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Health & Exercise Forum

Knee Arthritis in Athletes: Part I of II

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Sep 14, 2009

Dr. Paul MackareySome of you may know Don Loftus, teacher at Scranton Preparatory School and former high school and college athlete. Don, who suffers from knee pain due to arthritis, recently asked me if I had come across any new information regarding knee arthritis in athletes that might be helpful to him.

Unfortunately, I did recently read a study that did not offer encouraging news for him and other former athletes. A recent long-term study of thousands of Division I college athletes in all sports found significant differences in lifestyle due to arthritic pain when compared with the general population. This study found that these athletes experienced more pain in daily activities and required modification in lifestyle, often rendering them less active at an earlier age, than their contemporaries who did not participate in Division I college athletics. What does this mean? What is arthritis? How does it occur? How do I know if I have it?

All joints suffer from wear and tear over time. Weight-bearing joints such as the hip, knee and ankle, tend to wear out faster than others. Moreover, trauma, from sports, overuse, occupation, or accidents, will expedite this process. This form of arthritis is called, osteoarthritis. It is also known as degenerative arthritis. It is the most common form of arthritis in the knee. It is usually a gradual, slow and progressive process of “wear and tear” to the cartilage in the knee joint which eventually wears down to the bony joint surface. It is most often found in middle-aged and older people and in weight bearing joints.

Your family physician will examine your knee to determine if you have arthritis and rule out other diseases. In more advanced cases you may be referred to an orthopedic surgeon or rheumatologist for further examination and treatment. X-rays will show if the joint space between the bones in the knee is getting narrow from wear and tear arthritis. If rheumatoid arthritis is suspected, blood tests and an MRI may be ordered. The diagnosis will determine if you problem if minor, moderate or severe.

Symptoms of Osteoarthritis

  • Pain - usually occurs gradually. However, a sudden onset can occur, especially  associated with a sudden twist or fall. Pain is often worse in the morning and improves with movement. Changes in the weather or barometric pressure can cause pain associated with arthritis.
  • Swelling – can swell after increase activity at the end of the day.
  • Stiffness – is more noticeable in the morning and improves with movement. However, overuse can create more pain and swelling and lead to stiffness also.
  • Weakness – from disuse associated with pain and can lead to occasional buckling of the knee when walking or climbing steps.
  • Loss of Function- is associated with pain, swelling, weakness and stiffness which limits walking, stair climbing etc.
  • Deformity – overtime the affected joint may change shape. Also, changes in posture and/or walking may be noticed.

Causes of Pain From Osteoarthritis

  • Cartilage Deterioration – excessive wear and tear breaks down the cartilage, the primary shock absorber at the end of the bone and between each joint. This deterioration is a gradual process. First, the cartilage loses its elasticity, changing in texture as it dehydrates. This change makes it more vulnerable to injury from overuse, excessive bending and twisting.
  • Bone Reaction - Then, as the cartilage wears thin, the bones begin to rub and compress on each other without protection. The bone reacts by thickening and develops growth and spurs. Bone spurs and small pieces of cartilage may displace and float in the joint space.
  • Joint Lining Reaction - Next, the joint lining (synovium) becomes inflamed and releases chemical irritants. The normal lubricant of the joint (synovial fluid) loses its lubricating properties and allows for further damage to the joint.
  • Joint Deterioration - Eventually, the joint becomes so badly damaged that the pain, stiffness, deformity and swelling severely limit use for daily activities. At this stage, surgical joint replacement is the only option.

SOURCES: Rothman Institute, Philadelphia, PA and American Academy of Orthopaedic Surgeons

Next week, read “Knee Arthritis in Athletes – Part II of II”