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Sports and exercise injuries Q&A

Query 1

I’m a retired 52-year-old ex-footballer. I’m trying to lose and control my weight by exercising more, but I’m finding that my right knee is increasingly painful. During my playing days I suffered a cartilage (meniscal) tear, which was treated by surgery. I continued playing at a fairly high level until I was 34, and since then I’ve worked at a desk job.

I find that running on hard surfaces increases the pain, but occasionally I also get sudden intense pain and swelling which stops me running for over a week.

On one occasion I couldn’t run for four weeks. I’ve been told by my GP that I have osteoarthritis (OA) of the knee, but the knee doesn’t lock or give way, which I’ve been told can indicate a ‘mechanical’ problem in the joint. Is there any way of keeping myself active by reducing my knee pain?

What the expert says:

Simple analgesics such as paracetamol are effective for treatment of pain. Non-steroidal anti-inflammatory drugs (NSAIDs) shouldn’t be used long term. However, your flares of swelling and pain should be treated with short courses of anti-inflammatories such as diclofenac or ibuprofen.

Sudden episodes of swelling may just reflect flares of OA and require rest until the swelling settles. If you have persistent or severe swelling and pain you should have this assessed by your GP. Aspiration of the joint may be considered. This is where some fluid is taken from the joint, through a needle, for analysis. This may show signs of calcium crystals in the joint.

Crystal shedding within the joint can cause inflammation in the joint lining tissue (synovium), leading to sudden severe episodes of pain. Calcium deposits in the remaining cartilage can often be seen if you’ve previously had extensive cartilage surgery.

More recently, meniscal surgery has been less extensive, which appears to reduce the risk of osteoarthritis and calcium deposition later in life.

Your problems with road running illustrate one of the risks of high-impact exercise for people with osteoarthritis in the lower limbs. Running may be too high impact for people with an established form of the condition. Exercise is still encouraged, but lower-impact exercise is recommended. Try exercising using a cross-trainer or exercise bike, run on softer ground and follow the general safe exercise principles described in this booklet.

Query 2

I’m a middle-aged woman, working in a stressful job running an NHS human resources department. I’ve always tried to maintain some physical activity, but what with the demands of work and home life this has reduced over time. Because of this my weight has increased, and although I’m not obese, I do want to get slimmer.

What I really want to do is get fit to lose the weight, and so I’ve set myself the goal of running a 10 kilometre event for charity in four months’ time. Do you have any tips?

What the expert says:

So you want to start running – great! The first thing to do is walk more during your day and use the stairs. Then go along to a running club or specialist exercise shoe shop and find out which trainers would be suitable for your feet. Once your footwear is sorted, try running twice a week for two weeks, alternating between running and walking every four minutes.

You should try to go a little further each time, but don’t push yourself too far too soon. You may find that your muscles hurt after your first run, but this should ease after a couple of days.

Set yourself the goal of a 5-km run after a month or so. Be sensible though, and don’t run the whole way if you start to feel pain. Try again the next week until you can run the whole 5-km. You’re halfway to your target distance! After two months of regular running, you’ll probably start to feel completely different about your physique and will feel noticeably fitter. At this point you can add one longer run per week. Aim to be comfortably running about 9-km two weeks before the 10-km race.

But don’t stop after your 10-km – try adding some other physical activity into your weekly schedule, such as core strengthening and balance, which could include pilates classes, yoga or classes at the gym. There are also lots of good exercise DVDs which you can do in your home. Eventually you’ll find the stress of work easier to manage, and you’ll lose some of that excess weight.

For more information, go to www.arthritisresearchuk.org.
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