Limping through life after football -- and how doctors can help

In 2008, I attended a reunion for Miami Dolphins players who had played in the 1983 or 1985 Super Bowls. I was eager to go. It had been 25 years since I took off my pads and helmet for the last time, and since then, I’d had little contact with most of my former teammates.

My path to the NFL started at Yale, where I was an All-American running back. However, after a season with the Dolphins, which included playing in Super Bowl XVII, I left football for medical school back at Yale, followed by an orthopedic residency and fellowship. Eventually, I joined a practice as an orthopedic surgeon in my Connecticut hometown.

It was great to catch up with my former teammates at the reunion. But as a doctor, I found the weekend of camaraderie and reminiscing in Miami troubling. I realized quickly that most of my teammates had suffered terribly from their years in the great but violent game of football. Several already had undergone knee and hip replacements; one had endured an unsuccessful back fusion. Most had arthritis, and virtually everyone complained of joint pain. Others struggled with diabetes, and some even had heart disease.

Yet most of them were younger than 55.

The health news about NFL players tends to focus on the issue of concussions and head trauma, and I’m all for addressing that devastating problem. The price of a career in football shouldn’t have to include dementia or neurological trauma.

But I worry that we’re ignoring a much more prevalent, and treatable, consequence of careers in football. For every Tony Dorsett (the former Dallas Cowboy star reportedly diagnosed with degenerative brain disease), there is a roomful of less well-known players suffering from the consequences of joint trauma.

A 2009 University of Michigan study of retired NFL players concluded that “the most striking difference between NFL retirees and the general population” is that the former players younger than 50 were nearly five times more likely to have arthritis than comparable men in the general population. Former players older than 50 have twice the rate of arthritis as their non-player peers.

Though this is not surprising given the nature of the game, it is nevertheless deeply disturbing, especially since there is so much that former players could do to address their pain if they were alerted to possible treatments.

In recent years, medical understanding of osteoarthritis has undergone a dramatic change. No longer is it viewed simply as mechanical wear and tear of the cartilage but rather as a disease of the entire joint, involving chemical and mechanical processes.

Combating osteoarthritis requires a global approach to treatment, much of it involving lifestyle changes in physical activity and diet.

But here’s where there is a bit of a disconnect with former NFL players. They may be used to taking punishment, but they aren’t used to preventing pain through lifestyle changes. And while they certainly know how to be physically active, which is important for those with arthritis, the kind of exercise they performed during their careers — heavy weight training, sprints, squats — is completely inappropriate for those with osteoarthritis.

These guys need to learn to gently move the joints and thereby foster lubrication, to stretch the ligaments and maintain range of motion, and to work muscles to achieve functional strength. The goal shouldn’t be to regain the mass and power they once needed to bring down a 230-pound running back.

And then there’s diet. The eating habits many professional players develop while they’re in the game don’t serve them well once they’ve left. I saw this myself at the buffet table that night at the reunion, where even those trying to “watch their diets” loaded up their salads with fatty dressings and croutons. Many of my teammates had added weight since their retirement, and remember, these were already massive men when they played. Not only does added weight exacerbate joint problems, it often comes from eating habits that cause inflammation.

The NFL knows that its supersized players are at high risk of developing arthritis. Now it should make sure they are educated about the types of diet and exercise that could prevent it or make it less severe.

The health problems of all athletes, pro and amateur, should be of national concern. But the evolving treatments for osteoarthritis are encouraging. Moreover, we don’t need to change the rules of the game to have a major effect — just the habits of those who played it so well.

Richard Diana is a board certified orthopedic surgeon in Connecticut and the author of “Healthy Joints for Life.”