Consequences of injury are greater for Olympians than the general population

This blog provides an overview of two recent studies on the prevalence of and factors associated with osteoarthritis (OA) and pain in retired Olympians [1,2]. The study also compared OA and pain between Olympians and the general population.

Why is this study important?

Previous studies show retired athletes have higher rates of osteoarthritis compared with non-athletes. Injury is a known risk factor of osteoarthritis (OA) and so higher rates of OA may be due in part to athletes experiencing higher injury rates. In current literature few studies include comparisons to the general population and where these do exist they are focussed on single sex, isolated body joints and/or single sports. The aim of this study was to identify factors associated with OA and pain across multiple body joints in Olympians making comparison with a sample of the general population.

How did the study go about this?

This cross-sectional study surveyed 3,357 retired Olympians (45% female; 131 countries; 57 summer and winter Olympic sports) and 1,735 similar aged (58% female; 73 countries) general population controls. The study captured significant joint injuries, and other factors associated with pain and self-reported physician-diagnosed OA across the hip, knee and ankle, lumbar and cervical spine and shoulder for both groups.

What did the study find?

Olympians

One in four retired Olympians reported having physician-diagnosed OA in any joint, with the knee, lumbar spine, hip and shoulder among the most common sites for OA. 41% of Olympians also reported having current joint pain, with again the lumbar spine, followed by the knee, shoulder and cervical spine among the most common sites for pain.

Injury increased the odds of self-reported OA and pain in the knee, hip, and ankle, cervical spine, lumbar spine and shoulder in Olympians. Recurrent injury was also associated with increased odds of self-reported OA and pain in the knee, lumbar spine and shoulder for Olympians. Female Olympians had increased odds of OA at the knee, lumbar and cervical spine compared with male Olympians.

Olympians versus the General Population

Olympians had higher rates of injury compared with the general population. When adjusting for the known risk factors including injury, retired Olympians in the present study did not report having significantly higher overall rates of OA compared with the general population. 

However, when looking specifically at the knee, hip and shoulder, the consequences of injuries to those joints were significant. For example, Olympians who reported having a significant knee injury were 1.5 times more likely to report knee OA compared with those in the general population reporting a knee injury; Olympians were 4 times more likely to report hip OA after a hip injury, than the general population; and Olympians were 2.6 times more likely to report shoulder OA after a shoulder injury, compared with controls. 

Female Olympians were also more likely to report cervical spine OA compared with females in the general population; and overall Olympians had greater odds of experiencing current lumbar spine pain when compared with the general population.

What are the key take home messages?

Elite sport participation can lead to an increased risk of injury, and there is emerging evidence that the consequences of injury for athletes within some body joints are greater with respect to the onset of OA and pain, when compared with non-sporting populations.

Primary prevention initiatives should focus on preventing the occurrence of injury to these specific joints (e.g. knee, hip and shoulder). Secondary initiatives should focus on reducing the rates of injury recurrence e.g. allowing full, timely rehabilitation of these injuries before return to play, prescribing individualised ongoing pre-habilitation around these joints. Finally, tertiary initiatives, such as maintaining a healthy weight and encouraging continuing exercise and physical activity, should be targeted at retired Olympians with a history of significant injury to these joints, with particular focus on female Olympians. With these efforts it may be possible to minimise future occurrence, or at least slow the onset of, later life OA and pain in retired athletes.

 

Author information: Dr Debbie Palmer, UK Collaborating Centre on Injury & Illness Prevention in Sport, Institute for Sport, PE and Health Sciences, University of Edinburgh.

References:

[1] Palmer D, Cooper D, Whittaker JL, et al. Prevalence of and factors associated with osteoarthritis and pain in retired Olympians compared with the general population: part 1 – the lower limb. British Journal of Sports Medicine 2022;56:1123-1131

[2] Palmer D, Cooper D, Whittaker JL, et al. Prevalence of and factors associated with osteoarthritis and pain in retired Olympians compared with the general population: part 2 – the spine and upper limb. British Journal of Sports Medicine 2022;56:1132-1140

 

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