Young people, knee injuries and the risk of osteoarthritis—what’s the link?

A lot of young people are involved in sports, and a lot of sports can lead to knee injuries.  These injuries can in turn lead to a higher risk of osteoarthritis (OA) later  in life, due to both damage to the joint and potential weight gain that can result from lower activity levels after an injury. Dr. Jackie Whittaker, a physiotherapist and assistant professor in the Department of Physical Therapy at the University of British Columbia, is heading up a research team that’s looking to get a better understanding of how to delay or prevent OA from developing by improving joint health in young people. While the research is still preliminary, the team has identified some areas of interest that merit further study. If you’re a young person with a knee injury (or you’re a parent to one), here are some ideas about nutrition, psychology and injury recovery to keep on your radar and discuss with your health care team.

Fear of movement

After an injury, some people may experience fear, worry,  or anxiety around whether their knee is going to hold up, whether they’re going to get a jolt of pain, and whether they can do a particular movement, says Dr. Whittaker. “We know that people that have kinesiophobia, or fear of movement, tend to have more symptoms,  less strength, and do more poorly on functional tests,” she says. Dr. Whittaker adds that anxiety around doing certain tasks often holds some people with these injuries back from being physically active, leading to poorer overall health. Fear of movement after an injury is not confined to young people in particular, but it may be important to consider the role age plays. “When we look at other fears and anxieties, and how we deal with or confront them, it usually comes down to knowledge. It may be there is a certain age group where there is less knowledge about injury.”

Managing expectations

“We know that in sport-related knee injuries, a good chunk of [patients] have really inaccurate beliefs about how long it’s going to take to recover, what recovery is going to look like and what the long-term consequences of the injury are,” says Dr. Whittaker. “For instance, if you have a surgery and you think ‘in 3 or 4 months I’ll be back to normal,’ and then when it’s 4 or 5 or 6 or 8 months later and you’re still getting little bits of pain or are not able to do certain movements, there starts to be this whole other storyline developing around what’s going on, because you think you’re not progressing normally. Their expectations don’t fit with their experiences and that creates a problem.” Talking about managing expectations may need a different approach for a 14-year-old versus a 25-year-old, she says.

The social piece

Dr. Whittaker and her team also look at psychological, social and contextual factors for recovery after a knee injury. “A lot of these factors also influence recovery and ultimately whether people become inactive and develop other comorbidities and diseases such as OA.” One insight she provides is that, “A lot of these individuals are participants in team sports, and they value that social environment. Often their peer group are their teammates and their role models are coaches and older athletes who play the same sport. They lose that, potentially, when they are injured if there isn’t an effort from the team or coaches to engage those individuals in the team environment while they’reunable to play. Being involved in that same culture of sport is really important.”

Staying active

One of the tricky parts of recovering from a knee injury is the need to stay active, so you can continue to have a healthy body throughout your life, though without making movements that will re-injure the joint. “We’ve done some work previously where we identified that 3 to 10 years after a knee injury, youth that have had an injury are definitely less physically active than youth that haven’t had an injury,” says Dr. Whittaker. Consider this scenario, she says: Think of a 17-year-old who plays multiple sports. They tear their anterior cruciate ligament [ACL, a major knee ligament and a common sports injury] and they are off sport for a year. And during that year, they move out to go to university and they don’t have that same peer group of people that play sports. The longer they’re away [from sport], the less likely they are to return to that sport or physical activity in general. Then you throw in the frustration of ‘every time I try to do something my knee gets uncomfortable,’ and develop this anxiety around not wanting to upset the knee again. So down the road at the age of 35 or 40, you’ve got someone who is very physically inactive, maybe having gained weight, and who is living with early onset OA. That’s why working with a health care team to learn about activities that won’t reinjure the joint but still help build strength and cardiovascular health, like swimming or stationary cycling, is a key part to joint health. Activity levels shouldn’t be all or nothing. 

Health care team relationship

Young people should feel that they are involved in making some of the decisions about their care, and that they have a good relationship with their health care team, notes Dr. Whittaker. “It’s about their voice being taken into consideration and someone taking the time to fully explain to them what’s happened—what are your choices, what are the consequences of those choices, what do you want to do, what I think we should do—and coming to some sort of shared agreement.”

Food choices

One aspect of Dr. Whittaker’s study looks at individuals who play the same sport, both those who with and without a history of knee injury,, to see what their nutrition levels look like. Regardless of their injury status, there were similar dietary patterns which suggested that young people are not always getting the nutrients they need for good bone and joint health. “Very few were getting dietary requirements for vitamin E, none of them were getting the dietary requirements for vitamin D and we saw that both calcium and omega-3 intake wasn’t great either. The long and short of it was that some of these micronutrients that we know are important for bone and joint health, and you could argue for repair of tissue after injury, these kids aren’t actually taking in, and that’s concerning.” As well, a lot of the young people were eating foods high in fat and carbohydrates, and weren’t getting enough protein or fibre. “If you are a youth athlete, you eat a lot of food and you can get away with that because you are very active…After they’ve had an injury and are less physically active, they don’t need to consume the same amount of calories from food. Without the same output of calories from physical activity,  it starts to be a little bit of a mismatch.”

While more research needs to be done, it seems clear that a knee injury isn’t solely about the knee. To help heal and hopefully reduce the risk of OA later in life, it makes sense to pay attention to nutrition, physiotherapy, as well as physical and psychosocial health.

Dr. Whittaker’s research has been supported in part by an Arthritis Society Young Investigator Operating Grant active from 2016-20.  
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