In the clinic we often hear patients say, ‘I don’t run anymore because I’ve been told it will give me Arthritis’… Or ‘my doctor/surgeon has said I can’t run anymore because I have arthritis’.
Many of these patients are or have previously been avid runners and running is a big part of their lives. So….do they need to stop running?
And if they don’t, will they end up with horribly arthritic knees when they get older?
There is a lot of fear associated with arthritis and misconception surrounding what is a normal part of the ageing process. Many think that the impact of running is what causes Arthritis in the first place. Which is simply NOT true.
-Exercise does not harm joint cartilage.
The belief amongst some healthcare professionals and the general public that exercise is bad for cartilage is based on misinformation and not reflective of current research. So lace them up!
Don’t believe me that running doesn’t specifically cause knee arthritis?
A Study conducted at Stanford University USA followed forty-five long-distance runners and 53 controls (non-runners) with an average age of 58 years in 1984 were followed through until 2002 with follow up knee X-rays at regular intervals.
Results found that runners knees DID NOT display more arthritis than the non-long distance running group.
In fact, after 20 years the running group had LESS Osteoarthritis (OA) changes than the non-running group (Chakravarty et al 2008).
The Authors of the study concluded that: Long-distance running among healthy older individuals was not associated with accelerated X-ray Osteoarthritis findings.
Health professionals as a whole need to drop the ‘wear and tear’ description of OA and think more about load and load tolerance.
Our joints are incredibly robust and adaptable providing we are smart with how and when we increase the amount of exercise we do.
Movement is Medicine!
Additionally, for people who enjoy long distance running there are immense benefits if this is maintained through the lifespan.
A 21-year study comparing 538 members of a nationwide running club and 423 healthy controls from northern California who were 50 years and older beginning in 1984, found that vigorous exercise (running) at middle and older ages is associated with a significantly reduced disability in later life.
The running group demonstrated improved outcomes in:
reduction in cardiovascular-related deaths
reduced rate of deaths from other causes including malignant neoplasms and neurologic disorders.
Other benefits of Running or and cardiovascular exercise include:
Reduced incidence of dementia.
Reduced risk of several cancer types.
Increased cardiovascular fitness and improved aerobic capacity and organ reserve.
Increases in skeletal muscle mass and decreased frailty.
Lower levels of circulating inflammatory markers.
Improved response to vaccinations.
Improved higher-order cognitive functions.
Reduced risk of type 2 diabetes.
Meaning that runners not only potentially live longer than non-runners but they have a better quality of life and are less likely to suffer from debilitation co-morbidities.
So, the short answer is….
No, you should not stop running for fear of developing or progressing arthritis. The benefits of vigorous exercise far and above outweigh any potential risk.
Here at Melbourne Sports Physiotherapy, we would recommend runners aim for a gradual build up of distances and intensity to allow the body time to adapt and safely tolerate the loads (even repetitive, high impact loads). No different to like any other type of exercise or sport and there is nothing we like to see more than our patients smashing their exercise goals.
When shouldn’t you push ahead with long distance running?
Potential risk factors for increasing OA symptoms with long distance running:
If you have a current knee injury/uncontrolled swelling.
Obesity (Other forms of exercise or even shorter runs may be more beneficial until you weight is at and appropriate level)
Proprioceptive deficit – this includes poor balance and control (or in the early recovery phase from knee surgery)
Or poor muscle tone around the affected joint
What should you do if you already have been Diagnosed with Arthritis?
People with a Diagnosis of OA should be encouraged and supported to, at the very least maintain current activity levels or even increase their physical activity.
The American College of Rheumatology/Arthritis Foundation recently published their recommendations in the 2019 Guideline for management of Osteoarthritis.
Listed below are their top recommendations for the management of Arthritis:
Exercise and Strengthening (outcomes were superior when exercise programs were supervised)
These are all things good healthcare clinicians can help you with.
What shouldn’t you do?
The obvious answer would be the opposite of what is listed above.
Try to ensure that you:
Retain muscle strength around the affected joint
Speak to a health professional and seek a better understanding of your condition
Avoid gaining weight. BMI >30 is strongly associated with an acceleration in joint space narrowing and OA progression.
Arthroscopy for OSTEOArthritis management?
Other common statements and questions we see and hear in the clinic are things like:
‘I think I need an arthroscope?’ or ‘Does my knee need a clean out?’
This is often based on the thought that surgery will provide an immediate benefit or due to the fact they have read reports of professional sports people having surgical interventions for problematic joints.
The short answer to both questions is NO. For most cases of knee (and hip) OA arthroscopic surgery is not recommended as a treatment strategy for non-mechanical OA.
The Royal Australian college of general practitioners published in their 2018 report in which it stated - ‘strongly recommends against the use of arthroscopy’ for the treatment of knee osteoarthritis.
Additionally, the Australian Orthopaedic Association and the Knee Society position statement (www.kneesociety.org.au/resources/aksarthroscopy-position-statement.pdf) strongly states that arthroscopy is not indicated for the routine treatment of knee OA.
What Should I do if I have knee pain running?
The main cause of knee pain in running is overload.
If you have been diagnosed currently or previously with: patellofemoral pain, ‘Runners knee’, ITB friction syndrome, distal hamstring tendinopathy or Pes anserine bursitis. This may be a ‘too much to soon’ or load related issue. All the aforementioned conditions relate to the body not handling the load (amount you are running).
The good news is there are lots of things you can do to avoid an overload type injury. Including strengthening, appropriate programming and even running mechanics changes that can help progress your running and increase your tolerance.
If any part of this blog resonates with you or you have any questions, get in contact with our team on 03 9498 0205.
How can we help you?
At Melbourne Sports Physiotherapy our goal is to get you moving pain free as soon as possible.
But, we also want you to actually move better and live a healthier, more active and fulfilling life!
If your sports, fitness training or work has been wearing your body down, book in with one of our expert massage therapists so we can help you reduce your pain or stiffness.
If you are showing some signs of this condition or simply want help prevent this from happening in the future then book in with one of our highly experienced Remedial Massage Therapists today!