Knee osteoarthritis is a common chronic condition many endurance athletes (especially Spartans) must face. It generally stems from overuse, a previously torn ACL or meniscus, or both, and it totally sucks. When your cartilage in the knee joint suffers, so can your performance in OCR (and your performance potential when it comes to longevity in endurance sports). “Knee osteoarthritis won’t be caused by being an endurance racer, and studies on long-distance runners have shown that running does not increase one’s risk of arthritis,” says Dr. Michael Fredericson, Director of Physical Medicine and Rehabilitation (PM&R) Sports Medicine in the Department of Orthopedic Surgery at the Stanford University Medical Center. “But if you have underlying arthritis and a prior injury, too much high impact can make it worse.”

Dr. Fredericson’s research focuses on the etiology, prevention, and treatment of overuse sports injuries in athletes. He’s the Head Team Physician for the Stanford Track & Field and Swimming Teams, was a Tokyo 2020 Olympic Physician, and has published over 200 peer-reviewed articles as well as four books focused on an improved understanding and treatment strategies for overuse injuries in athletes. Here are his top tips and warning signs to watch out for if you’re a Spartan who struggles with knee pain, so you don’t shoot yourself in the (erm, knee) longterm. 

Mind the Pain

With Knee Osteoarthritis, Fredericson explains, “Essentially the cartilage — the protective covering over the bone — starts to wear down, then the bone-on-one contact becomes painful without any cushion. The knee will feel stiffer, you’ll lose some range of motion, and, at some point, it will become so painful that you won’t be able to tolerate higher levels of more intense training. This can also lead to over compensation issues that injure other body parts.”

2 Warning Signs: Watch Out for Stiffness & Progressive Pain

If your knee cracks and creaks, don’t worry — that’s not necessarily an indicator of OA. But if the knee starts to get swollen after you exercise while getting stiffer and more painful, that could be a warning sign. “There are three main compartments in the knee,” says Dr. Fredericson. “The medial [inside], lateral [outside], and patella femoral underneath the kneecap. An arthritic knee can hurt in one of those compartments, or be painful in the whole knee. It’s also not a great shock absorber, particularly with plyometric activity of higher impact repetitive movements like running.”

Treatment and Prevention

If you look at all the research on arthritis, the number one treatment is shown to be strengthening, so it only makes sense that doing strength work would help to potentially prevent arthritis, too. “Staying strong, particularly in the hip muscles, quadriceps, and core, is key,” says Dr. Fredericson. “Runners tend to be strong in their quadriceps and some of the glute muscles but not the outer medius and minimus — our stabilizer muscles. They need extra training to incorporate these unless they’re doing something more multidirectional…I’ve almost never met a runner who wouldn’t benefit from strengthening their outer hip muscles and core.”

Cross Training and Strengthening Exercises Are King

Everyone is going to get OA to some degree at some point. If you do the right things, including cross training, weightlifting and strengthening exercises, and being mindful of how quickly you come back to OCR after a knee injury (not too soon!) hopefully you can keep it at bay and stay active long term. 

What about hyaluronic acid injections?

“Those are really designed for someone who has mild to moderate arthritis and is having pain but is not yet ready for a joint replacement,” says Dr. Fredericson. It’s a middleground treatment, if you will. “Hyaluronic acid is naturally produced in the knee joint, but as you develop arthritis, an injection of this synthetic form of the thick gel can help coat the bone surface and lubricate it. It’s something that needs to be repeated, typically twice a year, which is about as often as most insurance companies will pay for it.”

In addition to these preventative measures, talk to your doctor about how to develop best practices for staying active for the long haul. Non-surgical treatment options clinically proven to help successfully manage symptoms over time, such as hyaluronic acid injections, like DUROLANE injections, may help mitigate pain from osteoarthritis and support you as you continue your physical activity. 

EDITOR’S NOTE: We’re not doctors. It’s imperative you consult yours before moving ahead with what’s right for you. 

DUROLANE is indicated for the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative non-pharmacological therapy or simple analgesics, e.g., acetaminophen.

Do not inject DUROLANE in patients with knee joint infections, skin diseases, or other infections in the area of the injection site. Do not administer to patients with known hypersensitivity or allergy to sodium hyaluronate preparations. Risks can include transient pain or swelling at the injection site.

DUROLANE has not been tested in pregnant or lactating women, or children.

Full prescribing information can be found in product labeling, or at www.durolane.com or by contacting Bioventus Customer Service at 1-800-836-4080. 

DUROLANE is a registered trademark of Bioventus LLC.