Sports Medicine..........................................................14

Cyclooxygenase (COX) which is important in progressing inflammation; by blocking it inflammation and pain is reduced. There are a range of NSAIDS available, and many are prescription only; as they have some common side effects and can interact with other medication, if you are going to take these regularly you should do this in consultation with your doctor. Finally, when simple analgesia is inadequate, we sometimes must resort to Opiate medication, particularly if the pain is interfering with sleep. Once again, this should be done as part of a wider health plan.

Beyond tablet medication there are a number of substances that can be injected directly into the knee joint that may help with pain and inflammation. Cortisone is a naturally occurring hormone in the body that has very powerful antiinflammatory effects, and this has been used widely for decades as an injection to settle inflamed knees. However, it needs to be used with caution as, along with a number of other well-recognised risks, more recent evidence has demonstrated that it actually accelerates osteoarthritis. It does remain a useful treatment in the right circumstances, however. Artificial joint fluids such as Hyaluronic Acid have also been used widely used in osteoarthritic knees and a good body of evidence suggests they are safe and effective in reducing pain and delaying surgery. Protein-Rich Plasma or PRP, which is derived from the patient’s own blood, is increasingly used in osteoarthritic knees, although evidence for efficacy is mixed. Finally, Stem Cell therapy is a new and promising area of medical exploration, however the evidence base remains very low and it has not yet reached into the mainstream medical cadre.

There are a range of non-pharmacological therapies on offer, of which two are worth mentioning. Extra-Corporeal Shockwave Therapy (ESWT), in which high energy acoustic waves are transmitted through damaged tissue to try and induce natural repair, has a growing evidence base for improving the symptoms of knee osteoarthritis. I have extensive experience with ESWT and, although I do use it in knee OA, I have found the results mixed and would not rely on it as a stand-alone treatment. As a nonpharmacological treatment, however, it is a useful adjunct, particularly in someone who cannot tolerate medication. Similarly, Low Level Laser Therapy (LLLT) in knee OA also has some promising evidence and is non-pharmacological and has minimal risk of side effects. Finally, although knee arthroscopy was once a mainstay of treatment options for osteoarthritis, evidence in recent years has shown that it was overused and should probably be used in a more targeted manner. There are certainly clear indications in which knee arthroscopy should still be used, but this option needs to be discussed with your Orthopaedic surgeon.

In summary, knee OA is a common and debilitating condition and there are a wide range of treatment options that can be offered, but none are guaranteed. As with most challenges that our bodies face, lifestyle interventions should be the first option and the earlier these are implemented, the better for the health of your knees. Beyond that it is likely that a combination of non-surgical treatments will have some impact on the symptoms and progression of the disease, and this should be done in discussion with your Sports or Orthopaedic doctor.

i https://www.health.harvard.edu/blog/a-new-look-at-steroid-injections-for-kneeand-hip-osteoarthritis-2019122318430

ii https://pubmed.ncbi.nlm.nih.gov/26806183/

iii https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383098/

iv https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670564/

v https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830679/

vi https://bjsm.bmj.com/content/55/13/707

The Power

of Patience

As I watched the amazing achievement of Flora Duffy becoming an Olympic champion in the triathlon in Tokyo, the power of patience resonated strongly. There is no question that exceptional athletes like Duffy have put in the training and they’ve “done the work.” But what is truly powerful is the timing that it all came together, and how each athlete had the patience to continue their quest to reach their goals, even when things didn’t seem to be going their way.

According to writer Mike Edger, the quality of being patient is an ability or willingness to suppress restlessness or annoyance when confronted with delay. When an athlete truly masters patience, the victories are even sweeter and the celebration is not only about the win, but the journey it took physically, mentally, and emotionally to get there.

Here are a few tips for athletes and coaches to keep in mind when things may not seem to be going your way.

PATIENCE WITH OURSELVES. Often the mind goes faster than the body in training, in racing or recovery from injury. We have a timeline in our own mind and want to hurry back to training, train harder or to get to the next race or performance to improve our time.