1 Miller M, et al. Br J Sports Med Month 2020 Vol 0 No 0 No pain no gain? A conversation on Olympians’ long-term health Mike Miller, 1 Debbie Palmer , 2,3 Jackie L Whittaker , 4,5 Rebecca Pike , 1 Patrick Schamasch, 6 Malav Shroff, 6 Joël Bouzou 1 Willie Banks OLY is smiling, he usually is. Olympian, former world record holder and world champion. Inventor of the now ubiquitous track and field competitor overhead hand clap. Successful businessman and interna- tional sports leader. Life has been good thanks to elite-level sport. There’s just one snag, Willie has osteoarthritis in his knees and hips. He is in constant pain and attributes his osteoarthritis to past sporting injuries. Willie is not alone. Olympians and former elite athletes often link their past sporting injuries to their current musculoskeletal pain. ADDRESSING THE BALANCE: RISK VERSUS BENEFIT There are many benefits to a life devoted to elite sport, with numerous studies reporting the positive effects of sport including a lower risk of morbidity, better self-reported health in later life and higher quality of life. 1–4 Despite this, major injuries including anterior cruciate ligament tears and substan- tial meniscal tears can contribute to radiographic and symptomatic osteoar- thritis, 5–8 and the risk of osteoarthritis in elite athletes may be higher than that in the general population. 4 This reality raises questions. Is enough being done to educate and support athletes and their entourages so they can minimise the long-term consequences of sporting injuries? What resources are allocated to research, to understand and prevent the onset of diseases such as post-traumatic osteoarthritis, and to mitigate any nega- tive health outcomes associated with a life lived at or near the top? Where does the duty of care of coaches, clinicians, Olympic committees and sporting feder- ations, to the stars of the sporting stage begin and end? (Figure 1) SUPPORTING OLYMPIANS The World Olympians Association (WOA) is an international organisation with a mission to connect and support the global alumni of Olympians of all ages, nation- alities and sports. As recognition of their outstanding achievements WOA provides postnominal letters OLY to Olympians. Since its launch in November 2017, over 13 500 Olympians representing 184 coun- tries out of a global population of approx- imately 100 000 have registered for OLY recognition. In 2015, stories like Willie’s inspired the formation of the WOA Medical Committee. This committee is composed of Patrick Schamasch (chair), Richard Budgett OLY, Fabio Pigozzi, Brian O’Driscoll, Jonathan Snell, Nick Webborn, Malav Shroff OLY and is driving a strategy to improve both the long-term physical and mental health of Olympians. As the first step of this strategy, WOA commissioned the Retired Olympians Musculoskeletal Health Study (ROMHS) to better understand the long-term bene- fits and consequences of elite sport. ROMHS is a collaboration of global clin- ical and research experts led by Debbie Palmer OLY. Self-report data collected from 3 357 Olympians are being analysed alongside data from the general popula- tion to expand our knowledge about the unique health of retired elite athletes. The paper in this edition of BJSM is the first in a series of manuscripts from ROMHS that highlight key issues underlying the long- term health of Olympians. This paper and the ROMHS data provide prelimi- nary evidence that can be used to inform discussion and recommendations among stakeholders such as National Olympians Associations (NOAs), International Sport Federations (IFs) and National Olympic Committees (NOCs). PRIORITISING THE LONG-TERM HEALTH OF OLYMPIANS Long-term athlete welfare is an emerging field of research, and there is still much to learn about the health of retired athletes. To ensure the findings of research in retired athletes are valid and robust current efforts could benefit from greater cross-sport and cross-discipline collabo- ration. As has been observed in prospec- tive studies from football, rugby and the Olympic Games, clinical and academic researchers should standardise injury and disease (eg, osteoarthritis) definitions and reporting, as well as harmonising methods of data collection. The use of appropriate, matched controls, in order to understand what is unique to retired elite athletes versus a normal ageing population, should also be included more regularly within academic studies. Many Olympians want to improve their long game and are willing to contribute data and share experiences to studies like ROMHS but real-world improvement cannot occur without the engagement of the wider sports community. Willie and the tens of thousands of Olympians need engagement from a broader community of stakeholders too, to work with them through WOA and others to ensure that their health is understood and prioritised. These efforts must include more data driven conver- sations about the long-term health of elite athletes across the fields of sports 1 World Olympians Association, Lausanne, Switzerland 2 School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK 3 School of Medicine, University of Nottingham, Nottingham, UK 4 Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada 5 Arthritis Research Centre Of Canada, Richmond, British Columbia, Canada 6 Medical Committee, World Olympians Association, Lausanne, Switzerland Correspondence to Rebecca Pike, World Olympians Association, International Olympic Committee, Lausanne 1007, Switzerland; rebecca.pike@olympic.org Editorial Figure 1 Willie banks OLY. Two-time Olympian (1984 and 1988) in triple jump for USA. Silver medallist at the International Amateur Athletic Federation World Championships Helsinki 1983. on February 19, 2022 by guest. Protected by copyright. http://bjsm.bmj.com/ Br J Sports Med: first published as 10.1136/bjsports-2020-102127 on 12 November 2020. Downloaded from