Men and Back Pain
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Men and Back Pain

Why men have back pain, how they can prevent it, and how it needs to be treated.

The Aging Athlete

He sits at a desk all week, then hits the courts or track on the weekend. Mix in a hefty dose of denial about not being a kid anymore, and you've got a recipe for sore muscles, torn ligaments, and inflamed joints.

Roy Leavitt, 46, has had pain in his right knee since college, when an opponent slammed into his leg during a basketball game. In the quarter century since that night, Leavitt, a social-services executive from Brooklyn, New York, has continued to play basketball, acquiring a list of injuries that includes repeated sprains in both ankles, a hyperextended elbow, jammed fingers on both hands, a permanently dislocated pinky, and a strained right rotator cuff.

But it was the knee problem that threatened to sideline him about a year ago, when in the middle of a driving jump shot (during a long-standing weekly pickup game), Leavitt's right leg simply gave way beneath him, and sharp, intense pain shot through his upper leg from knee to hip. His doctor diagnosed acute tendonitis, prescribed an anti-inflammatory medication and some therapeutic exercises, and warned that if the pain persisted, surgery was next. He also gently suggested that the aging jock might want to hang up his jersey.

"My wife agreed," says Leavitt. "She said, 'This is nature's way of telling you that you're too old for this game.' But as soon as the pain receded to a dull ache, I was back on the court."

Leavitt is one of legions of middle-aged men who suffer from "boomeritis," a term doctors use to describe the constellation of aches, pains, and injuries that are starting to afflict the 76 million-strong baby boom generation born between 1946 and 1964. In a 2000 report, the U.S. Consumer Product Safety Commission found that the number of sports-related injuries requiring medical treatment incurred by 35- to 54-year-olds jumped from 778,000 in 1991 to more than 1 million in 1998. "This generation is really the first to try to stay active and young on aging frames," says orthopedic surgeon Nicholas DiNubile, MD, a professor of medicine at the University of Pennsylvania, in Philadelphia. "And we're starting to see the result of that." Moreover, according to a study published last year in the journal Injury Prevention, men suffer such injuries at more than double the rate that women do.

Sports-Related Injuries

This gender gap, as with so many areas in which men and women diverge, is partly a function of biology and partly the result of cultural expectations of male behavior. "I'm convinced that testosterone, competitiveness, and aggressiveness have a lot to do with the way men push themselves past their limits," says Marianne Legato, MD, director of the Partnership for Gender-Specific Medicine at Columbia University in New York City. "Then there's the social conditioning that men get -- that they must suck it up and keep moving in the face of pain. Women, on the other hand, are encouraged to listen to their bodies and to stop if something hurts."

Dr. DiNubile says he treats four times as many men of that generation as women. "The imbalance has to do with the fact that men this age have been playing sports longer and therefore have beaten up their bodies more," he says. "Having experienced injuries as adolescents sets them up for problems down the line in the same parts of their bodies."

Many baby boomer women, in contrast, came of age before the explosion of organized girls' sports (ushered in by Title IX of the Higher Education Act, passed in 1972), and thus were largely spared this sort of wear and tear. But even in adulthood, notes Dr. DiNubile, men and women differ in their approach to physical activity. Women, he says, tend to be more vigilant about stretching, varying their activities, and not overexerting themselves. "At the gym, women are more likely to ask for advice from a trainer," he says, "whereas men, as we know, don't like to ask for directions. Women will do a balanced workout, while men are apt to overwork their 'mirror muscles' -- the biceps, shoulders, and chest. Plus, women are less likely to run out and play a contact sport with someone 10 or 20 years their junior to prove they can still keep up."

Younger men also suffer a disproportionate number of sports-related injuries compared with women, but the musculoskeletal system becomes more vulnerable as one ages. Soft tissues, such as muscles, tendons, and ligaments, become less flexible and more prone to fraying and tearing, and the disks that separate and cushion the vertebrae of the spine begin to degenerate, compromising their ability to protect the back.

Moreover, when injuries occur, an older body requires more time to recover, and recovery may be less than total. The same activity that caused no problems for a 25-year-old may well traumatize the body of a more mature person. And here, too, the psychology of baby boomers and their well-documented reluctance to acknowledge the inevitability of aging come into play. "A guy might think, I used to run five miles a day," says Julie Gilchrist, MD, a sports-injury specialist at the Centers for Disease Control and Prevention, in Atlanta. "But if he hasn't run recently, setting off for a five-mile jog is not a good idea. Yet you'd be surprised how many men do just that."

Indeed, many injuries arise from the so-called "weekend warrior" syndrome. "What I see most are strains and other injuries in guys who sit around all week, then on weekends try to play a sport as if they were 20 again," says Marc Safran, MD, director of the sports medicine program at University of California-San Francisco Medical Center. And when they do hurt themselves, he adds, many men do not seek immediate attention. "Many patients show up only when the pain has become too great for them to go out and play again."

Real Men Do Yoga

Doctors routinely recommend physical therapy for middle-aged men with both major and minor injuries, either as part of post-surgical recovery or as a way to recover without resorting to surgery. And increasingly, many urge their patients to take up body-movement practices such as yoga and Pilates, long popular with boomer women, to promote flexibility, strength, and relaxation without straining the musculoskeletal system.

And plenty of men are heeding the call without a doctor's advice. "Many men turn to yoga because their lives are sedentary or because they've injured themselves playing a sport and can no longer move easily," says Currie McLaughlin, a San Francisco-based yoga instructor who works with boomer-age men. "Not only do these guys regain some flexibility, they also discover a great antidote to stress."

"I never thought I'd do yoga," says Jack Hale, 47, a dedicated athlete from Cleveland who played competitive tennis as a youth and still plays at least once a week. "But my wife swears by it and kept after me to try it. Finally I went to one of her classes, and it was great. I've been doing yoga twice a week and haven't had a major tennis injury in the past year."

Ultimately, of course, the key to avoiding injury is moderation, a concept baby boomers have never been big on. "Sure, guys just want to have fun," says I. Martin Levy, MD, chief of sports medicine at Montefiore Medical Center in New York City. "But when they try too hard, they end up hurting themselves. The most important factor in any kind of athletic pursuit is knowing your limitations -- and then abiding by them."

Oh, the Places You'll Hurt!

Body Part: Shoulder Injury: Rotator cuff tear Why It Happens: This set of muscles and tendons connects the arm to the shoulder joint. Partial or complete tears can be brought on by heavy lifting, repetitive overhead motions, a traumatic fall, or age-related degeneration of the tissue. How to Fix: Cortisone shots are often prescribed; severe tissue damage may require surgery. A regimen of stretching and strength exercises, with medication, may suffice. Icing regularly also helps.

Body Part: Back Injury: Herniated disk Why It Happens: This injury occurs when the gel-like material inside the disks (which separate the vertebrae) protrudes and pushes against the nerves. Simple aging is one cause, as is lifting too much weight, lifting or bending improperly, and making other awkward movements. How to Fix: Rest, medication (pain relievers, muscle relaxants, and anti-inflammatory drugs) and physical therapy usually do the trick. Surgery is needed only in extreme cases.

Body Part: Foot Injury: Stress fractures Why It Happens: These minuscule cracks in foot bones generally result from excess activity and muscle fatigue, often after participation in high-impact sports (jogging, basketball). The problem is aggravated by wearing inappropriate shoes. How to Fix: If ignored, stress fractures can turn into full-scale breaks. They usually heal with rest and a hiatus from the risky activity. An orthopedist may suggest short-term use of protective foot gear.

Body Part: Knee Injury: Torn ligament Why It Happens: The anterior cruciate ligament (ACL) is a strong cord of tissue that helps attach the thighbone to the shinbone. It can tear if someone changes direction sharply, stops suddenly, or twists the knee, often while playing a sport that demands quick shifts in movement. How to Fix: Unlike many tissues, the ACL seldom heals without surgery. Recovery may take up to a year and require serious physical therapy.

Prevention Is the Best Cure

Stretching and warming up before an activity are both crucial for avoiding injury, yet many men neglect the latter. "You want to raise the muscle temperature with an activity that brings on a light sweat," says orthopedic surgeon Nicholas DiNubile, MD, who suggests running in place or doing jumping jacks for five minutes.

Originally published in Ladies' Home Journal magazine, June 2004.