At the peak of his career, Joe Montana was one of football's biggest names, with four Super Bowl rings to adorn his fingers. But now in his retirement, "Joe Cool" is the face of a nutritional supplement that he says helps his aching joints -- the price he has paid for 20 years of tackles.
"The joint pain started at some point a little bit into my career," said Montana. "When you have 300-pound fellows falling on you for that many years, you start to feel it."
Chronic joint pain plagues many of the NFL's finest, and many players say it just comes with the territory.
"For me, it was a stiffness that wouldn't go away," said Montana. "One knee was worse than the other, and then there was the swelling that goes along with it. The more you can keep your joints lubricated, the less you'll feel that."
Pain and stiffness are caused by injury to the articular cartilage, or the smooth white covering over the bones at the joints. Small injuries can become larger over time, and eventually the underlying bone is exposed. Even if the injuries have time to heal fully, different scar tissues can cause different kinds of stiffness.
According to the Centers for Disease Control and Prevention, more than 50 million Americans have some form of chronic joint pain or arthritis.
Repeated Trauma Causes Pain
"Joint pain is typically caused by post-traumatic arthritis, a form of degenerative joint disease," said Dr. Mark Miller, professor of orthopedic surgery at University of Virginia. "It is caused by repetitive trauma, some of which may not even be noticed by the athlete at the time."
But coaches and trainers often encourage elite athletes to push through the pain during competition, even if it may cause them lasting injury. To ease some of the throbbing during game time, athletes are often given numbing medications or injections to mask the pain temporarily.
"The few games they play are dwarfed by the number of practices, impact and trauma to joints, muscles, ligaments, tendons and bones," said Dr. Linn Goldberg, head of the division of health promotion and sports medicine at Oregon Health and Science University. "This repeated trauma causes a response of our tissues to try to protect it."
Miller said, "Arthritis becomes more noticeable down the line, often after retirement. Sometimes, the heat of the battle keeps the athlete going until they cannot continue."
But along with the pain can come a variety of other symptoms, as well.
"We conducted a study a few years ago that identified a substantial minority of retired NFL players who suffered high levels of chronic disease, including osteoarthritis and joint pain," said Dr. Thomas Schwenk, professor of family medicine at University of Michigan. "The pain was associated with significant levels of depression and low levels of daily function, causing significant distress and misery."
"Once their careers are over, a lot of the residual damage causes high level of arthritis and pain, and leads to depression, loss of physical activity and physical self-esteem," said Schwenk. "They often gain weight, especially the lineman, leading to diabetes, hypertension and heart disease."
With so many people playing through injury, a bias has been created for players to get in the game, even when injured, in order to keep their careers going, said Schwenk.
To prepare for the future, Dr. Jennifer Solomon, assistant attending physiatrist at Hospital for Special Surgery in New York, said it's important for everyone, and especially athletes, to use proper techniques when working out and be sure to make sure all the muscle are strong and balanced. It's also important to have a strong core, which helps to distribute forces evenly when one is pushed or tackled.
But either way, experts say many professional players in contact sports may have a painful road ahead.
"Most [NFL] players are very likely to have some sort of joint pain," said Solomon.
"There is no easy cure for this problem," said Miller. "Eventually, many of these aging athletes may need to have joint replacements."
Treating the Symptoms
In the interim, Miller said treatment tries to relieve a person's symptoms. Most physicians tell patients to avoid high-impact activities and focus on low-impact aerobic conditioning, supplemented by anti-inflammatory medications. They tell patients to keep a healthy weight. They may also recommend medications like glucosamine chondroitin sulfate and injections with hyaluronic acid.
Today, Montana is a spokesman for a supplement known as JointJuice. He says the mixture has helped to relieve some of built-up pain after years of professional football.
Montana said the two primary ingredients in the "juice" are glucosamine and chondroitin, two supplements that have been marketed for several years as a way to promote and repair cartilage in the joints.
Most doctors are hesitant about glucosamine and chondroitin as a treatment for arthritis. While they appear to relieve pain and stiffness, "the data on [those supplements] are very sparse and inconsistent," said Schwenk.
But Solomon said there is indeed some data to back up use of the supplements, based on a study from the National Institute of Health.
"It's still pretty unknown what the benefit is, but patients should ask their doctor because everyone reacts differently," said Solomon. "It's a safe medication, so go with a well-tested brand. But it may not be the magic pill that people may be looking for."
Still, Miller said that as players get bigger and faster, the need for a better joint pain reliever will likely grow.
"Unfortunately, as size, speed, and intensity of this sport continue to increase," he said, "these injuries and their long-term sequella may only get worse."