Injuries can be extremely frustrating when it comes to training for endurance events. But all athletes know that they are inevitable. The most annoying part of rehabilitation is when you think you are over an injury only to find out that you’re still dealing with chronic pain, inflammation and tenderness that comes hand in hand with early-onset osteoarthritis.

Osteoarthritis, essentially localised joint pain and disintegration tied to damaged cartilage, ligaments and tendons, can be utterly debilitating. It’s common in athletes under age 45, lifelong and irreversible. Daunting, right? That’s because it is.

You can eat a smart, heart-healthy diet to help mitigate inflammation and pain, and take smart, doctor-recommended action (like rigorous cross training) to stave off irritation, but ultimately, it’s a drag. And it’s not uncommon in endurance athletes — especially when you’re not mindful of the load you put on your joints while pursuing an active lifestyle.

So we sat down with orthopedic surgeon Anthony DeLuise, MD, FAAOS, CAQSH, Clinical Assistant Professor at Brown University and avid Spartan enthusiast, to get his take on avoiding this painful disease at all costs. While at 44, he hasn’t yet had to face osteoarthritis himself, he sees it daily in athlete patients, and knows firsthand exactly how much grit, determination and perseverance goes into training for, and completing a Spartan. Plus, he deals with joint pain, like us all.

Here’s what he has to say about endurance racing, managing injury and maintaining joint health to optimise performance as you age.


Q&A: Dr. DeLuise on Endurance Sports + Coping with Joint Pain and Osteoarthritis

SPARTAN: Why is joint pain so frustrating for athletes, and how can it really inhibit training?

ANTHONY DELUISE: Joint pain can be frustrating for athletes because of its effects on the body, overall. These can include swelling, inflammation and sometimes, a sense of instability. Joint pain can come from previous injury or something that has been chronic over a period of years.

There are several differences between joint pain and osteoarthritis. A person who has osteoarthritis has essentially worn out cartilage on the surfaces of the joint. This can cause swelling, pain, inflammation and bone spurs. Sometimes this can be seen on x-ray imaging, but is not too symptomatic. Oftentimes, it can be treated with appropriate, non-operative remedies. Joint pain on the other hand can certainly include osteoarthritis, but it could also be from other potential diagnoses such as muscle strain, tendinitis, ligament sprain or meniscus injury.

It’s certainly worthwhile to figure out what the issue is to appropriately manage it, especially when you want to stay active. In terms of setting back your training, this is certainly a possibility depending on what’s going on and how much that is affecting your day-to-day activities. Pain can cause your attention to be focused on the pain, and that can limit your ability to properly train, or even participate and engage in activities like obstacle races.

Spartan: Even though you don’t have osteoarthritis, have you ever experienced joint pain in your endurance sports pursuits?

AD: Yes, without a doubt. I have congenital stenosis in my spine, and now as I get older, I have arthritis along the joints in my spine, particularly in the lower lumbar region. It feels as though I am constantly stiff every single day, particularly around my core region. It limits my ability to properly stretch and essentially not be in pain.

I do my best on a daily basis to work on flexibility and core strengthening. I used to be involved with more weight training, but now I am focused on more dynamic exercise routines like P90X and Peloton. I do more yoga now than I did when I was younger, which is to say I never did yoga until my 40s. I have also worked on some of the Spartan exercise routines, which I think are pretty good too.

I think the key is to know your body and understand your limits. Strengthen your strengths, but pace yourself as you work on strengthening some of your weaknesses, too, in order to build muscle balance, and improve flexibility and core strength.

Spartan: What are the best things athletes can do to prevent osteoarthritis from forming, post-injury?

AD: This is a tough question. Osteoarthritis can be difficult to predict as to who will get it. Genetics can definitely play a role in getting osteoarthritis. Increased weight can also play a role. This is something that is at least somewhat controllable. If someone were to be overweight, I would really encourage them to focus on weight loss and maintenance of weight loss. Weight loss, or I should say appropriate body mass index, is beneficial for patients with, say, knee pain and knee pain from arthritis. It makes sense that appropriate BMI would perhaps prevent knee arthritis.

I would also recommend avoiding smoking and maintaining a healthy lifestyle. If someone were to have a knee injury, much would depend on the type and severity of that injury in terms of how it could potentially cause arthritis in the future. This is something that might be difficult to control.

If you already struggle with osteoarthritis, consider braces, glucosamine, and, as needed, NSAIDs (without overdoing them). Injections can be helpful if done appropriately. The benefits of staying active and cross training are important.

Spartan: Among many other Spartan Races, you conquered the 2015 Mt. Snow Beast. How did it go for you?

AD: Mt. Snow was very challenging, I think, because it was in darkness. We started in the mid-to-late afternoon. Going up and down the mountain through the woods with little light made things difficult in terms of footing and potential for falling. The log carries were heavy, and the up-down running was tough on the legs. It almost broke me mentally, but I learned that I could persevere and get through anything after that. I’ve learned that your mind can be helpful in these challenges if it stays strong and focused. When I finished, I said I never wanted to do it again but at some point, I think I will.

Spartan: Injury rehab is partly a mind game. What do you do to cultivate mental resilience to recover and accomplish these races?

AD: So, I’ve had several opportunities to challenge myself mentally. The most significant one was being my push to succeed in my education and getting myself through an orthopedic residency. I felt this was physically and mentally grueling, and I was quite proud of myself for accomplishing it and leading me to where I am today.

Since then, I’ve pushed myself to try new things. I learned tennis and I’ve competed in a dancing competition, which is outside my comfort zone. This competition benefits charitable organizations and since my win in 2014, I host the event each year.

In addition, I volunteer in youth sports [football and baseball] trying to teach my young athletes how to stay mentally resilient and strong in order to be successful as they grow. This commitment challenges me to juggle work, family life and my own personal exercise regimens and new races.

Conquering the Mt. Snow Beast was something I am very proud of. It was dangerous at times, physically challenging and mentally taxing. I certainly proved to myself that even as I age, the mental challenge of obstacles, both physical, mental and professional, can be overcome with belief and preparation.

Spartan: At Spartan, we’re all about grit, determination and perseverance. Can you speak to those values in terms of what it takes to recover from injury, and continue rehabbing it throughout your life?

AD: I am all for grit, determination and perseverance, as I do not feel I am the most gifted athlete out there. The things I’ve accomplished are mainly because of the belief I have in myself.

In addition to my chronic back pain, I’ve had a sports hernia and an inguinal hernia. Both of those required surgical repair and both required recovery and time away from training. The patience it takes to wait out an injury is certainly something that teaches you. The sports hernia occurred before the Mt. Snow Beast and my recovery, weight and eventual build-up back to training and baseline ability made my pride for finishing this race even more encouraging.

With regard to rehabbing my chronic back pain, I look at my recovery program as ‘this is just something I need to do in order to feel good on a day-to-day basis’. In addition to being able to continue to compete, I also push my young athletes further. For instance, we are currently working on conditioning. I am training with them, as opposed to just telling them what to do.

Spartan: Do you feel like you’re in better shape now at 44, than 15 years ago? If so, what are you doing differently?

AD: Yes. I am doing more dynamic workouts than heavy weightlifting. I am focusing more on core strength and flexibility. To me, it makes sense because as we age, we generally do get stiffer. Maintaining muscle balance, core strength and flexibility is helpful, at least for me. 15 years ago, I was still in residency and I had much less free time. Although I don’t have much free time now, I’ve learned to prioritize and organize my time so that I can give my body attention with almost daily morning workouts.

Spartan: What keeps you coming back to OCR?

AD: I like the challenge of it. I like the endurance portion of it and the strength portion of it. There are always new obstacles, which keep things fresh and fun. It is just another way to challenge myself. For instance when I turn 45, I will probably say to myself, ‘I can still run a Spartan Race at 45 years old.’ And do it.

Spartan: What advice do you dish out to patients who are recovering from joint injury to re-enter the game, ASAP?

AD: Once I feel that they are completely recovered, I tell them that they have no restrictions. They can then wean back into activity and build their strength and endurance back up. I understand it takes time. Most patients understand that it will take time. Generally speaking however, it’s more challenging with most athletes because they want to get back too soon. The trick is to go slow and not overdo it.

Struggle with osteoarthritis? Hyaluronic acid injections, like Durolane injections, can help decrease pain and support you as you continue your physical activity. Speak with your doctor about what treatment regimen is right for you. And always, always remember: less is more for the long game.