Baby boomers & sports medicine needs

NYTimes

April 16, 2006
Baby Boomers Stay Active, and So Do Their Doctors
By BILL PENNINGTON

For America's baby boomers, a generation weaned on Jack LaLanne, shaped by Jane Fonda videos and sculpted in the modern-day gym, too much of a good thing has consequences.

Encouraged by doctors to continue to exercise three to five times a week for their health, a legion of running, swimming and biking boomers are flouting the conventional limits of the middle-aged body's abilities, and filling the nation's operating rooms and orthopedists' offices in the process.

They need knee and hip replacements, surgery for cartilage and ligament damage, and treatment for tendinitis, arthritis, bursitis and stress fractures. The phenomenon even has a name in medical circles: boomeritis.

"Boomers are the first generation that grew up exercising, and the first that expects, indeed demands, that they be able to exercise into their 70's," said Dr. Nicholas A. DiNubile, a Philadelphia-area orthopedic surgeon, who coined and trademarked the term boomeritis.

"But evolution doesn't work that quick. Physically, you can't necessarily do at 50 what you did at 25. We've worn out the warranty on some body parts. That's why so many boomers are breaking down. It ought to be called Generation Ouch."

Led by baby boomers, loosely defined as the 78 million Americans born from 1946 to 1964, sports injuries have become the No. 2 reason for visits to a doctor's office nationwide, behind the common cold, according to a 2003 survey by National Ambulatory Medical Care.

A Bureau of Labor Statistics study said infirmities associated with the athletic activities of middle-aged adults were the source of 488 million days of restricted work in 2002. When the Consumer Product Safety Commission examined emergency-room visits in 1998, it discovered that sports-related injuries to baby boomers had risen by 33 percent since 1991 and amounted to $18.7 billion in medical costs.

"Knees, shoulders, hips and the lower back, we all have vulnerabilities that surface over time," DiNubile said. "It's a painful lesson to learn."

But for many baby boomers, regular exercise has become a quality-of-life issue.

Physical activity, even if it is of the weekend-warrior variety, is built into most boomers' schedules. So are visits to a cultural fixture that boomers helped create, the fitness gym.

Now more than ever, a lean, athletic shape is the prized look, and doctors and patients alike concede that vanity and a certain fountain-of-youth pursuit is driving baby boomers to exercise, sometimes to excess.

"The high divorce rate in this generation keeps people in the gym, too," said Andrea Evian, 54, of Narberth, Pa., who works out regularly and is separated from her husband. "That's not my reason for going there, but I see the divorced women working out with the other divorced women. They're all trying to get another man. And the divorced men are trying to meet a younger woman.

"There's a lot of competition out there."

A generation accustomed to using ingenuity, initiative or scientific gains to break through or overcome communal barriers, baby boomers have adopted a familiar approach to their injury predicament: Let's fix it.

"The baby-boomer patient faced with a problem, even a sore knee, does not go silently into the good night," said Dr. Riley Williams, an orthopedic surgeon at the Hospital for Special Surgery in Manhattan. "That patient's mind-set is that there must be something that can be done. And thanks to improved diagnostics and surgical advancements, often there is."

It was rare 15 years ago for doctors to perform complex reconstruction of the knee's anterior cruciate ligament in patients older than 50; now it is common. The same is true for surgical repairs to the shoulder's rotator cuff and operations to mend intricate ankle and elbow ailments. Elaborate knee and hip replacements have become routine. Williams said about half his sports-medicine practice is made up of baby boomers.

"But it is also true that I have people coming in who have already seen 10 doctors, had eight M.R.I.'s and want a third rotator cuff surgery so they can serve during their regular weekend tennis games," Williams said. "And then, the answer is, 'No, you are done.'

"This is a highly motivated group of people. And sometimes, you just have to inject a sense of realism."

The can-do generation does not always react well to being told no.

Evian has had anterior cruciate ligament reconstruction and cortisone injections for sore joints. She underwent rotator-cuff surgery on her left shoulder, and said she expects she will soon have similar surgery performed on her ailing right shoulder.

"I've not let any of it stop me," said Evian, who works part time in a dental office. "And I'm not going to let it stop me in the future, either."

Evian says she goes to a gym six days a week, plays tennis, does aerobics and goes skiing nearly every winter weekend. She recently tore a hamstring while kick boxing.

"Now, I just kick a little lower," she said.

John McGowan, 49, of West Chester, Pa., coaches three of his children's sports teams and exercises regularly, including the five to seven high school or youth basketball games he referees each week. McGowan had major reconstructive knee surgery in 1980 and has since had four arthroscopic procedures performed on his knees.

"Every time I go see my doctor, we agree I should referee just one more year," said McGowan, a health-plan administrator. "This has been my last year for about four or five years now."

Ellyn Rubin of Atlanta has had nine knee operations, the first in high school.

"For many years, I still ran a 10K just about every weekend," said Rubin, 50, a microbiology laboratory technician. "I had to give up running, but I can bike and swim."

Even seemingly routine or regular exercise can lead to problems for baby boomers.

"A patient might come in who was having a backyard catch with his son and heard something pop in his arm," said Dr. Frank Kelly, a board member of the American Academy of Orthopedic Surgeons, who practices in Macon, Ga. "Or someone who has been jogging for 15 years suddenly gets vague knee or heel pain and keeps running. But the pain doesn't go away. It's wear and tear of the joint over time."

It is not hard to understand why baby boomers are so driven to exercise, given the ubiquitous medical advice stating that a regimen of physical activity can help prevent everything from Alzheimer's disease to diabetes.

As McGowan said, "I might be pushing it, but if I'm going to have a health issue, I'd rather it be orthopedic in nature than cardiac."

That attitude among boomers has turned sports medicine into a fast-growing, lucrative field. Doctors maintain, however, that it is their patients' zeal to stay active (in addition to technological advances) that is creating the rise in surgical procedures.

"If I have a 65-year-old without arthritis in the knee who needs ligament reconstruction, why should I assign that patient to a lifetime of wearing a knee brace instead?" Williams said. "He wants to get out of a cab without his knee buckling, and maybe wants to bike a little. It's absolutely reasonable to do that surgery."

Dr. Thomas Schmalzried, a Los Angeles-area orthopedic surgeon who specializes in hip and knee replacement, said: "The majority of patients getting total knee and hip replacements are Medicare patients. And no one is getting rich from Medicare payments."

The National Athletic Trainers Association and the American Academy of Orthopedic Surgeons have turned their focus to preventing the rash of sports injuries by starting a national public-service campaign encouraging baby boomers to stay active, with modifications. The organizations have compiled information on avoiding and treating injury at nata.org or orthoinfo.org.

"A certified athletic trainer can customize a program that recognizes the weaknesses of your particular musculoskeletal system," said Majorie J. Albohm, the vice president of the athletic trainers association.

"Take running, which is great exercise. But most runners over 50 who just run start to have trouble with their knees. You might still be able to run a couple days a week, but an athletic trainer can keep you active on other days by designing a program that introduces cycling, rowing, stair climbers and core-muscle strengthening.

"There's no reason to stop or to be in pain."

Health care professionals say baby boomers can extend the warranty on their aging frames.

"Like other lessons in maturity, it's about being smarter," said DiNubile, whose book "Framework" outlined a seven-step program for recreational athletes. "You can't just do what you're good at or what you love to do. Men tend to like to do weight training when they should be doing more flexible things, and women tend to do flexible things when they should be doing more weights.

"If people find help getting in balance, there is no reason we all can't keep exercising because it is good for you and it makes you feel good."

It is a lesson not lost on Generation X. The offspring of the baby boomers have also spent a lifetime enveloped by America's fitness boom. And what awaits them in middle age?

Once again, it appears the baby boomers may have started something.

"The next generation is even more active and many have already had surgeries for athletic injuries in high school or middle school," said Gene Schafer, an athletic trainer who owns ARC Athletics, a fitness center in Manhattan. "I think this whole thing is just beginning. Maybe in 20 or 30 years we'll know if things have evolved into any real progress."