When people hear the word arthritis, they typically think of elderly people who are candidates for hip or knee replacements. Unfortunately, there is also a sizable percentage of the population that is young and wants to remain active athletically but can’t due to earlier stage or milder arthritis. Their joint degeneration is not severe enough to warrant surgery, but the pain is still significant enough that it limits their ability to do things such as running.
Usually, a physician will prescribe a period of rest, anti-inflammatory use, physical therapy, and/or a cortisone injection for these patients. In the past, when these modalities didn’t work, surgery was the only option. Over the last few years, however, Hyaluronic acid (also referred to as viscosupplementation), an artificial joint lubricant, has played a role in treating arthritis. Initially, it was used in the knee but now sports medicine doctors are using it in joints, such as the shoulder, hip, great toe, and ankle. Professional baseball and tennis players use it during the season when other modalities such as rest or surgery are not legitimate options. I am sure athletes in other sports use it as well. The good news is that it doesn’t only help high-level athletes.
“If people have failed standard treatments like oral medications and cortisone injections, hyaluronic acid injections may help the right candidates,” says Dr. Vijay Vad, a Sports Medicine specialist at the Hospital for Special Surgery and author of Arthritis Rx: A Cutting Edge Program for a Pain-Free Life (Gotham 2006).
“An arthritic joint loses its ability to produce the high-quality joint lubricant which is essential in pain-free and healthy functioning of the joint”, says Dr. Vad. Hyaluronic acid injected into the arthritic joint restores the properties of the joint lubricant. The two properties it restores are elasticity and viscosity which are essential in maintaining healthy and necessary joint function.
“The process involves getting about 3 injections of hyaluronic acid into the arthritic joint. Depending on the body part affected, ultrasound guidance may be used to provide precise placement of the medication in the joint”, says Dr. Vad. In cases of lower extremity arthritis, other modalities such as prescription foot orthotics that provide better stability to the joint and re-distribute the force thru the foot and ankle in a more efficient and biomechanically active position can be used in conjunction with the injections to give patients the best chance for a successful outcome.
After the injections, the patient is encouraged to engage in a proper exercise regimen such as bicycling or walking and icing the joint on a regular basis, particularly after exercise. Physical activity and mobility are encouraged as they help to increase the range of motion in the affected joint.
Dr. Vad maintains that patients best suited to do well with these injections are normally very active, have no major mechanical malalignment issues, and are not grossly obese.
Early arthritis doesn’t have to mean the end of athletic endeavors. “For the right candidate, viscosupplementation could mean restoration of quality of life without resorting to major surgical intervention”, says Dr. Vad.