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Osteoarthritis is the most common form of arthritis, affecting
nearly the entire elderly population. In fact, it has been
clearly shown in autopsy studies that degenerative changes
in joints begin to appear around the second decade and that
by the age of 40, 90 percent of all persons will have such
changes in their weight-bearing joints, even though clinical
symptoms have not been present.
The most likely factor for this is not the normal aging process, because the
articular cartilage changes in aging and osteoarthritis are completely different.
The factor that appears to be the most important variable in development of especially
severe degenerative arthritic changes in the joints is trauma and subsequent
ligamentous injury. (Lowman, E. Osteoarthritis. JAMA. 1955; 157:487-488.)
The trauma may be just a single episode or sports injury. More frequently, however,
it may produce repetitive damage through microtrauma. Joint instability from
ligamentous deficiency is the factor that causes the most significant arthritic
change in the joints.
Osteoarthritis is often called degenerative joint disease (DJD) because it involves
degenerative changes in all the tissues that form the synovial joint, including
the synovium, bone and joint capsule, but the most critical changes occur in
the articular cartilage. (Buckwalter, J. Articular cartilage. The Journal of
Bone and Joint Surgery. 1997; 79A:612-632.)
Osteoarthritis is described as a generally progressive loss of articular cartilage
accompanied by attempted repair of articular cartilage, remodeling, and sclerosis
of subchondral bone and, in many instances, the formation of subchondral bone
cysts and osteophytes.
The osteophytes are the overgrowth of bone that make joints look big and are
the abnormalities that physicians see on x-ray showing arthritis in the joints.
This decrease in cartilage and the overgrowth of bone causes the person with
arthritis to have restrictions in motion, joint pain, crepitus with motion, joint
effusions, and obvious joint deformities. The questions many athletes ask is, "Is
arthritis inevitable for me after my athletic career is over?"
The notion that sports and recreational activities cause an inevitable wear-and-tear
on the joints just does not hold up when the scientific studies are evaluated.
Because few competitive or recreational long-distance runners suffer severe joint
injuries, and many regular runners can recall how long and how often they have
run, studies of these people provide some of the best opportunities to examine
the relationship between exercise and osteoarthritis. In one investigation, 41
long-distance runners were compared with 41 matched controls. Runners with a
mean age of 60, who had run an average of 180 minutes per week for 12 years,
did not have a greater prevalence of osteoarthritis, although they did have a
40 percent greater density of their vertebral bones.(Lane, N. Long-distance running,
bone density, and osteoarthritis JAMA. 1986;
255:1147-1151.)
Another investigation compared 17 people with a mean age of 56, who had run an
average of 28 miles per week for 12 years, with 18 non-runners. Runners had no
more complaints of pain and swelling of the hips, knees, ankles, and feet than
non-runners, and radiographic examinations of the joints of the two groups did
not show any differences. (Panush, R. Is running associated with degenerative
joint disease? JAMA. 1986; 255:1152-1154.)
The hip joints of 74 former championship distance runners with a mean age of
55, who had competed for an average of 21 years, showed no greater prevalence
of osteoarthritis than controls. (Puranen, J. Running and primary osteoarthritis
of the hip. British Medical Journal. 1975; 2:424-425.) Numerous others studies
have confirmed the same fact: that running and other forms of exercise do not
cause arthritis.
It is not uncommon for athletes to injure joints. It is this injury or the nonhealing
of it that causes the degenerative process to start in the joints. Many sports
injuries and cumulative traumas through life can cause damage to the ligaments
and cartilage. Repetitive low-grade impact from athletic events can be enough
to damage the soft tissues and start the arthritic process. There have been some,
yet not many, pertinent observations that there is an increased incidence of
arthritis with certain sports. For example, wrestlers, boxers, baseball pitchers,
cyclists, cricket players, gymnasts, ballet dancers, soccer players, weight lifters,
and football players have all been reported to have degenerative joint disease
in articular sites subjected to sports-related stress.(Panush, R. Recreational
activities and degenerative joint disease. Sports Medicine. 1994;
17:1-5.)
The hope for the older athletes is to be as fit as when in the prime of their
athletic careers. Often, however, this is not the case because of the degeneration
that has occurred due to non-healed sports injuries. It is very evident that
the main sports injuries that lead to symptomatic osteoarthritis in later years
are those that occur to the ligaments, causing joint instability. It has to be
this because the body, in a homeostatic attempt to stabilize hypermobility and
protect joint structures, responds by depositing calcium along lines of stress.
This produces bone spurs, or exostoses (calcium deposits where ligaments attach
to bone), at the attachments of postural muscles and ligaments to bone. Calcification
of the whole ligament can occur, as happens in ankylosing spondylitis. Typically,
however, bone spurs develop in the ligaments/fascia (as in plantar fasciitis)
and these are generally a sign that the ligaments were no longer able to stabilize
the joint so ôreinforcementö was brought in, in the form of additional
bone. This additional bone is called osteoarthritis.
Sporting activities should be performed for a lifetime. Unfortunately for many,
degenerative changes occur in the joints because of non-healed old athletic injuries.
This combined with a decreased ability to heal, along with the natural degeneration
that occurs with aging, make sporting injuries commonplace in the older athlete.
A lifetime of microtraumas in ligaments and tendons over the years, along with
weakening muscles and poor flexibility, can lead to a reoccurrence of these injuries.
Fortunately, through the knowledge of the types of injuries that can occur and
further realization of the importance of the ligaments and tendons in protecting
the joints, pain can often be eliminated with Prolotherapy. Prolotherapy can
make a significant impact in the rehabilitation of the injured older athlete.
Despite age, typically only four or five sessions are needed for the athletes
to achieve complete healing and be back to their physical best. Injections involving
the feet and ankles, knees, elbows, and shoulders can easily be performed with,
often, dramatic results. Prolotherapy is also the treatment of choice for chronic
back pain because this condition is due to ligamentous weakness in the lower
back and not due to degenerative disc disease.
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