Martial Art Institute

Author Wai-Po Tang, 1997. Webpublish Dec 1999.

The Relationship of Elderly Martial Art Practitioners and Osteoporosis

Introduction
Female martial art practitioners and generally older practitioners (either gender) should be aware of training intensity at certain time of the month or year. One of a major factor that can have detrimental effect on long-term health is under-exercise or over-exercise. This present study looks at the skeletal structure from the sport medicine standpoint on bone density.

The word 'Osteoporosis' literally means porous or brittle bones; a reduction in bone mass due to the aging process.

Osteoporosis is a crippling and painful disease affecting one in three women and one in 12 men in the United Kingdom with an excess of 2 million sufferers (The National Osteoporosis society, 1996) . Twenty million people in the United States suffer from osteoporosis (Tortora and Grabowski, 1996). It is a major cause of fractures in the middle aged and elderly person and it is estimated that there are approximately 190,000 fractures a year in the United Kingdom, costing the national health service about £600 million (Kanis JA, Pitt FA 1992) . Research in the Americas found that women of over 70 years of age who have suffered a hip fracture, 70% of those discharged to a nursing home die within one year and 49% who return to their own homes die within two years (Pollner F, 1985) . Fractures in the hips are increasingly common particularly in the older women, whereas younger women and men suffer painful fractures of the hip, wrist, spine, and other bones.

The skeleton is a living organism and the bones are alive and constantly being rebuilt and they need a good calcium intake from our diet and also moderate amount of weight bearing exercises. Tennis players have more bone in their serving arm than their non-serving arm. Long distance runners have been shown to have a higher density of bone in their spines than people who take very little exercise. Inactivity has the opposite effect and astronauts who are weightless for a few weeks lose calcium very quickly from their bones. The National Osteoporosis society (1996) states that people who are more active and take regular exercises have been shown to have a higher bone density than sedentary people.

However, osteoporosis can be reduced by adopting a good healthy lifestyle, taking regular exercise and for women after menopause to receive hormone replacement therapy (HRT).

The bones of the skeleton consist of a strong outer casing called cortical bone and a mesh-like structure inside which is called trabecular bone. Osteoporotic's cortical bone (outer) is thinner and the trabecular bone (inner) is less dense when compared with normal healthy bone is clearly shown in diagram 1.

Prevention
Adopting the preventive approach to osteoporosis is probably the most positive attitude and there are important factors to consider such as diet, lifestyle and exercise. An adult requires a daily intake of 1,000 mg of calcium (a little over a pint of milk) to help to build (osteoblasts) healthy bones. Smoking and excessive alcohol consumption is harmful to bones. Taking steady, regular exercise such as brisk walking or other weight-bearing exercise for 20 minutes 3 times a week is recommended. Exercise has numerous benefits, it can strengthen muscles, improve balance and co-ordination and mobility which can help to reduce the risk of falling especially for the elderly.

Jacobson and et al. (1984) found that weight lifters had the greatest bone densities, whereas swimmers had the least. In addition, the level of bone mass in elite swimmers did not differ from non-athletic control subjects, suggesting the importance of weight bearing activity.

Diagnosis of osteoporosis is easy in the event of a broken wrist or hip after a minor fall but it is more difficult to judge whether back pain is caused by spinal fractures. X-ray can only show very severe osteoporosis and a bone density measurement can assess the extent of any bone loss.

Symptoms and Associated conditions
Typical symptoms of osteoporosis are: several lost inches in height; developed round shoulders and an increase in the curvature of the spine with possible associated back pain. However, there are possibilities of other underlying problems that can be associated with osteoporosis, they are as follows:

• Long term or high corticosteriod use - sometimes prescribed for asthma or rheumatoid arthritis. It may be very successful in treating those problems but it is bad for the bones.
• Overactive thyroid or too high a dose of thyroid hormone replacement.
• Hyperparathyroidism, where the parathyroid glands are overactive, leading to excessive breakdown of bone.
• Malignant disease, especially myeloma.
• Immobilisation or lack of mobility.
• Rare inherited conditions such as Osteogenesis Imperfecta.
• Anorexia nervosa or overdieting, resulting in loss of periods.
• Malabsorption problems such as chronic liver disease and after gastrectomy operations.
• Hypogonadism - when male or female sex organs have not properly developed, resulting in low circulating levels of male or female hormones.

In most cases osteoporosis will have no apparent underlying cause. In women, osteoporosis tends to be directly due to the loss of oestrogen at the menopause.

Treatments
Pain relief: heat pads, hot water bottles or ice packs; improve mobility and muscle strength; hydrotherapy exercises (heated swimming pool at 98°F); ultrasound; acupuncture; Transcutaneous Electrical Nerve Stimulator (TENS).

Medical: Hormone Replacement Therapy (HRT); Cyclical etidronate (non-hormonal treatment); Alendronate; Calcitriol; Calcitonin.

Alternative: Calcium Supplements; testosterone; anabolic steroids (nandralone decanoate); sodium fluoride.

Exercise Prescription
The amount and type of exercise will vary pending on the severity of the condition and how much pain is in existence. A golden rule, 'A little and often, not too much too quickly' is the right approach. The following exercises are designed to correct posture, improve mobility in the spine and joints, and to strengthen muscles that support the bones. Start with 5 to 10 repetitions of each exercise and gradually build up the repetitions but ensuring not do too much.

Conclusion
This article highlights the problem of osteoporosis and its associated symptoms; however, the recommendations are for guidelines only. Therefore, it is vital for any martial art instructor to consider training intensity on bone-to-bone contact of elderly students, and adapt training methodologies according to health conditions. Most importantly, seek medical advice or refer students to physicians to evaluate any uncertain symptoms.