Playing sport injured is associated with osteoarthritis, joint pain and worse health-related quality of life: a cross-sectional study

Bullock GS, Collins GS, Peirce N, Arden NK, Filbay SR. BMC Musculoskelet Disord 21, 111 (2020). https://doi.org/10.1186/s12891-020-3136-5

Full Text Freely Available

Take-Home Message

Elite and recreational cricket players have increased odds of having osteoarthritis and reporting joint pain if they continued to play sports while injured compared to those who did not play while injured.

Summary

Athletes often need to decide whether or not to compete while injured. However, we have little evidence to help advise athletes about the consequences of participating in a sport while injured. Hence, the purpose of this study was three-fold:

Determine the relationship between current health-related quality of life and history of playing a sport while injured Determine the odds of persistent joint pain or diagnosed osteoarthritis in people who played sports while injured Compare findings between elite and recreational cricket players

In the Cricket Health and Wellbeing Study, 2,223 current and former cricket players completed the Short Form-8 (mental and physical quality of life) and answered questions related to physician-diagnosed osteoarthritis and persistent joint pain on most days of the prior month. The authors also asked participants about playing sport while injured: “Have you ever played sport injured, despite feeling like doing so might make the injury worse?”. Most participants were current players (60%) and recreational athletes (62%). Seventy-seven percent of the respondents reported playing sport while injured. The authors accounted for factors like age, sex, number of joints injured, and years of sport participants. They found that athletes that reported playing while injured typically reported slightly lower physical and mental quality of life than those who did not play injured. If a cricket player reported playing while injured, they were about 2 times more likely to be diagnosed with osteoarthritis or to report persistent joint pain compared to players who did not play injured. These findings were consistent among elite and recreational athletes.

Viewpoints

More than three-quarters of cricket players in this study reported continuing to play sport while having a joint injury. These players had greater odds of being diagnosed with osteoarthritis or having persistent joint pain. There is likely a psychological factor among competitive athletes, regardless of level, driving them to push through joint injuries and continue to play. It would have been interesting to know the chance of these poor outcomes compared to athletes who were injured and stopped playing; however, the number of these athletes is small and were primarily people with a game-ending injury (e.g., fractures, dislocation, ACL sprain). Regardless, these findings reinforce many other studies that show an injury increases the risk of poor health outcomes. Health care providers should educate athletes (elite and recreational) on the short- and long-term health consequences of an injury and the possible consequences of playing sports while injured to ensure the patient is making an informed choice. Although many athletes are faced with outside pressures to continue playing during injury, clinicians should advocate for the athlete’s health and well-being. Having open and honest conversations about the athletes’ priorities may lead to better outcomes following a joint injury.

Questions for Discussion

Do you have discussions with your athletes about the implications of playing whilst injured? As a clinician, do you agree it is your responsibility to educate your patients about the consequences of long-term joint health following an injury?

Written by: Danielle M. Torp

Reviewed by: Jeffrey Driban

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