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Osteoarthritis is rarely top of mind for young people who experience a sport-related knee injury. Returning to sport is. Yet, once someone hurts their knee at a young age, we know they have about a six-fold increased risk of osteoarthritis and that about 50 per cent will go on to develop the disease.

“In my clinical practice as a physiotherapist, I can’t tell you the number of times people have asked, ‘Why didn’t someone tell me 20 or 30 years ago that my injury could lead to osteoarthritis or explain that I could do something to prevent it?’,” said Dr. Jackie Whittaker, a Research Scientist at Arthritis Research Canada and creator of the SOAR Program.

The good news is that we have really good evidence to suggest people can take action to lower their risk of developing osteoarthritis after a sports injury. The frequently asked questions, videos and other resources below are a great place to start.

Frequently Asked Questions

What is osteoarthritis?

Osteoarthritis is a degenerative joint condition and the most common form of arthritis. It’s characterized by breakdown of the cartilage, particularly in the larger joints of the body, but it can also affect smaller joints like the joints in the hand. The big thing to understand about osteoarthritis is that it is not just a consequence of aging. It is not normal wear and tear of the joints. It is an actual disease process.

What causes osteoarthritis?

Despite an incredible amount of research, we don’t know the exact cause of osteoarthritis. However, researchers have been able to determine who is at greatest risk and understand that there might be multiple causes. For example, people who have had a previous joint injury, have high levels of fat tissue, weak muscles, and genetic predispositions are more likely to develop osteoarthritis. Women are also more likely to have OA than men. We are not sure why, but these are fairly well-established risk factors.

When do people usually get osteoarthritis?

There are two groups of people who get osteoarthritis. The first group, and the one most people link to this disease, includes older adults who start to develop joint pain later in life, so in their 50s, 60s, 70s, and 80s. The second group includes young adults who have experienced a previous joint injury.

If we take into consideration that 80 per cent of people that have osteoarthritis have it in their knees, and that 10 to 15 years after a knee injury one can start to develop signs of OA, and then we consider that the most common age to have a knee injury is between 16 and 35, it is not uncommon to see people in their 20s and 30s with signs of OA in their knees if they have had a previous joint injury.

How common is it for someone to develop osteoarthritis after a sports injury?

Once someone hurts their knee at a young age, we know they have about a six-fold increased risk of osteoarthritis and that about 50 per cent of them will go on to develop osteoarthritis within five to 10 years.

How does a youth sport injury lead to osteoarthritis?

One of the most established risk factors for osteoarthritis is a joint injury. Considering that 80 per cent of osteoarthritis involves the knee, injuries that are most concerning when it comes to OA, or what we refer to as “post-traumatic” or “post-injury” OA, are knee injuries. People are most likely to injure their knees between age 16 and 35, and most commonly, those injuries are a result of participating in some sort of physical activity or a sport and recreational activity. Once someone hurts their knee at that young age, we know they have about a six-fold increased risk of osteoarthritis and that about 50 per cent of them will go on to develop it. The risk of OA after a youth sport or activity-related joint injury differs depending on the type of injury. Certain injuries, like an anterior cruciate ligament tear (ACL tear) are associated with a very high risk of osteoarthritis. There are also other injuries that aren’t quite as severe that are still associated with a higher risk of osteoarthritis than one would have if they didn’t have an injury.

What are the biggest myths or misconceptions about osteoarthritis?

Here are the three biggest myths, or misconceptions, about osteoarthritis: 

1) Only older people get it and it’s a consequence of aging and wear and tear of the joints. This isn’t the case. Young people can get osteoarthritis, which is a disease process and not a natural consequence of aging.

2) Osteoarthritis is caused by weight-bearing activities like running or jumping, as well as high-impact activities. What we are starting to understand is that osteoarthritis can actually be caused by inactivity and by really high levels of impact activity. Between those two levels, there is a very healthy amount of impact that keeps the joint healthy and functioning well.

3) There is nothing you can do about osteoarthritis. You just have to suffer with it until an orthopedic surgeon says, “Hey, it’s time. You can go ahead and have joint replacement surgery.” This is not true. We have really good evidence to suggest that many things can be done to minimize a person’s pain and improve their function to reduce symptoms and prevent osteoarthritis from impeding everyday life.

What's one stat that people might find shocking about osteoarthritis?

The most shocking statistic about osteoarthritis is that it decreases a person’s life expectancy. A lot of people think osteoarthritis is just pain that interferes with someone’s ability to do things. But there is irrefutable evidence that people with osteoarthritis have a shorter life expectancy than people without it. This is largely because pain often leads to decreased physical activity, which is associated with weight gain and the development of other chronic conditions. Osteoarthritis is a serious disease that needs to be addressed before a person goes down the road of becoming inactive, gaining weight and developing additional chronic diseases, which may shorten their life span.

How big of a problem is osteoarthritis in Canada?

Osteoarthritis is one of the fastest growing conditions in the world and rates for the disease are highest in North America. In Canada, about four million people currently have osteoarthritis and it is expected that one quarter of Canadians will have it by 2040, which is somewhere around 11.5 to 12 million people.

How can osteoarthritis impact a person's life?

It really depends on the individual, but we know that some people who start to have degeneration in their joints develop pain. That pain can start to restrict their ability to function in a physical sense so that they might have difficulty walking, climbing stairs, or doing the activities that are important to them (whether that be related to recreation, family life, or occupation).

Because they are less active and can do less of what they need to do, they can sometimes become socially isolated. We can see an increase in depression because of that. If someone is less physically active they can start to gain weight or fat tissue and that can lead to the development of other chronic conditions like diabetes and/or cardiovascular disease, which can limit or reduce a person’s life expectancy. Osteoarthritis often reduces overall quality of life.

How does a person currently recover from a sports injury in Canada?

Ideally, someone would have an injury and seek medical attention for that injury. This might involve visiting an emergency room, family physician, or a physiotherapist. The person would then receive a diagnosis and be referred to a physiotherapist to undergo rehabilitation. Depending on the severity of the injury, some people may require just rehabilitation with a physiotherapist, or they may also require surgery, which can involve waiting. Ideally, individuals requiring surgery would continue with physiotherapy during that wait, as well as after surgery. Ultimately, the goal would be to get back to a level of physical functioning that would allow a return to sport.

Although that’s the ideal pathway, the reality, especially in Canada, is that private insurance coverage dictates whether a person can do physiotherapy. Someone can have an injury, access a medical practitioner, the emergency room or a family physician at no cost. However, whether or not someone goes to physiotherapy, and the amount of physiotherapy they receive, depends on the insurance coverage they have. So there isn’t a nice, linear path of care before someone is discharged and returns to their sport.

People often see a physician and a physiotherapist once or twice. They then try to work on their rehabilitation at home or they might see a surgeon and continue with rehab on their own and/or have surgery. They then make a decision about whether they should return to sport without actually knowing if they’ve got the capacity or functionally to do so.

How can a person prevent osteoarthritis?

That’s the million dollar question! We don’t know for sure. We do know what increases a person’s risk. If you prevent a joint injury, you are less likely to get osteoarthritis. We also know that people with a lot of fat tissue are at an increased risk for OA. In theory, if we can help a person not gain fat tissue or reduce the amount of fat tissue they have, we should be able to lower osteoarthritis risk. But the reality of the situation is we don’t have the scientific research to show that we can prevent this disease. We have theories about how we can do it but we haven’t been able to conduct those studies. A big reason for that is, when someone hurts their knee, they don’t develop OA until 10 years later. We would need to construct a study that would follow people for 10 years. Or, if someone was going to reduce their risk for osteoarthritis by losing weight, it takes a period of time to lose weight before we would see an improvement. In theory, we can prevent osteoarthritis by reducing joint injuries, decreasing the number of people that have a lot of fat tissue or who are overweight or obese, keeping people physically active, living healthy lifestyles and eating healthy foods. However, we don’t have the studies to show this yet.

What is the SOAR Program?

SOAR, or STOP OsteoARthritis, is a new knee health program. It’s virtually delivered and designed to help people, who have had a previous knee joint injury, navigate their knee health and reduce their risk for osteoarthritis once they’ve been discharged from care for that knee injury.

The program consists of education, a home-based exercise and physical activity program with tracking, and one-to-one physiotherapy counselling.

How does it work?

We know that people who have experienced a joint injury are at an increased risk of developing osteoarthritis. We also know that risk never goes away. It’s unrealistic that people are going to continue to get care over the 10 to 15 year period before they develop OA. So SOAR gives people the tools to manage their own knee health over that period of time, and hopefully also reduce their risk for osteoarthritis.

How is SOAR different from other programs?

Currently, there aren’t a lot of osteoarthritis prevention programs. Some work has been done to try to reduce obesity as a risk factor for OA, but there aren’t many programs that target people after they’ve had a joint injury and before they develop signs and symptoms of the disease. The SOAR Program is also individualized and based on the priorities of participants in the program. We don’t tell them what exercises to do. Instead, we work with individuals to identify what their priorities are and to develop a program that meets their needs.

SOAR is also unique because it focuses on young people that are at an increased risk of developing osteoarthritis because they’ve had a joint-related injury (so people in their 20s and 30s).

What do researchers hope SOAR will achieve?

Ultimately, we hope the SOAR Program will reduce the number of people that get osteoarthritis. Or, we hope it reduces the severity of OA that people have and also empowers them to manage their own knee health from a young age through to the point where they may actually develop osteoarthritis. We want OA to have less of an impact on people and their overall quality of life.

Videos

Osteoarthritis 101

Osteoarthritis is a serious disease. It’s not just normal wear and tear of the joints. Learn about the most common type of arthritis, what causes it, who it impacts, and more from Arthritis Research Canada Research Scientist, Dr. Jackie Whittaker.

Osteoarthritis Myths & Facts

There are three main myths about osteoarthritis: 1) It’s not serious. 2) It’s caused by normal wear and tear on the joints. 3) There’s nothing a person can do about it once they have it. Arthritis Research Canada’s Dr. Jackie Whittaker debunks some of the biggest myths surrounding the most common type of arthritis.

Osteoarthritis Changes Lives

Osteoarthritis can impact many aspects of a person’s life. Some people who start to have degeneration in their joints develop pain. That pain can start to restrict their ability to function, so they might have difficulty walking, climbing stairs, or doing activities that are important to them (whether that be related to recreation, family life, or occupation). Dr. Jackie Whittaker, a Research Scientist at Arthritis Research Canada, explains how being diagnosed with osteoarthritis can interfere with daily life.

Preventing Osteoarthritis

How can a person prevent osteoarthritis? That’s the million dollar question! We don’t know for sure. However, we do know that some factors – like a previous joint injury or high amounts of fat tissue – increase a person’s risk of developing this disease. Find out more about potential ways to prevent osteoarthritis.

Osteoarthritis Research

About 50 per cent of people who experience a knee joint injury will develop osteoarthritis within five to 10 years. This is a serious problem. We’ve created a unique program that aims to help prevent osteoarthritis after a sport-related knee injury. SOAR, or STOP OsteoARthritis, is a new knee health program. It’s virtually delivered and designed to help people, who have had a previous knee joint injury, navigate their knee health and reduce their risk for osteoarthritis once they’ve been discharged from care for that knee injury. Learn more from the research scientist behind the program.

Targeted Movement and Arthritis

In this episode of Arthritis Wellness Conversations, host Sandra Sova talks with expert guest Dr. Jackie Whittaker, Research Scientist at Arthritis Research Canada, and Arthritis Patient Advisory Board members about targeted movement and how it can help you lead a better life with arthritis.

Musculoskeletal Research and Bone and Joint health

In this episode of Arthritis Consumer Experts’ Arthritis At Home, Dr. Jackie Whittaker highlights the importance of exercise and how staying active can help prevent, maintain, and manage bone and joint related pain and health. She concludes the interview by sharing insights and updates on osteoarthritis treatment.

Is Osteoarthritis Preventable?

In this episode of Joint Action, Dr. Jackie Whittaker discusses osteoarthritis prevention, risk factors and prevention strategies. Osteoarthritis is the most common joint condition, affecting more than 300 million people worldwide. There is no cure and current management strategies are focused on alleviating symptoms. However, research in the field of osteoarthritis prevention has been emerging, and although there is still work to be done, there have been new insights into modifiable risk factors such as obesity and joint injury.

Arthritis at UNH: Arthritis Web Seminar Series Lecture 40

Arthritis Research Canada Research Scientist, Dr. Jackie Whittaker, talks osteoarthritis, musculoskeletal rehabilitation and OA prevention in this webinar.

Exercise First E-Knee

Dr. Jackie Whittaker discusses sport-related joint injuries, risk of osteoarthritis, managing risk, as well as her research/work to develop a program to reduce a person’s chances of developing this type of arthritis after a knee injury.

Playing the Long Game: Consensus for Preventing Osteoarthritis after an ACL tear

Arthritis Research Canada Research Scientist, Dr. Jackie Whittaker, discusses osteoarthritis and preventing it after an ACL tear in this Osteoarthritis Action Alliance webinar.

Research

Preventing Osteoarthritis after a Sport-Related Knee Injury: The SOAR (Stop OsteoARthritis) Program

SOAR Recruitment Notice

Do People with Knee OA Use Guideline-Consistent Treatments After an Orthopaedic Surgeon Recommends Nonsurgical Care?

Does a History of Youth Sport-Related Knee Injury Still Impact Accelerometer-Measured Levels of Physical Activity After 3-12 Years?

"Every New Beginning Comes from Some Other Beginning's End": Anterior Cruciate Ligament Injury and Post-Traumatic Knee Osteoarthritis

Efficacy of the SOAR Knee Health Program: Protocol for a Two-Arm Stepped-Wedge Randomized Delayed-Control Trial

Health-Related Outcomes 3-15 Years Following Ankle Sprain Injury in Youth Sport: What Does the Future Hold?

'I Feel I'm Leading the Charge.' A Qualitative Analysis of a Virtual Physiotherapist-Guided Program for Persons with Sport-Related Knee Trauma

Balance, Reframe, and Overcome: The Attitudes, Priorities, and Perceptions of Exercise-Based Activities in Youth 12-24 Months After a Sport-Related ACL Injury

Removing the Training Wheels: Embracing the Social, Contextual and Psychological in Sports Medicine

A Lifespan Approach to Osteoarthritis Prevention

Searching for the Holy Grail: A Systematic Review of Health-Related Quality of Life Measures for Active Youth

Osteoarthritis Year in Review 2020: Rehabilitation and Outcomes

Vertical Drop Jump Biomechanics of Patients With a 3- to 10-Year History of Youth Sport-Related Anterior Cruciate Ligament Reconstruction

Secondary Consequences of Juvenile Idiopathic Arthritis in Children and Adolescents with Knee Involvement: Physical Activity, Adiposity, Fitness, and Functional Performance

Patient Beliefs About Who and What Influences Their Hip and Knee Osteoarthritis Symptoms and Progression

Factors That Patients Consider in Their Choice of Non-Surgical Management for Hip and Knee Osteoarthritis: Formative Qualitative Research for a Discrete Choice Experiment

OPTIKNEE Group: working in preventing ostearthritis after knee injury

Combined Hormonal Contraceptives Do Not Protect Against Musculoskeletal Injuries or Conditions

Articles

What? I can get osteoarthritis in my thirties!?

Dr. Jackie Whittaker’s work focuses on the connection between youth sports injuries and early onset osteoarthritis, as well as OA prevention. Millions of Canadians currently live with the pain and disability of this disease and it is estimated that 12 million Canadians will have osteoarthritis by 2040. We sat down with Dr. Whittaker to learn more about her exciting field of research.

 

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Knee Health: Helping Curb the Osteoarthritis Epidemic in Canada

Around 500,000 youth in Canada injure their knees while playing sports each year. Of those people, 50 per cent will develop osteoarthritis within 10 years. That is a lot of Canadians getting diagnosed with the most common type of arthritis by their 30th birthday.

 

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Surgery Not the Only Option for People with Knee Osteoarthritis

Only one in five people with knee osteoarthritis follow advice/international guidelines that recommend non-surgical treatments (e.g. education, exercise, weight management, and pain medications) as first-line treatments.

 

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Online Decision Aid Helps Patients Weigh Risks and Benefits of Surgery vs. Other Treatments

A research team led by Arthritis Research Canada scientists has developed an online tool, called a decision aid, that provides individualized information on total knee replacement surgery and non-surgical treatment options to people with knee osteoarthritis. In a randomized clinical trial, participants who used the decision aid prior to their surgical consultation had a better understanding of what their options were and the potential risks and benefits. This led to patients being more informed about their options and making better quality treatment decisions, even if that meant deciding against surgery.

 

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Alberta in Need of More Resources for Rural Residents with Osteoarthritis

New research reveals Albertans who have osteoarthritis, and live in rural parts of the province, have limited access to the care they need to manage their disease, symptoms and pain.

 

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At-Home Exercise Guide for Arthritis

Physical activity plays an important role in managing arthritis – especially when it comes to reducing pain and improving mobility. Yet, many people living with different types of this disease do not meet recommended physical activity levels. In fact, 50 per cent of people in Canada are not physically active during their free time, and the rate is even lower in people with arthritis.

 

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Preventing Knee Osteoarthritis in Youth Who Play Sports

When kids injure their knees playing sports like soccer, not many of us think about how that injury will manifest itself 10 or 15 years down the road. Millions of Canadians currently live with the pain and disability of osteoarthritis. It is estimated that by 2040, 25 per cent of all Canadians will have osteoarthritis. This percentage will be higher in those who suffer a traumatic knee injury.

 

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Youth, Knee Injury and Osteoarthritis Risk and Prevention

A lot of young people are involved in sports, and a lot of sports can lead to knee injuries. These injuries can, in turn, lead to a higher risk of osteoarthritis later in life, due to both damage to the joint and potential weight gain that can result from lower activity levels after an injury. Dr. Jackie Whittaker, a physiotherapist and assistant professor in the Department of Physical Therapy at the University of British Columbia, is heading up a research team that’s looking to get a better understanding of how to delay or prevent OA from developing by improving joint health in young people.

 

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Knee Injuries Plague Women Soccer Stars

Several top women players are missing the FIFA World Cup because of knee injuries. Research shows women are more prone than men, but experts say the reasons go far beyond biology.

 

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Women’s World Cup: The Epidemic of ACL Tears in Female Soccer Players is About More than Just Biology

Over 25 of the world’s top female soccer players are missing the 2023 FIFA Women’s World Cup because of ACL tears, including Canada’s Janine Beckie. Female athletes are two to eight times more likely to tear their anterior cruciate ligament (ACL) compared to males, and their odds of returning to sport within five years are 25 per cent lower.

 

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Helpful Links

Physical Activity Tips for Adults (18-64 years)

Physical activity plays an important role in your health, well-being and quality of life. Improve your health by being active as part of a healthy lifestyle. Learn more about the Government of Canada’s physical activity tips.

 

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24-Hour Movement Guidelines

Canada’s first ever 24-Hour Movement Guidelines for Adults offer clear direction on what a healthy 24 hours looks like for Canadian adults aged 18-64 years and 65 years or older.

 

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Life After Youth Sports Injury

Youth who have had a sports-related knee injury are more likely to develop knee osteoarthritis. Researchers found that youth and young adults experience a poorer health-related quality of life – including physical, psychological, and social aspects – even as long as three to 12 years after injury. Those with previous knee injuries who had a more complex injury history, injury type, or knee pain were even more likely to experience poorer outcomes.

 

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How to Save Your Knees Without Giving Up Your Workout

There’s no magic bullet to knee health, but staying active and building muscles around the joint are crucial. Find out more in this New York Times article.

 

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Knee Health: Helping Curb the Osteoarthritis Epidemic in Canada

Around 500,000 youth in Canada injure their knees while playing sports each year. Of those people, 50 per cent will develop osteoarthritis within 10 years. That is a lot of Canadians getting diagnosed with the most common type of arthritis by their 30th birthday. It is estimated that by 2040, 12 million Canadians will be living with osteoarthritis.

 

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Journal of Orthopaedic and Sports Physical Therapy Insights Podcast: Old knee, Young Adults

Protecting the health of our best and brightest stars of the future holds a special place in Dr. Jackie Whittaker’s heart. How do you ensure youth athletes stay healthy and happy in sport, and what do you do if it goes pear-shaped? Dr. Whittaker shares her tips, honed from years of clinical practice and field-leading research, on planning and managing return to sport after serious knee injury.

 

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Dr. Jackie Whittaker on Osteoarthritis Prevention and Physiotherapy in Sports

Shanon McQuitty, a member of the Arthritis Patient Advisory Board of Arthritis Research Canada, interviews Dr. Jackie Whittaker, Assistant Professor in the Department of Physical Therapy at the University of British Columbia, on osteoarthritis prevention and physiotherapy in sports.

 

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Hey OA! Podcast

Dr. Jackie Whittaker, an assistant professor of physical therapy at the University of Alberta, compares primary, secondary, and tertiary osteoarthritis prevention, discusses the challenges and opportunities for research with youth populations, and chats about using Twitter for research.

Please click “Learn More” below and scroll down to episode 17.

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TSN Radio Edmonton 1260 Krush Performance ‘Optimizing Health after a Youth Sport Injury’

Dr. Jackie Whittaker talks about recovering from youth sports injuries on TSN Radio Edmonton 1260 Krush Performance.

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