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he importance of sport and physical While it is important to exercise to keep fit and
T exercise for maintaining a healthy
body and mind is well documented.
But for many people with arthritis,
the additional pain associated with
undertaking sport or other kinds of
healthy, it is equally important to look after
your joints while you do it. Mo Atchia explores
how over doing exercise and injury can
physical activity can present a daunting
prospect. exacerbate arthritis
In general, exercise helps to keep joints
Sporting
and muscles healthy, and in good working
order. This is endorsed by a government
report published in April 2004 which
chance
states that physical activity can help
prevent osteoarthritis by strengthening
cartilage and muscles, which in turn
protects joints and bones.
However, active participation in exercise
and sports can all too easily involve injuries
to joints, tendons and muscles. If these are
not treated properly they may lead to soft
tissue rheumatism or even osteoarthritis. In
addition excessive physical activity can
increase the risk of over-use injury.
Unsurprisingly, a host of former
professional sportsmen and women have
developed osteoarthritis.
These include former football tough-
tackling Liverpool and England defender
Tommy Smith, former Arsenal and
Scotland goalkeeper Bob Wilson, and
former Newcastle and England striker
Malcolm McDonald.
Former Welsh rugby wizard Gareth
Edwards, Spanish golfing legend Seve
Ballesteros and former tennis player Alice
Peterson also now live with the pain of
arthritis developed largely as result of their
sporting careers. And across the Atlantic,
American basketball superstar Shaquille
O’Neill has even had to take time out due
to arthritis of his big toe.
there are ways of
minimising the risk of
injuries
Research published in the British Journal
of Sports Medicine last year revealed
professional footballers are 10 times more The relationship between sports injuries ‘Perhaps the most important aspect of
likely to have arthritis in their hip later in and arthritis is currently being investigated our work has been acknowledging that this
life. And the problem is not confined to by Alan Hodson, who is head of the relationship between the two actually
Photos: Mauro Fermariello/Science Photo Library,
men, as research carried out by Swedish English Football Association’s Medical and exists,’ he tells Arthritis News. ‘What we
researchers last year found, women Exercise Science Unit. need to do is ask the question: Is there
Alpha/Empics, Peter Robinson/Empics
footballers are more prone than men to His department is responsible for the anything we can do to increase and
knee injuries which can lead to arthritis. education, training and co-ordination of improve methods of preventing arthritis as
Many of the women they interviewed at courses for people, representing over a result of football and other high impact
Lund University who damaged a ligament 43,000 affiliated amateur, youth, semi- sports?
went on to develop arthritis of the knee, professional and professional clubs. The ‘The main areas of concern for players
leading researchers to estimate the risk of department has joined forces with Bath tend to focus on the hips, ankle and knee
knee ligament injury is three to four times University to try and tackle the problem joints. Unfortunately with joints there is
higher for young female players. of arthritis. little we can do to prevent injuries taking
10 arthritis news
before matches.
‘The strain and the damage I was doing
to my body was terrible, but in those days,
when you were injured, the clubs wanted
you back playing as soon as possible. I, of
course, wanted to prove that I could cut it
at the top.’
‘Listen to your body’ is becoming an
increasingly familiar mantra among those
working to prevent injuries among
athletes. But is it as relevant to those
pursuing sport and physical activity as a
hobby as it is to top professionals.
rest gives the body a
chance to
reconstruct
Damien Doyle is a sports therapist at
English Football League One outfit
Brentford. He tells Arthritis News: ‘Rest
and allowing the body adequate time to
recuperate is as important as exercise itself.
In many ways, it is almost like an extra
training session.
‘During any kind of physical activity the
muscle fibres break down. The more time
that is spent undertaking physical activity,
the faster this process takes place. Rest is
vital as it is gives the body the chance to
reconstruct these fibres.
(above) Gareth ‘The muscles are naturally stronger and
Edwards of Welsh rugby ‘It was an amazing time,’ he says. ‘I was firmer once the fibres are reconstructed,
fame has arthritis. very head-strong and determined to reach and are better prepared for subsequent
(right) Goalkeeper Bob the top. It’s every kid’s dream to become a physical activity. If you are tired or in pain,
Wilson has had a hip footballer, and here I was with arguably it is your body’s way of saying: Stop, I’m
replacement as a result one of the world’s biggest clubs.’ not ready for this.’
of osteoarthritis However, Mark’s dream eventually By not listening to your body, the
turned into a nightmare when, after a individual heightens the risk of sustaining
place, but there are ways of short period of illness, he began to an injury. Non-professional athletes, who
minimising the risk of such experience pain during games and sagging may not have the advice and guidance of a
injuries inevitably leading to energy levels. trained sports therapist easily to hand, are
arthritis. One of these is by ‘I found that I was getting extremely particularly susceptible.
reducing the number of tired and my joints started to creak. It was ‘The players at Brentford train every day
games played by players very painful. I spoke to the people at the of the week to maximise their performance
who are still relatively very club and they wanted to send me out on on the Saturday,’ says Doyle.
young, and whose bodies are loan to another team to gain some match ‘Unfortunately, the Sunday league player
continuing to grow.’ experience, but I refused. I wanted to who works in the week, and does not train
prove myself, but was not listening to what to strengthen the muscles to prevent
I was determined to my body was telling me.’ injuries, often ignores this fact. As a result
reach the top The ‘wear and tear’ of too many football
matches, inadequate treatment for injuries
he or she makes themselves much more
susceptible to trauma injuries, such as a
and rushing back into action before he was sprained ankle or knee ligament strain.’
Mark Earp was once one of the aspiring ready all took their toll. Mark developed A sprained ankle is an example of what is
footballers Mr Hodson refers to, with some osteoarthritis in his early 20s. known as an acute, or sudden, injury, and
of Europe’s biggest clubs chasing his ‘I must have had around 30 cortisone requires immediate treatment to lessen the
signature. He signed his first professional injections in my four years at Ajax. I used risk of the injury being aggravated in the
contract with Dutch giants Ajax, spurning to go onto the pitch like a mummy, future. This is also essential in reducing the
a similar offer from Chelsea. At 16, Mark completely wrapped up in bandages risk of the development of arthritis.
looked set for a glittering career as a star around my ankles and knees. On several Damien Doyle, along with other
centre forward. occasions I had pain killing injections right sport therapists, employs the RICE ➥ p13
february/march 2005 11
➥continued from page 11 for: Rest, Ice,
principle, which stands
as being prime causes of over-use injuries
to the shoulders, arms, hands, wrists and
then surgery can arrest the development of
arthritis. Things become more
Compression and Elevation. neck. He added that all sports place a problematical when ligament injuries are
‘What we try to achieve is the avoidance potential damaging strain on the back. sustained over the age of around 30.’
of a build up of fluid and inflammation Thomas is part of a new-look team that
around the injured area,’ he says. it’s important people sustaining sporting injuries can
The immediate immobilisation of the
affected area (rest) should be followed by
people tailor their turn to during the recovery process. They
include a growing number of GPs specially
the application of ice, a compress and regime trained in dealing with sporting injuries,
elevation of the affected area, ideally above rheumatologists, orthotic surgeons (who
heart level while lying down. Another factor people should take into study feet), physiotherapists, dieticians and
However there is more to injury account is the correct equipment, says nutritionists, and personal trainers. All but
prevention that simply ensuring you get Thomas. ‘It sometimes comes across as a the latter are generally available to patients
adequate rest. Panos Thomas is an trivial matter, but the appropriate footwear on the NHS.
orthopaedic surgeon at the Whittington and protective clothing can play a crucial An exciting feature of this new set-up –
hospital in London. He works with several role in the prevention of injuries.’ which is being advocated by the
football teams across the capital, including While Thomas does not believe age Government as part of its drive to improve
Arsenal, as well as people who have should prevent someone taking a health among UK citizens – is the capacity
sustained injuries through others sports programme of sensible exercise, he adds for GPs to prescribe exercise programmes
such as cricket, tennis and rugby. that as people grow older the body’s tailored to an individual’s needs.
As well as being a sports injury expert, metabolism changes, causing less calcium ‘This will give the patient the
opportunity to aid, for example,
the cardiovascular system,
through a prescription of
exercise tailored by his or her
GP or physiotherapist to meet
his or her specific fitness levels
and health needs,’ says Thomas.
participation is a
great boost
Mark Earp for one has refused
to allow his experience of
pushing his body to breaking point to
Mark Earp (right) playing for his local club recently, and prevent him from enjoying the benefits of
(inset) with legendary Dutch club Ajax in the 70s exercise. From taking on opponents on the
football field, he has transformed his
Thomas was formerly a professional to be produced by exercise regime.
footballer himself, plying his trade for the body to protect He now spends a couple of hours a week
Greek club Panathanaikos before joining bones from fractures. practising tai chi and Pilates. Both are
Italian side Fiorentina in the 1980s. As a result the muscles become less flexible, aerobic exercises which require a minimum
‘Diet, fitness and warming up are leading to a greater predisposition for impact on the joints, but which are
essential composites for people wishing to strains and tears. excellent ways of keeping healthy and fit.
avoid injury,’ he advises. However, Thomas adds: ‘It would be Yoga and swimming are other ideal
‘If someone wants to take part in a wrong to suggest that once you have ways of ensuring your body is able to
physically demanding, high-impact sport reached a certain age that sport and receive a thorough workout while
like football or rugby, then preparation and exercise is no longer an option. It is just reducing the risk of injury. It is, of course,
training should be undertaken gradually. important that people tailor their always important to consult your GP or
Weight training is a good way of building particular regime or programme to their specialist before beginning a programme
up stamina and muscle strength, but, individual circumstance.’ of physical activity.
again, this should be done carefully.’ He does, however, believe that certain ‘In many ways, developing arthritis has
There are broadly two kinds of sporting types of injuries have a greater potential to helped me appreciate the benefits of
injury – acute, as outlined above, and precipitate arthritis than others. ‘It’s fair to exercise,’ claims Mark. ‘Having the
injuries sustained as a result of over-use. say someone sustaining a bone fracture will condition doesn’t mean having to settle for
‘Over-use injuries can be quite prevalent be more likely to see the development of watching other people enjoy themselves
in racket sports such as tennis, badminton osteoarthritis later on in life. The same can from the sidelines. Participation in itself is
and squash,’ said Thomas. ‘Even golf can not be said with the same degree of clarity a great boost and, as long as you take a
pose problems, as the same muscles and with ligament injuries. sensible approach, there is no reason
ligaments are in constant use.’ ‘Evidence suggests that if ligament why you can’t live a full, active and
Thomas highlights racket sports and golf injuries are sustained before the age of 30, healthy life.’
february/march 2005 13
Physically
demanding
John Barnwell, head of the League Managers
Association and former midfielder, chats to
Mo Atchia about how injury led to a
shortened playing career
ohn Barnwell is as well placed as
J anyone to understand the pressures
that go hand-in-hand with life as a
professional sportsman. In his prime,
during the 50s and 60s, he was a creative
midfielder plying his trade for giants of the the end of the road of his
English game Arsenal and, subsequently, career as a professional
Nottingham Forest. footballer in 1970, at the age
Today he heads the League Managers of 32.
Association, the ‘trades union’ for all Despite going on to
professional football managers in England. become a successful manager
As one of the ‘old-school’, football was a – he took Wolverhampton
Barnwell (above) scoring for Nottingham Forest
very different proposition for him than it Wanderers to League Cup
in 1965 and (above right) as Wolverhampton
is for today’s breed of high-earning stars. glory in 1980 – Barnwell
manager in the 70s
‘Not to put too fine a point on it, it was believes the delay in a proper
basically a lot more violent then than it is idea how serious it was. As he admits: ‘It diagnosis of his injury cut at least three
now,’ he told Arthritis News. ‘The modern was the beginning of the end of my career more years off his playing career.
game is certainly quicker and more – and I didn’t even know it. ‘There aren’t many things I regret about
intensive, but in terms of brute force and ‘We were playing against Barcelona and my life, but that is certainly one of them.
aggression, there is no comparison.’ an opponent trod on my heel, injuring my It shouldn’t have happened. I was good
Like many other athletes Mr Barnwell right ankle. The initial diagnosis was that I enough to have played on for a few more
went on to develop osteoarthritis, and had sustained an Achilles tendon strain. It years, but was robbed of the chance.
underwent a hip replacement operation. was the summer so I had about eight ‘Fortunately that sort of thing would
‘The wear and tear of the game took its weeks rest before I began pre-season not, could not, happen now. The medics
toll. Much of my career was spent playing training which was always tough. employed by clubs are so much more
when substitutions were not allowed. professional than when I was playing.
‘Players were encouraged to stay on the if you were injured, ‘Cortisone use is frowned upon, and
pitch, even if they had sustained an injury. there is a whole team of nutritionists,
We used to mask injuries with cortisone
you’d be worried fitness experts, physiotherapists and sport
injections, carry on playing and end up someone would take scientists that have revolutionized the way
with an even worse injury. we view and treat injuries. The players are
‘But it wasn’t just the clubs that exerted your place far more protected than we ever were.’
pressure on us. Players weren’t earning Despite this revolution, Barnwell
thousands of pounds a week, and, ‘The new season began and I started the acknowledges that some things in
therefore, clubs could afford to have a few first two games, scoring in one of them professional football will never change.
more on their books. against Arsenal. However during the Results are as key now as they ever were.
Photos: Peter Robinson/Empics; Barratts/Empics
‘If you were injured, you’d be worried second match my ankle was giving me ‘Managers are always going to want their
that someone else would come in and take terrible trouble, eventually it broke down. strongest side out, the margin between
your place. There were also win bonuses ‘A different doctor was brought into success and failure is incredibly small. But
and appearance fees that you couldn’t earn examine it, and he told me it had been there are obvious dangers in rushing
if you weren’t playing. A lot of players fractured for two-and-a-half-months.’ players back, and physios and club doctors
placed pressure on themselves.’ The injury required an operation but, need to be strong in the face of that kind
It was while at Nottingham Forest that even though he ‘trained like mad’ to of pressure.
Barnwell experienced his first major injury. recapture full fitness the damage inflicted ‘The days where a career in sport
The problem was that neither he, nor the on his ankle, plus subsequent injuries to inevitably leads to a long-term injury
medical staff who examined him, had any his other ankle and knee, eventually meant should be far behind us.’
february/march 2005 15
