Have you ever heard the term “arthritis” or “degenerative joint” and wondered what it really means for NFL players? Below I’ll breakdown the definition, what it means and how it might affect players’ longevity and ability to perform.
Here’s a quick anatomy lesson: The knee joint is made of the patella (kneecap) tibia (shin bone), and femur (thigh bone). On the inside of the knee joint, there exists a thick layer of connective tissue called the meniscus. The meniscus has two parts, a lateral (outside) portion and a medial (inside) portion. The meniscus is there to provide stability within the knee. Think of the meniscus as the brake pads on a car. Lastly, on the ends of both bones, "articular" cartilage exists for added lubrication of the joint and to reduce friction as it moves. See the picture below for an illustration.
Now, osteoarthritis, otherwise known as arthritis or degenerative joint disease, is a term for an ongoing process that degrades the meniscus and/or articular cartilage inside the joint. In O.A., because of irreparable damage, the body constantly tells the brain to release a cascade of chemicals to the area and "clear up" an injured body part. These same chemicals signal the brain that there may be damage and the brain interprets the situation as “painful”. In turn, we alter our behavior and take time to heal by resting. During regular run-of-the-mill injuries, this inflammatory process is a good thing and necessary to heal injured tissues and initiate the recovery process. The problem with O.A. is that this process never ends. The brain (usually correctly) interprets this ongoing process as painful. Now, the body usually adapts in some way or another by suppressing the signals and/or through altering the way we move, but the core issue is not resolved. Due to the constant signaling of damage, the cycle continuously repeats itself. Arthritis can occur in any joint in the body but are very common in the spine, knees and hips. Risk factors include obesity, trauma and history of intra-articular (inside the joint) surgeries. Read more about OAhere.
What to Expect?
Arthritis can be extremely unpredictable, especially when adding in several mini car crashes every Sunday. Even people who are not elite athletes report having “good days” and “bad days” when dealing with arthritis. Even sleeping in an awkward position can trigger an exacerbation, so being pile-driven into the ground by a 300lb NFL defender is very much a risk factor for exacerbation. In case you haven’t connected the dots yet, that can occur at any given time during the season, which increases volatility. Furthermore, with reduced performance comes less work and worse overall conditioning. Worst of all, when a player who has O.A. finally does see some work, planting his foot in the ground to plow over a defender becomes more of a… ahem…business decision than before. Lastly, here’s a Scrabble word for you:Arthrogenic inhibition. If you’re interested, read about ithere. This simply means that when a joint takes on even minimal swelling, the brain shuts down use of the muscles surrounding the joint. Well, this is a problem with a condition who’s name itself has the root word “inflammation” in its name. No amount of “toughing it out” can turn this evolutionary mechanism off. In fact, the more people try to fight it, the worse it can become. Think of this as mother nature’s way of forcing us to rest. So, in addition to aerobic capacity and confidence taking a hit, reductions in performance are very much possible without any existing pain.
Astudy in 2006 took 205 individuals with OA and asked them to rate their pain from 1-10. MRI’s of their knee were then compared against that pain report. They found that “abnormal” finding like cysts, swelling, and bone deformities correlated very poorly with subjective pain reports. In other words, a person who reports no pain in their daily life could have the gnarliest looking knee on an x-ray and never know it. The opposite is also true. Several different studies in subsequent years have validated this. Simply put, the overall perception of a “degenerative knee” is overblown, and what matters are the reports from the patient. It matters less that players like Todd Gurley look to have O.A. on an x-ray and matters more when he begins to report pain and swelling that won’t resolve. More good news is that this condition is very manageable with load management. Coupled with daily prehab/rehab, and constant communication with the coaching/medical staff players can play through O.A. Todd Gurley proved that in 2019 (despite massive dips in production).
The Bottom Line
Arthritis is a very scary term and when severe enough the only solution is a joint replacement surgery. However, there’s plenty of research showing that with physical therapy, average people can go about their daily life without any issues despite the diagnosis of “arthritis” or “degenerative joint disease”. In fact, the research says that many of you likely have a wonky looking x-ray and won’t ever know it! The problem here is that NFL players are not average people and require being absolute peak condition to perform at a high level. So, if a player is diagnosed with this condition, expect significant volatility from them form week to week. Thanks for reading!