Osteoarthritis in Younger Active Folks

[californiagrown]

Looking for tips on how to manage Osteoarthritis without just throwing in the towel on being an athlete.

I am 34, played highlevel baseball and high school football, and have been skiing and mountain biking for a couple decades (with all the normal crashes and injuries). I have always had loose shoulder joints but after my ball-sports career ended i decided to get my labrum and shoulder capsule repaired in my throwing shoulder. I then slipped in the shower 1 week after surgery and the shoulder did not heal well at all. Fast forward 15 years and way too many subluxations and separations and my right (throwing) shoulder is fucked. Back in the spring i was shut down for a month with awful pain and near zero mobility so i went in to the best shoulder ortho in the Seattle area to put together a plan to manage/fix/mitigate the shoulder issues in preparation for when my 1 yr old can start playing ball sports. I was told that my labrum is torn nearly circumferentially, theres a deflated cyst in there, and i have advanced osteoarthritis with a big-ass goatsbeard bone spur. The ortho said that he would HIGHLY recommend not getting surgery as fixing the soft tissues would tighten the shoulder up (good), but create a worse situation with the arthritis- which is the long term bigger issue here. Scary when a gung-ho ortho says your too far gone for surgery.

currently ill have 3-4months pain free, able to lift weights, be athletic, etc. And then out of the blue mowing the lawn, or brushing my teeth ill feel something catch in my shoulder (no pain), and ill then be in for a couple weeks at least of 5-7/10 pain and almost zero mobility, and 4-6weeks till im back to normal. I stay on top of rotator cuff exercises, have good posture, have good scapular mobility and a strong upper/mid back etc but shit just hits the fan sometimes doing innocuous things. I dont like taking NSAIDs during these arthritic episodes as i have read that they inhibit healing, and CBD does absolutely nothing for me in any form so im stuck smoking week and taking tylenol to manage pain.

For any folks out there who are younger or highly active, what are you doing to manage your osteoarthritis?

[Dantheman]

AC "managed" her Stage 4 OA with a total knee replacement at 39. I don't know shit about shit but I'd say you're probably looking at a shoulder replacement in the not-too-distant future, unfortunately. Good luck, sounds like a very shitty situation.

[I've seen black diamonds!]

I have arthritis in my foot, hands and lower back from a series of wrestling and football injuries. I'm 45. It all started getting worse in my mid 30's, years after the worst injuries originally occurred. My back, especially, could be debilitating at times. It's much better now. The trick for me has been refocusing my exercise around keeping my body feeling good, instead of training to be stronger/ faster. I'm no less fit than I was 10 years ago because I aggravate the old injuries so much less. I've done a ton of work with multiple physical therapists. Most of them were helpful. A few were pretty clueless. But even with the good ones, not all their suggestions are going to be good for you. I learned to listen to my body and selectively adopt and ignore their suggestions after trying them out. It took about 5 years of trial and error to figure what helps, what doesn't, what to avoid entirely, and eventually develop a general approach to keeping my body functioning.

This might seem sort of like a non-answer, but it's what you need to do. There is no one-size-fits-all approach to keeping a fucked up, aging body working fairly well.

[californiagrown]

I have arthritis in my foot, hands and lower back from a series of wrestling and football injuries. I'm 45. It all started getting worse in my mid 30's, years after the worst injuries originally occurred. My back, especially, could be debilitating at times. It's much better now. The trick for me has been refocusing my exercise around keeping my body feeling good, instead of training to be stronger/ faster. I'm no less fit than I was 10 years ago because I aggravate the old injuries so much less. I've done a ton of work with multiple physical therapists. Most of them were helpful. A few were pretty clueless. But even with the good ones, not all their suggestions are going to be good for you. I learned to listen to my body and selectively adopt and ignore their suggestions after trying them out. It took about 5 years of trial and error to figure what helps, what doesn't, what to avoid entirely, and eventually develop a general approach to keeping my body functioning.

This might seem sort of like a non-answer, but it's what you need to do. There is no one-size-fits-all approach to keeping a fucked up, aging body working fairly well.

No, it is helpful. It is confirming my decision to nearly completely move away from aesthetic/strength goals in the gym, and refocus on quality of movement. The chore now, like you said, is to figure out exactly what helps, what hurts, and what does jack shit. But, damn these flareups of arthritis are debilitating and fuck with my mental health too. And NO ONE believes a 34yr old who complains or begs out of some activity because of "arthritis".

Are there any meds that people use, which they would reccomend? I want to stay away from drugs that will harm healing (cortisone, NSAIDs, Toradol, etc), but i also dont want to be sweating and swearing because of pain in the morning during these flareups.

[ianpnw]

I wonder if your pain flare-ups are due to muscle spasm, in which case Robaxin (methocarbamol) may be worth trying - it was certainly useful as part of a multi-modal pain treatment post-op. Here it’s prescription only but in Canada I believe you can buy it OTC in combination with Tylenol (it’s called Robaxacet).
It may also be worthwhile seeing a different ortho who might recommend surgery to debride the joint (take out the bone spur for example) as a temporizing measure (Drs Basamania or Dick Kirby come to mind). Another option might be seeing Dr Brian Snitily, who’s a physiatrist (he works with an ortho group but is not a surgeon), and has helped me with a frozen shoulder and FAI in my hip without surgical intervention.
Good luck!

[meter-man]

I'm 42, just diagnosed with OA in my patellofemoral joint. I've been working with PTs for a while - that has helped.

Looking into platelet-rich plasma (PRP) injections. Also considering hyaluronic acid (HA) injections. Or both. Eventually, will have to do knee replacement.

The goal of PRP is to stimulate re-growth of articular cartilage. It is very difficult to stimulate regrowth of AC, but PRP has had some good success.

Unfortunately, no insight into shoulder issues, but I'll post up if I learn anything useful for fellow yutes afflicted with OA.

[touriafuji]

im 32 yo and walking every day 10 km

[californiagrown]

I wonder if your pain flare-ups are due to muscle spasm, in which case Robaxin (methocarbamol) may be worth trying - it was certainly useful as part of a multi-modal pain treatment post-op. Here it’s prescription only but in Canada I believe you can buy it OTC in combination with Tylenol (it’s called Robaxacet).
It may also be worthwhile seeing a different ortho who might recommend surgery to debride the joint (take out the bone spur for example) as a temporizing measure (Drs Basamania or Dick Kirby come to mind). Another option might be seeing Dr Brian Snitily, who’s a physiatrist (he works with an ortho group but is not a surgeon), and has helped me with a frozen shoulder and FAI in my hip without surgical intervention.
Good luck!

Ooff. I was at the start of another "episode" with my shoulder when i started this thread. Just now getting to where i can start moving it again fairly normally. Rough 3 months, and losing all that strength from atrophy fucked up the muscular balance in my upper body so i had/have numerous neck and back and rib issues that have been a PITA too... those were spasm issues mostly so my stock of flexeril did help there.


Anyways, debridement of the joint was an option the original ortho offered, and it *should* provide immediate relief.... but it also runs the risk of scar tissue formation making things worse. But getting a scope to clean up the pastrami and bonespurs in there seems like a better and better option come late spring. Pretty embarrassing to need my wife to lift anything above waist height for me the last 3 months.

[OrthoDoc]

Have you looked into PRP? Plate-rich plasma injection.

It's essentially a form of stem cell injection. Basically taking your own blood and spin down (centrifuge) to concentrate the proteins and plates, and inject that into the arthritic joint (or tendonitis). It doesn't reverse the arthritis, but study/data so far have shown to reduce pain over longer period of time compare to other modalities (NSAIDS, cortisone injections).

The downside is that it's not covered by insurance (because it's hasn't approved by FDA yet), so you will have to pay out of pocket. So shop around (I've seen $5-700 per shot up to $2k).

Definitely do your own research and see if that's something may interest you. I recommend it as it's low risk (your own blood), and data has been very promising.

Good luck.

[garyfromterrace]

Ok so I'm not "younger", but I'm fairly active... Rt Knee is really acting up lately. Had ACL recon (patella tendon) 25 years ago. Scope to trim miniscus and get rid of some floaties about 10 years ago and another to do some debridement 2 years ago.

From what I've been reading it sounds like my options are now:
Injections (offering some temporary relief for perhaps another year or so), then knee replacement.

Any truth or basis in trying to improve the situation through diet?eg. lots of blueberries, pineapple, salmon, magnesium, etc..
Yoga?
Any advice or comments appreciated (except "quit eating donuts you fat fuck"). This shit sucks.

[buttahflake]

I’ve had injections, not only are they painful, they didn’t seem to do much at all.

[garyfromterrace]

Ok, thanks for the input bf. So you got this shit? Anything else work?

[auvgeek]

I’ve had injections, not only are they painful, they didn’t seem to do much at all.

"Injections" is pretty broad. Cortisone? PRP? BMAC?

jesski (wife) had a very osteoarthritic ankle after 2x ground falls while climbing. They said her imaging looked like the ankle of a 75+ year old. Several surgeons recommended a total ankle replacement at age 33. A BMAC stem cell injection got her back to skiing, skinning, and hiking again. She probably won't ever run marathons again, but she can jog a bit and do big days in the backcountry (skinning, booting, cramponing, etc). That was 4-5 years ago now, and she's still going strong, though she's considering a PRP injection prophylactically.

This is very anecdotal, and I am not claiming everyone will have the same results. But if it were me, I would find a surgeon who could shave down any mechanical impingements/bone spur (so it's not wreaking havoc in the joint) AND hit the joint space with BMAC while they're in there. If no mechanical issues, then just a stem cell injection.

ISBD's advice is also spot on.

[buttahflake]

I’ve had both Synvist and Cortisone, neither were worth the pain of that needle hitting bone.

[californiagrown]

"Injections" is pretty broad. Cortisone? PRP? BMAC?

jesski (wife) had a very osteoarthritic ankle after 2x ground falls while climbing. They said her imaging looked like the ankle of a 75+ year old. Several surgeons recommended a total ankle replacement at age 33. A BMAC stem cell injection got her back to skiing, skinning, and hiking again. She probably won't ever run marathons again, but she can jog a bit and do big days in the backcountry (skinning, booting, cramponing, etc). That was 4-5 years ago now, and she's still going strong, though she's considering a PRP injection prophylactically.

This is very anecdotal, and I am not claiming everyone will have the same results. But if it were me, I would find a surgeon who could shave down any mechanical impingements/bone spur (so it's not wreaking havoc in the joint) AND hit the joint space with BMAC while they're in there. If no mechanical issues, then just a stem cell injection.

.

Interesting. Ive been leaning more an more toward getting general cleanup done, but PRP and Stem cell just seem really expensive for minimal benefit. Were the BMAC injections covered by insurance for you? Getting some injection while im under would be a good way to go if the expense makes sense.

I’ve had both Synvist and Cortisone, neither were worth the pain of that needle hitting bone.

Ive had 8ish cortisone shots to my knee and shoulder. Once you get over the fact that the needle they use seems waaaaaay too large, and that they sink that fucker to the hilt into a painful joint where you swear there isnt enough space for 4" of needle, its not that bad. What freaked me out more was the fact i could still feel grinding/catching/ripping in my shoulder, but had zero pain... so i knew i was doing more damage but didnt know the extent because i had no accompanying pain.