diet and knee osteoarthritis

Diet & Detox: the best approach to dealing with knee osteoarthritis

It’s January; a time of fresh starts and new resolutions and a recent report from the Radiological Society of North America is further proof that adhering to the right diet and taking a prudent approach to healthy living is not just for the first few weeks of the new year.

The study, the results of which were presented at the annual meeting of the Radiological Society of North America (RSNA), was an attempt to discover what role diet and exercise played in reducing the risk of knee osteoarthritis, and which method works best. It involved the tracking of 760 people with an average age of 63 and a body mass index of greater than 25, who either had mild to moderate osteoarthritis or were displaying risk factors for the disease.

The people involved were divided into two groups: those who had lost weight, and those who hadn’t. The weight-loss group were then divided into groups corresponding to how they lost weight: diet and exercise together, diet alone, and exercise alone. The research teams then measured knee osteoarthritis with MRI at the beginning of the study, after 48 months, and finally at 96 months.

Exercise is not enough

The results were interesting, to say the least: unsurprisingly, cartilage degeneration was significantly lower in the group which had lost weight compared to the group who over the 96 months. However, this finding was only present among the patients who lost weight through diet and exercise or diet alone – and although the group who only exercised lost as much weight as those who dieted, they displayed no significant difference in cartilage degeneration when compared to the group who lost no weight.

“The more weight loss the patients achieved, the greater the benefits were, even if they remained obese after losing weight,” said Dr Alexandra Gersing, of the Department of Radiology and Biomedical Imaging at the University of California, in San Francisco and the study leader. “These results add to the hypothesis that solely exercise as a regimen in order to lose weight in overweight and obese adults may not be as beneficial to the knee joint as weight loss regimens involving diet.”

Exercise and diet go hand-in-hand

Why would exercise alone prove to be so ineffective in reducing the risks of developing knee osteoarthritis?  The study doesn’t go that deep, unfortunately – but at a rough guess, weight loss through exercise would involve putting a lot more strain on the joints than shedding pounds through eating more of the right things. And, of course, more exercise means more muscle build, which can load up the strain on the joint areas.

However, no-one is playing down the benefits of regular exercise on the whole of the body, never mind the joints – and as good habits in the gym or on the track naturally lead to equally good habits in your diet, you should not be put off from embarking on an exercise regime this New Year. Naturally, you’re not advised to plunge in at the deep end: if you haven’t been active in the gym for a while, it makes sense to seek advice and work out an exercise plan that best suits your needs and capabilities.

knee osteoarthritis and fear of movement

‘Fear of movement’ limiting activity levels of knee osteoarthritis patients 

We may be aware of the damage that osteoarthritis can impose on the body, but we’re still trying to understand how it affects us mentally – as a new study from the University of North Carolina reveals. According to the study, which was published in the American medical journal Arthritis Care & Research last month, sufferers of knee osteoarthritis are developing a fear of movement associated with the condition, which is leading to a decrease in active lifestyles, a drop in their quality of life, and increasing the risk of their conditions worsening.

The study involved a total of 350 participants, who were invited to take part in a clinical trial where they were asked to evaluate their fear of movement, as well as providing details on their age, sex, race, education, pain levels and general daily activities. Trends such as knee symptom duration, depressive traits, injury history and balance were also assessed.

The fear of falling

After the date was processed, it revealed that 77% of the study group agreed with at least one item on the Brief Fear of Movement measurement scale, with 36% endorsing three or more items, suggesting they had a pronounced fear of movement. Furthermore, it was found that patients’ age, daily activity levels, history of depression and capacity for exercise all had a big influence on their mindset in this regard.

Clearly, these results are concerning to say the least. It’s an understandable point of view, though: when a part of your body that you’ve trusted to work throughout your life breaks down, it’s very difficult to get that trust back. And the results suggest that this fear of further damage are holding back OA sufferers from staying active, which can lead to even worse damage in the long term.

Take the first step back to health

As all sports medicine experts know, getting an athlete off the surgery table and back onto the field of play takes so much more than a mere operation: the athlete has to both physically and mentally prepare themselves to relearn the techniques that were natural responses before the injury, and to trust their own bodies not to let them down again.

As this study makes clear, non-athletes need to take that same journey too. And, like the pros, more often than not they’ll need a bit of help to get there. As Devi Rani Sagar – research liaison manager at Arthritis Research UK – pointed out: “We know that the chronic pain caused by arthritis can be a barrier in keeping active. This understandable fear of movement, caused by the pain someone can feel, is a factor in stopping people from including exercise in their daily lives.

“Exercise is incredibly important and we are committed to helping people remain active. We have developed specialised exercises tailored specifically for people with knee osteoarthritis to help people build up the confidence to exercise. We also recommend that a person with their arthritis speak to their GP if they are worried about exercising.”

total knee replacement for pro footballers

Retired pro footballers found to be at higher risk of developing knee osteoarthritis

Recent research from the University of Nottingham has confirmed that retired professional footballers are far more prone to develop knee pain and osteoarthritis and face problems with their knees earlier in life than the average person, with increased rate of total knee replacement surgery performed at some point.

The research was led by Dr Gwen Fernandes and Professor Michael Doherty from the Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, and was funded by Arthritis Research UK with from FMARC (FIFA’s Medical and Research Centre) the Professional Footballers Association and the SPIRE Healthcare Group. Their conclusion: male ex-pros were two to three times more likely to suffer from knee pain and knee osteoarthritis and require a total knee replacement – even after adjustment for other risk factors including significant knee injury.

The pain of retirement

Furthermore, the study – published in the British Journal of Sports Medicine – reported that ex-footballers reported more knee pain, structural knee osteoarthritis on x-ray and total knee replacement surgery across all age groups in the study – and especially in younger age groups, such as the 40-54 age group. It wasn’t all doom and gloom, however: the research also revealed that although former footballers presented with more musculoskeletal pain, they were less likely to suffer with and report other conditions or diseases such as diabetes, heart attacks and cancer.

The study – one of the largest and most comprehensive of its kind – recruited over 1,200 ex-footballers with an average age of 59 years, recruited via the PFA and from individual league clubs and professional football associations in the UK. Their data was cross-referenced with that of over 4,000 men from the East Midlands with an average age of 62.8 years, and as well as the main findings, the date threw up all manner of strange conclusions, such as;

  • Ex-footballers had more osteoarthritis in the end joints of their fingers (nodal OA)
  • Ex-footballers were more likely to have an index finger shorter than their ring finger — also known as a pattern three-digit ratio, which has been previously linked to osteoarthritis risk
  • Ex-footballers reported significantly more body pain, knee misalignment and use of painkillers than the study group from the general population

‘Repetitive Microtrauma’ singled out for blame

 Why would playing professional football cause such an increased risk of osteoarthritis? The study flags up the ‘repetitive microtrauma’ that the sport imposes on its participants, and has identified it as the most likely main cause. And although the health benefits of professional sport are obvious, so is the concern for the welfare of players after their careers are over.

As the FA, PFA, the Premier League and English Football League announced in a joint statement: “We welcome Arthritis Research UK’s study into cases of ex-professional footballers affected by osteoarthritis and have collectively and collaboratively supported them in this research. Although there are multiple health benefits from playing football, we are also aware of the risks of intensive and prolonged training and playing at professional level.

“We understand that there are far-reaching and wider benefits of playing football, including overall quality of life and physical and mental well-being. However, it is important that we continue to support ex-professional players with the condition and use this new research to form practical guidance for current professional footballers and clubs to help minimise the risk of developing osteoarthritis.”

knee replacement surgery in rugby

Rugby union players more likely to develop knee arthritis

We all know what a tough code rugby union is, but a new study – led by the Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis at the University of Oxford – has spelled out just how gruelling it is.

Researchers discovered that rugby players aged 50 and above were more likely to suffer from physician-diagnosed osteoarthritis, site-specific joint replacement such as knee replacement surgery and osteoporosis when compared to non-players. Furthermore, reported problems in health-related quality of life were more prevalent for mobility, self-care, pain or discomfort and usual activities.

Consequently, the researchers have called for specific monitoring of rugby players in order to analyse and address the particular demands that the sport puts on its players.

Over 50 years of hurt

While it’s a given that sports participation – particularly sports such as rugby, which encourage movement and tests of strength – are very adept in promoting musculoskeletal health, the high-impact nature of the code means that it’s saddled with a higher rate of injury than other sports. And the study – which examined morbidity and health-related quality of life trends among 259 former elite-level rugby players compared to the general population, found that the price to pay for a rugby career was a higher occurrence of osteoarthritis, joint replacement and osteoporosis.

The results, which were published in the journal Scientific Reports, also pointed out that more former players experienced a quality-of-life impact as a result of mobility and pain or discomfort issues, which affected their ability to take part in usual activities and self-care.

However, the news isn’t all bad. When questioned about their opinions of playing the sport, 95% of former players claimed that considering the risks and benefits of their previous participation in rugby union, they would do it all over again – and 78% of them would recommend the sport to their children, relatives and close friends. And when it came to issues of anxiety and depression, the survey reported that rugby players fared better than their non-playing peers, as well as having a reduced risk of diabetes.

Players and physicians in union

As we have reported in previous posts, the attention to detail in risk management in contact and non-contact sports is being ramped up, and for good reason. As the researchers of this study concluded; “The magnitude of musculoskeletal morbidity in this population warrants proactive education and management within this at-risk sporting population. Further research in other sports may encourage the adoption of a more proactive approach to long-term health within elite and recreational sports, encouraging healthy sporting activity for all participants.”

The administrators of code are fully on board with their sport being put under the microscope, too. “Long-term player health is a key but, to date, relatively poorly understood area,” claimed Simon Kemp, the RFU’s chief medical officer. “We were delighted to collaborate in this important study and the findings help us to build a better understanding and more complete picture of both the short and long-term impacts of the sport, so we can continue to develop targeted and evidence-based initiatives to support player welfare.”

ACL injuries in young women

Increased risk of ACL reconstruction in young athletes

Two new studies conducted in Scandinavia have further confirmed something the sports medicine community is all too aware of: that the boom in sporting activity amongst the young could be storing up a heap of long-term problems.

According to one study, conducted by Oslo University Hospital, adolescents who participate in both level I sports such as football and handball and in sport competitions had a significantly increased risk of undergoing primary ACL reconstruction.

University Hospital researchers tracked 7,644 adolescents – 3,808 boys and 3,836 girls – who were included in the Young-Nord-Trøndelag Health Study from 2006 to 2008. Level of sport participation and sport competitions were included as main risk factors of interest, and the endpoint was primary ACL reconstruction recorded in the Norwegian National Knee Ligament Registry between January 2006 and December 2013.

The results demonstrated that level I sports had an ACL reconstruction incidence rate over 3 times higher than level II or level III sports, which was also seen in sex-stratified and age-adjusted analyses. And compared with adolescents who did not compete in sports, the patients who participated in sport competitions had a 4-times higher incidence of ACL reconstruction.

Women affected more than men with ACL injuries

Meanwhile, a study conducted at Sweden’s Karolinska Institutet reports that an average of three in every ten adolescent elite athletes suffer an injury, with the worst affected being young women – and the risk of injury increases with low self-esteem, especially in combination with less sleep and higher training volume and intensity.

The study, headed by Philip von Rosen, researcher at the Department of Neurobiology, Care Sciences and Society at the Instituet, consisted of surveys taken by 680 elite athletes representing 16 different sports at 24 schools around the country on injury occurrence and the volume and intensity of their training programmes.

“Our studies show that the incidence of injury is high in adolescent elite athletes,” said von Rosen. “During the average week, one in three of them was injured. Over a year, almost all of them had been injured at least once and around 75 per cent reported that they had been seriously injured at least once during the year.”

Lack of sleep and self-esteem a huge factor

To ascertain the possible risk factors behind the ACL injuries, the participants were also asked every term about their self-esteem, nutrient intake and self-rated stress and sleep. Those who increased the volume and intensity of their training while reducing the duration of their sleep showed a 100 per cent rise in risk of injury. And an athlete with low self-esteem who increased the volume and intensity of his or her training while cutting back on sleep had three times the risk of injury compared to an athlete with average self-esteem who had not changed his or her training or sleeping habit.

In smaller research groups, students also talked about negative psychological consequences of ACL injuries, such as guilt, frustration and anger, and how injuries made them consider quitting elite sport altogether.

Both studies clearly point to a problem that is only going to get worse over time, as the risks and rewards of professional sport continue to mount up – and demonstrate that the problems for younger athletes are mental as well as physical and both aspects should be incorporated into our approach to training and developing the next generation of athletes.

rugby concussion study

English rugby clubs to take part in concussion study

Even more eyes than normal will be on this year’s rugby season with researchers from the University of Birmingham analysing play in a bid to develop a pitch-side test to quickly and accurately evaluate whether a player has been concussed. Although not the usual rugby injury that orthopaedic knee specialist Mr Jonathan Webb treats in clinic, one of his roles at the RFU is chair of Concussion Risk Management Group.

Similar to the one the NFL in the USA has started to conduct, the study, which will run throughout the 2017/18 season, is the biggest of its kind to take place in UK sport, and the goal is to refine and hone a test which could be performed almost instantly during games and determine if a concussion has taken place – with the long-term hope that it could not only be used across all sports and even aid military and NHS medics in making a rapid and accurate diagnosis.

When one thinks of instant sporting concussion diagnosis, the mind invariably drifts off to boxing referees holding up a number of fingers – but the team at the University’s College of Medical and Dental Sciences have developed a more technical approach. They’ve spent nine years carrying out research which has led to the development of a test that measures biomarkers present in saliva and urine. If the trial season pays off for the research team, the goal is to create a hand-held testing device.

Could saliva be the key?

Here’s what’s happening this season: players participating in the study provide saliva and urine samples before a game, which will be used as a base-line benchmark. If any of those players suffer a concussion – or are suspected to have taken a head knock – during a match, they will provide further saliva samples immediately after the event.

Players will also provide follow-up saliva and urine samples as they go through the return-to-play protocol, which will be compared to the baseline benchmarks – along with samples from other players from the same game who didn’t suffer head injury, or had other injuries.

A positive impact on concussion diagnosis

“This is an important addition to the breadth of research we are undertaking into concussion and player welfare more broadly,” said Dr Simon Kemp, RFU Chief Medical Officer. “There is currently no reliable or proven biomarker or objective test for the diagnosis of concussion and this lack of objectivity is the biggest challenge facing medical professional in dealing with this type of injury.”

Dr Kemp was very keen to point out that the study was “very much an exploratory piece of research”, but – like many others in the game – is excited by the potential of a new and rapid tool for concussion diagnosis. “This is a project that has the potential to make a very significant impact on the diagnosis and management of players following concussion” he claimed.

patellar instability

Managing patellar instability

The American Orthopaedic Society for Sports Medicine has just concluded its annual meeting in Toronto and one research project stood out among the rest, suggesting that younger patients who suffer patellar dislocations are at a higher risk of recurring dislocations, especially in the long term.

The research project, which was conducted by The Mayo Clinic in Rochester, Minnesota, won the Herodicus Award for the best resident paper featured at the meeting, examined a study group of 232 patients who were deemed as ‘skeletally immature’ at the time they suffered ipsilateral recurrent patellar dislocation (in other words, their proximal tibia and distal femoral physes were open at the time of dislocation), who had suffered their injury between 1990 and 2010.

The study concluded that over 20% of those recurrent cases happened in the first two years after the initial injury, and by the 15 and 20-year mark, cases of reoccurrence had shot up to 54% of the study group patients.

Patellar instability: the facts

When we talk of ‘patellar instability’, we’re essentially referring to a welter of conditions which affect movement of the patella or knee cap, including patellar dislocation and patellar subluxation. The patella is a very important part of the knee joint: it forms part of the extensor mechanism, a chain of structures that give the knee the ability to straighten. The patella rests in a groove at the lower end of the femur called the trochlear groove, or trochlea, which centres it during knee flexion and extension, with ligaments on either side of the patella adding further support in keeping it central.

Patellar instability can happen at any time, and complete dislocation of the patella causes sudden, intense pain in the front and side of the knee and a sensation of the knee giving way or popping out. There may be a visible deformity of the knee, due to the patella moving out of position, accompanied with a rapid onset of swelling within the first couple of hours after injury.

Some sufferers of patella dislocation can experience a reoccurrence, where patella moves out of position rather more easily, but it can return to its original position with certain knee movements, usually involving straightening the knee. When this happens, pain and swelling may occur, albeit on a minor basis.

Clicking, crunching, popping and locking

Obviously, for professional athletes and dedicated amateurs, patella dislocation can seriously impact a sporting career, with an ongoing discomfort that may increase on activity, and reoccurrence of pain during knee flexion activities including hill work, squatting or lunging (and going up and down stairs, or course). There can often be tenderness on the lateral side of the patella, as well as clicking or crunching within the joint during flexion and extension, due to articular damage sustained during the dislocation. And of course, the fear of the knee giving way at any point can weigh heavily on your mind.

The study adds weight to previous research, which typically shows that 40% of adolescent patients go on to experience a recurring patellar dislocation. However, the news was not all bad. “Despite high numbers of recurrence, our research showed that these young patients did not develop significant patellofemoral arthritis,” said Thomas L. Sanders, MD, corresponding author of the study. “We hope to use our research to help educate both physicians and parents on the risks young athletes face after these injuries in their early years, and hopefully take steps to prevent them.”

Does patella instability require surgery?

Patella instability typically requires physiotherapy to strengthen the supporting structures of the knee. If there has been damage to the patello-femoral ligament or if the patella is failing to align properly, then surgical repair to the ligament may be an effective option. In severe or recurrent cases, a partial knee replacement may be the preferred option. London knee specialist Mr Jonathan Webb will discuss your options in full during your consultation.

knee replacement surgery

Study finds that knee arthritis rates have doubled in just a few generations

A recent study from Harvard University resulted in a mass of media attention: people born after World War Two are twice as likely to develop knee arthritis as those born in generations beforehand.

The study, which involved an examination of more than 2,000 ancient skeletons dating as far back as 6,000 years and cross-referencing the data with information on human knee health from the mid-nineteenth century right up to the modern day. And the results concluded that knee arthritis is clearly on the rise. As Professor Daniel Lieberman of Harvard University pointed out, “The most important comparison is between the early industrial (1800s) and modern samples. Because we had data on each individual’s age, sex, body weight, ethnicity and, in many cases, their occupation and cause of death, we were able to correct for a number of factors that we considered important co-variants.”

It’s not necessarily a weight problem

So, what’s the cause for this? The obvious answer would be a comparable rise in lifespans and obesity – after all, pronounced weight gain clearly puts extra pressure on the knees, and by simply being around longer, one runs a greater risk of contracting any particular ailment – but according to the experts, this isn’t necessarily the case.

“Before this study it was assumed without having been tested that the prevalence of knee osteoarthritis hadn’t changed over time. We were able to show – for the first time – this pervasive cause of pain is actually twice as common today than even in the recent past,” said Dr Ian Wallace, also of Harvard University. “But the even bigger surprise is it’s not just because people are living longer or getting fatter, but for other reasons likely related to our modern environments.”

Everything from refined sugar in our diet or the fact that we are pounding pavements could be a potential factor.

Counting the cost of arthritis

What dangers these ‘modern environments’ harbour, however, is the bone of contention – and the race is on to pinpoint the causes. And the stakes are high, as a study from Arthritis Research UK pointed out last month. According to their figures, arthritis will cause 25.9 million lost working days from this year to 2030, costing the country £3.43 billion.

As their report – dubbed The Nation’s Joint Problem – points out, one in six people in the UK suffer from arthritis – a figure that is predicted to rise to one in five by 2050 – and treatment and care of arthritis sufferers is expected to soak up an estimated £118.6 billion over the 2020s.

A more positive conclusion drawn from the study is that the researchers are pointing the way towards the finding of ways to prevent the onset on knee osteoarthritis, going so far as to draw comparisons between it and heart disease. “Knee osteoarthritis is not a necessary consequence of old age. We should think of this as a partly preventable disease,” claimed Professor Lieberman. “Understanding the origins of knee osteoarthritis is an urgent challenge because the disease is almost entirely untreatable apart from knee replacement surgery – and once someone has knee osteoarthritis it creates a vicious circle.

“People become less active which can lead to a host of other problems – and their health ends up declining at a more rapid rate. Right now, our society is barely focusing on prevention in any way, shape or form, so we need to redirect more interest toward preventing this and other so-called diseases of ageing,” concluded Professor Lieberman.

Until a plan of action has been mapped out, it makes sense to give yourself the best shot at avoiding knee arthritis by going for what we currently know: keeping tabs on weight gain, strengthening the quads through exercise, avoiding unnecessary injury by warming up and cooling down properly, and maintaining a healthy diet. However, if you’re suffering from the aches and pains associated with knee arthritis, arrange a consultation with a knee specialist to discuss your options.

return to running

Return to running after a knee injury

It goes without saying that we’re always keeping an ear to the ground for new developments in the field of knee injury rehabilitation, so a new report from the University of Kent has piqued our interest – especially as it could be a breakthrough for athletes who have recovered from a knee injury, but are struggling to get over psychological barriers that stand between them and getting back on the field.

In a report published in Physical Therapy in Sport titled ‘Return to running following knee osteochondral repair using an anti-gravity treadmill’, Dr Karen Hambly – a knee rehab expert who specialises in helping athletes who have been given the all-clear to resume sporting activities but may have concerns about moving from being a patient with a knee injury to being an athlete again – has explained how a graduated return to running using an anti-gravity treadmill can help to reduce fears about re-injury, and increase the athlete’s self-belief in being able to run on the injured knee.

How does walking on the Moon help return to running?

The case report focuses upon a 39-year-old female endurance runner and spells out the regime she undertook from the end of her post-knee surgery rehabilitation to taking part in her sport again, which involved an eight-week programme designed by Dr Hambly which incorporated the use of an anti-gravity treadmill.

The treadmill – which can be adjusted to reduce the body weight of the client from 100 per cent to a mere 20 per cent, which is a precise simulation of what it would be like to walk on the moon – is designed to reduce the load on the joints in the lower limbs. This means that not only is the client given the opportunity to ease their joints back into the swing of running with no chance of re-injury, but it also offers a vital psychological boost as the pressure is reduced over time.

While this is a potential breakthrough in the field of sports rehab, it goes without saying that anti-gravity treadmills are still thin on the ground – and walking holidays on the Moon aren’t an option. But there are still plenty of options available for the post-rehab athlete who still isn’t ready to trust putting their full weight on their joints.

Post-injury rehab: have a plan, and stick to it

You may not know it, but by being leery of returning to your sport, you’ve already won half the battle for a successful rehab – because you already know that it’s going to take a while before you’re back to peak fitness. The key here is to maximise what you can do during this period – and ensure you get the support system you need.

What you’re looking to achieve here is a graded return, by finding a level that you can manage at the moment and creating a manageable route map that will allow you to progress back to full fitness at your own pace without risking setbacks.

The first thing to do before starting on this road is to get the injured knee checked out. There should be full range of movement in the joints surrounding the affected area with no risk of instability, no swelling, and – ideally – you should be pain-free. From there, you can start the rehab process. This article from Running Physio is a great overview of what you should be doing – and what you need to avoid.

knee damage sports

Study reviews the worst sports for knee damage

Osteoarthritis – the condition that causes joints to stiffen and cause pain – has long been seen as an inevitable consequence of the ageing process, but it’s also a distinct hazard for athletes. We’re already seeing incidences of osteoarthritis in middle-aged and even young adults with athletic backgrounds, as a consequence of the sports they play. But which are the worst knee damage sports that risk players developing knee osteoarthritis at a later date?

A recent study conducted by assorted universities in America looked into this question and the results are very interesting. A team of researchers from US universities carried out a review of six databases to analyse the link between different sports and osteoarthritis among nearly 3,800 athletes.

The results? Around 45 per cent of the athletes ended up with knee osteoarthritis – and the risk increased to 57 per cent among those who had suffered knee injuries, and rose to 61 per cent among former athletes who become obese. And when they dug deeper into the actual sports the athletes participated in, a pattern of sorts began to form.

Football, weightlifting, wrestling… and knee damage

The least surprising sport which cropped up in the study results was long-distance running but, according to the data, football, weightlifting and wrestling are the prime culprits – raising the chances of developing osteoarthritis in the knees by three to seven times when compared to low-risk sports, such as basketball, boxing and track and field events.

Why would one sport be more damaging to the knee joints than another? Well, the dangers of long-distance running are obvious: repetitive shock and stress on a targeted area over time. The shock and stress that can be brought on by weightlifting and wrestling target the same area, albeit with massive and concentrated amounts of pressure on the joints.

Football’s hazards are brought on by extended periods of running combined with instantly stopping (or twisting and turning) – not to mention the sharp impact of making a tackle, or receiving one. But why would basketball be seen as the safer sport, in that case? Well, it’s a matter of endurance – while the average NBA player covers a distance of 2.72 miles in an average game, his Premier League counterpart can cover anything up to 9.5 miles in a game.

…and don’t forget tennis

Although it wasn’t mentioned in the study, tennis is another sport where the threat of knee injuries hangs over its participants. Although the repetitive pounding of the turf (or clay, or asphalt, or concrete) isn’t as relentless as other sports, the stopping, starting and twisting is even more of a requirement. And such stress can cause torn cartilages, knee swelling, and general wear and tear.

Another factor unique to tennis is that it is one of the few athletic pursuits where the participants are unable to pace themselves to a set time or distance. Runners have a rough idea of how long they’ll be required to perform, footballers know how long they’ll be required to play, but the nature of tennis means that a game can last anything from an average of an hour and a half hours (in the case of women’s tennis) or two and a half hours (for men’s), to anything up to five hours – and the Wimbledon record is an incredible eleven hours and five minutes (held over three days, admittedly, but still…).

Whatever sport you play, preparation is essential. Preventative measures – such as an extensive warm-up regime, constant monitoring of the state of the joints, an approved exercise programme and a strong line of communication with training and medical staff – can help you avoid osteoarthritis issues throughout and beyond your sporting career.