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010 Osteoarthritis and Cycling

Osteoarthritis and Cycling

Old- age, ageing, wear- and - tear are important factors that impact on the skeletal axial system of man. Cyclists in the veteran and senior age- groups also suffer the consequences of OA. Discomfort is experienced in the neck, thoracic and lumbar vertebral areas. Involvement of one on both knee joints is very common after the age of 50- years. Soft- tissue around the joints are also affected to a degree. Cycling four times a week is very hard on the ageing body above the age of 50- years. Recovery is slow and more rest is needed. A bad back or knee are often disabling, cessation of cycling, partially or permanently is the usual outcome. "Rheumatism" often accompanies OA resulting in a feeling of tiredness or asthenia in the afternoon. OA is a seperate entity from RA, but may accompany it.

How does OA restrict the activity of the cyclist?

Pain experienced in joints (knees, upper and lower back)
Discomfort after cycling- in joints and surrounding soft tissue
Aches and pains the following two days after cycling
A feeling of tiredness or fatigue more than usual
Need for painkillers
Reduced motivation because of chronic, fluctuating discomfort
Negative impact on mindset and enthusiasm
Severe joint pain experienced before, during and after cycling in winter and cold weather.

What goes wrong in osteoarthritis?

Osteoarthritis, commonly affects weight bearing joints and is characterized by degenerative changes in the articular hialine cartilage. Factors that contribute to this disorder include occupational strain, genetic factors, old joint fractures, hormonal factors, obesity, rugby injuries, altered joint alignment, wear- and- tear of increasing age with repeated trauma or irritation. It is a progressive disease in which the articular cartilages gradually soften and disintegrate. Pain and restriction of joint movement is the result and follows on often- repeated slight trauma of the cartilage. The onset is slow and insidious but may fluctuate. An early symptom is joint stiffness experienced after rest and disappearence on movement. A soft creaking (crepitus) can be felt or heard. Pain and swelling follow.

Recent data show that about 30 % of people aged 45- 65 years, and 63- 85% of individuals older than 65 years have symptoms or X- ray changes of OA. Physical restriction is the result (Brandt et al 1996). Therefore, golden oldies, veteran and senior cyclists can expect to experience some symptoms of OA. Often symptoms of fibromyalgia and related fibrositis will be experienced in this age group.

Cycling problems with OA

Early, pain with joint use. Later discomfort at rest (hand, knee, foot, heels)
Reduced joint movement- neck and back. After cycling stiffness is a problem but unavoidable. Bike set-up is important.
Joint instability (knee)
Night pain
Tests the cyclist must undergo who have suspected OA
Full blood count and sedimentation rate
Arthritis screen and exclusion of rheumatoid arthritis
X- ray of joint (knee) or cervical/ lumbar vertebra
MRI, if disc prolapse expected, or referred pain is experienced in an extremity or the trunk.

Cycling advice for golden oldies

For the golden oldy,OA in a knee or the back is not good news. Severity of involvement will determine the outcome

Warm up and down

Dress warmly

Don't push yourself to the limits. Use a heart- rate monitor

Be careful with the use of pain- killers. Cycling may, however be impossible without them. Pills have side- effects and may affect the liver and kidneys. Paracetamol in pharmacological dosis is usually prescribed (0.5 gm- 1 gram) 6 hourly. For cycling, this agent is mostly ineffective, but safe.

NSAIDS are frequently needed and abused. The result can be progression of the disease (abuse of indomethacin), oliguria, bleeding stomach ulcers, heartburn, reflux and renal failure. There is a wide choice of products (ibuprofen is frequently prescribed). The efficency of the products is currently much the same. A combination of NSAIDS is to be discouraged. Long- term treatment is detrimental. Reasses the situation after 3 weeks of treatment. Avoid narcotic analgesics- rather stop cycling than going over to this drastic step. The new Cox- 2 inhibitors are available in the RSA. Side- effects are refuted to be less- this has advantages. Compared to older drugs, Cox- 2 inhibitors, have not been shown to be more effective. They are a good alternative to the conventional NSAIDS but are very expensive.

Stretching and local rubs, are important. A knee- guard may bring temporary relief. A back brace is of benefit for a sore upper back.

Consider a visit to a physiotherapist, rheumatologist, chiropracter or orthpaedic surgeon.

Avoid unnecessary invasive testing and operations. In some cases, a joint washout may be of value- consult an orthopaedic surgeon and obtain a second opinion.
Modify or upgrade your bike. Bike- fit is important. Saddle height is relevant and a new, extension stem may be indicated to reduce the strain on the upper back of the cyclist.

Frequently Prescribed NSAIDS AND DRAWBACKS

Drug Side- effects

Indomethacin GIT ulceration, cartilage damage
Naproxen GIT disturbance, ulceration
Diclofenac GIT disturbance, ulceration
Ibuprofen Peptic ulcers, bleeding
Piroxicam Bleeding, ulceration
Flurbiprofen GIT disturbance
Celecoxib GIT disturbance
Rofecoxib GIT disturbance, hypertension

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