Answers to Common Questions
Tips to Reduce the Risk of Osteoarthritis
ATOAC Newsletter Clinician’s Corner
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- While physical activity is good for joints some athletes are at risk for osteoarthritis.
- Individuals with a history of knee injury are 3 to 6 times more likely to have osteoarthritis than a person with no history of injury.
- Individuals with a prior injury are often diagnosed with osteoarthritis 10 years younger than their peers.
- OA is not just for older adults. More than 50% of adults with osteoarthritis are under 65 years of age.
- Young people with osteoarthritis are psychologically distressed & frequently report work disability.
- Lower extremity post-traumatic osteoarthritis costs >$3 billion/year in direct healthcare expenses
- What is the average active person’s risk for knee arthritis?
- Lifetime risk for diagnosed symptomatic knee OA is about 14% regardless of whether or not they were a former athlete.
- How common is this condition?
- Osteoarthritis, which is the most common form of arthritis and affects more than 30 million Americans.
- Osteoarthritis is one of the most common causes of disability.
- Osteoarthritis will become more common as the population ages and the obesity epidemic worsens.
- How is it diagnosed?
- Osteoarthritis is typically diagnosed based a physical exam by a healthcare professional. In some cases x-rays or other imaging or lab tests may be ordered if the clinician is concerned about other possible causes of the joint symptoms.
- What are the symptoms of knee osteoarthritis?
- Symptoms can vary greatly among people. Pain, stiffness, hearing or feeling a grating, functional limitations, diminished range of motion are common symptoms. If your joint doesn’t feel normal it’s always wise to mention it to a healthcare professional.
- Does osteoarthritis always cause symptoms?
- No, while people with osteoarthritis are more likely to have symptoms it is possible that some people can walk around with very bad looking joints on x-rays but be asymptomatic but the opposite can also be true where someone with mild disease may have severe symptoms.
- At what age do people typically develop this condition?
- Osteoarthritis is typically diagnosed between 55 to 64 years
- Despite people thinking it’s a disease of older adults – more than half of all persons with symptomatic osteoarthritis are younger than 65 years
- People with a previous joint injury are often diagnosed 10 years earlier than their peers.
- Younger people with osteoarthritis report significant decreases in quality of life and work-related disability and will likely live several decades with disability.
- Can anything be done to reverse osteoarthritis?
- No, no intervention has been approved by the US FDA to stop, slow or reverse the onset or progression of osteoarthritis.
- We can take steps to reduce the risk of osteoarthritis (weight management, injury prevention program)
- Does being an active person who exercises or plays sports increase the chance someone will develop osteoarthritis?
- No, being active, including running, poses no harm and may even be beneficial.
- However, some athletes may be more likely to have osteoarthritis later in life. For example, athletes with a joint injury and participants in soccer, elite-level long distance running, elite-level wrestling, and elite-level weightlifting.
- Can knee injuries lead to osteoarthritis?
- A person with a history of a knee injury is 3 to 6 times more likely to get knee osteoarthritis than their peer.
- How does being inactive change my chance of osteoarthritis?
- Physical inactivity contributes to an increase in weight gain and obesity, which is a major factor that contributes to osteoarthritis.
- Being inactive also increases a person’s risk for other chronic disease and may lower the person’s quality of life.
Tips to Reduce the Risk of Osteoarthritis
- Support and implement evidence-based primary injury-prevention interventions to reduce the risk of acute traumatic joint injuries (see helpful resources below).
- Educate patients with joint injuries about their increased risk of osteoarthritis, other common risk factors for OA, self-management strategies to minimize the burden of osteoarthritis, and strategies to regularly monitor changes in joint health.
- Encourage athletes to maintain a physically active lifestyle once their participation in competitive sports has ceased to reduce the risk of obesity and promote long-term health and wellness.
- Use existing guidelines and recommendations for managing OA among physically active individuals (also see this full text)
- Journal of Athletic Training – Special Issue on Osteoarthritis
- The Role of Athletic Trainers in Preventing and Managing Posttraumatic Osteoarthritis in Physically Active Populations: a Consensus Statement of the Athletic Trainers’ Osteoarthritis Consortium
- Knee OA as a long-term consequence of injury – Lower Extremity Review
- Osteoarthritis: Staying in the game is a ‘joint’ effort! – Osteoarthritis Action Alliance Infographic
- Preventing ACL Injuries and Improving Performance – Osteoarthritis Action Alliance (Brochures and Consensus Opinion on Best Practice Features)
- National Public Health Agenda for Osteoarthritis 2010
ATOAC Newsletter Clinician’s Corner
The Clinician’s Corner features the previous month’s most-talked about research article. We ask the authors for a clinical take home message and ask a clinician to provide feedback on how they can use the research to improve their practice.
Burland JP, Lepley AS, DiStefano LJ, Lepley LK. No shortage of disagreement between biomechanical and clinical hop symmetry after anterior cruciate ligament reconstruction. Clinical Biomechanics. 2019;68:144-150.
- Purpose: to determine the agreement between 3-D sagittal plane biomechanics and percent limb difference during the triple hop for distance task in patients with a previous ACL reconstruction.
- Individuals achieve symmetrical hop-distance using different knee biomechanical strategies after ACLR
- Trial-by-trial analyses have utility, as averages can mask failures
- These findings do not undermine the value of the return to sport hop testing, as these criteria have been associated with higher re-injury rates
Clinical take home message:
Dane Langellier, MS, ATC Associate Athletic Trainer at Illinois State University, agrees with [Dr. Burland’s] findings stating “our athlete’s performance and symmetry on the triple hop test mask their actual ability to perform more sport-specific tasks and these tests over-predict their true functional ability.” While the triple hop test is one of several functional tasks his athletes perform (see: Advanced Lower Extremity Sports Assessment (ALESA)), Mr. Langiller also uses other clinical assessments like visual inspection of a double-limb squat task to evaluate movement performance based on limb symmetry and favoring of their non-injured limb.
Mr. Langiller stated when using hop tests to assess functional performance he follows guidelines from the ALESA measuring the average of 3 trials and comparing those between limbs with a recommended 85% agreement between limbs before progressing into more difficult functional tasks. He also said “We use [the ALESA] throughout the rehabilitation process to measure an athletes’ progression- we can show them how much they are improving by showing their limb symmetry gradually increasing.”
When asked about his thoughts on Dr. Burland’s recommendations to assess hop tests trial-by-trial, he replied “I can see [individual trials] giving us a better story than the average scores” but their decision to begin a return to play progression is based off much more than just functional hop testing. “Once you see an athlete attempting their sport-specific movements in a simulated practice environment, that’s when you can tell if they are ready to return to play.”