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Arthritis and Degenerative Changes

Arthritis is a painful inflammation and stiffness of the joints. The average age of pickleball players is around 60 years of age. And, the majority of middle aged and older individuals have symptoms of osteoarthritis or wear and tear arthritis, a chronic common form of degenerative joint disease. It commonly begins as stiffness and pain in the spine, hips or knees. Typically, it is worse in the morning and gradually improves as the day progresses. Toward the end of the day and into the night, the pain and symptoms reappear.

Osteoarthritis primarily results from a reduction and deterioration of hyaline cartilage. Articular cartilage is
the connective tissue between joints that acts as a shock absorber and cushion. This prevents the bony surfaces from rubbing against each other. Cartilage is a gristle like protein matrix that does not regenerate and can be broken down by injuries, wear and tear and aging. Once cartilage wears down, the resulting bone rubbing on bone causes pain, lack of mobility and the formation of bony growth known as osteophytes.

Osteoarthritis is a progressive degenerative disease which typically worsens with age. However, some of the risk factors that predispose an individual to osteoarthritis include: genetics, obesity, joint trauma or injury, gender, race and certain occupations and recreational activities. For athletes participating in gravity based sports and activities, the loading, impact and surrounding soft tissue damage causes stress on the cartilage.

Arthritis is easily diagnosed by film x-rays or magnetic resonance imaging (MRI). These typically show a loss of, or irregular joint space with calcified or damaged cartilage and osteophytes.

The greatest threat to the joint and structural system of the aging athlete is not the aging process itself, but inactivity. Motion and activity are critical to maintain joint and articular cartilage health and healing. Once osteoarthritis advances and the pain increases and mobility decreases, the aging athlete is faced with either giving up or modifying his sport or switching to a more joint friendly activity, such as swimming or cycling.

In the past, treatment for degenerated joints consisted of oral NSAIDS, cortisone injections and arthroscopic surgery. However, some patients who use NSAIDS develop serious gastrointestinal (GI) side effects, due to the acid content in these medications. Alternative treatment with a combination of glucosamine and chondroitin has not proven to be an effective treatment. Bracing can, however, sometimes be an effective non-surgical option for instability in the knees and ankles.

New advances in medical treatment for degenerative joint disease have given many athletes a new lease on
life. Currently, joint instability and cartilage wear can be treated with prolotherapy, consisting of platelet rich plasma therapy and stem cell injections. Another non- surgical option is the injection of Hyaluronic acid. This is a gel like substance made from chicken combs that cushion and lubricate the joint and acts as a shock absorber. The application of moist or dry heat can also help to decrease pain, stiffness and increase mobility. When the pain and inflammation is more acute, ice application also can be helpful.

When non-surgical options have been exhausted and the pain, inflammation and limitation of motion become unbearable, joint replacement or arthroplasty becomes an option. The choice for a total or partial arthroplasty
is based on numerous factors: age, activity level, weight and the extent of degenerative disease. Partial joint replacement has a higher failure rate than total replacements. However, partial arthroplasty has fewer complications, reduced time in the hospital, a smaller incision with less blood loss and a quicker return to normal activities.

Last year, I had the opportunity to play on a Decoturf cushioned Pickleball court in Colorado. This surface played like a normal hard court but provided cushioning similar to playing on a soft tennis court. Unfortunately, the Decoturf system is expensive and not readily available at this time. Because these courts offer real relief for older players with sore, worn out arthritic joints, hopefully the trend toward cushioned courts will continue.

Alan Bragman is a chiropractor living in Atlanta, Georgia. He is an IPTPA-certified coach and a 4.5 level player. In addition, he is a former Cat 3 cyclist, nationally ranked table tennis player and inline speed skater. He was on the medical advisory board at Bicycling magazine for 10 years and has written for numerous other sports publications.

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