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Football and osteoarthritis study kicks off

Published on 07 January 2014
Source: Arthritis Today

As our new study examines why so many ex-professional footballers end up crippled with osteoarthritis, two former players talk to Jane Tadman about their experience of injury.

Ian Mellor and his son Neil pictured at the headquarters of the Professional Footballers' Association in ManchesterProfessional footballers can enjoy lucrative and successful careers playing a game they love and often getting well paid for it, but they can pay a heavy price, usually after they’ve retired.

The roll-call of ex-pros struggling with painful hips and knees in the years after they’ve left the game is lengthy, and a number of high-profile former players have needed knees or hips replacing, including Sir Trevor Brooking and Bob Wilson.

It’s hardly surprising. After aging and obesity, injury to a joint is the third major risk factor for developing osteoarthritis, which is the main reason for replacing a worn-out joint.

These days it’s probably fair to say that professional football is less of a contact sport than in the days when pros routinely and legally kicked lumps out of each other. Nevertheless, today’s players still undergo long periods of intense physical training to earn a living, and their knees are put under constant strain and are prone to injury.

But until now very little research has been done to find out exactly why so many footballers develop osteoarthritis – and why others don’t. 

Now a new five-year study, the first of its kind, aims to find out how common the condition is among ex-professional footballers compared to the general population. And the findings could have implications far beyond the relatively small world of professional football and lead to greater awareness of how to avoid and prevent injuries for people who play sport at whatever level.

The study, Osteoarthritis Risk of Professional Footballers, is one of the biggest projects being carried out as part of the Arthritis Research UK Centre for Sport Exercise and Osteoarthritis, partly funded by FIFA and supported by the FA. 

The study has the backing of Sir Trevor Brooking, who says: “A few years ago I had a knee replacement for my left knee and have benefited enormously from that successful operation in my daily work commitments. There’s very little research on this important topic, and the study will be of immense benefit to the current football community, and will help to direct the game for future generations of footballers.”

Based at Nottingham University, the study is led by clinical biomechanist Dr Gwen Fernandes in the department of academic rheumatology.

“Professional footballers appear especially prone to arthritis due to the intensity of the sport they play and the injuries sustained during their playing careers,” explains Dr Fernandes. “They seem more likely to develop early onset osteoarthritis of their knee joints, for example. The results of our study will establish the prevalence of osteoarthritis among professional footballers compared to the normal male population and hopefully identify the specific risk factors for knee osteoarthritis in footballers.”

As part of the first phase of the study, the research team will work with football associations to recruit at least 18,000 ex-professional footballers over the age of 40 and ask them to fill in a questionnaire. Questions will include how many games they played, how many hours they spent training, how long they played and at what level, whether they were injured, and whether they now have osteoarthritis and so on, enabling researchers to build up a detailed picture of their playing careers.

A further 900 players will then have their knees x-rayed (courtesy of Spire Healthcare’s research arm, Spire Perform, based at FA headquarters at St George’s Park) which will provide evidence of structural changes in their knees. This information will be mapped against the self-reported pain in the questionnaires.
The results of the questionnaires and the x-rays will then be compared against a control arm of 500 healthy volunteers recruited from the community cohort in Nottingham.

As well as having an impact on the way that footballers train, practise and play, the results will throw a fascinating light on training regimes and attitudes to fitness in the world of professional football, and how they have changed over the past 20 or so years.

The research will dovetail in with other work being carried out at the centre for sport, exercise and osteoarthritis’s University of Southampton site. Professor of musculoskeletal rehabilitation Maria Stokes is working with Southampton FC in designing targeted training programmes aimed at reducing injuries among players and protecting them against developing osteoarthritis in later life. 

Ian and Neil Mellor – a footballing father and son’s experience of injury.

Ian Mellor in the 1970s when he played for Manchester CityIan Mellor is typical of many ex-professional footballers of his generation. The former Manchester City, Norwich City and Sheffield Wednesday winger retired from the game in 1984. Now 63, Ian has had both hips re-surfaced, surgery on both knees, and an ankle replacement, all as a consequence of osteoarthritis. He also has metal plates in both forearms as a result of an accident in training.

“It was very different in my day to how it is now, and players put up with all sorts then – it was our job and quite normal,” he recalls. “If you twisted your ankle you’d wrap it up and out you went – we were on appearance money then. And I’d have injections before a game if I was in pain and still go out and play.”

Ian was lucky to remain fairly injury-free between the ages of 17 – when he damaged the cartilage in his knee – and 29, when he suffered a serious Achilles injury (something he attributes to being tall and slim), but says his problems really started when he retired. To keep fit after leaving the game at the age of 34, he took up road-running and squash, which may also have contributed to his later joint problems.

Ian worked for the Professional Footballers’ Association (PFA) in Manchester for 20 years until he retired last year and has seen countless players require help and support when they have had to retire early because of injury.

Ian and Neil Mellor at the headquarters of the Professional Footballers' Association in ManchesterOne is his own son, Neil. Neil Mellor was a striker at the top of his game when he was forced to retire at the age of only 29 last year following an injury during a match between Preston North End and Milton Keynes Dons. The former Liverpool player damaged his cartilage and cracked some bones in his knee. 

“I knew something was wrong but I didn’t think it was that serious,” says Neil, now 30. “I had an operation on my knee and the surgeon said that that the worst case scenario was that I would have to stop playing. When I tried to come back I knew straight away that I couldn’t. I’d been jogging for 15 metres, then changed direction, and my knee just swelled up. It happened just at the point in my career when I was doing really well and I was ready to move back up a level.”

Neil Mellor’s enforced exit from the game he loved is evidence, that despite all the changes in the way that footballers train and play, and the emphasis on nutrition and fitness, injuries and accidents can still happen in football and still wreck careers.

Neil, who signed for Liverpool when he was 16, after being a youth player at Manchester City from the age of 10, has very different memories to his dad of his days as a pro.

Neil Mellor in Sheffield Wednesday colours“My era was more scientific, and the training was more specific to the individual, depending on your build and position,” he explains. “In my dad’s day it was more: ’go out and do 10 laps’. We were taught about injury prevention, and the physio got us to do lots of stretching and strengthening. There also an emphasis on nutrition. And at Preston we had hydration tests before training, because if you were dehydrated it was more likely to lead to injury.”

Ian concedes: “Neil’s era was better for thing like training and warming up, no doubt. When I was an amateur player I’d have fish and chips before a game. And I used to hide before a game because they wanted us to warm up – I thought running around for 90 minutes was enough! There’s a lot more awareness now and the PFA run lots of training programmes. 

“Neil couldn’t even take a Locket before a game because it was regarded as a drug. Their generation is very lucky because they’ve been educated, and now even lower league teams are more into that kind of thing. The modern game is a lot better than it used to be.”

Neil now works part-time for the PFA and also has a fledgling career as a Sky Sports commentator. “I’m focused on other things now rather than thinking about what I can’t do any more,” he says. “I can’t change what happened.” He can no longer run – he played in a charity match the summer and couldn’t walk for two weeks afterwards – but enjoys yoga and Pilates, and plays golf. Having his dad around to advise him has also helped him keep his feet on the ground.

Asked whether he’d do it all again knowing how serious his osteoarthritis would be later in life, Ian, who was a postman before starting his professional career at Manchester City, says: “Ask any 16-year-old and they’d say yes. You don’t think that far ahead and you think you be the one who doesn’t get injured. And if you ask most men what they’d rather be – a postman, a warehouse man or a footballer…?”

Both are very supportive of the new study, although Neil is too young to take part. He says: “Research like this might help players in 10-15 years’ time so they have fewer injuries and better everyday health. It might educate coaches how to train players better and provide an evidence base to help players play more safely. That’s got to be a good thing.”

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