Saina Nehwal’s arthritis diagnosis: How years of competitive sport can impact body

From indianexpress.com

The former Olympic medallist recently opened up about retiring because of arthritis. An orthopaedic surgeon explains why elite athletes may develop arthritis early, the warning signs to watch for and how to stay active after diagnosis

Ace shuttler Saina Nehwal recently spoke candidly about how arthritis brought her illustrious badminton career to an end. During an interview with Hauterrfly, when asked, “When you retire because of arthritis, it must be so hard for you,” the former Olympic medallist reflected on life after stepping away from competitive sport.

“It hurts a lot, you know, when you play some sport for 25 years. Every day is like a challenge; you have to fight, you have to just give your best. So it feels like life has become a little easier, and how do I make it even tougher every day? So that becomes a challenge,” she said.

Arthritis is often viewed as a condition that affects older adults. But can years of high-intensity training, repeated impact and sports injuries cause joints to wear out much earlier? Dr Sanjeev Jain, Chief of Orthopaedics (HOD) & Joint Replacement Surgeon, KIMS Hospitals, Thane, explains.

                                                     Saina Nehwal on artritis diagnosis (Photo: Instagram/nehwalsaina)

Can years of competitive sport lead to arthritis at a younger age?

According to Dr Jain, the answer is yes—especially for elite athletes whose joints endure years of repetitive stress. “Certainly, it can. Because of their years of training, competition and vigorous movement, elite athletes subject their joints to repeated stress.”

Sports that involve frequent jumping, sudden changes in direction and repetitive impact can gradually damage the protective cartilage inside joints.

“Sports which include a lot of jumping, frequent changes in direction and heavy impact can slowly deteriorate the cartilage,” he explains.

The risk rises significantly if an athlete has previously sustained serious joint injuries. “The risk is even greater if the athlete has already suffered ligament injuries, meniscus tears or fractures since these conditions can change the way the joint functions and accelerate cartilage damage,” he adds.

However, Dr Jain points out that arthritis is not inevitable. “While not all athletes go on to develop arthritis, a long sporting career together with past injuries can lead to osteoarthritis appearing earlier than would be expected.”

What are the early warning signs athletes shouldn’t ignore?

According to Dr Jain, arthritis often begins subtly. “The first signs are usually mild and can easily be regarded as just normal aches.”

He says athletes and physically active individuals should watch out for:

* Persistent joint pain
* Morning stiffness or stiffness after periods of inactivity
* Swelling around the joint
* Reduced flexibility
* Clicking or grinding sensations
* Pain that returns during activity
* Longer recovery after training sessions

“Some athletes also find that their recovery time after training is longer than it used to be,” he adds.

Ignoring these symptoms can delay treatment. “When joint pain lasts for several weeks, keeps coming back, hampers performance or is accompanied by swelling or instability, it is important to see an orthopaedic specialist. Early diagnosis may help in slowing down the progression and in maintaining joint function,” he explains.

Does arthritis mean you have to stop exercising?

Dr Jain says remaining active is one of the most effective ways to manage arthritis and maintain joint health. “Receiving a diagnosis of arthritis doesn’t mean that one has to stop exercising. On the contrary, remaining active is one of the best methods for keeping your joints in good condition.”

The focus, however, should shift from high-impact activities to joint-friendly exercises. “Instead of concentrating on high-impact activities, you should turn to exercises that are kind to the joints, such as swimming, cycling, walking, yoga and strength training under supervision,” he explains.

Increasing the amount of muscle surrounding the joint in question helps to improve stability and lessens pain. He also recommends combining exercise with other lifestyle measures.

“Weight management, physiotherapy, wearing good footwear and making changes to the way you are active are also important factors. The aim is to stay active while at the same time protecting the joints, not to entirely avoid movement,” he adds.

DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.

https://indianexpress.com/article/lifestyle/health/saina-nehwals-arthritis-diagnosis-how-years-of-competitive-sport-can-impact-body-10816299/ 

How Some Sports Injuries Can Cause Arthritis at an Early Age

From cedars-sinai.org

Your high school soccer career ended with a torn anterior cruciate ligament (ACL) and knee surgery. Now, 20 years later, you’re experiencing increasing pain in that same knee and the doctor diagnoses the problem as post-traumatic osteoarthritis (PTOA).

“How can I have arthritis?” you groan. “I’m only 35 years old!”

This kind of case is not unusual. Nearly 4 million Americans are estimated to have post-traumatic osteoarthritis (PTOA). Many suffered ACL tears or other joint injuries early in life, and despite reconstructive surgery, later developed PTOA.

PTOA is a form of osteoarthritis (OA). OA affects about 33 million American adults and is the most common form of arthritis.

“OA is a huge source of disability and a huge part of our national expenditure for health-related issues,” said orthopaedic surgeon Andrew Spitzer, MD.

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"[Osteoarthritis] is a huge source of disability and a huge part of our national expenditure for health-related issues."

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The cause is a degeneration of the articular cartilage that sits between bones to help them move smoothly against one another.

“Healthy cartilage has a coefficient of friction lower than anything else known to man,” said Spitzer. “It's very smooth and pristine, white and shiny.”

It can become damaged over time, making age a significant risk factor. Almost half of all OA sufferers are over the age of 65.

But an early injury to a joint—such as an ACL tear, meniscal tear or fracture—can lead to the much earlier onset of OA known as PTOA. About 12% of all osteoarthritis is estimated to be post-traumatic. In fact, more than 50% of patients who suffer an early ACL tear are found to have PTOA 20 years after reconstruction.

“Anything that disrupts the pristine interior of the joint—whether it’s a meniscal injury or a ligamentous injury or something more serious, like a broken bone—can change the way the bones glide upon one another,” explained Spitzer. “And that can change the wear patterns on the cartilage and accelerate the degeneration of the cartilage, leading ultimately to arthritis.” 

https://www.cedars-sinai.org/blog/arthritis-at-early-age.html

Post-Traumatic Arthritis: Osteoarthritis After an Injury

From verywellhealth.com

Early treatment helps prevent chronic symptoms

Post-traumatic arthritis (PTA), or post-traumatic osteoarthritis (PTOA), is caused by injury or accident triggering cartilage bruising and joint inflammation. In severe cases, it can also tear the cartilage from bone resulting in cartilage loss and eventual joint degeneration. It is also known as secondary osteoarthritis (OA) because it is has a secondary cause and is not associated with aging and wear-and-tear on the joints. Post-traumatic arthritis causes pain and even temporary disability, but there are ways of managing.

This article will explain how PTA affects you, as well as its causes, treatment options, and ways to manage it.

 Post-Traumatic Arthritis in the Knee

Is Post-Traumatic Arthritis Temporary?

The good news is post-traumatic arthritis caused by accident or injury typically is temporary, lasting a few months or so. It is different from primary osteoarthritis (OA), which is a chronic condition and the most common form of arthritis.

Prevalence

Post-traumatic arthritis is the cause of an estimated 12% of all cases of osteoarthritis.

Parts of Body Affected by Post-Traumatic Arthritis

PTA can affect any joint that has been injured or experienced a physical trauma. However, osteoarthritis is generally associated with common body parts, including:

• Knees
• Hips
• Shoulders
• Wrist

Types of Sports and Accidents 

Studies have shown that sports injuries are risk factors for developing osteoarthritis later in life, but they can also be triggers for developing PTA immediately after injury, too.

High-contact sports, or highly physical sports in which contact injuries are likely to occur, cause the most  injuries or accidents leading to PTA injuries or accidents leading to PTA.

These include:

• Football
• Soccer
• Hockey
• Lacrosse
• Rugby

Certain injuries are also associated with PTA, which include fractures, cartilage damage, acute ligament sprain, and chronic joint ligament instability. Experts say the most frequent clinically significant injuries are in the anterior cruciate ligament (ACL), the menisci, and the hyaline cartilage.

Examples include:

• ACL tear (knee): A tear or sprain in the connective tissue linking your femur (thigh bone) and tibia (shinbone)
• An acute meniscal tear: Knee injury often caused by pivoting
• Intra-articular fractures: Breaks in bones that cross a joint
  
  

How Do You Know If You Have Post-Traumatic Arthritis?

Unlike osteoarthritis, which develops over years, PTA will have acute or sudden signs and symptoms. These may appear right away or in the months right after injury. These will tell you whether or not you should speak to a healthcare provider about PTA.

Signs and symptoms of acute post-traumatic arthritis:

• Joint swelling or fluid buildup in the joint (synovial effusion)
• Severe (localized) joint pain and stiffness
• Inability to put pressure or bear weight on the injury area
• Soft tissue inflammation around the affected joint

Post-traumatic arthritis may also involve internal bleeding due to a high-impact injury. It's important to consult a healthcare provider for a physical exam following a sports injury or accident. They can provide diagnosis and next steps for your situation to reduce inflammation, pain, and, if necessary, bleeding.

Goal of Post-Traumatic Arthritis Treatment

This type of osteoarthritis is typically temporary, but it isn't reversible and there is still good reason to seek treatment for PTA. The goal of PTA treatment is to minimize symptoms including inflammation and swelling contributing to pain and loss of joint mobility and function.

Early Treatment Benefits

Early and localized treatment may be an effective way to reduce likelihood of developing chronic PTA after direct joint trauma.

Managing Chronic Post-Traumatic Arthritis

Chronic PTA is when symptoms of post-traumatic arthritis persist or last for six months or more. The transition from a temporary to a permanent condition is linked to severe inflammation. Managing chronic post-traumatic arthritis will involve treating the inflammatory mechanisms causing pain.

Medications for treating pain or inflammation

Many options exist for managing chronic pain. Finding what works best to reduce inflammation and pain may take some trial and error. The following are common options for treating osteoarthritis pain.

• Analgesics (pain relievers) such as over-the-counter (OTC) Tylenol (acetaminophen) or prescription opioids
• Nonsteroidal anti-inflammatory medications (NSAIDs) such as aspirin (acetylsalicylic acid), Advil (ibuprofen), Naprosyn (naproxen), and Celebrex (celecoxib) available OTC or in prescription-strength options
• Corticosteroids or prescription steroidal anti-inflammatories in oral or injection options
• Natural counterirritants such as capsaicin, menthol, or lidocaine that irritate nerve endings to change the sensation to cold, hot, or itchy and redirect your mind away from the pain

Lifestyle Modifications for Managing Chronic Pain

In addition to medication and following any specific treatment recommendations from your doctor or rheumatologist (arthritis specialist), experts suggest managing osteoarthritis of all kinds with exercise and assistive devices that can help support your joint strength, mobility, functioning, and overall health.

Examples include:

• Exercise that includes a mix of strength-training, range of motion exercises, cardio or aerobic activities, and balancing exercises
• Weight loss, if necessary, to remove excess pressure on joints
• Physical therapy and assistive devices like braces for reducing pressure on joints where necessary

Complementary Therapies for Pain

You may need more than one treatment for pain, including at-home complementary therapies for post-traumatic arthritis. According to the National Centre for Complementary and Integrative Health (NCCIH), a growing body of evidence supports the following therapies’ use for short- or long-term pain management:

• Acupuncture
• Hypnosis
  Massage therapy
• Mindfulness meditation
• Music-based interventions 
• Chiropractor work or spinal manipulation
• Tai chi
• Qigong
• Yoga
  

Surgery

Surgery for PTA may be needed in severe cases that cause persistent symptoms that interfere with quality of life. Surgical options include:

• Joint fusion, when a plate and screws hold the joint together
• Joint replacement surgery (arthroplasty), when an artificial joint replaces the damaged one
  

Summary

Post-traumatic arthritis is a secondary type of osteoarthritis caused by direct joint trauma or injury and accident. Symptoms can start right away or emerge in the months after injury. The condition usually is temporary, although symptoms lasting longer than six months indicate it has become a chronic condition. Repetitive and high-impact, high-contact sports are associated with developing osteoarthritis or experiencing post-traumatic arthritis.

Treatment is geared toward reducing physical trauma and inflammation and preventing chronic symptoms. Options include OTC and prescription medications, lifestyle modifications that include a range of exercises, assistive devices where necessary, and complementary therapies.

https://www.verywellhealth.com/post-traumatic-arthritis-7853503 

Dr. Jose: Knee pain while running? Don’t blame arthritis.

From seacoastonline.com

Is running bad for your knees? Does it cause arthritis?
We get asked these questions a lot, especially by clients who are in their 50s and 60s and wondering if it’s safe to keep running.
The short answer is: No!

If you experience knee pain when you run, it’s not that you’ve “aged out” of the sport, or because it’s causing arthritis in your knees. This is a very common misconception about running when in fact, research supports that running may actually be GOOD for your knees, and that running alone does not cause arthritis to develop.

Staying strong, active, and mobile is your best defence always against osteoarthritis. Therefore runners, because they are typically active and healthy individuals, often have healthier knees compared to their non-running counterparts.

OK then, so if not arthritis — what really causes knee pain in runners?
In most cases, it’s simply a bio-mechanical issue that goes unaddressed over time. But the GOOD news is that once identified, these issues can actually be fixed with proper education and strengthening. (Best offered by a movement specialist — like us!)

Here are three of the most common factors we see that are often the true culprit of knee pain when you run (not arthritis):

1. Poor ankle mobility

Ankle mobility affects the way force hits your foot, which can impact your knee. If your ankle doesn’t move fully, freely and adequately — excess forces will be shifted up to your knee. The knee may be forced to flex, and/or rotate, and/or tilt more than it needs to. This, in turn, may result in unwanted loads that the tissues of the knee can’t handle. A biomechanical and movement expert can not only help you identify if this is your true “knee problem” — but can also help you improve your ankle mobility in order to prevent long-term damage to the joints, tendons and ligaments of your knees. We actually see this as a very common problem in those that have sprained or twisted their ankles in the past. If that’s you — this could be a reason why you’re suffering from knee pain while you run.

2. Weakness in your hips and thighs

There’s a widely perpetuated myth out there that runners don’t need to strength train. That’s simply not true! Adding strength training to your running regimen makes it way less likely that you’ll suffer an injury. When it comes to protecting your knees, developing good, balanced strength in your hips and thighs is critical. The hamstring and quadriceps muscles play a crucial role in stabilizing the patella, otherwise known as your kneecap. Since running is extremely repetitive on your joints, especially your knees, it requires they have good durability and endurance - something that is lost quickly when you neglect proper strength training. Often “wear and tear” in your knees (otherwise known as arthritis) will get blamed for your knee pain when in actuality, the loss of strength around your knees is what’s causing that wear and tear to feel worse than it needs to.

3. Unstable core

It may seem like running is all in the legs, but the stability of your pelvis and trunk have a huge influence on how your legs perform. You derive the majority of your power, speed, and stamina from your core muscles and glutes. Much like with ankle mobility, if your core is not performing adequately or efficiently — your legs will have to work harder. A stable core is key for developing and maintaining good balance and rhythm with any activity — but especially running. With a repetitive activity like running, efficiency and form is everything. Without a strong core, it’s impossible for your leg muscles and knee joints to work as efficiently as they were designed to, and it will be really difficult for you to maintain good and proper running form mile after mile. When your core strength is weak, and doesn’t have enough endurance to sustain the amount of miles you want to run, your knees will suffer.

What’s important for you to remember is that arthritis is NORMAL — everyone gets it as they age.
What doesn’t have to be “normal” is for arthritis to stop you from running, or doing any other activity that you love. You can get surgery to fix the “wear and tear” in your knees, or injections to decrease the inflammation, but if you don’t check and address any of the biomechanical issues I just mentioned, among others, these fixes will be temporary and your knee pain will keep coming back. And worse ... could force you to stop running all together!

If you’re suffering from knee pain, and it’s starting to impact your ability to run or do any other activity that you love, you might want to join us for our next live Zoom workshop: Preventing and Overcoming Knee Pain so you don’t have to stop activities you Love!
It’s free, and happening Tue. Aug 25 from 6 to 7 p.m. Just call or email to reserve your virtual seat.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or get a free copy of her guide to preventing and stopping knee pain, email her at info@cjphysicaltherapy.com.

https://www.seacoastonline.com/sports/20200815/dr-jose-knee-pain-while-running-donrsquot-blame-arthritis

Skiing with arthritis

From timesofindia.indiatimes.com

Arthritis used to end people’s skiing lives. No longer. Current non-operative therapies, as well as operative repairs, now have people on the slopes into their 90s. Here are the reasons why:

Arthritis of the knee and hip are the most common aches and pains that discourage people in their middle and older ages from skiing. Yet today, these men and women visit our offices for “lube jobs,” as many call them, in order to enjoy winter sports. What has changed?

Joint lubrication used to be a simple injection of hyaluronic acid (HA). It worked but often didn’t last long enough. This was in part because inflammation is the most common cause of joint pain, and HA alone is not potent enough to combat the inflammation generators. Today, HA is combined with growth factors from a variety of sources. These include your own blood (called PRP), amniotic fluid and membranes, fat, and bone marrow. These growth factors stimulate the joint lining to produce more HA, decrease the degradative enzymes in the joint associated with arthritis, and increase the anabolic factors that promote healing.

The current thinking is that specific growth factors recruit the body’s own stem cells to the joint. These further decrease inflammation and promote whatever healing can occur. Last year’s thinking—that we should inject stem cells directly—has been replaced, as it is now believed that the directly injected stem cells probably die off too quickly. But since all people have billions of stem cells, recruiting them to the site of injury makes the most sense. Our research today focuses on which injected bioactive factors are most effective at recruiting stem cells: producing natural HA as a lubricant and decreasing inflammation. Our “lube job” of today is a potent cocktail of these factors. Many patients report six months to a year of joint pain relief—usually enough to get through the ski season.

Physical therapy, Pilates, yoga, and workouts with stretching, guided by great trainers and therapists, definitely helps keep arthritic joints moving. Stiffness and loss of motion are what people notice the most when returning to skiing, and those activities help tremendously. Getting in a hot tub before skiing, and doing a stretching fitness class early in the morning before hitting the slopes, are also great ways to get more enjoyment out of your day. Even a pre-ski 20-minute stationary bike spin can do the trick. Most of my 70-90-year-olds ski the sweet spot of the day (10 am -2 pm), avoid low visibility or icy days, and smile all the way down the slopes. I often write prescriptions that state, “must ski powder.”

NSAIDS such as Ibuprofen and Celebrex still have their place and can be used for a few days before and during skiing. We prefer not to keep people on them, as they have deleterious side effects. We avoid cortisone, preferring to use bioactive factors.

If the tissue is damaged enough, it’s best to repair it rather than masking the injuries. Surgical repairs, both biologic and bionic, have improved so much that skiing after either meniscus replacement and articular cartilage repair, or after robotic partial and total knee replacements, is now prescribed as a therapy rather than abandoned. In general, it takes three to six months to return to skiing after complex knee joint repairs—so many patients opt for surgery in the late spring or summer. By the time early winter comes, they prefer joint lubes. This allows them to delay their joint repairs until after the snow has melted.

So buy your lift tickets. Tune your skis. Buckle the new lightweight soft-flex, high-reactive ski boots and head for the hills. If your joints talk to you, quiet them with targeted care that keeps you moving, sliding, turning, and gliding.

DISCLAIMER : Views expressed above are the author's own.

https://timesofindia.indiatimes.com/blogs/siliconvalley/skiing-with-arthritis/