Youth Sports Injuries in the form of traumatic & repetitive overuse are of growing concern with the rise of competitive success expectations, training intensity and frequency of participation(year round), and early specialization.
The result is a growing incidence of injury to Tendons, Ligaments(ACL injury), Bone, and Joint Structures(meniscus and articular cartilage).
These injuries have a long-lasting physical impact on joint health as a result of osteoarthritis.
THERE IS A 10-FOLD INCREASE OF POST-TRAUMATIC OSTEOARTHRITIS(PTOA) 15 YEARS POST-KNEE INJURY
This article will address:
Osteoarthritis facts and risk factors related to disease progression.
The impact of youth athletic injuries related to the onset of osteoarthritis.
Factors that may influence the increasing frequency of knee injuries in youth sports.
Natural alternatives to reduce osteoarthritis progression.
Polyphenol and full-spectrum collagen nutraceutical support of osteoarthritis.
Osteoarthritis(OA) is the most common form of arthritis in the body. The wear and tear progression of joint arthritis is a debilitating disease most frequently occurring in the weight-bearing joints of the body.
What most people do not understand is the fact that degenerative joint changes begin early in life.
Arthritic joint changes can be detected in 50% of all people over 35 years of age.
Almost all people over 60 have some form of osteoarthritis.
Osteoarthritis is the result of chronic stress and is the most frequent pathological joint change observed in adults. It increases with age but also exists in younger people.
Osteoarthritis(definition): Sometimes called degenerative joint disease, or “wear and tear” arthritis, OA is the most common chronic condition of the joints. It occurs when the cartilage or cushion between joints breaks down leading to pain, stiffness, and swelling.
OA is a complex disease with a varied etiology and multiple risk factors.
There are critical events for OA initiation and disease progression:
- over activated catabolic(degradation) activity primarily mediated by pro-inflammatory cytokines
- deleterious stresses such as oxidative stress as well as the impaired defense mechanisms against these stress factors(i.e., oxidative stress)
- chondroprotective molecular and cellular processes
- bone, cartilage and synovial fluid biomarkers
The ability to control inflammation, oxidative stress and maintain the balance of Extracellular Matrix synthesis and chondrocyte degradation provide effective chondral(cartilage) protection to the advancement of osteoarthritis onset and progression.
Influencing these cellular activities and joint homeostasis, play an important role in the development of natural joint therapeutic strategies over pharmacological alternatives due to adverse risks and expense.
Therapeutic nutraceutical alternatives exist that combat the symptoms and potential for progression of degenerative joint disease(Read Below).
Impact of Knee Injuries in Youth Athletics and Osteoarthritis Onset
Joint changes can begin at an early age as a result of sports injury and overuse. It is repetitive injury and acute trauma, such as Anterior Cruciate Ligament(ACL) tear, that begins the degenerative cascade of Osteoarthritis.
The long-term effect of an ACL rupture is the development of degenerative changes within the knee, which may become symptomatic and require treatment. Both the reconstructed and untreated ACL rupture have an increased risk.
Osteoarthritis in patients with anterior cruciate ligament rupture: A review of risk factors Hugues Louboutin, R. Debarge, J. Richou, Tarik Ait Si Selmi, Simon T. Donell, Philippe Neyret, F. Dubrana.
The Risks of Developing Osteoarthritis after Youth ACL Injury
There is a growing participation of female athletics, particularly for youth female soccer players. This group is experiencing an increased risk of ACL injuries at a rate of 4-5 times higher than boys.
There is a growing body of scientific reports demonstrating the progressive onset of osteoarthritis that results from ACL and meniscal injuries.
ACL tears are a common injury, particularly in the athletic and youth populations. The known association between ACL injury and subsequent osteoarthritis (OA) of the knee merits a more in-depth understanding of the relationship between the ACL-injured knee and osteoarthritis. ACL injury, especially with concomitant meniscal or other ligamentous pathology, predisposes the knee to an increased risk of osteoarthritis.(Simon, David, et al.)
In male and female soccer players sustaining ACL tears, approximately 80% had radiographic OA 12 to 14 years later, irrespective of whether they had surgical intervention... approximately 70% had functional limitations and reduced quality of life due to their knee.(Von Porat AR, et al.)
10 to 20 years after injury approximately 50% of those with ACL or meniscus tear have OA with associated pain and functional impairment.(Lohmander, L. Stefan, et al.)
In a prospective study of ACL-injured patients followed for 15 years, the primary risk factor for tibiofemoral OA was a prior meniscectomy. (Neuman, Paul, et al.).
The result of osteoarthritis is progressively increased pain, loss of joint mobility and impaired functional abilities.
Anterior Cruciate Ligament(ACL) tears, and associated meniscal tears, chondral lesions and cellular changes in the joint increase the chance of developing early degenerative changes in the joint.
Changes in biomarker concentrations after an ACL injury suggest an alteration in cartilage turnover and joint metabolism in those sustaining ACL injuries compared with uninjured matched controls. This includes Type II Collagen degradation as indicated by serum biomarkers.
Physiological Risk Factors
- Excess or incorrect strain on Cartilage
- Trauma(acute or repetitive)
- Overweight(excess body weight)
- Lack of Exercise
- Joint laxity
Beyond the physiological stressors of joint injury are growing demands placed on the youth athlete that results in an ever-increasing frequency of knee, joint, soft tissue, and head injuries.
These demands include:
- Increased frequency of playing, or Year Round Sports(Increased Exposure)
- Playing one sport at an early age(No Variability)
- Overuse injuries related to playing through injuries(No Recovery or Rest)
- Not Following Return to Play Guidelines(Athlete Unable to Meet Demands of Sport upon Return to Play)
As the joint cartilage does not possess any nerves, early joint cartilage lesions are not associated with the early warning symptoms of pain.
Symptoms of OA:
- Stiffness and limited joint mobility
- Joint swelling
- Decreased physical function
- Restricted social and work activity
The natural progression of OA has consequences of impaired joint mobility, strength and functional abilities, and lifestyle change.
I am a practicing Physical Therapist for over 25 years. In this time I have treated numerous athletic injuries; youth, high school, collegiate and professional. The ACL injury and associated involvement of meniscal and joint cartilage structures have impacted seasons and careers in these athletes.
Many of these athletes, injured in their youth, are experiencing some degree of articular cartilage degeneration, associated symptoms, and some change of their lifestyle habits(exercise, recreation, etc.).
There have been great gains in the development of performance, injury prevention, and rehabilitative programs, in addition to surgical techniques.
The next evolution of youth injury management is post-surgical/incident intervention in the way of developing therapeutic alternatives to prevent the progression of degenerative joint disease; maximizing the long-term health and quality of life after sustaining a sports-related injury.
The long-term impact of injuries must be addressed through education of all parties(athlete, parents, coaches, administrators, and yes, healthcare professionals)
The Management of Early Onset of Knee Osteoarthritis in the Youth Athletes
Youth athletes with a history of knee injury are at greater risk of developing degenerative joint changes. The primary risk factors that can be controlled in preventing OA are healthy lifestyle practices that include maintenance of healthy body weight, clean eating habits, supplemental joint support, and individually designed exercise programs.
Injuries to joint structures can initiate the cascade of degenerative joint disease
Sport-Specific training programs have made inroads to prevention and treatment of ACL and other athletic injuries. These programs include:
- ACL Rehabilitation Protocols
- Neuromuscular Training Programs
- Functional and Biomechanical-Based Programs
- Speed Training and Agility
"These programs must include Osteoarthritis Education as an integral component to maximize Athlete performance, and prioritize the long-term health consequences that result from youth sports participation". - Randy Bauer PT
There are positive actions being taken by Healthcare Providers to provide education to athletes post-injury regarding osteoarthritis prevention.
Nutraceutical Support as Alternative to Degenerative Joint Disease Treatment
Nutraceuticals provide a safe and effective adjunct to prescription medication and invasive procedures.
Nutraceuticals support age-related degenerative diseases through molecular activities that include:
- Antioxidant Support
- Anti-Inflammatory Activity
- Cellular Protection and Activation
- Metabolic Energy Support
- Pain Control
Nutraceutical Osteoarthritis Support of Olive Polyphenol Hydroxytyrosol
Hydroxytyrosol (HT) is a bioactive phenolic compound mainly found in olive leaf and oil.
Include Olive Oil and Hydroxytyrosol as part of Your Daily Nutrition and Nutraceutical Supplementation.
The plant polyphenol Hydroxytyrosol is attributed to many health benefits that combat age-related degenerative diseases.
- Joint Health
- Heart Health
- Diabetes and Metabolic Health Support
- Skin Health
- Mitochondrial Biogenesis
- Caloric Restriction Mimicker
See OLEA25®HYDROXYTYROSOL- Health Benefits from Olive Leaf (SlideDeck)
Beneficial Properties of Hydroxytyrosol and the Metabolic Pathways
Including Olive Oil and Olive Leaf Extract(OLE) has been found to reduce inflammatory biomarkers. This includes the articular cartilage of joints through the decrease of Reaction Oxygen Species(ROS) through the antioxidant role of HT.
Hydroxytyrosol and Chondroprotective Actions in Osteoarthritis
Olive and its derivatives show therapeutic potential in preventing cartilage damage due to OA. This is attributed to their antioxidant, anti-inflammatory, DNA protection, and autophagy-promoting activities.
Image from Therapeutic Effects of Olive and Its Derivatives on Osteoarthritis: From Bench to Bedside
Nutraceuticals provide a safe and effective adjunct to prescription medication and invasive procedures.
Hydroxytyrosol(HT) is one of the most extensively studied olive polyphenols for the anti-inflammatory properties and various pharmacological activities, suggesting their potential use for the development of functional food.
HT exerts anti-inflammatory effects probably through the suppression of COX-2 and iNOS expression (Zhang, et al.)
Hydroxytyrosol can modulate the SIRT-1 gene to improve autophagy and survival of chondrocytes.(Chin, K.-Y.,et al.)
Hydroxytyrosol has the ability to relieve pain related to inflammation as described in a double-blind placebo-controlled trial conducted on 25 patients with knee OA.(Takeda, R., et al.)
The use of Hydroxytyrosol to treat and prevent osteoarthritis has been supported by research efforts:
HT reduced or prevented increases in cell death and activation of executive caspases, DNA damage, expression of pro-inflammatory genes (COX-2, iNOS) and of genes driving chondrocyte terminal differentiation (RUNX-2, MMP-13 and VEGF), all of which characterizing OA pathogenesis.
Youth Sports Injuries of the ACL and Meniscus Impacts Onset of Osteoarthritis in Adulthood.
Joint Health Support with Olea25® 25% Hydroxytyrosol and TendoGuard™
Polyphenol Support of Olea25® 25% Hydroxytyrosol is a food grade natural organic olive leaf extract biotransformed into an ideal 25% Hydroxytyrosol.
Research has confirmed the chondroprotective role of Hydroxytyrosol from anti-oxidant, anti-inflammatory and autophagic properties for osteoarthritis.
Olea25® Hydroxytyrosol Natural food grade organic olive leaf extract bio transferred into 25% Hydroxytyrosol
1-2 Caps per day(1-Cap is 25mg of Hydroxytyrosol)
*You may take topically, or open cap and sprinkle in a green smoothie or over your salad.
Type II Hydrolyzed Collagen Peptide Supports Healthy Joint Cartilage
TendoGuard™ provides anti-inflammatory and anti-bacterial support naturally.
Collagen Hydrolysate and Eggshell Membrane a food-grade natural alternative for articular cartilage & joint health; helping to relieve pain caused by inflammation, and improving joint mobility.
Collagen Type II is the primary collagen found in joint articular cartilage. Research supports the finding that bioactive collagen peptides stimulate Type II collagen and proteoglycan synthesis in articular cartilage. (Oesser and Seifert 2003)
Cartilage degradation and extracellular matrix(ECM) support can counter the typical wear and tear of joint surfaces, and reduce pro-inflammatory and pain-mediating processes.
Collagen peptide supplementation induces a glycine-mediated inhibition of cytokine release (Hartog et al. 2013)
Hydrolyzed Collagen Type II, a nutritional alternative for articular cartilage & joint health, can help with pain, inflammation, and mobility.
TendoGuard™ is a naturally sourced Type I, II, V and X, Hydrolyzed Eggshell Membrane, Hyaluronic Acid and Mucopolysaccharides that act to promote collagen synthesis and joint health. No Gelatin or Synthetic Source.
TendoGuard™ is sourced from denatured chicken collagen, processed using an exclusive water extraction technology process without a solvent (ethanol) to change the original molecules for assimilation. The ingredient is recognized as a nutrient and building block for damaged cartilage.
Olea25® Hydroxytyrosol and TendoGuard™ are an Excellent Nutraceutical Combination for Natural Joint Health Support of Joint Mobility, Joint Metabolism, and Cartilage Protection.
- Cattano, N. M., Driban, J. B., Barbe, M. F., Tierney, R., Amin, M. and Sitler, M. R. (2017), Physical activity levels and quality of life relate to collagen turnover and inflammation changes after running. J. Orthop. Res., 35: 612–617. doi:10.1002/jor.23250
- Chin, K.-Y.; Pang, K.-L. “ Therapeutic Effects of Olive and Its Derivatives on Osteoarthritis: From Bench to Bedside.” Nutrients 2017, 9, 1060.
- D’Adamo, Stefania, et al. “MicroRNAs and Autophagy: Fine Players in the Control of Chondrocyte Homeostatic Activities in Osteoarthritis,” Oxidative Medicine and Cellular Longevity, vol. 2017, Article ID 3720128, 16 pages, 2017. doi:10.1155/2017/3720128
- Echeverría, Francisca et al. “Hydroxytyrosol and Cytoprotection: A Projection for Clinical Interventions.” Ed. David Arráez-Román and Ana Maria Gómez Caravaca. International Journal of Molecular Sciences 18.5 (2017): 930. PMC. Web. 7 Oct. 2017.
- Facchini, A., Cetrullo, S., D'Adamo, S., Guidotti, S., Minguzzi, M., Facchini, A., ... & Flamigni, F. (2014). Hydroxytyrosol Prevents Increase of Osteoarthritis Markers in Human Chondrocytes Treated with Hydrogen Peroxide or Growth-Related Oncogene [alpha]. PLoS ONE, 9(10).
- Killeen, J. Matthew, et al. "Hydroxytyrosol An examination of its potential role In cardiovascular disease, inflammation, and longevity." Agro FOOD Industry Hi Tech 22 (2011): 5.
- Lohmander, L. Stefan, et al. "The long-term consequence of anterior cruciate ligament and meniscus injuries." The American journal of sports medicine 35.10 (2007): 1756-1769.
- Lotz M, Carames B. Autophagy and Cartilage Homeostasis Mechanisms in Joint Health, Aging and Osteoarthritis. Nature Reviews Rheumatology. 2011;7(10):579-587. doi:10.1038/nrrheum.2011.109.
- Louboutin H, et al, Osteoarthritis in patients with anterior cruciate ligament rupture: A review of risk factors, The Knee (2008), doi:10.1016/j.knee.2008.11.004
- Neuman, Paul, et al. "Prevalence of tibiofemoral osteoarthritis 15 years after nonoperative treatment of anterior cruciate ligament injury: a prospective cohort study." The American journal of sports medicine 36.9 (2008): 1717-1725.
- Oesser, Steffen, and Jürgen Seifert. "Stimulation of type II collagen biosynthesis and secretion in bovine chondrocytes cultured with degraded collagen." Cell and tissue research 311.3 (2003): 393-399.
- Hydroxytyrosol and Osteoarthritis: Reviewed References
- Physical Activity Levels and Quality of Life Relate to Collagen Turnover and Inflammation Changes After Running
- Palmieri-Smith RM, Cameron KL, DiStefano LJ, Driban JB, Pietrosimone B, Thomas AC, Tourville TW, Athletic Trainers’ Osteoarthritis Consortium. J Athl Train. 2017 Jun 2;52(6):610-623. doi: 10.4085/1062-6050-52.2.04. (The Role of Athletic Trainers in Preventing and Managing Posttraumatic Osteoarthritis in Physically Active Populations: a Consensus Statement of the Athletic Trainers' Osteoarthritis Consortium).
- Porfírio, Elisângela, & Fanaro, Gustavo Bernardes. Collagen supplementation as a complementary therapy for the prevention and treatment of osteoporosis and osteoarthritis: a systematic review. Revista Brasileira de Geriatria e Gerontologia, 19(1), (2016): 153-164.https://dx.doi.org/10.1590/1809-9823.2016.14145
- Simon, David, et al. "The relationship between anterior cruciate ligament injury and osteoarthritis of the knee." Advances in Orthopedics 2015 (2015).
- LTC Steven J. Svoboda, Travis M. Harvey, LTC Brett D. Owens, William F. Brechue, Patrick M. Tarwater, and Kenneth L. Cameron; Changes in Serum Biomarkers of Cartilage Turnover After Anterior Cruciate Ligament Injury,
- Takeda, Ryuji et al. “Double-Blind Placebo-Controlled Trial of Hydroxytyrosol of Olea Europaea on Pain in Gonarthrosis.” Phytomedicine 20.10 (2013): 861–864. Phytomedicine. Web.
- Von Porat AR, Roos EM, Roos H. "High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes." Annals of the rheumatic diseases. 2004 Mar 1;63(3):269-73.
- Weber, Kathryn T. et al. “Serum Levels of the Proinflammatory Cytokine Interleukin-6 Vary Based on Diagnoses in Individuals with Lumbar Intervertebral Disc Diseases.” Arthritis Research & Therapy 18 (2016): 3. PMC. Web. 11 Oct. 2017.
- Zhang, X., Cao, J. & Zhong, L. Naunyn-Schmied, “Hydroxytyrosol inhibits pro-inflammatory cytokines, iNOS, and COX-2 expression in human monocytic cells”, Arch Pharmacol (2009) 379: 581. https://doi.org/10.1007/s00210-009-0399-7