Over 40? Say Ouch

Health Care & Insurance

Over 40? Say Ouch

You're working hard to stay fit, and therein lies the problem.

You've spent the past few decades running, dunking and pedaling. You planned to spend the next few decades swinging, smashing and pivoting. Retirement? You thought you'd do a little bit of all those things, plus maybe hip-hop lessons and that cross-country trip on the Harley. But somewhere along the line, your hips (or knees or shoulders) started to ache. Then they began to hurt. Now you're so creaky that even a chop shop wouldn't take you.

It's the boomer conundrum: Act young longer, get old faster. "Baby-boomers are the first generation trying to stay active on an aging frame -- and they're challenging that frame," says Dr. Nicholas DiNubile, who coined the term boomeritis to describe the joint and muscle pain besetting the 42-to-60 age group. Musculoskeletal ailments account for 16% of health-care costs, or $254 billion annually. In 2004, nearly 700,000 people had a total hip or knee replacement, according to the American Academy of Orthopaedic Surgeons. Insurance companies pay up to about $30,000 for replacement surgery, which includes the surgeon's fee and hospital charges (see Who Pays the Bills for a rundown of typical benefits).

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But weekend warriors aren't waving the white flag yet. "Boomers have decided they do not have to live with a handicap," says Dr. Richard Berger, an orthopedic surgeon at Rush University Medical Center, in Chicago. "They want to golf, play tennis and travel around the world." With new therapies and surgical techniques, they can do just that, says Berger.

Pills, shots, stretches

Cathe Friedrich, 42, may have been born at the tail end of the baby boom, but she got a jump on joint trouble. A fitness instructor who also makes exercise DVDs (www.cathe.com), she was demonstrating a kickboxing routine about a year ago when she felt a burning sensation in her knee. "Wrong kick, wrong way -- boom!" says Friedrich of Glassboro, N.J. She underwent surgery to remove scar tissue that had become inflamed through overuse. "It was silly of me to think I was Superwoman."


Indeed, the further you get past 40, the closer you get to the kryptonite. Overuse (say, acing a tennis ball a thousand or so times) triggers tendinitis, an inflammation of the tissue that connects bone to muscle. You also become prone to bursitis, an inflammation of the fluid-filled membranes that cushion joints.

Worse, as you age, your cartilage -- the rubbery material that allows the joints to move smoothly -- thins and dries out, causing the bones to rub together and creating the painful condition known as osteoarthritis.

But don't despair at the first twinge. Mild inflammations -- say, an aching knee -- respond to basic first aid: wrapping and elevating the affected joint, resting it for a few days, and applying ice to reduce swelling and heat to relieve stiffness. Acetaminophen, the active ingredient in Tylenol, and nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen, tamp down pain. So do the topical analgesics Icy Hot, Bengay and Zostrix. Some studies suggest that the dietary supplements glucosamine and chondroitin sulfate also relieve pain.

But if the soreness persists or you experience weakness, you'll need to see a physician. You could start with a physiatrist, who prescribes medication and exercise and uses x-rays or ultrasound to guide pain-relieving injections. If necessary, the physiatrist refers the patient to a surgeon, says Dr. Todd Stitik, at the University of Medicine & Dentistry of New Jersey√źNew Jersey Medical School.


Either specialist will likely prescribe a stronger NSAID. The first generation of such drugs may cause peptic bleeding and other serious side effects; newer NSAIDs, called COX-2 inhibitors, put you at lower risk for gastrointestinal problems but have been implicated in heart attack and stroke. Doctors usually prescribe a COX-2 inhibitor, such as Celebrex, for patients over 60, who are more prone to abdominal bleeding, says Stitik.

You also have to recondition the affected joint by stretching it. A physical therapist or an athletic trainer can design a regimen; their tools include moist heat packs, ultrasound for deep heating and electrical stimulation, all of which soothe pain and help tissue to heal.

Some conditions, such as a rotator-cuff tear, may have you slogging through rehab for several months. In those cases, "cortisone injections can be very helpful," says Dr. Roland Moskowitz, a professor of medicine at Case Western Reserve University School of Medicine, in Cleveland. Corticosteroids eliminate pain for weeks or months, allowing you to supercharge your regimen.

In recent years, doctors have added hyaluronic-acid therapy, also known as viscosupplementation, to their quiver of strategies. Injected into the knee joint, viscosupplements relieve the symptoms of osteoarthritis by boosting the thick, slippery substance that lubricates and cushions the joint. Viscosupplements are approved only for knees but, says Stitik, "we're hoping that relatively soon, the Food and Drug Administration will approve them for hip osteoarthritis."


Time for a trade-in

Dan Briscoe, of Downers Grove, Ill., played basketball, racquetball, golf and tennis until osteoarthritis in both hips slowed him down. "It started in my early forties," says Briscoe, now 50. "I was in a lot of pain. I felt like I was 70." Three years ago, he underwent hip-replacement surgery at Rush University Medical Center; his other hip was replaced last January.

Not long ago, conventional wisdom held that a 50-year-old was too young for joint-replacement surgery. Doctors hesitated to install a device that could wear out in ten or 15 years. Now, with longer-lasting materials and improved techniques, "it's not uncommon for me to operate on people in their forties and even thirties," says Berger. New-model implants for hips and knees -- the most common replacements -- can last up to 25 years.

No matter how old (or young) you are, you face replacement surgery if osteoarthritis has progressed so far that your bones have begun to erode. A surgeon may, however, be able to forestall replacement with arthroscopic surgery. In that procedure, the doctor uses instruments that look inside the joint and clean out loose bone or trim cartilage. "When arthritis is in its very early stages, some cartilage flakes off or gets a little torn, which can be painful. Arthroscopy smoothes cartilage out," says Berger. Surgeons also use the procedure to repair tendons and ligaments.

On paper, joint-replacement procedures seem like a simple construction project, with tools including a power drill, a mallet and screws. The surgeon makes an incision, removes the damaged bone or cartilage, smoothes the surface of the remaining bones and inserts the artificial joint. Then the surgeon applies bone cement or uses a cementless procedure to keep it in place. Weight-bearing materials, such as stainless steel, titanium and ceramics, are used for hip implants, along with heavy-duty plastic. Knee implants, which require flexibility, rely mostly on plastics.


With traditional replacement surgery, you spend several days in the hospital and at least six weeks rebuilding with a physical therapist. If your job requires that you stay on your feet or do any lifting, you could be off work twice as long. As a salesman for Hewlett-Packard, says Briscoe, "I couldn't be out of commission for six weeks." He discovered minimally invasive surgery, in which doctors use a muscle-sparing incision to insert the implant. "Recovery takes weeks, not months," says Berger, who developed the technique.

Briscoe was back at work part-time after two weeks. Now he is playing golf again and walks 2.5 miles a day, but has no plans to "push it," he says. Most surgeons recommend modifying your activities after replacement surgery -- say, by swimming rather than running or by using a treadmill instead of a track. Briscoe, who figures he has regained 90% of his range of motion, says, "I'm not going to do splits, but I'm very satisfied. I have all the mobility I need."

Advanced technology

Advances in technology, including minimally invasive surgery, have improved once-arduous surgeries, such as repairing the anterior cruciate ligament, or ACL. "We now do an incision that's less than an inch long," says Dr. Nicholas DiNubile. "Instead of being in a cast or a brace, you put weight on it right away." Soon, says DiNubile, researchers hope not only to replace but also to regenerate new parts, such as the ACL and rotator cuff. Surgeons already use cell transplants to create a collagen patch for knee repair. "The technology in orthopedics is unbelievable," says DiNubile, who wrote FrameWork (Rodale, $18), about keeping your frame in shape.