Research into the Relationship Between Football and Osteoarthritis

In an earlier feature (here), we discussed the risk of developing chronic traumatic encephalopathy (CTE), a form of dementia, as a result of playing football professionally. Our article had a particular focus on ex-professionals who regularly headed leather footballs during the course of their playing careers, but extended the debate to consider the prospect of future risks associated with the modern day game too. In this article, we look again at the profession of football but this time we delve into a possible attribution between professional football and knee osteoarthritis.[i]

According to Dr Stephen Simpson, Director of Research & Programmes at Arthritis Research UK (ARUK):

Osteoarthritis is the most common cause of joint pain and affects over 8 million people in the UK’.

The University of Nottingham’s School of Medicine, with the assistance of ARUK funding, has been researching a potential link between the sport and the joint-stiffening disease. This month, the institution published its findings in the British Journal of Sports Medicine.[ii] FIFA's Medical and Research Centre (FMARC) and the Professional Footballers Association (PFA) have provided collaborative support, both of which are influential organisations within the footballing sphere.

Professor Mark Batt, Director of ARUK, stated that the purpose of this research was ‘... to more accurately communicate both the associated benefits and risks to those involved in the industry’, while Dr Simpson digressed that:

‘Studies that focus on elite athletes, such as professional footballers, are useful in understanding the long-term impact of specific movements on musculoskeletal health, especially those associated with sports. Ultimately, this can help pinpoint links and risk factors for osteoarthritis leading to effective ways to treat it and to prevent its development’.

In order to conduct the largest and most comprehensive study, not just in the UK, but internationally, the PFA recruited more than 1,200 male, ex-professional footballers, with an average age of 59, and compared them against 4,000 men from the general population of the East Midlands, who had an average age of 62.8 years.

Results of the investigation show that male footballers are two to three times more likely to suffer from knee pain and knee osteoarthritis, necessitating total knee replacement. This is still the case, even though knee injury, the predominant causative risk factor, was accounted for when calculating prevalence of the condition. In fact, it is suggested by lead authors, Dr Gwen Fernandes and Professor Michael Doherty, based in the department of Academic Rheumatology, that ‘repetitive microtrauma’ is responsible for the onset of knee osteoarthritis.

Since playing football at least ‘doubles the risk’ of the disease, across all age groups (especially in individuals between the age of 40 and 54), football was described, by the study, as an ‘occupational hazard’. It may be the case, therefore, that national bodies are forced into recognising knee osteoarthritis as an ‘industrial disease’ in due course.

Proceeding the publication of the research paper, the Football Association, Professional Footballers' Association, Premier League and EFL, released a statement, as follows:

‘We welcome Arthritis Research UK's study into cases of ex-professional footballers affected by osteoarthritis ... Although there are multiple health benefits from playing football, we are also aware of the risks of intensive and prolonged training and playing at professional level ... it is important that we continue to support ex-professional players with the condition and use this new research to form practical guidance for current professional footballers and clubs to help minimise the risk of developing osteoarthritis.’


[i] Emma Thorne, ‘Retired professional footballers at higher risk of knee osteoarthritis’ (3 November 2017 Nottingham University) <> accessed 13 November 2017.

[ii] Fernandes GS, Parekh SM, Moses J, et al Prevalence of knee pain, radiographic osteoarthritis and arthroplasty in retired professional footballers compared with men in the general population: a cross-sectional study Br J Sports Med Published Online First: 03 November 2017. doi: 10.1136/bjsports-2017-097503 <> accessed 13 November 2017.