cardiologist who, among other things, has been in charge of screening all the top National Basketball Association rookies for potential heart problems: ''Sure, it's not unusual for coronary problems to result in the death of a runner or two during, say, the New York or Boston Marathons or other major corporate distance races that involve large groups of runners. Unfortunately, a lot of folks don't train properly or take stress tests when contestants possess obvious risk factors like elevated cholesterol, elevated blood pressure, a family history of heart disease, diabetes and a history of smoking. Still, a program of strenuous exercise like running beats a sedentary lifestyle almost every time.''
Still, some caution is in order. Especially since research shows that human beings reach their physical peak at around 25 years of age. From then on, one's physical condition begins to decline, slowly at first, and then with gathering speed after age 50. Muscle mass diminishes. Ligaments, the body's basic suspension system for joints like the knee, ankle, hip and shoulder, lose their suppleness and flexibility. Physical endurance flags.
Wear and tear on the cartilage cushions of the joints accumulates, leading to aches and pains, reduced range of motion and ultimately, perhaps, potentially crippling arthritic inflammation of a joint. In addition, a slowing of the reflexes can betray the aging athlete by robbing him or her of the necessary quick reaction time to avoid a collision on the touch football gridiron or properly negotiate a tricky bump on the ski slopes.
Of course, adequate conditioning and stretching can retard this grim progression and help the recreational athlete avoid pulled muscles or more serious injuries. Sure, Gordie Howe played all-star caliber professional hockey into his 50s, as sports buffs invariably point out. And Nolan Ryan was still popping fast balls (and pain-killers) in the Major Leagues after age 40. But for most weekend warriors, the responsibilities of career and family begin to obtrude at almost precisely the point that physiological decline begins to set in.
The recreational athlete doesn't have the time to work out as much, and deconditioning, as the physical-therapy crowd calls the process, sets in. This is usually accompanied by a weight gain or, at least, some redistribution of body fat, which puts additional strain on muscles, bones and joints.
However, our discussions with exercise experts turned up a number of suggestions as to how desk-bound professionals and others can remain athletically active without major trauma to life or limb. Perhaps most controversial, they suggest that the over-the-hill gang think about giving up heavy-impact sports like touch football, baseball, rugby, hockey or basketball by the time they reach 35 or 40 years of age. Or at least ratchet down the action somewhat by either playing with folks one's own age or going at less than full tilt.
''A sport will generally tell you when it's time to quit. When you can't comfortably compete against younger players or you're sore for days after you play even though you did proper stretching, it's time to move on to another activity,'' says Dr. Elton Strauss, Chief of Orthopaedic Trauma and Reconstructive Surgery at New York's Mount Sinai School of Medicine.
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Now 50, Strauss practices what he preaches. He gave up five-on-five basketball and flag football at 35. And he wishes he'd given up ice hockey at the same time. He still has two screws in his elbow from an ice hockey mishap suffered a year later. Yet Dr. Strauss is hardly a shrinking violet these days. He still kickboxes and plays tennis with his 22-year-old daughter. Nor does he necessarily insist that patients drop sports like skiing even after hip or knee replacement surgery. ''Life is function, and function is life,'' he observes in Zen-like fashion. ''People have to do what they want to do.''
Up to a point, that is. Dr. Russell Warren, a Manhattan orthopedic surgeon and team physician for the New York Giants, has to look no further than his examining room to see the toll that Baby Boomers' machismo is exacting. Warren himself had to give up rugby a decade ago when he was 47 because of stiffness that persisted even days after a match.
What activities exact the biggest toll and at what age are athletes most vulnerable? To answer these critical questions, Barron's was able to unearth some obscure government statistics on sports injuries compiled by, of all agencies, the U.S. Consumer Product Safety Commission. It seems almost any injury under the commission's definition involves a product, whether it be running shoes, cleats, shoulder pads, weight-lifting stations or skis. Thus, the agency systematically surveys a representative sampling of the America's 5,000 emergency rooms to estimate the number and the nature of all sports injuries each year. At Barron's request, the agency's National Injury Information Clearinghouse was also kind enough to take the results for 1986 and 1996 (the last year for which figures have been completely compiled) and slice and dice the injury totals by sport and age group. As a result, readers can look up their favorite athletic pursuits and see where the greatest number of injuries occur for the over-40 crowd.
Perhaps the clearest indication of Baby Boomers' refusal to go quietly into middle age is the dramatic increase in emergency-room admissions for sports injuries. Between 1986 and 1996, such admissions for those over 40 increased by a little over 60%, from 71,749 to an astounding 180,632.
One of the most dangerous activities, oddly enough, turned out to be bicycling. Whether for broken bones, concussions or serious abrasions, 47,143 bicyclists over 40 years old were admitted to emergency rooms in 1996, more than double the 20,149 that were admitted a decade earlier.
Almost as injury producing was skiing, with 43,491 admissions among the over-40 group. And the increase here has been astronomic, as suggested by the fact that in 1986 only 3,562 skiers over 40 were admitted to emergency rooms. From the look of it, a lot of Baby Boomers learned to ski during the 1960s and they don't want to give it up. Perhaps the draw is the natural beauty of so many ski sites or the glamour of the apres-ski scene. In addition, skiing requires a certain affluence that's more likely in an older crowd.
It's important to note that the older bunch has vastly more potential for serious injuries to areas like the back, knee and lower leg. So the rule is: Unless you're in terrific shape, if you want to keep skiing into your 40s and 50s, be prudent.
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How does Michael Jordan avoid injury? Trainer Tim George makes him stretch for an hour or more before and after every practice.
Most guys have the common sense to quit playing football by their mid-20s. But there are plenty of exceptions, particularly when you include all the touch-football and flag-football players that do battle every autumn. This contingent, often flabby and out of shape, helps explain why more than 21,000 football players over age 30 were admitted to emergency rooms in 1996, up from about 13,000 a decade earlier.
Even when it comes to easily manageable activities like weight-lifting and using exercise equipment, America's aging Boomers seem to be pressing too hard. About 1,150 weightlifters in their 50s were admitted to emergency rooms in 1996, up from about 575 back in 1986. Admissions after use of other types of exercise equipment jumped to 2,415 in 1996, up more than fourfold from a decade earlier. Staying in shape is great, but remember, muscle tears and hernias are a heavy price to pay to look as ''buff'' and ''ripped'' as those who are 20-something.
Although the roller-skating category shows a rise in injuries among people over 40, this is almost surely due to heavier participation, particularly in rollerblading. Notably, there has been a steep decline in emergency-room admissions among younger skaters over the past decade, probably owing to the increased use of safety gear, such as knee pads, elbow guards and wrist protectors. Among 15- to 19-year-olds, for example, there were 5,651 emergency-room admissions in 1996, down from 10,389 admissions in 1986.
Don't think softball is any respecter of age. That staple of adult leagues, company outings and family picnics inflicted more injuries (22,131) on 30- to 34-year-olds in 1996 than it did on players in their early 20s (19,851). And the injuries of those over 30 tended to be more severe. They sustained 30% more traumas to critical areas like the knee and shoulder. Lest one think softball is a pantywaist pursuit compared to hardball, note that softball injuries for athletes aged 25 to 50 were nearly twice the total of 38,653 suffered by baseball players of the same age span.
As athletes move into their 40s and 50s, many migrate to lower-impact sports like golf or swimming. It's easy to see why. With golf, tennis or swimming, an athlete can stay fit, work the cardiovascular system and burn off a few calories, all the while minimizing the chance of injury. The statistics bear this out. Emergency-room admissions for golf in 1996 totaled 19,989; tennis, 16,211, and swimming, 12,107. These figures are dwarfed by the comparable injury totals for basketball, 451,903; football, 196,682, and skiing, 88,791.
Yet the big three sports of the country club set pose their own hazards. Golfers between the ages of 45 and 54 suffer twice the number of injuries as those in their 20s do, with shoulder, lower-back and lower-leg problems accounting for the bulk of the difference. Tennis players in their early 40s, meanwhile, can count on elbow, wrist, back and foot injuries to crop up. As for swimmers, injuries seem to crest in the late 30s as shoulder and lower-back problems develop. Muscle ''impingement'' from rotator-cuff problems in the shoulder force many veteran swimmers to abandon the crawl or butterfly for the breast and side strokes.
Of course, no amount of denial or even conditioning can change the fact that physiologically it's downhill after age 25 for the broad range of athletes. Sure, some can compete well into their 30s or even 40s. But averages are averages.
Dr. Haupt of St. Louis, who has made a specialty of studying the aging athlete, describes the process with clinical detachment. First, of course, muscle mass or strength begins to decline. Initially this loss is barely perceptible, at about 4% per decade until age 50 when it accelerates to about 10% per decade. By 60, the average male has lost roughly a third of his muscle mass if he fails to stay in reasonable shape through regular exercise.
This fact affects more than physical performance. Muscles are, after all, what give us strength and speed, powering the body like a motor powers a car. Muscle and tendon systems serve as well as secondary stabilizers to joints like the all-important knee, protecting not only the joints but their primary stabilizers, the ligaments. Late in life, the loss of muscle strength often leads to the falls and broken bones that bedevil the aged.
Meanwhile, according to Haupt, the body's cells stop functioning with peak efficiency as time goes by. Athletes' endurance suffers as the cells no longer process oxygen as effectively. The tired athlete, of course, becomes more inattentive and, therefore, prone to injury. That's why, as any ski-patrol member will tell you, the bulk of all ski accidents occur in late afternoon.
Healing rates also decline with age. At least that's what a number of animal studies show. The young animal can fully heal from muscle and other soft-tissue injuries in 30 days, while older animals are only about two-thirds recovered.
Lastly, joints progressively lose their flexibility with aging. This is in large part because collagen, the main building block of soft tissues like muscle, tendons and ligaments, becomes more fibrous and therefore less elastic. As a result, these stabilizers afford less protection to the joint. They are also susceptible to pulls and tears. At the same time, the built-in shock-absorbers of the joints -- cartilages -- tend to erode, flake and compress with wear and tear.
As if this weren't depressing enough, the aging athlete can be betrayed by what's commonly known as ''muscle memory,'' according to Dr. James Bradley, a Pittsburgh orthopedist who is also the physician for the Steelers football team. As he explains it, the neural connections to the muscles, forged over years of practicing, say, a spin move in football or a twisting move to the hoop in basketball, can fire in their normal sequential order only to find that while the spirit may be willing, the flesh isn't. ''If you don't use the key muscles in a sport regularly, you lose them and suffer injuries in the process,'' Bradley observes. ''It's not just athletes who sometimes live in the past. So do their nervous systems.''
Yuppie narcissism reigns these days, with American men and women pumping iron with maniacal zeal. Little wonder that one of the fastest-growing niches in magazine publishing is the men's magazine, replete with male beefcake photos on the cover and articles with headlines like ''Bigger Biceps in Two Weeks.'' Indeed, the legacy of today's generation of insecure American males may be the transformation of showy muscle groups like the biceps, ''abs,'' ''pecs,'' ''lats'' and ''quads'' into objects of religious veneration.
America's tendency to beef up is certainly evident in the National Basketball Association. The league players have been transformed over the past 10 years from a bunch of angular giants into a crew of bulked-up physical specimens. Today the power game, featuring behemoths grappling for position under the hoop, has supplanted the run-and-gun style popularized by the Los Angeles Lakers of the 'Eighties.
No player epitomizes this transition more clearly than Michael Jordan, now 35. From a skinny rookie in 1984, Jordan has become a demigod, whose sculpted physique is an object of both conscious and subliminal identification on the part of millions of Americans. Nobody in professional athletics works out harder, according to Tim Grover, Jordan's private strength coach and trainer, who has worked with the superstar exclusively since 1989. Jordan trains under Grover for more than an hour before and nearly an hour after every practice, either in a gym in his home on Chicago's North Shore or in private health clubs in cities where the Bulls are playing road games. Jordan is all business in the gym, engaging in little small talk with his aging workout mates, Scottie Pippen and Ron Harper.
In addition to the usual upper-body strength work, Grover has Jordan concentrate on areas of the body that are vulnerable to injury in basketball, including the fingers, toes, ankles, wrists and knees. To increase the strength and flexibility of arms and tendons, Grover has Jordan do the martial arts exercise of kneading wet rice in buckets with his hands. The superstar also scrunches wet towels on the floor to strengthen his toes. Ankles are built up and made flexible by walking on two-by-fours and purposely rolling ankles in and out. The latter exercise allowed Jordan to miraculously recover from a bad ankle sprain suffered in the playoffs several years back; he was able to start in the following game, just 48 hours after the mishap.
Much of Jordan's routine remains shrouded in mystery. Grover and Jordan have no desire to give away any secrets. But the point the recreational athlete should remember is simple, according to Grover: ''If you try to be like Mike, remember that, like most top athletes, he works out six hours a day, eleven months a year.''
Despite the heightened risk of injury for aging weekend warriors, the allure of team sports endures. The motivation is complex, going well beyond any attempt to deny the passage of years and remain suspended in eternal youth. Joe Kita, a writer at Men's Health magazine, wrote a wonderful article in the magazine about how, at age 38, he returned to the Pennsylvania high school where he'd been cut from the basketball team some 20 years before and managed to make the varsity this time around. Of course, he wasn't eligible to play in any league games. But at least he had the satisfaction of knowing from the head coach, some 12 years his junior, that he'd earned a spot on the ''press team,'' used for defensive stands during key moments.
Kita also found that, as a result of weeks of ferocious preparation, he arrived for tryouts in far better condition than his slack-jawed teenage rivals. Of course, before long, he was starting to wear down. He was afflicted with soreness and aches and pains, while the kids seemed to recover from the previous day with just a night's rest.
But no matter. He'd made his point. He's righted a grievous wrong that had haunted him through adulthood, and a whole lot more.
He found he got goosebumps at the end of every practice when the team met in a tight circle, linked hands and reverently intoned the word ''team'' before heading to the locker room. All for one and one for all. After years of anonymity in the workplace, those moments meant far more to Kita than any kid could realize. The bonding. The solidarity. Perhaps, he found himself thinking, all weddings, family gatherings and business meetings should end the same way. It sure beat the ersatz identification adult Americans have with their favorite sports teams.
In team sports, a coach is a far more positive force than any boss in the workplace. A true coach ''wants you to improve and succeed, as much for yourself as for the team. He's the objective taskmaster your father can never be, the field psychologist who understands what drives you,'' Kita wrote.
Finally, Kita savored those magic moments during the long tryout when he felt like a 17-year-old rather than the balding, greying adult he'd become. ''You know the soul never ages -- at least until you look in the mirror,'' he observed.
As noted above, women these days are, with worrisome frequency, suffering ghastly tears to the anterior cruciate ligaments of their knees. Theories abound as to why. Some experts wonder whether women athletes condition themselves as thoroughly as men do. Alternatively, women may not have as much exposure to sports early in life, and therefore may not develop the same neural hardwiring and coordination. Or perhaps female knees are more subject to stress because of subtle alignment differences caused by women's wider pelvises. Some doctors have speculated that the problem is caused by the shape of the female knee or hormonal shifts during the monthly menstrual cycle weakening the ligaments. Right now, no one really knows.
The good news is that ACL tears are no longer the career-ending injuries they once were. Dr. Mike Dillingham of the 49ers had star receiver Jerry Rice back on the field just three and a half months after a surgery in which Dillingham created a new ACL by using part of Rice's kneecap tendon as a substitute. ''Rice was just transcendent for the first half of his return game,'' Dillingham recalls. ''Unfortunately, he then fractured his patella as a result of a freak play. Yet he'll be back better than ever next year.''
Other medical breakthroughs are brightening the prospects that all weekend warriors will be better able to cope with their inevitable injuries. Arthroscopic surgical techniques, which are minimally invasive, have improved results and reduced recovery times. Cartilage that once was routinely removed can now be surgically repaired, and advances in cell technology promise to permit the reproduction of cartilage from a patient's own cells. The endemic ''loose shoulder'' problem of aging athletes no longer requires painful surgery followed by months of rehab. Now surgeons are starting to use arthroscopically delivered heat probes to the capsule of tendons inside the rotator cuff to shrink them, much like cooking bacon, thereby restoring stability to the shoulder.
The list of new procedures goes on and on, offering hope for a quicker recovery and an old age freer of the crippling pain of arthritic joints. Still, the recreational athlete must never forget: It's better to quit a sport before you push it too hard, not when you're on the way to the hospital. |
