The Long Road Back: Special Rehabilitation Problems of the Elderly – Same Diagnosis, Different Problem

By | April 9, 2014

The quality of the ruptured tendon in an elderly patient is seldom as good as in this young soldier.

The quality of the ruptured tendon in an elderly patient is seldom as good as in this young soldier.

We return to ours series on special problems with rehabilitation in the elderly which was last posted on March 31st.  Even when the injuries suffered by the old and the young are on the surface similar, there are usually underlying differences, which outweigh any similarities. Let’s take an acute Achilles tendon rupture such as the one suffered by Kobe Bryant earlier this season as an example. In a young athlete it is a sudden painful and catastrophic injury, which is often described as feeling like being hit in the back of the ankle with a baseball bat. In the elderly the same tendon tear often is slow, gradual and sometimes painless with the patient seeking medical attention only because they can no longer press down on the gas pedal. Likewise the response to treatment also differs markedly. In athletes such as Kobe there is almost always a clean tear in the tendon, which can be repaired, usually with good results. The question is whether or not they will be able to return to sports at the highest level, but activities of daily living are virtually assured. In the elderly the tear usually occurs in an area of prior degeneration. Repairs are difficult or at times impossible due to the loss of substance and the poor quality of the remaining tendon that often will not hold sutures. The repair if it holds is often loose resulting in a significant loss of range of motion and power with respect to plantar flexion. The same principles apply to the treatment of chronic back pain in the elderly as compared to the young. At Schlesinger Pain Centers we understand that because of other structural weaknesses in the back even the treatment of simple disc problems in the elderly requires more time and care than would be necessary in younger patients.


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