Are you a futsal, judo or marathon die-hard? Have you sustained one too many sprains and strains while participating in such activities?
Then do be careful because some sports injuries can develop into osteoarthritis later in life.
While it’s commonly associated with the elderly, athletes and younger ones can also be afflicted with this “wear and tear” disease.
When osteoarthritis strikes, the cushioning material (cartilage) that covers the ends of the bones breaks down.
Symptoms include pain in the joints, tenderness when touched, a grating sensation at the joints, stiffness upon waking up or loss of flexibility.
When cartilage wears away completely, the bones rub against each other, which can be even more painful and debilitating.
Research suggests that athletes are more prone to osteoarthritis than the general population because of the years of punishing physical activity that has placed excessive stress on the joints.
“Osteoarthritis is basically a cartilage failure; to regenerate or regrow it is difficult, so the risk is higher with increased age and body weight.
“Cartilage can grow physiologically, but bear in mind where the injury site is.
“If the injury occurs at the smaller or non-weight-bearing joint, e.g. shoulder, hand or metacarpals, regrowth is faster than compared to the knee, ankle and hip because these carry our weight,” explains consultant orthopaedic surgeon Dr Mohd Fairudz Mohd Miswan.
Damage to cartilage is not readily repaired by the body because unlike most tissues in the body, cartilage doesn’t have its own blood supply to bathe damaged tissue and provide factors that promote regeneration.
If an injury occurs at an older age (60 and above), it takes even longer to heal.
“For me, if a patient is 50 or 54, I still consider him young, but osteoarthritis can occur at any age, even in those who have never had injuries. This becomes a primary factor.
“For those with previous injuries, it’s obvious that we can consider osteoarthritis a secondary factor because there are other factors involved.
“The treatment is then more complex,” he says, adding that there is an increasing trend of injuries among recreational futsal and contact sports players.
The main culprit of osteoarthritis is excess body weight, which leads to heavy loads on the joints.
While Dr Mohd Fairudz doesn’t think there is a genetic predisposition, he says osteoarthritis could stem from a secondary disease such as Marfan syndrome.
This disease is caused by a defect in the gene that enables your body to produce a protein that helps give connective tissue its elasticity and strength.
People with Marfan syndrome are normally tall and thin with disproportionately long arms, legs, fingers and toes.
The damage caused by this syndrome can be mild or severe. If your aorta – the large blood vessel that carries blood from your heart to the rest of your body – is affected, the condition can become life-threatening.
He says: “The patient usually has extreme laxity so the joints can dislocate easily.
“Like other autoimmune diseases, their cartilage can become abnormal, and even a normal load can cause injury.”
When to seek help
Most of the time, patients seek treatment when the pain is no longer tolerable.
However, with younger patients, their pain threshold is much higher and seldom do they visit a doctor.
“Within one or two months of injury, it’s quite difficult to say if the patient will get osteoarthritis.
“Even MRIs (magnetic resonance imaging) cannot pick up osteoarthritis. It can only tell us there is a cartilage injury, but how bad it is, we cannot tell unless we do a scope,” says Dr Mohd Fairudz.
If it’s the knee joint that is affected, the patient will usually walk with knees turning outward and feet inwards.
X-rays can show some changes in the first two stages, especially when the cartilage begins to thin.
“The cartilage regrowth cannot occur at the site of the injury or affected area because you still need to put weight on the joint to bend and straighten it.
“So the cartilage starts to ‘sulk’ and grows outside, away from the force. This is the third stage and you can see the bony projection (osteophyte).
“Finally, when the cartilage cannot get any thinner, it hardens to protect the bone so we can see sclerosis (hardening of tissue that appears whitish on x-rays).
“Then, when you put more weight on the joint, it cracks and leaves a hole below the cartilage inside the bone (bone cyst).
“Once you’re in the third or fourth stage, you cannot reverse the condition.
“At this point, don’t waste time and money, just opt for knee replacement,” Dr Mohd Fairudz advises.
The main goal of treatment in osteoarthritis is to minimise pain and improve functionality.
For athletes, this becomes critical as return to play is the main gauge of functionality.
However, if you soldier on and ignore pains in the joint, you are going to worsen the condition.
While exercise and rehabilitation are important for osteoarthritis patients, putting heavy loads on the joint can spell disaster.
The current craze in extreme sports and adventure races drives people to push their bodies to the limit, just to gain satisfaction and a sense of triumph.
“Even with normal sports, you’re susceptible to all kinds of injuries, what more with extreme sports?” comments Dr Mohd Fairudz.
With injured younger patients, they sometimes walk in with an “agenda” and say they want to be active again in two months.
They may not be professional athletes, but such is their dedication, or perhaps addiction, to the sport.
“We must be very careful with this group,” he shares, “because a high percentage of them don’t listen.
“We have no magic pill and cannot measure the regrowth of cartilage.”
The last resort
Dr Mohd Fairudz shares that his youngest osteoarthritis patient is 35.
He had suffered a motor vehicle accident at age 30 and tore two of his knee ligaments.
But, because he didn’t have any insurance, the active fellow decided not to do anything about it.
“After four years, he came to see me and said he had saved enough money for the surgery, but by that time, the x-ray showed full blown osteoarthritis.
“Nothing could be done except total knee replacement. He got a new knee and is still active in sports though I’ve told him it’s not advisable to play contact sports.
“You can continue to be active, but not super active. Stick to carom or chess,” he says, smiling.
Knee replacement involves resurfacing your damaged knee with artificial components called implants.
Worldwide, almost every joint can be replaced artificially, but in Malaysia, as far as Dr Mohd Fairduz knows, only the bigger joints can be replaced.
There is also unicompartmental knee replacement (also called “partial” knee replacement) available, where only a portion of the knee is resurfaced.
This procedure is an alternative to total knee replacement for patients whose disease is limited to just one area of the knee.
One criterion to qualify for this surgery is that the patient must be below 45 years of age.
However, the price for this surgery is the same as that for a total knee replacement.
The consultant is quick to point out that even with these joint replacements, there is no guarantee that one will be 100% pain-free.
“You can achieve up to 95%, but the other 5% of pain may come from other sources.”
With an artificial knee, which can last up to 25 years, one cannot give extra force to the joint. Only small jogs are recommended.
Dr Mohd Fairudz says, “If my 35-year-old patient is normal, he will see me for a revision at 60. Or else, he has to come earlier.
“Doing revision is more difficult as we’ve got to take out the whole implant and put a new one in.”
When we get older and slow down, that’s when things strike.
So, unless you’re a professional or elite athlete who’s undergoing a specific training modality to up your game, do preserve your joints and don’t push yourself too hard daily.
“If you want to take it easy, yet be healthy, just do things according to your age, capability and speed.
“If you’re 35 now and aspire to become a sprinter, it’s not possible.
“What is it you want to achieve if you go beyond what the body is capable of?” he asks.
Of course, there are the one in a million old people who can do amazing things, but the risk factor is always there.
“So, don’t overdo things. Follow your age, check your body weight, let the previous injuries heal, please seek treatment early and don’t wait until the second or third symptoms to strike before seeing the doctor.
“My role is to make you better and if I’ve done everything I can, but you still don’t quit your activity, I’ll quit myself as your doctor!” concludes Dr Mohd Fairudz, throwing his hands up in mock surrender.