Age happens, regardless of the physical standards you achieved in your youth. Perhaps you were involved in high school or college sports, part of an organized community team, maybe an elite athlete and in great shape. Perhaps you’re still pushing hard but the reality of an aging body that doesn’t rebound as quickly as before, stares you in the face.

We are part of a generation that realizes that we have control of certain aspects of aging and that inactivity plays a huge role in how we feel. Dr. DiNubile, an orthopedic surgeon in Philadelphia, notes that “We have doubled our life expectancy in the last 100 years, but our frames are not designed to last that long. There’s a mismatch between longevity and durability. It becomes a matter of how do you extend the warranty on your frame.”

In 1998, according to the U.S. Consumer Product Safety Commission, boomers – those born between 1946 and 1964- sustained more than 1 million sports injuries, leading to nearly $19 billion in medical costs. Exercise and sports in our best and final act, becomes a dance of injury management where party conversations are peppered with tales of back pain, rotator cuff problems, herniated discs and anything ending in an “itis”. 

The upside of age includes being comfortable in our skin, gaining insight, wisdom, and fostering lasting relationships. In the physical realm, certain things, whether we like it or not, are diminished with age including muscle strength, bone health, balance and flexibility.  Old sports injuries frequently rear their heads as problems later in life, especially arthritis.

Understanding what to do, what to avoid and how to pace ourselves, is essential for remaining strong and healthy over time.

I’m a former professional dancer who pushed my body beyond its limits for decades. Contrary to the image of ease and invincibility presented on stage, dancers, or as Martha Graham used to call us, “Athletes of God”, spent many a night post performance nursing painful body parts with ice packs in hotels around the world. 

As an aging athlete, I’ve had to navigate acute and chronic injuries including rotator cuff rupture and low back disc herniations. In order to continue to do what I love, I’ve learned how to modify movements in Pilates, dance and Bikram yoga, as well as during activities of daily living to spare my spine.

In Bikram yoga, participants tackle the standing head to knee pose which involves holding one leg straight in front of you parallel to the ground with a deeply rounded spine, a difficult task (and one that should be avoided for anyone with low bone density or herniations). I stand instead like a stork with one knee bent in the air, my spine long and vertical. This avoids further debilitation of my spinal discs while still benefitting from single leg weight-bearing balance. 

In that same class, participants perform transitional straight leg sit ups between mat exercises where they explosively round up and do a “double jerk, double exhale” percussive ballistic forward flexed bounce. I’ve modified this instead into a log roll to my side to safely transition to the next exercise.  Medical wisdom now directs us to ditch crunches and straight leg sit ups and choose other, smarter spine sparing techniques, which I’ll share shortly.

I think we all want to keep our bodies as safe, strong and mobile as they can be for as long as possible. How do we work around aging and injuries? 

When I had rotator cuff surgery 3 years ago, I used Pilates to continue to train the rest of my body while avoiding the injured shoulder.  I worked on core and leg strength, flexibility and balance. The beauty of the spring assisted Pilates environment is that it is so modifiable. It’s easy to accommodate for injuries and work around your limitations safely so you can remain fit.  In the following video, I’m one-week post rotator cuff surgery and you can see how I’m able to still get a decent workout despite my arm being in a sling. 

Get Smarter About Exercise

My belief is that we need to physically train to get older. Getting older is not for sissies. We need to get smarter about exercise.  What does smart exercise look like? 

Disregard that old adage of No Pain No Gain.  It’s important to heed the warning signs of any injury. Pain is your body’s signal to back off and give yourself time to recover.  Don’t push through those pain signals or you’ll slip into a continuing loop of pain and inflammation.

Warm up before you exercise and allow more recuperation and stretching time after exercise.

Train smarter not harder which means not overdoing it.  Tom Brady, the aging Patriots winning quarterback has a workout regimen that is 90% focused on resistance bands, not heaving heavy weights.  If you’re planning an intensive golf weekend, practice some swings and controlled spine rotations and ensure good mobility leading up to it. Don’t walk in cold. 

Form and alignment is critical not only with exercise but also with your activities of daily living like how you pick things up off the floor or how you hoist your carry-on luggage into the overhead compartment of a plane. All the little things that you do on a daily basis add up, and if you’re doing them wrong, you’ll experience cumulative insidious injury – the math will work against you.

If you’re like most people, you might have a chronic injury or are dealing with vulnerabilities that put you at increased risk of an injury.  I’ll cover just a few of the common areas where we should demonstrate more caution and care.

Feet/Ankles/Calves

Common conditions I see as a PT working with aging athletes include plantar fasciitis, stiff feet/ankles, and tight cramping calves.

Our feet are what support us and get us from point A to point B.  We need mobile, strong and malleable feet to support a strong and stable body. What do most of us do with our feet during the day? We provide sensory deprivation as we shove them into ill-fitting or stiff shoes that prevent intrinsic movement of the feet. Instead of functional feet, many of us have clubs at the end of our ankles. The feet have the highest percentage of proprioceptors in our body, telling our brain where our body is in space.  If those proprioceptors signals are muffled and under stimulated it creates balance issues and a tendency to lose our footing. 

Tips for Feet: Walk barefoot, use full tennis balls or any of those nubby textured foot mobilizers to massage the different areas of your feet, increasing flexibility and improving healing blood flow and circulation.  Use ½ tennis balls for a gentler safer alternative that won’t roll away. Use resistance bands around the sole of the foot, holding the ends like reins as you slowly point and flex the ankle, strengthening all those underused small foot muscles.

For cramping calves check with your medical professional to see if you have a potassium or magnesium deficiency and supplement accordingly.  Also make sure you’re drinking enough water. Lack of adequate hydration often leads to leg cramps.

Finally be sure to stretch both regions of your calf muscles. Stand at the edge of a step with one heel lowered. The gastrocnemius (the meaty calf muscle that is more superficial and visible) is addressed when the stretching leg has the knee straight.  To stretch the deeper soleus calf muscle, you must bend that knee slightly while stretching the calf.

Knees
Painful knees are often the byproduct of weak leg muscles, tight calf and leg muscles as well as faulty alignment when you bend your knees.

What to do? 

Check your mobility-can you touch your toes with your knees just slightly unlocked?

Can you put the ball of your foot on a step and lower your heel down below the step with ease?   Can you pull your foot behind you to your bottom for a quad stretch with good alignment or do you stick your bottom out behind you when you try this? 

Some of the key remedies for avoiding knee pain include ensuring you’re tracking your knees over the center of your foot every time you bend your knees. Since bending your knees is something you do every time you get up and down from a chair, toilet, car seat etc. it’s imperative that it’s performed with ideal alignment each and every time. This will prevent potential torqueing of the knee.

In addition, strengthening the muscles that attach to the knee is essential as the stronger your leg muscles are, the more they will support and decompress the knee joint.  Include closed chain exercises that incorporate the hamstrings (back of your legs), the quadriceps (front of thighs) and the calves. This is particularly helpful if you’re suffering from pain or arthritis stemming from previous injuries.

One good example is wall sits: stand against a wall with your feet about 6-12in from the wall. Then bend your knees to a point that’s painfree (up to a 90 degree angle) keeping the back of your pelvis, upper back and head in contact with the wall. Hold that position for 30 sec’s slowly increasing the duration over time and varying the degree of knee bend.

If your pain is due to old injuries, notice what movements or activities trigger your pain and try and remove or minimize those triggers.

With aging athletes, studies point to targeting power to improve strength. So, for example rising from a chair explosively (without locking your knees) then slowly lowering your bottom to a hover over the chair and repeating that with good form will create gains.

Be sure you’re stretching your hamstrings, quadriceps and calves on a daily basis to keep them healthy and mobile. This will help mitigate knee problems.

Back Pain

Intermittent or chronic back pain is a common complaint for many aging athletes particularly dancers, gymnasts and other athletes where they are asked to move their spines in ranges that were not intended for the spine.  Keep in mind that the spine is designed for stability with the hips and shoulders created for mobility.

Most people in their lifetime will experience some type of back pain typically caused by injury or degeneration.

Examine what you’re doing on a daily basis and how it might be affecting your spine. 

Are you sitting excessively? This will shorten the muscles that cross the hips affecting the spine.  Do you find yourself commonly in a slumped posture?  This will compress your discs and may cause nerve compression resulting in numbness and tingling down the legs.

Might you have an undiagnosed spine fracture? Be sure to get a bone density (DXA scan) if you’re over 65 and notice any of the red flags like a loss in height greater than 2 inches, being a female with a small frame or if your mom had osteoporosis. Some modifiable risk factors include smoking, drinking excessively and inactivity.

Are you still doing crunches? Dr. Stuart McGill, a Canadian PT, researcher, and world-renowned spine expert recommends avoiding crunches due to the excessive loads placed on the discs and ligaments of the spine during movements involving loaded spine flexion. His book “Back Mechanic: The secrets to a healthy spine your doctor isn’t telling you”, is a practical easy to understand resource for how to find your pain triggers and clear steps to help you improve.  Keep in mind also that if you have low bone density crunches can predispose you to spine fractures and if you have spinal disc compromise, sit-ups and crunches can lead to disc herniations.

Healthy alternative? Instead choose core exercises that keep the spine in a neutral position like planks including forearm, straight arm and side planks. 

Remember to use the spine sparing technique of hip hinging where you fold at your hips, for any lifting or bending to avoid rounding your back. Doing your daily activities including exercising with a neutral-stable spine will spare your back. 

Keeping an injury-free edge as we exercise in middle age

Be willing to modify and accommodate for your body.  If you’re asked to do lunges in a class done barefoot and your metatarsal (toe area) joints just don’t bend that way due to arthritis or surgery, put on your tennis shoes or supportive shoe wear to provide the support needed to accomplish this excellent exercise.

Mindfully improve mobility with flexibility exercises while maintaining good alignment. Give Pilates or Yoga a try.

Cross train to give your body a break from repetitive motions.

Strengthen your core muscles including your abdominals, back, pelvic floor and diaphragm, to support your spine.

Work on your dynamic balance, not just standing still on 1 leg. Most people don’t trip and fall while standing like a stork. Try this exercise to challenge your dynamic balance.

Ignore the mantra “No Pain, No Gain” and replace that with “Feel Pain, Be Sane”

Get enough restorative sleep and pay attention to nutrition.

Prioritize alignment and form during exercise as well as during daily activities.

Warm up thoroughly before your chosen activity.  I’ve noticed that it takes me much longer than before to warm up sufficiently enough to prevent injury before physical endeavors.

Post-exercise static stretching is a useful tool for promoting relaxation (by increasing parasympathetic nervous system activity which controls rest and digestion) and improving flexibility (by causing changes to the mechanical properties of the muscle-tendon unit.)  Research shows minimal effect on reduction of muscle soreness 1-7 days post exercise.

Don’t underestimate the benefit of regular massage to relax muscle tissue. It may also help with reducing pain and improving function.

Work around your injury. If you’ve injured a particular body part, say your foot, don’t ignore the rest of your body. Find ways to incorporate core training and other exercises that work your heart and uninjured areas. It will not only help your body but also your mind and spirit.

If you have low bone density, be sure you’re including weight bearing resistance and impact exercise. Avoid forward bending (flexion) of your spine as that can increase your risk of fracture.

Foam rollers are a popular and effective tool for the aging athlete.  They work with your weight and are easily used on most parts of the body. In addition to massaging tight muscles, rollers can help with myofascial pain by compressing trigger points. They can also improve hydration in your fascia, the connective tissue that acts as a saran wrap around your muscles and organs.  If your fascia develops adhesions, where disorganized tissues don’t glide freely over each other, this can manifest as pain or stiffness. Rolling has been particularly effective for the upper back, the gluteals, and various regions in the legs including the iliotibial band (ITB), a trouble area for runners and often a difficult area to release when tight. View some of my top foam roller exercises.

Small firm balls of all kinds are an inexpensive and handy aid in trigger point release. For instance, placing a ball under the center of one glute and putting your weight into it can release a tight piriformis muscle, a common cause of sciatic pain.

Despite some controversy, ice continues to be a safe and effective alternative for pain management and is still the modality of choice for acute injuries. Pain and swelling can inhibit muscle strength. Cryotherapy continues to play a key role in rehabilitation.

Trust your intuition and your own body wisdom.  No one knows your body and its particular quirks better than you.  If it’s telling you to back off, listen.

We all eventually slow down as we age and we need to recalibrate our expectations creating new goals that keep us motivated and functional.

Whatever it was that drove you to be an athlete in the first place, hold onto that feeling. You can still keep an active lifestyle as you age and maintain that feeling of health, fitness and joy of being alive!

Author-Teresa Maldonado Marchok MPT

Licensed physical therapist, PMA certified Pilates instructor, conference presenter, ambassador for the national organization “American Bone Health“, creator of the BoneSmart Pilates® Method and AGING STRONG Pilates® DVD series and a former soloist with the Martha Graham Dance Company. She’s been affiliated with Stanford’s Health Improvement Program since 1998 as a lecturer and Aging Strong Pilates® instructor. www.BoneSmartPilates.com