Review Finds Increased Osteoarthritis Risk in Tactical Athletes

By Anne Harding

February 14, 2017

NEW YORK (Reuters Health) - Members of the military and firefighters are at increased risk of osteoarthritis (OA), a new systematic review shows.

"Osteoarthritis is more common in people who are tactical athletes, people who are firefighters and military service members, than it is in the general population," Dr. Kenneth Cameron of Keller Army Hospital in West Point, New York, the lead author of the new study, told Reuters Health by phone. Physicians should be alert to the possibility of OA in tactical athletes seeking care for joint pain, he added, even if the patient seems too young to have the disease.

Tactical athletes are individuals in service professions such as the military, firefighting, law enforcement and first responders, who have "significant physical fitness and physical performance requirements associated with their work," Dr. Cameron and his colleagues explain in their report.

The study findings appear in the November issue of the Journal of Athletic Training, which according to the National Association of Athletic Trainers was released in early January.

Tactical athletes are more likely than civilians to have OA risk factors, including acute traumatic joint injury and repetitive movement, the researchers say. To investigate whether they were more likely to have OA as well, the team analyzed 12 studies, including three of active duty military personnel, two of veteran military parachutists , one of firefighters, and six of individuals in mandatory national service.

Firefighters had an adjusted risk ratio of 2.93 for knee OA and 2.52 for hip OA. Compared with the general population, military service members were also significantly more likely to be diagnosed with OA and to have hip OA, regardless of age or sex.

The higher OA risk for service members increased with age compared to non-service members. And junior enlisted service members had a higher risk of any OA diagnosis and hip OA than senior listed personnel and senior officers.

Knee OA risk was higher for veteran military parachutists than for sport parachutists. The investigators also found a higher risk of lumbar and cervical OA in veteran parachutists and active duty military pilots compared with controls, but the difference was not statistically significant.

The most likely reasons for the increased risk of OA seen in tactical athletes include their greater likelihood of acute traumatic joint injury, and the fact that their jobs often require repeated bending, squatting, kneeling and lifting, Dr. Cameron told Reuters Health. Given that extra weight in the form of obesity increases OA risk, he added, tactical athletes who regularly carry heavy loads may also be causing extra wear and tear on their joints.

"Any strategy to try and reduce joint injuries in the first place would probably go a long way toward reducing the risk of osteoarthritis subsequent to those injuries," Dr. Cameron said. "Primary prevention is the best prevention."

Future research should look at secondary prevention measures to help slow the development of osteoarthritis in individuals who have already injured their joints, he added. And physicians who treat tactical athletes with OA should be familiar with evidence-based recommendations for managing OA, which are not implemented consistently in clinical practice, Dr. Cameron noted.


J Athl Train 2016.