|
|
|
Athletes of all calibers get a lot of good out of sports: pride, glory, camaraderie and a host of health benefits. But if they don't take preventive measures, they are at risk of injury and perhaps a lifetime of pain.
Almost from the beginning, at age 13, Patty Hendrix played with pain. But her passion for soccer overcame the discomfort and the frequent dislocations of her left knee and even her first surgery at age 15. Talented and inspired, she went on to help her Kingsport, Tenn., high school soccer team win four state championships. Playing center forward, she was named best offensive player in the state in 1981. And she dreamed of one day playing in the Olympics.
But Hendrix's body would not cooperate with these plans. Even as she continued to play on intramural teams during college and later in adult soccer leagues, her knees were taking a pounding. The pain and instability grew steadily worse, necessitating a series of surgeries.
By the time of her third, and last, knee surgery in 1992, Hendrix's anterior cruciate ligament (ACL), the powerful ligament that once stabilized the front of her knee, as well as the medial meniscus, a crescent-shaped piece of cartilage that once cushioned the joint, were shot. Her injuries had left her with a knee that would dislocate when she rolled over in bed and a painful case of osteoarthritis (OA), a chronic condition in which bone rests on bone, because of the loss of cushioning cartilage. Osteoarthritis is not often seen in someone so young, except where injury is involved.
Today, at 37, Hendrix has finally faced that her soccer days are over. Occasionally, she will kick around the soccer ball in the backyard of her suburban Nashville home with her 11-year-old son, Cory, but not for long. If she plays more than 30 minutes, she pays for it the next day with pain and fluid build-up in her knee. The OA also makes it painful to walk for long periods on hard surfaces. Two hours is her limit at the mall, she says, and she finds it hard to squat and to walk up and down stairs.
When Injury Leads to OA
Unfortunately, stories like Hendrix's are not unusual among dedicated athletes. Many promising athletic careers have been ended by a torn or ruptured ACL or an injury caused by repeated trauma to a joint over time. And it appears that the risk is greater for women. According to the American Academy of Orthopaedic Surgeons (AAOS), women who play soccer or basketball are three to four more times likely to injure their ACL than men, although research, so far, has shown no definitive reason why. And a recent Scandinavian study showed that 34 percent of female soccer players who had torn an ACL had X-ray findings consistent with OA just 12 years later.
An injury such as an ACL tear, particularly one that is not allowed to heal properly, can make the joint unstable, causing uneven wear to the cartilage that cushions the bones where they meet. As a result, the cartilage breaks down, leaving bone against bone. This is the hallmark of osteoarthritis, the most prevalent form of arthritis.
Whether injury alone is sufficient to cause the disease, however, is debated. According to Michael G. Ehrlich, MD, an orthopaedic surgeon and chairman of the department of orthopaedics and rehabilitation at Brown University in Providence, R.I., "The impression that ACL [tears] lead to OA was based on animal studies but the path to OA in people is less certain," he says.
While few would disagree that injuries can contribute to OA and hasten its development, most doctors believe that even in the case of OA following injury, genetics and obesity often play a role too. "A person may have an inherited predisposition to develop osteoarthritis, but develop it only where a biomechanical insult, such as a knee injury, has occurred," says David T. Felson, MD, a rheumatologist at Boston University School of Medicine's Arthritis Center.
| |
Do You Have Osteoarthritis?
If, after a workout, you feel pain inside a joint, you may have arthritis and need to see a doctor. If you feel pain outside the joint, chances are it's just muscle soreness.
Test yourself. Send for a free copy of the Arthritis Foundation's questionnaire, Assess Your Joint Health. You can take this quiz to see if you might have arthritis or are at risk. To order, call the Arthritis Foundation at 800/283-7800.
|
The impact of injury on the development of OA can perhaps be seen most dramatically in the athletic world. In their heyday, athletes like Nolan Ryan and Joe Namath suffered a litany of injuries, ranging from elbow and arm injuries to injured hip flexors and torn ACLs. Now, instead of playing, they act as spokespeople for arthritis pain remedies for the approximately 21 million other Americans who have OA.
These elite athletes have suffered injuries and put their bodies through stresses we can scarcely imagine. But it's not only gifted athletes who get hurt. Sports injuries affect all age groups, from children and teenagers to baby boomers and the elderly. Injuries include sprains, dislocations, stress fractures, torn ligaments, pulled muscles and conditions like tendinitis and bursitis. The repetitive motions, some of them requiring awkward body mechanics, required by backhand swings, swift side steps and pitching can take a toll too. According to groups like AAOS and the U.S. Consumer Product Safety Commission (CPSC), doctors are seeing more such injuries each year. Increasingly, studies suggest that it's only a matter of time until those injury patients become osteoarthritis patients.
Putting Risk into Perspective
If this bit of news makes you want to hang up your soccer shoes, stow your basketball or retire your racket, read on. It's not physical activity itself that is harmful. "There's no evidence that any exercise leads to osteoarthritis in healthy knees, for example," says Kevin R. Stone, MD, an orthopaedic surgeon and chairman of the Stone Foundation for Sports Medicine and Arthritis Research at the Stone Clinic in San Francisco. What's harmful are the injuries that can occur as a result of going at a sport too strenuously, using improper technique and not wearing appropriate gear. Even when injuries do occur, damage can often be avoided by allowing the affected area to heal fully before being stressed again.
In fact, exercise is not only generally safe but may be beneficial for arthritis — and your overall health. The right physical activity performed properly may actually reduce your risk of OA or minimize its effects by strengthening the muscles that support and help stabilize joints. In addition, regular exercise has protective effects against potentially devastating health problems such as diabetes, cancer and cardiovascular disease.
If there is any good news to be gleaned from reports of increased sports injuries it's the suggestion that more injuries mean Americans are exercising more — a positive trend that many rheumatologists believe may outweigh the risks of injury. The upshot: Exercise, yes, but exercise caution.
Keep Playing — but Safely
One way to make safety a priority is to look at training as a year-round lifestyle activity. "We counsel adults who want to get in shape to try to do something every day, not just three times a week," says Dr. Stone. "Even 20 minutes of exercise raises the heart rate."
The exercise you do should be varied. Do some strength training, range-of-motion work and aerobic or cardiovascular conditioning — no matter which sport you choose, says Dr. Stone. Variety in exercising prevents boredom and keeps you well balanced physically.
Even if you prefer high-intensity sports like football, soccer or ice hockey, you can decrease the risk of injury to a joint with preventive measures such as using proper equipment, shoes and braces, for example, and by strengthening the muscles to improve joint stability, Dr. Felson says.
"I tell my patients you don't play a sport to get in shape. You get in shape to play a sport," says physical therapist Stephen Clark, owner of Athletic Physical Therapy in Los Angeles. "If you know you are going skiing in a couple of weeks and need to strengthen your legs, don't wait until the day before," he cautions.
Patty Hendrix admits she has finally gotten smarter about physical activity. As a physical therapist with HealthSouth, a nationwide provider of rehabilitative services, Hendrix has learned to practice what she preaches to her patients. She still exercises but on a more moderate level, giving proper attention to joint protection.
To keep your body working for you, the key is to listen to it, Hendrix and Clark agree. Sports help you stay in shape, lower stress and be social, but all games have rules. Make sure you follow the rules of exercise too.
Park Morgan is Arthritis Today's senior editor.
|
