Following the releases of the PFA’s research into the wellbeing of retired and transitioned players, which revealed that one in five former players suffer chronic pain, FIFPro Chief Medical Officer Dr. Vincent Gouttebarge shares with the PFA his research into the high incidence of knee osteoarthritis amongst former players.

As elite athletes from other sport disciplines, professional football players are sustainably exposed during their career to high energic load and intense physical activities such as sprinting, jumping and landing, suddenly twisting/turning, sliding and dribbling. When this continuous exposure becomes excessive when compared to recovery time, health-related problems such as injuries, illnesses or mood disturbances might occur.

Contrast between short- and long-term health problems

In professional football, the occurrence during a career of acute, chronic and/or recurrent injuries of the musculoskeletal system (muscles, bones, ligaments) has been worldwide and for decades explored. Especially, studies have shown that many professional football players suffer during either training or competition from injuries involving especially hamstrings, knees and ankles. In contrast, the occurrence of long-term health problems after a professional football career has been scarcely explored. This seems quite peculiar. Indeed, these long-term health problems are likely to influence the sustainable health, participation and functioning in work and daily life until older age, aspects that are essential to a high quality of life! Over the past years, the few studies about that topic have suggested that a professional football career might cause negative long-term health effects, especially osteoarthritis of the knee.

What is knee osteoarthritis?

Known worldwide as the leading cause of pain of the musculoskeletal system (muscles, bones, ligaments), osteoarthritis is a joint disease caused by the overuse of joint cartilage. Osteoarthritis results in irreversible cartilage change and damage in the affected knee that can lead to knee pain, stiffness, reduced function, instability, deformity, and activity impairments.. Several aspects play a role in the occurrence of osteoarthritis, for instance age, obesity, joint injury, and intense physical loads on joints during occupational and sport activities. Consequently, with regard to the sustain exposure to activities involving the knee joints and the occurrence of knee injuries during their career, professional football players are likely to suffer on the long-term (that means after their career) from knee osteoarthritis.

What is the rate of knee osteoarthritis among former professional football players?

A study from 2012 explored the recent scientific evidence about the rate of knee osteoarthritis among former professional football players. Only four scientific studies were available about how many former professional football players suffer from knee osteoarthritis, endorsing the lack of research about negative long-term health effects as a consequence of a football career. Based on this recent overview, it was shown that 40% up to 80% of former players having played professional football for 10 to 14 years (Slovenia, Tunisia, United Kingdom) suffered from knee osteoarthritis at an age from 35 years old. This rate of knee osteoarthritis can be acknowledged as high when compared to other groups from the same age as illustrated here below.

Comparison groups (age matched) Rate of knee osteoarthritis (%)
General population Australia 5 – 20
General population France 10 – 15
General population Netherlands 20
General population United Kingdom 12.5 – 25
Construction workers 34
Manual workers 2
Mine workers 6
Former professional football players 40 – 80%

 

What are the consequences of knee osteoarthritis for quality of life?

Only few scientific studies have explored whether former professional football players suffering from knee osteoarthritis are impaired during work or daily life activities because of their medical condition. More than 12 years ago, two surveys were conducted in the United Kingdom among 185 to 285 retired professional football players. From them, 60 to 140 reported that they had been diagnosed with knee osteoarthritis at an average age of 35 years old. Nearly 90% of these former professional football players suffering from osteoarthritis reported to have moderate or severe joint pain and discomfort, while around 65% indicated to experience moderate or severe problems related to mobility and performing usual activities (work, study, house…). Furthermore, 37% of these former players reported moderate or severe problems related to anxiety/depression because of their medical condition. From these former professional football players suffering from knee osteoarthritis, 12 were interviewed by telephone in order to retrieved further information about the consequences of their medical condition. These players reported that knee osteoarthritis was very painful, constantly, leading to restricted mobility, affected quality of life, and limited employment. In addition, they reported that knee osteoarthritis had negative consequences for mental well-being as it caused emotional distress.

The management of knee osteoarthritis?

Programs aiming to help patients in the management of osteoarthritis (not exclusively knee osteoarthritis) have been developed and applied in middle-old (over 55 years old) patient populations. However, these programs are not suitable for the specific characteristics and needs of former professional football players. Despite that single strategies have been evocated for the management of osteoarthritis in (former) professional athletes (Bennell 2012; Kirkendall 2012), a management program specifically meant for former professional football players suffering from knee osteoarthritis is lacking and should be developed, of course based on scientific evidence. The development of such a management program is currently having my attention, in consultation with the FIFPro.

What about the ankle joint?

With regard to the sustain exposure to activities involving the ankle joints and the high rate of ankle injuries in professional football, the question arises whether former players might be at risk for ankle osteoarthritis on the long-term. This question will be explored in a later blog.

Key points

> Despite the lack of scientific studies, it has been suggested that a professional football career might cause negative long-term health effects, especially osteoarthritis of the knee.

> 40% up to 80% of former players having played professional football for 10 to 14 years suffer from knee osteoarthritis at an age from 35 years old.

> This rate of knee osteoarthritis among former players can be acknowledged as high when compared to other groups from the same age (general population from 5% to 25%; construction workers 34%; manual workers 2%).

> 65% to nearly 90% of the former professional football players suffering from osteoarthritis reported to have moderate or severe problems related to joint pain, discomfort and impaired mobility.

> 37% of the former professional football players suffering from osteoarthritis reported moderate or severe problems related to anxiety/depression because of their medical condition.

> A management program for former professional football players suffering from knee osteoarthritis is lacking and needs to be developed.