Joint pain can set you back but doesn’t have to take you out of the game

By Louise Taylor

When B.K. Milne broke his leg in an auto accident, then again while ski racing, both before he was 20 years old, he probably didn’t give much thought to how that might affect his athletic pursuits two decades later.

But that day has arrived, and Milne, 39, an active and fit Calgarian, is feeling the effects of osteoarthritis. His groin and thigh hurt, and running, cycling and tennis have not been his best friends these days. Even getting out of a chair can be aggravating. It’s all been tough to take for a man who cycled and ski-raced competitively, and had taken up distance running.

“The fact that the issue was a large one was obviously very disappointing and discouraging, but not entirely surprising given my history of injury,” says Milne. “There was some relief once the diagnosis began to take shape as at least I was getting to a point where I was aware of the issue and able to get advice on how to address it, not only today, but going forward.”

One in 10 Canadians suffers from osteoarthritis, and exercise is one of the key ways to fight back against the incurable disease. It can also be an aggravating factor, if you don’t choose your activities wisely. Research has shown the strain of training for elite athletic activity can predispose one to the development of osteoarthritis.

In early stages of osteoarthritis, the most important approach is keeping the muscles around the joint strong, maintaining or regaining mobility of the joint, addressing weakness in neighbouring joints and keeping the core strong for better stability.

As the condition advances, an athlete will likely have to change his sport regimen. Impact exercise is bad! Cycling, cross-country skiing and swimming all tend to be good. A runner may switch to triathlon as multisport minimizes the impact of running training. A marathoner may cut back to run 10K. A tennis player may switch to doubles. Staying active is key and a good gym program is essential to keeping joints as healthy as possible and managing muscle imbalances that come from altered movement patterns, that generally occur because of pain or stiffness. Using anti-inflammatory medication or painkillers is dangerous as it can mask the pain and joint irritability. Pain may be reduced, but more harm may be occurring.

Being given a diagnosis of osteoarthritis at 39 is young to be contemplating hip replacement procedures. With the advent of newer surgical procedures such as hip resurfacing joint replacement, men and women in their 40s and 50s have the option of surgery over the reduced function and pain related to advanced osteoarthritis. But surgery is an advanced stage treatment and the long-term benefits and risks of the procedure are still being studied. Prevention and early stage identification and management is the better approach.

The early degenerative changes in Milne’s case may be related to his old injuries. How many of us have had orthopedic trauma that may have altered the way we move, weakened muscles or changed body alignment? A broken ankle in volleyball, torn knee ligaments from soccer, or repetitive falls on the hip in football may set off a domino effect in how body parts function together after injury. Joint injury itself increases osteoarthritis risk tenfold. Symptoms of pain, stiffness and swelling may not start to manifest for 15 to 20 years after the event. In some cases, an athlete’s osteoarthritis might be genetic.

Current research does not have all the answers, and in fact, keeps coming up with more questions. Are people developing arthritis at a younger age? In what way does the cartilage weaken physiologically before it starts to fall apart? Why do some people have advanced osteoarthritis and little pain? What is the source of pain when cartilage itself does not have nerve endings to transmit pain sensation? What can be done to treat osteoarthritis at onset?

Physiotherapy is helpful in diagnosing muscle imbalances and providing exercise to regain joint mobility and strength. Gait analysis with video can be a helpful tool to identify faulty movement patterns. Use of ice and heat can help manage symptoms, and acupuncture has been shown to help with the pain of arthritic joints. Joint injections of cortisone or lubricants may also help symptoms of pain, swelling and stiffness, but often this is temporary. Once X-rays show osteoarthritis is moderate, lifestyle changes are a must.
Canadian researchers have identified molecules in the blood that may be able to predict the severity of osteoarthritis progression. Specific genes related to osteoarthritis have been found in rats. Finding genetic markers in humans may help identify predisposed individuals and allow for preventative strategies like weight control, injury prevention and strength exercises.

Studies are being done to see if transplanting healthy cartilage cells can be used to treat osteoarthritis in its early stages, before the need for joint replacement. The potential for stem cells to differentiate into cartilage cells is also being studied as a promising source for cartilage repair in the near future.

It’s all good news for being able to mange osteoarthritis at a very early stage and minimize its debilitating effects.

Milne has modified his lifestyle over the past two years. He is stretching most days, attending Pilates, strength training, playing tennis and cycling. He has stopped running. Managing risk factors like body weight, impact activities and muscle imbalances are in his control. How Milne’s genetic programming responds and how fast the arthritis progresses is not within his control.

What happens in the future and what new treatments might be developed may be the most interesting part of the story.

Louise Taylor is a physiotherapist at The Downtown Sports Clinic — TD Square, Calgary

The Facts on Osteoarthritis

• Osteoarthritis (OA) is a degenerative joint disease characterized by the destruction of the cartilage and bone of joint surfaces. It is associated with pain, stiffness and decreased function in knees and hips.
• X-ray findings in OA are joint space narrowing, which implies reduction in cartilage covering the bone, osteophytes, which are small bony projections that grow around the joint edges and sclerosis which is a hardening of the underlying bone.
• By the time OA is confirmed on X-ray, cartilage damage is advanced.
• OA symptoms can develop and deteriorate rapidly or can begin slowly and have minimal impact over time.
• OA affects one in 10 Canadians. This is expected to increase to one in five by 2031.
• 60% of Canadian cases are between the ages of 20-64.
• OA is seen more commonly in men before age 45. In women it occurs more commonly after age 55 and seems related to post-menopausal changes. By age 70 most people will have some degree of OA.
• Most significant risk factors are age, obesity, previous orthopedic trauma and joint malalignment.
• Elite athletic activity (national level and higher) or occupations involving repetitive deep knee bending predispose one to the development of OA.
• Carrying one extra kilogram of body weight increases knee forces by three to six kilograms per step.
• An estimated 600,000 hip replacements and 1.4 million knee replacements will be performed in the U.S. in 2015.

Sources: Statistics Canada; Alberta Bone and Joint Health Institution; Fast Facts: Osteoarthritis, Health Press Ltd.


May/June 2011 Issue

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