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Chapter 16
Prevention & Management of
Common Musculoskeletal Injuries in
the Aging Female Athlete
Mimi Zumwalt, MD
Learning Objectives
• Understand the hormonal, physiological,
anatomy/musculoskeletal changes in the aging
female athlete
• Recognize the differences AND similarities
between older males and females’ body
composition, musculoskeletal components, and
athletic performance
• Learn the more unique musculoskeletal traumatic
and orthopaedic conditions in the master female
athlete
• Comprehend different prevention measures and
methods of management of orthopaedic injury in
elderly females, including appropriate exercise
prescription
Introduction
• Lifespan alterations in females
• Structural, hormonal, physiological,
neurological, & musculoskeletal
• From pubescence in adolescence to
senescence after menopause
• Gradual deterioration of the neurological
& musculoskeletal systems
• Can partially combat by staying active
Musculoskeletal Alterations in Aging
Female Athletes
• Bone loss after peak bone mass in mid-20’s
• Accelerated at menopause in mid-40’s
• Osteoporosis runs rampant
• Endurance performance, aerobic capacity, &
cardiorespiratory functions all decline
• Body composition shifts from relatively
more muscle to more fat
• Muscular mass/strength decreases
• Neuromuscular control slows down
Body Composition, Musculoskeletal
Concerns, & Athletic Performance in
Older Male vs. Female Athletes
• Female athletes w/higher body fat than
males dependent on sport but still lower
than sedentary females
• Athletic performance in many sports
declines x for golf, equestrian, & swimming
since dependent on acquired skills
• Bone & muscle mass loss can be offset by
weight bearing & resistance training
• Other parameters of fitness can also be
improved with exercise
Musculoskeletal Injuries &
Orthopaedic Conditions in Aging
Female Athletes
• Bone & soft tissues “wear out” over time
• Degenerative joint disease ensues
• Tendinosis/bursitis & muscle “pulls”
• Shoulder impingent syndrome/rotator
cuff disorder
• Medial/lateral epicondylitis
• Achilles tendinitis
• Osteoporotic/fragility fractures
Prevention of Musculoskeletal
Injuries in Aging Female Athletes
• Be in the best fitness shape possible
• Choose type of athletics carefully
• Avoid risky activities such as skiing,
rock climbing, & team sports
• Must workout regularly to include
endurance training & resistance exercise
• Weight bearing activity better to build
bones but limit impact since damaging
to joints
Management of Orthopaedic
Conditions in Aging Female Athletes
•
•
•
•
•
•
PRICE - Protect, Rest, Ice, Compress, Elevate
Medications (analgesics & NSAIDS)
NO sports supplements
Calcium/vitamin D for osteoporosis
Physical therapy rehab
FIT(T) exercise – frequency, intensity, time &
type of workouts
Conclusion
• “Use it or lose it” as one ages
• Attempt to maintain integrity of
musculoskeletal & other body systems w/
regular exercise
• Avoid risky athletic activities
• Better to prevent rather than treat
orthopaedic injuries
Case Study
• You are a nurse practitioner for an internist in a mid-size town. Your adult
patient population ranges from young adults to senior citizens. You see an
array of patients with different clinical entities ranging from the simple
common cold to complicated cardiopulmonary disease. One of your hobbies
is playing recreational tennis in a female over fifty league at the YWCA.
You meet with your teammates twice a week and you serve as the team
captain for these female athletes. Another one of your pastimes is working
out at a local health club 3 to 5 times a week. Your doubles tennis partner is
55 years of age and is an avid runner and climber, as well. She pretty much
participates in some sort of sporting activity every single day of the week.
Lately she has been frequently absent, sending in a substitute player and
complaining of vague, achy shoulder and deep knee pain. Unfortunately,
before you could help her sort things out, she suffered a fall, sustaining a
wrist fracture on her dominant side (opposite of her involved shoulder) and
finally made it to your clinic for evaluation and treatment. You have known
this woman for several years and she refuses to let anything slow her down
in terms of exercise. She is extremely frustrated with her injuries, wants to
heal really fast and get on with her active life again as soon as possible.