Juvenile Idiopathic Arthritis and Athletic Participation: Are We Adequately Preparing for Sports Integration?

Abstract

Children with juvenile idiopathic arthritis (JIA) now have well-controlled disease due to improved therapies and management strategies. Children with JIA are more active than in the past and often participate in dynamic, high-loading sports. Standard measures of disease control include examination findings, laboratory values, and patient-directed surveys. However, these standards do not address the subtle deficits in biomechanics and neuromuscular control, which could place affected joints at higher risk for injury. Currently, there are limited evidence-based guidelines to structure conditioning recommendations as to the fitness and mechanics needed to provide safe integration into sports in this population; therefore, tools that objectively measure function with high accuracy and precision may be warranted. Previous work using 3-dimensional motion analysis demonstrated usefulness in guiding physical therapy treatment to correct these deficits. The use of a multidisciplinary team, including physical therapy, rheumatology, and sports medicine, is crucial for preparing these children to return to play. We suggest that the child transition into a sport preparatory-conditioning program to address any underlying deficits. A pediatric exercise specialist who is sensitive to the needs of this population can work with a physical therapist to then appropriately integrate the child safely into sport. Encouraging an active lifestyle is vital to the management of JIA and does not worsen the symptoms associated with childhood arthritis.

Physical activity for children with chronic disease; a narrative review and practical applications

“…Ideally, children with JIA should be followed by a multidisciplinary team involving primary care physicians, as well as physiotherapists and qualified exercise professionals, when returning to activities, especially high loading sports, as children with JIA may have changes to neuromuscular function that increase their chance of injury [146]. Furthermore, there are multiple subtypes and severities of JIA, some of which can result in organ inflammation including the heart.…”

Physical Activity and Sports for Children With Juvenile Idiopathic Arthritis

“…With active JIA, joint inflammation may cause pain, stiffness, and decreased range of motion, thus limiting activity [41]. Insufficient physical activity during periods of active disease may lead to a more sedentary lifestyle, which can result in decreased muscle mass and exercise capacity [5,37].…”

“…Such programs may include the advanced tools used by rehabilitation clinicians, such as video motion analysis. These tools allow for detection of subtle alterations in biomechanics and neuromuscular control to inform the most appropriate training in preparation for more complex motor activities [41]. Promising outcomes have also been seen with internet-based exercise programs, such as telehealth or home exercise program tracking with smart phone applications [22].…”

“…Findings suggest that certain structured physical activities improve at least 1 health outcome in JIA [7]. Physical activity and exercise programs combined with pharmacotherapy have shown positive results in children with JIA; this includes reduced number of active, inflamed joints and intensity of pain, as well as improved range of motion, muscle strength, functional status, and QOL [6,21,41]. To date, research on physical activity in this population has shown potential benefits with no adverse effects.…”

“…Research acknowledges the lack of evidence on outcomes for therapeutic exercise programs and sports participation in children with active disease [6]. The current consensus is that children with moderate to severe joint disease can participate in physical activity to pain tolerance with the goal of preserving joint motion and muscle strength or they should consider forms of activity that do not exacerbate pain [6,14,17,30,41,45]. Children with actively inflamed joints should avoid high-impact activities [21,30,31], although “high-impact” is not clearly defined in the rehabilitation literature.…”