Retired professional footballers at higher risk of knee osteoarthritis

03 Nov 2017 00:15:00.000

Retired professional footballers are far more prone to develop knee pain and osteoarthritis and face problems with their knees earlier in life than the average person, a study has revealed.

The research was led by academics at The University of Nottingham and funded by the charity Arthritis Research UK with collaborative support from FMARC (FIFA’s Medical and Research Centre), the Professional Footballers Association (PFA) and SPIRE Healthcare Group.

The study reported that male ex-footballers were two to three times more likely to suffer from knee pain and knee osteoarthritis and require a total knee replacement, even after adjustment for other risk factors including significant knee injury. Ex-footballers reported more knee pain, structural knee osteoarthritis on x-ray and total knee replacements across all age groups in the study and especially in younger age groups (40-54 years).

Click here for full story

Published in the British Journal of Sports Medicine, the research also revealed that although former footballers presented with more musculoskeletal pain, they were less likely to suffer with and report other conditions or diseases such as diabetes, heart attacks and cancer.

The study was led by Dr Gwen Fernandes and Professor Michael Doherty who are part of the Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis and are based in the department of Academic Rheumatology in the University’s School of Medicine.

Benefits and risks

Professor Mark Batt, Director of the Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, and part of the research team, said: “This was a well-conducted study powered to investigate both the positive and negative effects of playing professional football. The research will allow us to more accurately communicate both the associated benefits and risks to those involved in the industry.”

This is the largest and most comprehensive study conducted in the UK and internationally on establishing how common knee pain, osteoarthritis and knee replacements are among ex-professional footballers when compared with the general population and to look specifically at whether this was influenced by other factors such as previous knee injury.

More than 1,200 ex-footballers with an average age of 59 years were recruited via the PFA and from individual league clubs and professional football associations in the UK and compared to more than 4,000 general population men from the East Midlands region with an average age of 62.8 years.

Other novel findings include: ex-footballers had more osteoarthritis in the end joints of their fingers (nodal OA), were more likely to have an index finger shorter than their ring finger — also known as a pattern three-digit ratio, which has been previously linked to osteoarthritis risk; and reported significantly more body pain, knee misalignment and use of painkillers.

The research suggested that there could be modifiable risk factors such as obesity management and not engaging in other high-risk occupations post-retirement from professional football.  Reducing the number of significant knee injuries in professional football would also have an important impact on the development of knee pain, knee osteoarthritis and the requirement for a knee replacement.

The study concludes that the ‘repetitive microtrauma’ of professional football, regardless of significant injury, is likely to be the main cause of increased risk of knee osteoarthritis. The reported degree of increased adjusted risk (at least doubled) is in the order required by many national bodies to recognise knee osteoarthritis as an industrial disease for professional football.

Dr Stephen Simpson, Director of Research & Programmes at Arthritis Research UK, said: “Osteoarthritis is the most common cause of joint pain and affects over 8 million people in the UK.”

“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.

“It’s worth reminding people who take part in regular sports or physical activity, such as football, that regular exercise is important for all ages and the long-term health benefits are immense.

“If you are injured, we would advise that you take care and consult a health professional as soon as possible, to get advice to enable the best recovery.”

The Football Association, Professional Footballers’ Association, Premier League and EFL, said: “We welcome Arthritis Research UK’s study into cases of ex-professional footballers affected by osteoarthritis and have collectively and collaboratively supported them in this research. 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.

“We understand that there are far-reaching and wider benefits of playing football, including overall quality of life and physical and mental well-being. However, 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.” 


— Ends —

Our academics can now be interviewed for broadcast via our Media Hub, which offers a Globelynx fixed camera and ISDN line facilities at University Park campus. For further information please contact a member of the Communications team on +44 (0)115 951 5798, email or see the Globelynx website for how to register for this service.

For up to the minute media alerts, follow us on Twitter

Notes to editors: 

The University of Nottingham is a research-intensive university with a proud heritage, consistently ranked among the world's top 100. Studying at the University of Nottingham is a life-changing experience and we pride ourselves on unlocking the potential of our 44,000 students - Nottingham was named University of the Year for Graduate Employment in the 2017 Times and Sunday Times Good University Guide, was awarded gold in the TEF 2017 and features in the top 20 of all three major UK rankings. We have a pioneering spirit, expressed in the vision of our founder Sir Jesse Boot, which has seen us lead the way in establishing campuses in China and Malaysia - part of a globally connected network of education, research and industrial engagement. We are ranked eighth for research power in the UK according to REF 2014. We have six beacons of research excellence helping to transform lives and change the world; we are also a major employer and industry partner - locally and globally.

Impact: The Nottingham Campaign, its biggest-ever fundraising campaign, is delivering the University’s vision to change lives, tackle global issues and shape the future. More news…


Story credits

More information is available from Dr Gwen Sascha Fernandes in the School of Medicine, University of Nottingham on +44 (0)115 823 1679,

Emma Thorne Emma Thorne - Media Relations Manager

Email: Phone: +44 (0)115 951 5793 Location: University Park

Additional resources

No additional resources for this article

Related articles

Football and osteoarthritis study kicks off

Published Date
Wednesday 12th February 2014

New national research centre to reduce sport injury risk

Published Date
Monday 10th June 2013

New research could signal progress in osteoarthritis pain relief

Published Date
Wednesday 26th February 2014

Media Relations - External Relations

The University of Nottingham
YANG Fujia Building
Jubilee Campus
Wollaton Road
Nottingham, NG8 1BB

telephone: +44 (0) 115 951 5798