Features June 2005 Issue

Staying In the Game

Arthritis and sports may seem like strange bedfellows, but with a few caveats you should be able to compete worry-free.

More than 100 million North Americans participate in some form of sports competition. Many of these athletes, especially those over 40, suffer from arthritis, according to rheumatologist David S. Silver, M.D., author of the book Playing Through Arthritis. Some sports you can continue to participate in without worry; others you should avoid altogether. We recommend the following sports if you suffer from arthritis.

Hall of Fame golfers Arnold Palmer and Jack Nicklaus competed at the highest level even though they suffered from arthritis. Golf can improve the strength and flexibility of almost every joint in the body. Walking the course is good for maintaining weight and improving your cholesterol. Swinging a club enhances upper body strength and lower body flexibility. The Arthritis Foundation claims that golf can enhance your range of motion, as well as improve balance and coordination. The best thing about golf for those who have arthritis is that there are many ways to adapt to the sport, including modifying grips, shoes, balls, and clubs. A few suggestions:

• Use clubs with lightweight graphite shafts.
• Use a low-compression ball.
• Use a perimeter-weighted clubhead.
• Wear wrist braces or gloves on both hands.
• Wear spikeless golf shoes or comfortable walking shoes.

During a round, carry only the five or six clubs you use most often. Use tees for all shots except putts. Don’t feel obliged to play 18 holes; on many days, nine is enough. Stay hydrated during play and take a warm bath or long shower after a round to relax your muscles. Bottom line: Playing golf is one way to stay physically active and manage your arthritis at the same time.

Swimming is a great activity if you suffer from arthritis, and age-group competitive swimming is popular. Water takes the load off stiff, achy joints while allowing the arms and legs to move through a wide range of motion. Like golf, you can modify swimming activity to fit your needs.

“Pick a stroke that’s comfortable,” advises A. J. Cianflocco, M.D., a primary-care sports medicine physician at The Cleveland Clinic. “The breaststroke, rather than freestyle, might be better if you have arthritis in the upper body.” You can also modify your exercise program by limiting or increasing the number of times per week you swim, by choosing to swim a shorter distance or in less time, and by swimming at an intensity level that is consistent with your physical condition.

“If you’re going to swim competitively,” suggests Dr. Cianflocco, “you should also include some strengthening exercises for the rotator cuff and the muscles that stabilize the shoulder blade.”

Tennis is acceptable if you suffer from arthritis, but doubles is more advisable than singles. Singles requires constant starting, stopping, and changing direction, all of which stress the joints. The simple act of serving, hitting groundstrokes, and absorbing the impact of the ball on volleys and other strokes can cause problems, but fewer of those problems occur in doubles than in singles. In doubles, you hit half the shots, cover half the court, and serve once every four games instead of every other game. Singles is a physical challenge. Doubles, especially as you get older, places more emphasis on strategy, court position, and shot selection.

Don’t automatically rule out singles play just because you have arthritis, but begin developing your doubles skills for the time when playing singles does more to compound the problems of arthritis than it does to resolve them.

Approximately 50 million Americans bowl competitively, making it one of America’s top sports in terms of numbers. Dr. Cianflocco thinks it should also be among the top sports for people with arthritis. “It’s very popular in the Midwest and Northeast, it’s competitive, and it’s a sport that can be played year-round.” Best of all, bowling allows you to exercise the upper and lower body in a controlled manner—with none of the surprises or sudden impacts that you might experience in other sports.

Competitive cycling is primarily a sport for younger athletes, but recreational bicycling benefits adults of any age. After swimming, it offers a better option for anaerobic exercise than golf, tennis, or bowling. It is more beneficial to people with arthritis in the lower part of the body than typical aerobic activities such as walking, jogging, or dancing because it places less stress on the knees, feet, and ankle joints.

Alpine and cross-country skiing are sports that provide an impressive combination of cardiovascular, strength, and range-of-motion benefits. However, they require a level of fitness and health that is considered moderate to intense for any exerciser, and they may not be appropriate for all arthritis patients. Those obstacles can be minimized by skiing on less challenging slopes and cross-country skiing over shorter distances. Because of its seasonal nature, skiing means you can also take part in alternative warm-weather sports such as golf, bicycling, and tennis. 

Sports to avoid
Dr. Cianflocco warns there are some sports that should be avoided. “High-impact or bouncing activities rule out sports such as running/jogging, basketball, singles tennis, racquetball, and squash for most people with arthritis. And if you have arthritis in the upper extremities, you might have to cut back or eliminate sports that require swinging or throwing.”

Warm up, cool down
Whatever your sport, warm up in three phases. Start with an activity like walking, calisthenics, or riding a stationary bike to raise your body temperature and increase circulation. Phase 1 is over when you break into a sweat. In Phase 2, golfers should work on stretches for trunk flexibility, and swimmers, tennis players, softball players, and bowlers should stretch the muscles of the upper body. Tennis players should do stretches that prepare their lower legs for quick starts. Phase 3 is for sport-specific movements. Swimmers should swim a few laps slowly, golfers should take practice swings, bowlers should ask for practice rounds, and tennis players should rally with their opponents.

“A cool-down period after participating in a sport helps prevent sudden changes in the cardiovascular system that can cause lightheadedness or fainting,” says Dr. Cianflocco. “When blood pools in the lower extremities, the heart can be deprived of the blood it needs during recovery.” Cool down with sport-specific movements that return your body to a normal state.

Is it right for you?
There are warning signs that a sport may be aggravating your arthritis. If it produces joint pain during and after participation, if it aggravates underlying stiffness, or if it leads to redness, swelling, or warmth in the joints, seek medical attention right away. “Not everyone with arthritis can play every sport,” says Dr. Cianflocco. “You may need the assistance of a knowledgeable professional to begin a sport or to adapt one to your needs.”