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Age and Injuries - What is the Link?

 

According to Sports Medicine Australia, up to 70% of runners suffer an injury each year. It's not a promising statistic!

 

Age significantly influences the type of injuries that runners and athletes are likely to suffer. Efficient and injury-free exercise relies on a synergy between the muscles, ligaments, tendons and ligaments. As such, injury commonly targets the weakest link in this chain, which differs for adults compared to children. Injury risk is also influenced by other factors including training load and experience, lifestyle factors, body composition, biomechanics and running gait.

 

Injuries Amongst 'Experienced' Athletes

The "I'm getting too old for this" is thrown around far too often.

There are reasons why the ageing body doesn't recover as quickly, and these are predominantly thanks to the natural ageing process. Understanding these changes and the likely injury risk associated with different activities will allow sensible and well-managed involvement in activities to reduce risk and maintain health and fitness.

 

When functioning optimally, tendons are stiff, with elasticity and recoil properties to help with shock attenuation and propulsion. However, the elasticity and pliability of tendons and ligaments reduces with age, so there's an increased risk of injury and prolonged recovery time. Previous soft tissue injuries to tendons, ligaments and muscle can also heighten risk - particularly if not rehabilitated properly at the time of injury. Poorly treated soft tissue injuries are likely to develop scar tissue and adhesions, which hinder the function and elasticity of fibres. These areas are prone to injury because of sub-optimal function, whilst surrounding areas are also at higher risk, often compensating and taking more strain to offload the compromised tissue.

 

Walking, yoga or pilates and bodyweight strength exercises are great ways to get moving without putting too much strain on the body. Muscles and joints respond well to a gentle, active warm up, especially before high intensity sessions that demand more from the body. 10-15min of low intensity exercise, plus some dynamic stretches and activation movements are ideal before such sessions - ie. before running faster, start with a walk or jog, then some dynamic stretches (eg. leg swings), running drills to encourage good posture and muscle activation, and strides to gradually increase pace.

With age, balance and proprioception capabilities also tend to decrease, but it's important to regularly practice exercises that focus on these skills. Having good balance aids mobility and reduce falls risk, allows continued participation in exercise, and is vital to maintaining independence and confidence during everyday living. Balance is very simple to practice - standing on both legs without support and progressing the difficulty by moving to just one leg, closing your eyes or balancing on an unstable surface.

 

The reliance on basic strength during everyday life is often overlooked. Seemingly simple tasks like getting up from a seated position without assistance (sit to stand), walking for long periods of time (leg and calf strength endurance) and carrying the shopping (upper body strength) can become challenging. Maintaining a regular strength routine using bodyweight and light weights as resistance can have a profound and positive impact on daily life and maintaining independence by promoting an base level of muscular strength high enough to continue these everyday tasks. Regular resistance training has also shown to assist in promoting good bone health and maintaining bone density, which is typically known to peak around age 30 and then gradually decline.

 

Whilst getting older is known to increase risk for a number of injuries, and prolonged recovery time is also a common frustration for older runners, there's no reason why age should be a limitation to keeping fit and active. Maintaining physical activity as you age is extremely important for your health and wellbeing - both physical and mental, and can prevent the onset of age-related conditions and co-morbidities.

 

Injuries Amongst the Younger Generation

Even though children often act like invincible energiser bunnies, they too can be sidelined due to injury, particularly if they’re doing high volumes of training.

In general, children will recover more quickly from injuries compared to their older counterparts. However, this doesn't mean that the injuries suffered by children and adolescents are any less damaging. In fact, if poorly treated, serious childhood injuries can significantly impact growth and development, and taint their passion for running for months or even years to come.

 

Bone growth occurs throughout childhood and adolescence, with different bones maturing at different stages. During development when bones are trying to fuse to their adult composition, the growth plate is weakened and more prone to injury. Growth plate injuries (Apophysitis) are more common in active children, but risk varies depending on the bone/region in question. Susceptibility is typically heightened for approximately 6-12 months within a 3-4 year window. Growth-related injuries resolve with time, but seeking professional advice and treatment is important to reduce pain and manage the injury to ensure it doesn’t cause permanent damage or another compensatory injury. Common examples of Apophysitis injuries include:

- Sever’s Disease (Posterior Calcaneus – Achilles Tendon)

- Osgood-Schlatter Disease (Tibial Tuberosity – Patella Tendon)

- Sinding-Larsen-Johansson Syndrome (Patella – Patella Tendon)

 

Activity modification and load management are important when treating Apophysitis injuries. Treatment should also address contributing factors and biomechanical issues to assist in pain and symptom relief. For example, Sever’s can be successfully managed with many strategies including regular icing and the addition of heel lifts to all shoes to reduce strain on the Achilles tendon and posterior heel.

 

The soft tissue structures in children are much more pliable and more resistant to injury, so muscle and tendon injuries are much less common. Young bones are also more flexible and less brittle, so they too are more resistant to injuries, and stress fractures in particular are unusual injuries for children. Fractures are not uncommon, but in most cases they result from

acute trauma.

 

In comparison, the incidence of stress fracture in adolescents is concerningly high, especially amongst those involved in endurance and high-load activities. However, training load and physical attributes are only part of the problem. Reducing the incidence of bone stress injuries within the adolescent population needs to come from a societal change to healthcare, and attitudes about body image, physical and mental health. Prevention is always better than a cure, but this is especially true when it comes to reducing the risk of bone stress injuries, because an athlete who has suffered one bone stress injury is 600% more likely to suffer another - because bone health is compromised.

 

Whether intentionally or not, many young athletes are not fuelling adequately for their training. Bone health, or lack thereof, has been strongly linked to relative energy deficiency (RED), so it's really important to address bone stress injuries in particular with a wholistic approach that incorporates both physical injury management, as well as addressing psychological and nutritional concerns.

 

Be aware that active children are likely to suffer an injury at some point, whether it be due to training or a traumatic event. Even though their pain may be inconsistent, or their symptoms may be different to those experienced by adults, their injuries should not be ignored. Serious injury can lead be detrimental to their long-term health and wellbeing, so they should be given the same treatment opportunities as adults to ensure their injuries are diagnosed and managed as efficiently as possible.