by Jonathon Sullivan MD, PhD, SSC, PBC
Our approach to the pain of aging is intelligent, careful, informed...and life-altering.
I'm hurting today. I have a smoldering osteoarthritis of my right thumb that's been bothering me on and off for a few years now, and today it's a bit worse. I have a back tweak from a few weeks ago that's been slow to heal up. I just took a week off from heavy deads and squats. Last night I cautiously put up 325 and 250, respectively. While the back is better today and ready to go slowly and carefully forward, it's still talking back a bit. The knee tendinitis is so much better than it used to be, but it comes and goes--some days I'm a supple leopard, some days I'm a creaky crab. Today I'm a bit creaky. And crabby.
How about you? Anybody out there over 50 or 60 completely pain-free, all the time, or even most of the time? Hands?
Yeah. I didn't think so.
I have a lot of clients, old and young, and most of these athletes hurt from something at any given time. For most of the athletes I know, pain is like a little demon that darts around the body: Pain Demon. With analgesics and movement and tincture of time you chase him out of your shoulder and he decamps to your knee. With some Aspercreme and wraps and a modification of your squat stance you exorcise the Demon from your knee and he possesses your ankle. With an ace bandage, some stretches, and few carefully chosen words of Latin, you shoo him out of your ankle and he spirits away to another body part.
It's uncommon for me to be entirely pain-free in the course of a day. This has been true for some time now. It was true when I was in my late thirties and relatively sedentary, it was true when I was active again in my forties but not training intelligently, and it's true now that I train aggressively in my sixties. What's different is the type of pain, the way I perceive pain, and my response to the pain. In medical residency and fellowship, when I was in the very worst health and physical shape of my life (no, the irony is not lost on me), my back and feet hurt all the time, all my joints ached, and I also confronted the mental anguish of realizing what was happening to me. When I got back "into shape" with running, martial arts, running, the Bowflex, running, thrashabout calisthenics, running, crazy nutrition, and running, I still hurt all the time. My muscles were always sore, my knees were worse than ever, and I was throwing my back out once or twice a month. My Pain Demon was billing me for overtime.
Training with a program for strength and cardiovascular conditioning got me into the best shape of my life, reduced my injuries, and made me feel better. Sully the retired ER doc at 61 could stomp Sully the Marine at 19. Training has given me resiliency, toughness, mobility, and strength. It's given me a deeper perspective on nutrition, sleep, stress reduction, and life habits than I've ever had. It's taught me a kind of discipline that Sully the Marine could not have fathomed. It's rewarded me with a profound delight in physical movement that would have confused Sully the Marine, which seemed unthinkable to Sully the 39 year-old flabby guy, and which persistently eluded Sully the 45 year-old obsessive exerciser guy. Training has even changed my personal, metaphysical idea of what life is.
But training did not make my Pain Demon go away.
This is a deeply unsatisfying fact of life in general and the Athlete of Aging's life in particular. We accumulate boo-boos. We hurt more often, and in more places. Embarking on middle age is like going to one of those "painless" dental clinics: They're lying. And you knew they were lying when you went in there...or else you were really kidding yourself. But the pain of going to the dentist, with the needles and the grinders and that evil little hook and the drills and that godawful sucker thing...all of that is nothing compared to the pain of not going to the dentist, the pain of not taking care of your teeth. Pay me now or pay me later, with interest. You know the drill.
Similarly, the pains and strains of being an Athlete of Aging, with the tweaks, the muscle soreness, and the constant objections from aging tendons and joints, is nothing compared to the pain of obesity, diabetes, weakness, immobility, overmedication, and fear of movement. The Athlete's pain is the pain of defiance and self-determination and living. The Sick Aging Phenotype's pain, the pain of being sedentary and unfit in every dimension, is the pain of surrender, hopelessness, and dependence.
So we all have pain, but we cultivate it, experience it, and react to it differently. The way of the Sick Aging Phenotype is to sit down for a month or two, order up some comfort food, and pop another Norco.
That is not our way. If our musculoskeletal pain is new, severe, debilitating, or associated with systemic symptoms like fever or vomiting, we do our due diligence and get looked at. You didn't get to be an independent 68 year-old athlete by being stupid. But we all know that's not what I'm talking about here. We're talking about another bout of back pain or sciatica, a knee that's being a twerp this week, a shoulder that's beginning to act up again, a new hamstring strain.
First and foremost, we remind ourselves that we're not broken. We give it a bit of rest, and train around it. We treat it with over-the-counter analgesics, because it's so nice to live in a world with Tylenol and aspirin. We slather our favorite placebo goo onto the area (I like lidocaine and Tiger Balm) and we apply the ice or the heat, whichever feels better.
Most importantly: we keep moving. We work the range of motion. We lift an empty bar, or even the light bar or a broomstick. We do air squats. We train the movements that don't hurt. We unload the movement that does hurt, but we keep doing that movement, or some tolerable variation thereof, until it feels better, which it will in due course.
We do not surrender. We do not let the Pain Demon dig in, either by ignoring the pain or immobilizing a body part. Ignoring the pain and avoiding analgesics is like going to an exorcism without a prayer shawl or Holy Water: you're just asking for Linda Blair to drown you in pea soup and twist your head right off. Going immobile allows the Pain Demon to dig in and build himself a bunker out of short tendons, scarred muscle, and calcium deposits. You'd be lucky to get him out with a flamethrower and a bazooka.
We aren't stupid. We're not martinets or masochists. We talk sensibly with ourselves, our partners, our coaches, and our doctors. Our pain usually gets better, and when it doesn't we seek professional help to get us moving again. Our approach is intelligent, careful, informed...and life-altering.
There's a difference between surrender and being gentle with ourselves--indeed, gentle compassion is precisely our approach. We treat our pain with analgesics, mechanical support, and movement, until the Pain Demon retreats to another position. Process repeats. It's a Forever War in which we can never really surrender.
We can wear out, or we can rust out. That's our call. But everybody hurts from something.
Jonathon Sullivan MD, PhD, SSC, PBC is a retired emergency physician and research physiologist, and the owner and head coach of the Greysteel Strength and Conditioning Clinic in Farmington Hills, Michigan, which specializes in training adults over 50. He is the author of The Barbell Prescription: Strength Training for Life After Forty, with Coach Andy Baker.