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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

and muscles healthy, and in good working
order. This is endorsed by a government
report published in April 2004 which

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
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
                                                                                               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
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