How Athletes Can Cope With Osteoarthritis

Joe Hahn is a little slower than he used to be. A high school football career and subsequent decades devoted to running and playing lacrosse every week have led to osteoarthritis -- a wearing away of the cartilage -- in both of his knees. "It affects how you move laterally. Your brain gives you the green light, but your body just says no. It slows down what you can do and changes the dynamic of how you're performing," explains Hahn, a 48-year-old from Cleveland.

Hahn is like many lifelong athletes who discover that years of punishing physical activity take a toll. Research suggests that athletes are more prone to osteoarthritis than the general population, especially professional and elite athletes. "It has to do with putting a lot of miles on the body. It can be very frustrating for athletes who are used to being exceptional at what they do and using their strength, mind, body and spirit to excel at their sport," says Dr. Jason Genin, a Cleveland Clinic physician who specializes in orthopedics and sports medicine. He's also the team physician for the Cleveland Indians.

What Is Osteoarthritis?

Osteoarthritis is a degenerative condition that affects about 30 million Americans, according to the Centers for Disease Control and Prevention. The condition can occur in any joint and is common in the knees, hips, lower back, neck, hands and big toe.

It's not clear exactly what causes osteoarthritis. Risk factors include old age, obesity (which adds pressure on the joints), injury, family history and bone deformities.

But we do know that when osteoarthritis strikes, the cushioning material (cartilage) that covers the ends of the bones breaks down. Symptoms include pain, stiffness, crunching or grating sounds when the joint is flexed, swelling and loss of flexibility. When cartilage wears away completely, the bones rub against each other, which can be even more painful and debilitating.

[See: Osteoarthritis and Activity: Walking It Out.]

Seeking Treatment

If you soldier on as an athlete and ignore osteoarthritis, you may face several consequences:

-- You could make symptoms more pronounced. "We're not sure if it causes more degeneration, but if you continue to put heavy loads on the joints, it has the potential to make osteoarthritis pain worse," Genin says.

-- You could miss another condition, like a muscle or tendon injury, without realizing it. "Often an older marathoner can have a tendon overuse injury which isn't actually a tear but causes buttock or groin pain that mimics hip arthritis," Genin points out.

-- You may experience stress or anxiety about the injury. "Athletes deal with the psychological side of osteoarthritis and uncertainty about what to do and whether they can keep doing what they're doing," says Matthew Ithurburn, a sports medicine researcher and assistant professor of physical therapy at the University of Alabama at Birmingham.

Both Genin and Ithurburn recommend that you seek treatment for osteoarthritis sooner rather than later. You can turn to a physician (such as a primary care doctor, orthopedist or rheumatologist) or a physical therapist (in some states, like Florida, you don't need a doctor's referral to visit a PT).

The first step is receiving a diagnosis, which typically involves a doctor's interpretation of a physical exam, your medical history and X-rays.

[See: How to Practice Yoga When You Have Arthritis or Another Chronic Condition.]

The First Line of Defense

Don't assume that osteoarthritis automatically leads to joint replacement surgery. The American Academy of Orthopaedic Surgeons recommends physical therapy as one of the best approaches for managing osteoarthritis of the knee or hip.

Physical therapy involves a tailored program of exercises that stretch and strengthen the muscles supporting the arthritic joint. For the knees, that means strengthening and stretching the quadriceps and hamstrings in the thighs as well as the hip muscles (gluteus maximus, minimus and medius). "When the muscles are stronger, they absorb some of the force that would otherwise go through the joint," Ithurburn explains. "It helps relieve pain and also keeps the mechanics of the joint working properly."

Exercise is also important when you have osteoarthritis. "Healthy cartilage requires some amount of loading to maintain its mechanical properties," Ithurburn says. He recommends low-impact activities such as swimming, cycling or using an elliptical machine, or working out in a pool where buoyancy will decrease the load on the joints.

You can also modify exercises you enjoy if osteoarthritis makes them too painful. "Instead of power walking, slow down," Ithurburn suggests. "And if you want to walk but it hurts after 20 minutes, then walk for 15 minutes."

Weight loss is another simple but effective approach to managing osteoarthritis if you're carrying extra pounds. "Every one pound of weight you lose takes four pounds of pressure off the knee," Ithurburn says. So losing 10 pounds would mean that you relieve 40 pounds of pressure.

And when it comes to managing arthritis pain, resting and icing arthritic joints can help.

Medical Treatment

For athletes whose osteoarthritis has advanced or is causing relentless pain, medical treatment may be necessary. These approaches include:

-- Nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin). "We have to be careful with NSAIDs. Some studies suggest they're linked to an increased risk for heart attack, damage to the kidneys and gastrointestinal bleeding. It doesn't mean you can't use them, but you should be monitored," Genin warns. Make sure you speak to your doctor before taking NSAIDs on a regular basis.

-- Corticosteroid injections. Corticosteroids are powerful anti-inflammatory drugs that can help reduce inflammation. But the effect is temporary, lasting only weeks to months, and frequent shots are not recommended.

-- Hyaluronic acid injections. These are injections of a synthetic lubricant similar to a component in the body's natural joint lubricant, synovial fluid. The Food and Drug Administration has approved numerous hyaluronic acids for injection and treatment of knee arthritis, but studies about the effectiveness of the injections are mixed and indicate that at best they may offer temporary relief. The AAOS does not recommend use of the injection.

-- Orthobiologic injections. This can include platelet-rich plasma (using platelets from your own blood, which are loaded with growth factors), stem cells (cells with the ability to develop into other types of cells) or cells derived from human placentas (after a baby is born). But keep in mind that some of these treatments are experimental and not yet FDA-approved, and studies about whether these treatments work are inconclusive. "As of yet, the studies haven't been well-defined," Genin says. PRP is not regulated by the FDA, but the equipment used in the procedure is approved.

[See: How to Get Your Fitness Groove Back.]

The Bigger Picture

Genin emphasizes that treatment typically requires a number of approaches, and that it must be individualized. "Some athletes need anti-inflammatories and physical therapy. Others need an exercise plan and injections," he says. "It depends on the person and the stage of arthritis." He notes that in general, the earlier you seek treatment, the more effective it is.

And when all treatments fail, joint replacement is the last resort.

Hahn has had knee injections and is still debating which way to go next for treatment. He and other athletes can be buoyed by the options.

"You really can get back to doing what you love," Ithurburn says. "I've seen athletes strengthen their muscles and get back to running, and they're in less pain and are less limited than they were before."

Heidi Godman is a freelance health reporter for U.S. News. Her work has appeared in dozens of online and print publications, including the Harvard Health Letter (where she serves as executive editor), the Chicago Tribune, Baltimore Sun, Orlando Sentinel and Cleveland Clinic Heart Advisor. Heidi also spent more than 20 years as a TV news anchor and health reporter. She's interviewed surgeons in operating rooms, scientists in laboratories and patients in all phases of treatment. Heidi has earned numerous awards for outstanding health reporting and was the first TV broadcaster in the nation to be named a journalism fellow of the American Academy of Neurology. Email Heidi at health@heidigodman.com.