To athletes over the age of 40, osteoarthritis is a little like bad weather—you complain about it but you do your workout anyway. You probably know some people in their 70s and 80s who grumble about stiff, aching joints that don’t bend very well or that make walking difficult. As an active person, you may wonder if you’ll develop osteoarthritis when you reach the age of 50, 75, or 100. If you do, what could the disorder do to your athletic life? What can your doctor do to treat the condition?
Let’s get the bad news out of the way first: If you live long enough, you’ll probably encounter at least a touch of osteoarthritis. Further, you can’t actually overcome it in the sense of defeating it forever. It’s a non-infectious, progressive, degenerative disease of the joints that just won’t quit. So far there’s no cure, although researchers are hard at work.
The good news is that you can overcome osteoarthritis in the sense of successfully dealing with a problem or a difficulty. There are many ways to work around the condition and to keep on pursuing your fitness goals well into old age. You can learn to handle it. Many treatment options are available right now, and more are coming.
The sneaky news is that for years, you may not even know you have osteoarthritis. It’s a wear-and-tear disorder that develops over time. According to the Arthritis Foundation, X-ray studies show that up to 95 percent of people over age 50 have one or more degenerating joints somewhere in the body. The Mayo Clinic notes that articular cartilage, the slippery but firm substance between the bones of a joint, starts wearing away and becomes rough. That’s osteoarthritis in a nutshell. What happens next varies from person to person and from joint to joint.
With less cartilage to cushion them, the bones often develop spurs or overgrowth that can grind together. Some people feel the pain of bones rubbing together; others feel no pain at all. Sometimes the bones harden too much or become misshapen so that the joint loses some or most of its range of motion. Think of this as when the elbow won’t bend as far as it used to. If the space between the bones narrows enough as the cartilage erodes, the ligaments that attach the bones to each other can lengthen so much that the joint becomes unstable. This is more like when the knee may threaten to buckle. Although osteoarthritis doesn’t show the kind of inflammation that rheumatoid arthritis does, a degenerating joint can swell and become painfully inflamed. Osteoarthritis in its severest form can cause considerable disability and can damage the quality of life as much as heart disease or cancer.
Researchers don’t yet know exactly why cartilage erodes in many people’s joints but not necessarily in everyone’s, nor are they sure why some joints lose more cartilage than others. Instead of causes, the Arthritis Foundation lists the top five risk factors for developing osteoarthritis:
Growing older is a big one. The longer you’re alive to use your joints, the more likely they are to wear out (along with everything else). However, experiencing pain and loss of mobility is not an inevitable part of an osteoarthritis diagnosis. Even if you’re well along in years, the condition doesn’t have to stop you in your tracks. It may be an annoyance but it doesn’t have to be a showstopper.
Another predictor of osteoarthritis is being overweight or obese. The extra weight particularly distresses the knee and hip joints. According to the Arthritis Foundation, “For every pound you gain, you add four pounds of pressure on your knees and six times the pressure on your hips. Recent research suggests that excess body fat produces chemicals that travel throughout the body and cause joint damage, which would mean obesity plays a systemic, not just a mechanical, role in osteoarthritis onset.” And yet many active people carry extra weight without apparent consequences.
Injury or overuse can contribute to osteoarthritis. After an injury or after surgery to repair an injury, the joint can begin to develop osteoarthritis right away or years later. With overuse, such as engaging in a constant repetitive motion, the condition usually manifests itself after a considerable period of time.
Genetics or heredity can affect osteoarthritis, especially in the hands. If one of your parents or grandparents passes on the gene for misshapen bones of the hand, you have a higher, but not an inevitable, chance of developing problems with your hands as well.
Muscle weakness, especially of the muscles surrounding the knee joints, can lead to osteoarthritis. These are the joints that bear much of your weight, and the muscles supporting them need to stay strong.
Many diseases and conditions are associated with the same symptoms as osteoarthritis. One of the more common symptoms of osteoarthritis is that your joints feel sore after you have used them more than usual or when you resume activities after a period of inactivity. Another is stiffness of the joints first thing in the morning or stiffness after a lengthy period of rest that goes away when you return to your normal activities. Also, tingling and numbness can signal osteoarthritis. Pain is often the first symptom that gets your attention. This pain can be caused by weakened muscles around the joint and can also result from subjecting the joint to heavy impact.
According to the Arthritis Foundation, your physician can diagnose osteoarthritis by taking a medical history, conducting a physical exam, and taking an X-ray. If there is a possibility of rheumatoid or juvenile arthritis, the doctor may remove a small amount of fluid from the space in a joint. Ruling out these two more severe forms of arthritis is a useful step toward treatment.
“Don’t stop moving,” advised Dr. Lori B. Wasserburger, M.D., physical medicine and rehabilitation physician at Sports and Spine Associates. In her practice, she treats a number of athletes battling chronic osteoarthritis. She notes that the human body provides excellent repair mechanisms. The cycle of breakdown and repair is not unique to osteoarthritis, but patients can gain considerable benefit from understanding the process. A reasonable amount of activity followed by a reasonable period of rest can make many cases of osteoarthritis quite manageable for a long time.
Dr. Wasserburger unquestionably includes appropriate exercise in her recommended treatments for the disorder. If you’re an avid runner with osteoarthritis, you might not like to hear that you should alternate running days with rest days, but you can probably run many more years if you don’t run long distances on five or six days of every week. On alternating rest days, you can always cross train with swimming, cycling, walking, and other low impact or no impact activities.
The other main non-surgical treatments Dr. Wasserburger advises are alignment modification, oral supplementation, viscosupplementation, plasma rich protein therapy, and prolotherapy (see page 71 for additional information on each of these options).
The good news for active people is not only these non-surgical treatments but also the advice: “Don’t stop moving!”
Depending on which joint is affected and how severe the pain is, you can do a lot to treat mild arthritis yourself by trying these strategies:
Human skin can regenerate itself, but cartilage can’t. Several groups of scientists are working on developing artificial cartilage that can be inserted in a joint to replace what has eroded. A team at Duke University is studing how to convert adult stem cells into something with the properties of embryonic stem cells. These cells can then be stimulated to become cartilage suitable for your body. Look for the article, “Duke researchers generate cartilage from pluripotent stem cells” on Dukehealth.org for more information.
Another approach is to use treated animal ligaments and tendons in biologic replacement therapy. Dr. Kevin Stone, an orthopedic surgeon, gave a TED talk on this subject. It’s available on YouTube; search for “Kevin Stone: The bio-future of joint replacement.”
By the time today’s infants become grandparents, it’s likely that osteoarthritis will be much more effectively treatable, if not curable. What will they grumble about if their joints don’t ache?
Alignment modification means correcting the effects of a degenerated joint by using heel wedges, knee or ankle braces, prosthetics in the shoes, and similar devices to moderate the impact or to alter the location of the impact. It’s the same principle as buying running shoes to correct excessive pronation or supination. You may have to experiment quite a bit to find the modifications that are right for you.
Oral supplementation includes taking recommended doses of glucosamine or glucosamine with chondroitin as well as appropriate doses of pain relievers. Since both over-the-counter and prescription pain relievers can cause major devastation to the kidneys over time, you’ll want to be especially careful to follow your doctor’s advice. You don’t want to wind up on a kidney dialysis machine several mornings a week, advised Kelly Foster, a nurse practitioner nephrologist.
Viscosupplementation refers to injections into an area near the joint. The substance injected is similar to naturally occurring hyaluronic acid, a fluid that lubricates the joint and helps absorb the shock of impact. The artificial fluid can help fill the void left by the eroded cartilage, but it may need to be replaced a number of times.
Plasma rich protein therapy consists of injections of your own concentrated platelets to stimulate cell growth and healing. These injections intensify your body’s natural repair cycle along with reducing pain and inflammation.
Prolotherapy involves injections of a dextrose solution into tissue near a weak ligament. The solution irritates the ligament and inflames it a bit in order to force more blood and nutrients into the area. The tissue is stimulated to repair itself.
• Physical therapy to strengthen the muscles surrounding the affected joint.
• Specific exercise programs designed by a personal trainer familiar with osteoarthritis.
• Acupuncture and massage therapy.
• Chiropractic adjustments.
• Partial or total joint replacement using a substance such as metal to reinforce the degenerated joint.