Osteoarthritis is a degenerative irreversible condition whose presence, most automatically assume is a sign of getting old, but as the use of diagnostic tools and clinical observations become more precise in acknowledging osteoarthritis it appears we are seeing it in younger and younger persons. The reason for this may be due to a number of reasons, which tends to be thrown around every now and then, from; vitamin D deficiency, malnutrition, harder playing surface, increase training volume and increased BMI placing strain upon the joints. In this article we look at the evidence about osteoarthritis in the athletic population.
Osteoarthritis is a degenerative joint disease which develops due to the interactions associated with genetics, mechanical forces, both cellular and biomechanical processes and foremost joint integrity. The cause of osteoarthritis is secondary to overuse of the joints cartilage which ends in pathological joint changes.
The acts of dribbling, sprinting, landing, jumping, passing, sliding and opponent physicality expose soccer players to increased, intense and prolonged demands upon the body. Additionally, based within the general population things such as joint integrity, mechanical force, cellular and biomechanical processes as well as genetics all play a role in the development of osteoarthritis.
Osteoarthritis can be split into two categories;
Primary OA: an idiopathic phenomenon
Secondary OA: A joint disease resulting from a clear predisposing factor, as mentioned above.
Osteoarthritis of the ankle joint is estimated to be found in 1-4% of the general population and knee osteoarthritis is found in over 10% of those over the age of 55. Additionally, osteoarthritis is believed to be a secondary factor to 15% of musculoskeletal consults.
Breaking down the joints of the lower limb and the frequency they are seen to have osteoarthritic changes are as follows:
Hindfoot – Uncommon
Mid-Foot – Common (post-traumatic)
Forefoot – Frequent
1st MTPJ – 35-65% of adults over the age of 65
Mid-foot osteoarthritis is believed to be a primary instigator of hallux limitus and hallux rigidus by causing a compression of the dorsal aspect of the MTPJ during propulsion in people with excessively wide 1st metatarsals, phalanx or the presence of long sesamoids. This can also be exacerbated by previous footwear uses such as high heels which place increased pressures through both the mid and forefoot.
Diagnosis of osteoarthritis includes a physical examination, X-Ray results and anamnesis combined will produce a number of the following signs and symptoms; abnormal skin and soft tissues, presence of tender areas, synovitis and effusion. Instability of the joint, joint impingement and restricted range of motion as well as muscle weakness and possibility of a limb length discrepancy.
The plain radiograph grading system for osteoarthritis is reported as showing the following;
Grade 0: Normal
Grade 1: Doubtful narrowing of joint space
Grade 2: Definite osteophytes and possible narrowing of the joint space
Grade 3: Multiple moderately sized osteophytes with definite narrowing of the joint space, some sclerotic areas and possible bone deformity.
Grade 4: Marked narrowing of the joint space with severe sclerosis and definite deformation of the bone contour.
Treatment, as with most musculoskeletal conditions should be based on the stage of that particular condition however, in a nutshell, the following options should be explored.
Short term use of NSAIDs have been shown to give moderate relief of symptoms, however, due to the high impact of the bodily organs should not be considered a long term option. For long term symptomatic relief the use of glucosamine and chondroitin are safe and potentially effective aids. The modification of footwear choices or to the footwear itself has been found to be fruitful, with rocker-bottom soles and polypropylene orthotics the commonly suggested modalities. Additionally, regular self-administered or assisted joint mobilization can be used in adjunct to specific exercises to increase muscle strength, activation and neuromuscular function for support of the joint. It is suggested that a healthy lifestyle be worked towards to help weight control and therefore a life coach, dietitian or nutritionist is suggest for referral.
If conservative measures fail then the use of corticosteroids should be considered before the use of surgical intervention.
The medial knee is the number one lower limb area of osteoarthritis with research supporting the use of lateral wedging of the rear to forefoot in the treatment with the interest of reducing varus torque. Medial wedging has been shown to increase the varus torque at the lower leg and more specifically the knee creating a less mobile and everted foot type which encourages knee varus malalignment.
Those with medial knee osteoarthritis have been found to have deficits in afferent and efferent neural pathways demonstrated in proprioception, muscle strength and muscle force control. The neuromuscular systems ability to sense and execute demands is potentially impacted by the presence of pain, neural deficits and damage to joint structures. There is an increase in popularity for the use of exercise based programs and consults to limit the deficits placed on the surrounding structures.
Hip osteoarthritis is the second most common lower limb site of osteoarthritis. It is encouraged that those who are able too with OA of the hip complete 30min of moderate intensity exercise at least five times a week to promote cardio health in addition to a couple of strength session activities as well.
Osteoarthritis is a condition which can be treated in a highly beneficial way if done so by a multi-disciplinary team. Most people live with OA thinking it is just part of getting old. Many practitioners shy away from or undertreat those who have OA due to the treatment only slowing down the progress of the condition as opposed to the quick fix many people are looking to receive. To get the most out of treatment for OA a number of practitioners should be involved, including podiatry, physiotherapy, exercise physiologists, dietitians and if the patient request other modalities can be explored like chiro or Chinese medicine.
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