Table Of ContentMasterful Care of
the Aging Athlete
A Clinical Guide
Vonda J. Wright
Kellie K. Middleton
Editors
123
Masterful Care of the Aging Athlete
Vonda J. Wright • Kellie K. Middleton
Editors
Masterful Care of the
Aging Athlete
A Clinical Guide
Editors
Vonda J. Wright Kellie K. Middleton
UPMC Center for Sports Medicine Department of Orthopedic Surgery
Pittsburgh, PA University of Pittsburgh
USA Pittsburgh, PA
USA
ISBN 978-3-319-16222-5 ISBN 978-3-319-16223-2 (eBook)
https://doi.org/10.1007/978-3-319-16223-2
Library of Congress Control Number: 2018946804
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Preface
As an orthopedic surgeon, researcher, and healthy aging advocate, I’ve seen proof
that we all have the power to transform our health through mobility and smart nutri-
tion. In fact, more than 70% of our health trajectory is controlled by the active life-
style decisions our patients make. Restoring their mobility via conservative and
operative intervention is not just a procedure for us to complete, but in the larger
scope of our patients’ health, allowing them to stay mobile, we are restoring the key
to healthy aging.
At ages historically dedicated to “slowing down,” masters athletes and active
people of all ages and skill levels fill the roads, playing fields, and sporting venues,
harnessing the power of mobility and sport to keep them youthful both physically
and mentally. Their efforts are supported not only by enthusiasm for active aging,
but also by a powerful body of literature that points to mobility as a key element in
prolonging health and diminishing the effects of chronic disease and passive aging.
Today, it is common for professional athletes once considered “past their prime”
to make significant contributions to their teams and for individual endurance ath-
letes to win events outright at ages pushing 40. These feats of skill, strength, and
endurance are not isolated to the professionals alone but reflect a generation who
expect high performance from their bodies and prove that our bodies are dynamic
adaptors capable of more than we historically have expected of them.
One of my favorite sports writers, John Hanc, in an article for Best Life Magazine,
summarizes it well:
It’s as though 21st century professional athletes and weekend warriors are living out the
Benjamin Button fantasy: Through a combination of scientific training, disciplined diet and
advanced sports medicine they are overturning immutable laws of biology and they are
reversing or at least fighting to a at draw, the aging process. The new old pros are busy mak-
ing 40 the new 30. The truth behind the headlines, while encouraging, is complicated.
Overall, athletic performance clearly declines with age. At the same time, late-career ath-
letic productivity is showing an unprecedented rise.
As gatekeepers of mobility, the orthopedic surgeon and musculoskeletal col-
leagues play a key role in keeping these actively aging athletes on the road and out
of the doctor’s office. This takes a paradigm shift within our own ranks from simply
v
vi Preface
advising people to “slow down and act your age” when injured to an exploration of
the clinical, technical, and research avenues for prolonging the ability of masters
athletes to optimize their performance and while minimizing injury.
This book is a compilation of clinical, technical, and research approaches to
keeping active people moving, returning them to sport rapidly and durably, and
protecting them from the sedentary lifestyle that can ravage health.
I am thankful to all my colleagues who join in the movement to save lives by
saving mobility and have contributed so heavily in this book.
Pittsburgh, PA, USA Vonda J. Wright, MD, MS
Contents
Part I T he Science of Musculoskeletal Aging and the Benefits of Being a
Masters Athlete
1 The New Science of Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Vonda J. Wright
2 The New Science of Musculoskeletal Aging in Bone,
Muscle, and Tendon/Ligament . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Vonda J. Wright and Farah Tejpar
3 Structural Brain Benefits of Maintained Fitness . . . . . . . . . . . . . . . . . 17
Vonda J. Wright and Emily Zhao
4 Psychological and/or Mental Health Benefits
of Maintaining Activity and Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Vonda J. Wright and Emily Zhao
5 Maximizing Nutrition and Supplements for Masters Athletes . . . . . . 31
Jeff Lucchino and Kellie K. Middleton
6 Antiaging and Performance-Enhancing Drugs . . . . . . . . . . . . . . . . . . 45
Zaneb Yaseen
7 Injectable, Biologics, and Stem Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Mitchell S. Fourman, Jay V. Kalawadia, and James Bradley
Part II C ommon Injuries in Masters Athletes, Treatment Considerations,
and Return to Sports
8 Knee Injuries: Conservative Management, Operative Management,
and Return to Sport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Nicole A. Friel, Drew A. Lansdown, and Brian J. Cole
vii
viii Contents
9 Common Hip Injuries: Conservative Management . . . . . . . . . . . . . . . 89
Vonda J. Wright, Philip Zakko, Edward Chang, and
Kellie K. Middleton
10 Shoulder Injuries: Conservative Management,
Operative Management, and Return to Sport . . . . . . . . . . . . . . . . . . . 95
Albert Lin and Jason P. Zlotnicki
11 The Management of Distal Radius Fractures
in the Aging Athlete . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Brent Schultz and Robert J. Goitz
12 Foot and Ankle: Conservative Management,
Operative Management, and Return to Sport . . . . . . . . . . . . . . . . . . . 143
Monique C. Chambers, Dukens LaBaze, Jesse Raszeswki, and
MaCalus V. Hogan
13 Spine Injuries: Conservative Managment, Operative
Management and Return to Sport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Chinedu Nwasike, Paul Hong, and Joon Y. Lee
Part III Thriving as a Masters Athlete
14 Return to Sport Following Total Joint Arthroplasty . . . . . . . . . . . . . . 167
Michael J. O’Malley and Brian A. Klatt
15 Maximizing Performance and Preventing Injury
in Masters Athletes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Christopher L. McCrum and Kellie K. Middleton
16 An Exercise Prescription for Healthy Active Aging . . . . . . . . . . . . . . . 195
Dukens LaBaze, Jared Anthony Crasto, and Kellie K. Middleton
17 Importance of Core and Gluteus Strengthening . . . . . . . . . . . . . . . . . 205
Philip Zakko and Ron DeAngelo
18 Longevity and Epigenetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
James Irvine
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Contributors
James Bradley, MD Department of Orthopaedic Surgery, University of Pittsburgh
Medical Center, Pittsburgh, PA, USA
Monique C. Chambers, MD, MSL Department of Orthopaedic Surgery,
University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Edward Chang, MD Inova Health System, Alexandria, VA, USA
Brian J. Cole, MD, MBA Departments of Orthopedics and Surgery, Rush OPH,
Shoulder, Elbow and Knee Surgery, Cartilage Restoration Center at Rush, Rush
University Medical Center, Chicago, IL, USA
Jared Anthony Crasto, MD Department of Orthopaedic Surgery, University of
Pittsburgh Medical Center, Pittsburgh, PA, USA
Ron DeAngelo, MEd, CSCS, LAT, ATC, FAFS UPMC Sports Medicine,
Pittsburgh, PA, USA
Mitchell S. Fourman, MD, MPhil Department of Orthopaedic Surgery, University
of Pittsburgh Medical Center, Pittsburgh, PA, USA
Nicole A. Friel, MD, MS Rush University Medical Center, Chicago, IL, USA
Robert J. Goitz, MD Department of Orthopaedic Surgery, University of Pittsburgh
Medical Center (UPMC), Pittsburgh, PA, USA
MaCalus V. Hogan, MD Foot and Ankle Division, Department of Orthopedic
Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Paul Hong, MD Sutter Medical Group Neurosciences, Sacramento, CA, USA
James Irvine, MD Department of Orthopaedic Surgery, University of Pittsburgh,
Pittsburgh, PA, USA
Jay V. Kalawadia, MD Department of Orthopaedic Surgery, Orthopaedic
Associates of Allentown, Allentown, PA, USA
ix
x Contributors
Brian A. Klatt, MD Department of Orthopaedic Surgery, University of Pittsburgh
Medical Center (UPMC), Pittsburgh, PA, USA
Dukens LaBaze, BS Department of Orthopaedic Surgery, University of Pittsburgh
Medical Center, Pittsburgh, PA, USA
Drew A. Lansdown, MD Rush University Medical Center, Chicago, IL, USA
Joon Y. Lee, MD Department of Orthopedic Surgery, University of Pittsburgh
Medical Center, Pittsburgh, PA, USA
Albert Lin, MD Department of Orthopaedic Surgery, University of Pittsburgh
Medical Center (UPMC), Pittsburgh, PA, USA
Jeff Lucchino, MS, RD, CSSD, LDN, CPT UPMC Lemieux Sports Complex,
Pittsburgh, PA, USA
Christopher L. McCrum, MD Department of Orthopaedic Surgery, University of
Pittsburgh, Pittsburgh, PA, USA
Kellie K. Middleton, MD, MPH Department of Orthopaedic Surgery, University
of Pittsburgh Medical Center, Pittsburgh, PA, USA
Chinedu Nwasike, MD Department of Orthopedic Surgery, University of
Pittsburgh Medical Center, Pittsburgh, PA, USA
Michael J. O’Malley, MD Department of Orthopaedic Surgery, University of
Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
Jesse Raszeswki, MBS Alabama College of Osteopathic Medicine, Dothan,
AL, USA
Brent Schultz, MD Department of Orthopaedic Surgery, University of Pittsburgh
Medical Center (UPMC), Pittsburgh, PA, USA
Farah Tejpar, MD Cleveland Clinic, Weston, FL, USA
Vonda J. Wright, MD, MS Department of Orthopaedic Surgery, University of
Pittsburgh, UPMC Lemieux Sports Complex, Pittsburgh, PA, USA
Zaneb Yaseen, MD Department of Orthopaedic Surgery, Cayuga Medical
Associates, Ithaca, NY, USA
Philip Zakko University of Pittsburgh Medical Center, Farmington,
CT, USA
Emily Zhao, MD Department of Orthopaedic Surgery, University of Pittsburgh,
Pittsburgh, PA, USA
Jason P. Zlotnicki, MD Department of Orthopaedic Surgery, University of
Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
