Williams, P.T. OSTEOARTHRITIS IN RUNNERS AND WALKERS Medicine & Science in Sports & Exercise
The number of runners studied here is larger than any
previous study of physical activity and OA and hip replacement
and exceeds by more than 10 times the number of
runners previously studied in all previous cross-sectional
studies combined. Included among these were 863 runners
who reported running 60 miles/wk. Contrary to many
previous reports (2,3,6,16,23,31,32,37), we find no evidence
than running increases the risk of OA, including participation
in marathon races, and, in fact, subjects that ran
12.9 km/wk were at significantly
lower risk for both OA and hip replacement. The reduction
in risk for running
more than compensates
for the 1.6% per year risk increase for hip replacement
during the first 21 yr. Moreover, there was no particular
advantage to walking rather than running in reducing OA
and hip replacement risk. In fact, runners were more likely to
benefit from less OA and fewer hip replacements because a
greater proportion exceeded
(89.5% vs 52.8%).
Previous studies suggesting a protective role for physical
activity are much fewer than those showing a risk increase or
no effect. In one, joint space loss was observed in nonrunners
but not runners, suggesting that running preserved cartilage
thickness (18). In another, knee replacements decreased with
increasing cumulative hours of recreational physical activity
(24). Our data even showed that marathon frequency, marathon
intensity, and 10-km intensity did not predict any risk
increase for OA or hip replacement, in contrast to the report
of Michaelsson et al. (26) that skiers who repeatedly participated
in a 90-km ski race increased OA risk in proportion
to the number of races run and performance (speed).
The OA-protective effects of running or walking appeared
have already occurred by suggesting the
association may be due primarily to increased OA in the
least active individuals. Articular cartilage thickness is reduced
in animals subject to prolonged immobilization (36).
Cartilage is also thinned in the absence of normal joint
loading in spinal cord injury patients (35). In children, articular
cartilage volume is increased in association with
vigorous physical activity and muscle strength cross sectionally
(13), and those who engaged in more intense sport
gained more cartilage over time (12). Triathletes have
thicker patellae cartilage than inactive subjects, albeit thinner
medial femoral condyle cartilage (28). Some (4), but not
all (8), studies suggest that physical activity may enlarge the
knee joint surface area in adults. Glycosaminoglycans are
used in the synthesis of proteoglycans, which provide
cartilage_s viscoelastic properties (22). Early OA consists of
a focal loss of proteoglycans (5). Running increases the
glycosaminoglycan content of human knee cartilage (34).
Roos and Dahlberg_s (30) randomized trial showed that
exercise produced a healthier distribution of proteoglycans
in cartilage vis-a-vis nonexercising control. Animal studies
also suggest that the patellar cartilage of sedentary hamsters
have a lower proteoglycan content than those that are active
(29). Moderate exercise has also been shown to inhibit the
development of surgically induced OA in the rat (7). In
dogs, however, shifting from moderate to strenuous running
eliminated increases in cartilage thickness and proteoglycan
content produced with moderate running (14).
Our analyses showed that in contrast to running, other
(nonrunning) exercise increased the risks for both OA and
hip replacement. This result is consistent with more than
twofold greater prevalence of tibiofemoral or patellofemoral
OA in soccer players (29%) and weight lifters (31%) than
runners (14%) reported by Kujala et al. (15). Research on
occupational activity shows that OA is more common in
jobs requiring knee bends, kneeling, or squats (25), which
may be more characteristic of exercise performed in gyms,
circuit training, and aerobic classes than running or walking.
Work-related knee bending exposure increases the odds for
knee OA by up to sixfold (21).
Our analyses confirmed the well-established association
between BMI and incident risk of OA and hip replacement
even within the purported healthy weight range, and attributed
45% and 28% of the running associated decrease in OA
and hip replacement to BMI, respectively. In addition to
promoting weight loss directly (39), running attenuates
middle-age weight gain (38), such that higher mileage runners
gain only half as much as low mileage runners. The prevention
of weight gain is an additional mechanism for limiting
risk OA and hip replacement risk. Body weight has a much
weaker association with other exercise than with running
(40), which may explain in part their different associations
with OA and hip replacement, particularly given that adjustment
for BMI did not affect the concordance between baseline
other exercise and both OA and hip replacement.
There are important limitations to these analyses that
warrant acknowledgment. The results are based on self reported
physician-diagnosed OA and hip replacement
rather than medical chart review or imaging. However, reviews
suggest stronger associations have been reported for
clinically assessed hip OA than its radiographic assessment
(20). Patient self-report of physician-diagnosed arthritis has
been found by others to be the best predictor of radiologically
ascertained OA, showing 64% specificity, a 57%
positive predictive value, and 71% negative predictive value
(33). We do not believe that the declining incidence of OA
and hip replacement with greater MET-hour per day walked
or run was due to fewer opportunities for diagnosis in the
more athletic men. The Health Professional Study reported
that their more vigorously active participants had more
routine medical checkups than less active men (19). It is
possible that there is a higher pain threshold in longer distance
runners, but it is unclear why this would not also be
true for other exercise as well. It is unclear whether the exclusion
of preexisting injury would be warranted in
assessing the OA risk in runners, if such injuries were the
consequence of the exercise per se. Finally, we acknowledge
that the analyses would have benefited from the complete
follow-up of NRHS-II and NWHS. Heretofore, we have
been unable to secure funding for their follow-up, and there
is no evidence that the NRHS-I (80% follow-up) and NRHSII
(51.7% follow-up) show different relationships between
MET-hour per day run and the risks for OA (P = 0.45 for
difference) or hip replacement (P = 0.89 for difference). The
lower follow-up of the walkers (33.2%) than NRHS-II
(51.7) reflected our recruitment priorities rather than differences
in the responsiveness of the walkers and runners;
however, we do not believe that this affected the comparison
of walkers and runners given that comparable results were
obtained when the analyses were restricted to the initial
33.2% of the NRHS-II runners recruited.
In conclusion, these results may not apply to truly elite
athletes, but for recreational runners who even substantially
exceed current guideline activity levels and participate in
multiple marathons annually, running does not appear to
increase OA and hip replacement risk and may, in fact, be
preferable to other exercise.
See the Big Picture. Treat the CAUSE of injury.
This is the ‘hands-on’ of physiotherapy which is found at the Saanichton Physiotherapy and Sports Clinic. Although there are certain improvements that can be made by stretching and massage alone, sometimes a more specific technique is required to mobilize or manipulate joints that don’t move properly. Often Manual Therapy can help minimize the likelihood of major injury by looking at the big picture. We treat the CAUSE and not just the SYMPTOM. After such a treatment, you may be shown home exercises that can be done to keep your joints functioning well.
What types of Manual & Manipulative Therapy can Physiotherapists provide?
Joint mobilization – a skilled passive slow movement applied by the therapist to the affected joint to improve its range of motion. This can be applied to any joint, from the jaw all the way to the toes.
Joint manipulation – a skilled passive fast movement applied by the therapist to a stiff joint. There is usually a characteristic ‘pop’ sound or feeling. These can be applied to most joints of the body. Manipulations of the spine itself are limited to those professionals with advanced training in this area, including physiotherapists.
Back and neck pain are among the most widespread reasons patients seek physiotherapy. And back pain is one of the most common medical problems, affecting 80% of people at some point during their lives. Back pain can range from a dull, constant ache to a sudden, sharp pain, and can be acute or chronic. Neck pain, which is closely associated with back pain, occurs when muscles are strained from poor posture or injury, or when joints are worn or nerves are compressed. Both conditions can be debilitating and effect a patient’s physical and mental wellbeing.
Early access to physiotherapy (within 14 days of occurrence) has a significant long-term impact on the health of patients as it helps to prevent chronic disability and decreases the proportion of cases that become chronic.
So, if you suffer from back or neck pain, seeking the guidance of a physiotherapist is a great first step towards finding pain relief and keeping you moving for life.
Vary your position. Sitting at computers and desks all day puts increased pressured on your spine. After 30 minutes of sitting make sure you walk around to keep the flow of blood and fluids to your spine. Set up a standing workstation to vary your position while working at your computer. Make sure your work desk and computer are set up properly for sitting or standing to encourage optimal posture. Your physiotherapist will prescribe suitable and safe stretches or “pause exercises” and provide tips on how to correctly position yourself in front of your computer.
Stay flexible. Optimal spinal health means having flexibility in all directions. If your thorax (upper-mid back and ribcage) has limited rotation movement, more load and stress can be transferred to your low back, neck or other body parts. Check your rotation by sitting in a chair with your arms crossed across your stomach; you should be able to turn equally to the right and left and see behind you easily. If you have an asymmetry between the right and left directions, or reduced motion, your physiotherapist can assess the reason why, mobilize your spinal joints, and give you exercises to maintain your thoracic mobility – essential for a healthy low back and neck.
Keep your core in check. Regain optimal control of your deep spinal muscles (core) following an episode of neck or back pain. Your physiotherapist will provide a thorough examination of your spine, provide manual therapy and other treatment techniques, and help you regain any lost mobility by instructing you on how to achieve ideal postural alignment and prescribing exercises that will support your spine.
Correct postural habits. Be aware of habitual postures and positions (such as always sitting on one side of the couch, slouching with your feet on the coffee table, carrying your bag/purse always over the same shoulder, sitting cross legged, leaning usually on the same elbow etc.) Habitually poor postures may indicate weaknesses in certain muscle groups or stiffness within the body. Your physiotherapist can assess reasons why you may adopt these positions and how to correct them.
Physiotherapists are the rehabilitation specialists recommended most by physicians. They are university-educated health professionals who work with patients of all ages to diagnose and treat virtually any mobility issue. Physiotherapists provide care for orthopedic issues such as sport and workplace injuries, as well as cardiorespiratory and neurological conditions. As Canada’s most physically active health professionals, BC’s physiotherapists know how to keep British Columbians moving for life.