Playing sport injured is associated with osteoarthritis, joint pain and worse health-related quality of life: a cross-sectional study
Bullock GS, Collins GS, Peirce N, Arden NK, Filbay SR. BMC Musculoskelet Disord 21, 111 (2020). https://doi.org/10.1186/s12891-020-3136-5
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Elite and recreational cricket players have increased odds of having osteoarthritis and reporting joint pain if they continued to play sports while injured compared to those who did not play while injured.
Athletes often need to decide whether or not to compete while injured. However, we have little evidence to help advise athletes about the consequences of participating in a sport while injured. Hence, the purpose of this study was three-fold:
- Determine the relationship between current health-related quality of life and history of playing a sport while injured
- Determine the odds of persistent joint pain or diagnosed osteoarthritis in people who played sports while injured
- Compare findings between elite and recreational cricket players
In the Cricket Health and Wellbeing Study, 2,223 current and former cricket players completed the Short Form-8 (mental and physical quality of life) and answered questions related to physician-diagnosed osteoarthritis and persistent joint pain on most days of the prior month. The authors also asked participants about playing sport while injured: “Have you ever played sport injured, despite feeling like doing so might make the injury worse?”. Most participants were current players (60%) and recreational athletes (62%). Seventy-seven percent of the respondents reported playing sport while injured. The authors accounted for factors like age, sex, number of joints injured, and years of sport participants. They found that athletes that reported playing while injured typically reported slightly lower physical and mental quality of life than those who did not play injured. If a cricket player reported playing while injured, they were about 2 times more likely to be diagnosed with osteoarthritis or to report persistent joint pain compared to players who did not play injured. These findings were consistent among elite and recreational athletes.
More than three-quarters of cricket players in this study reported continuing to play sport while having a joint injury. These players had greater odds of being diagnosed with osteoarthritis or having persistent joint pain. There is likely a psychological factor among competitive athletes, regardless of level, driving them to push through joint injuries and continue to play. It would have been interesting to know the chance of these poor outcomes compared to athletes who were injured and stopped playing; however, the number of these athletes is small and were primarily people with a game-ending injury (e.g., fractures, dislocation, ACL sprain). Regardless, these findings reinforce many other studies that show an injury increases the risk of poor health outcomes. Health care providers should educate athletes (elite and recreational) on the short- and long-term health consequences of an injury and the possible consequences of playing sports while injured to ensure the patient is making an informed choice. Although many athletes are faced with outside pressures to continue playing during injury, clinicians should advocate for the athlete’s health and well-being. Having open and honest conversations about the athletes’ priorities may lead to better outcomes following a joint injury.
Questions for Discussion
Do you have discussions with your athletes about the implications of playing whilst injured? As a clinician, do you agree it is your responsibility to educate your patients about the consequences of long-term joint health following an injury?
Written by: Danielle M. Torp
Reviewed by: Jeffrey Driban
Impaired Quality of Life in Young Athletes after Injury
More Evidence: Knee Injury Increases the Risk of Knee Osteoarthritis, Regardless of Injury Type
Mental health issues and psychological factors in athletes: detection, management, effect on performance and prevention: American Medical Society for Sports Medicine Position Statement-Executive Summary
From an athlete standpoint, my athletic trainers have had discussions with me regarding the implications of playing but that is usually something athletes don’t care much about, they simply want to play. As an athletic training student, I have accompanied my preceptor to those tough discussions. I think it is very important to educate your patients about the implications of playing while injured and make sure they understand the severity and magnitude of what could happen as a result of playing. I feel as though patients do not always fully understand the dangers of playing while injured and are only focused on the fact that they could still play. I think long-term joint health is a topic we often forget about because we are young and its not as relevant to our everyday lives. This is a bad mindset to have regarding bone/joint health and more attention needs to be drawn to it. One of my clinical rotations was at an orthopedic physicians office and most of the older female patients were shocked to find out their bone/joint health was detoriorating significantly. Bone/joint health is one of those topics that you just assume will never effect you, until it does. In conclusion, I think more conversations need to be had regarding long-term bone/joint health with our younger population in regards to playing while injured.
Thank you for your comment and input on the topic of long-term joint health.
Patient education about long term health is very important and I feel clinicians are lacking in discussing it. As in the research above 77% reported playing injured with lower quality of life. We often have this focused on the now mentality and ultimately fail to look at the bigger picture simply because we are uneducated. For high school and below athletes I feel it is especially important to educate the parents also as they have direct influence over the athlete. Is playing that one game worth a career ending injury? Along with putting it into perspective about the pain, suffering and money that cost them later in life. Also, it would be very interesting to ask the adults with osteoarthritis if they had an injury in their youth/young adult lives that may have predisposed them to the osteoarthritis.
Thank you for your comment. I agree that it would be interesting to hear the perspectives of the older patients on the choices they made to play injured and their current health. I also agree with the need for clinicians to educate parents, especially in young athletes. From my experience working in the collegiate setting, often times the parents are the ones pushing for their children to continue to play. Athletes are being pressured to play and perform from all sides and clinicians need to be the ones advocating for their best interests when it comes to long-term joint health and quality of life.