Arthritis in Sport
With players now competing longer into their careers, managing ‘wear and tear’ increasingly becomes an important part of scheduling and training decisions. ROB BRANDHAM explains
Unfortunately our joints are not designed to last forever. Degenerative changes, known as osteoarthritis, often impact larger weight-bearing joints such as hips, knees, ankles, shoulders and spine.
What is osteoarthritis?
It is often thought of as the end stage of the degenerative process, but really osteoarthritis is a progressive disease of joints with a large spectrum of severity of changes over time. Once characterized as a disease solely of the cartilage, further research has revealed it also impacts joint structures such as ligaments, bones and muscles.
Many factors can contribute to its development, including stress on joints caused by weight, overuse and genetics. A major contributing factor is injuring the joint surface when you are younger, where there is risk the cells that nourish the cartilage, as well as bruising the bone that underlies it, can be damaged. This will progressively lead to the break down of the cartilage. As the cartilage layer does not have many sensory nerves within it, we often don’t feel a lot of pain when injury occurs. Conversely the bone underneath has lots of nerves and also provides the cartilage with its blood supply, therefore significant pain is often not associated with arthritis until the cartilage layer has been reduced to the point where the bone is then placed under stress. This is a reasonably slow process, hence why it affects older athletes.
Symptoms and prevention
Pain, swelling and tenderness are all symptoms, as is stiffness after inactivity and crepitus, the ‘crunchy’ sounds that joints can make.
Arthritis cannot be completely prevented, however the progression can be slowed with the following measures:
- Maintaining muscle strength
- Exploring options that help facilitate optimal joint alignment, such as wearing correct footwear and correcting techniques
- Keeping body weight within a healthy range
- Taking note of warning signs of wear and tear and allowing the joint time to settle down
Reigning Australian Open champions Roger Federer and Serena Williams are two examples of older players who now carefully manage their schedules to allow time for their bodies to heal. Extended breaks have helped both produce outstanding results late in their careers.
No matter age or experience, there are lessons to learn from this. If you are consistently pulling up stiff and sore in a particular joint after playing, it is best to shorten sessions or allow more time to rest. Correcting some of the risk factors is also advised.
Once the damage has been done there is very little that modern medicine can do to reverse these changes, not yet anyway. This does not necessarily mean you have to do give up playing either, it just increases the need to be more sensible and conservative with expectations of what the joint may be able to endure.
REST AND DEVELOP
Younger players are not exempt from joint injuries either – with bone stress injuries a common concern for athletes in their teenage years.
Growing bones are in a constant state of remodelling and development, making impact activity more likely to place stress on bones and create microscopic damage. Putting prolonged and repetitive stress on growing bones is a constant balancing act of allowing the bones adequate time to repair and recover, as well as grow.
In tennis the lower back, the humerus (upper arm bone) and wrist are the most impacted. This can result from significant increases in training volume and technique changes, especially when aiming for greater extension in the lower back with the service action and not having adequate strength in the trunk muscles for this movement.
Bone stress injuries often lead to stress fractures, which require a lengthy period of rest and rehabilitation to allow the bones adequate time to fully recover. This can take up to three months.
Structured and progressive training plans can help with prevention. Adopting correct techniques and ensuring joints are rested when first signs of stress appear is also recommended.