Does running accelerate the development of osteoarthritis?
There are so many misconceptions about running and how bad it can be for your joints. You may have heard many friends and family members comment on this and they may have even tried to convince you to stop running and go swimming instead. Here is what the scientific research tells us so far:
Osteoarthritis (OA) is a musculoskeletal condition that involves degeneration of the joints and impact during weightbearing exercise such as running and may contribute to joint loads. There is very little evidence however, that running causes OA in the knees or hips. One study reported in 1985 by Sohn and Micheli compared incidence of hip and knee pain and surgery over 25 years in 504 former cross-country runners. Only 0.8% of the runners needed surgery for OA in this time and the researchers concluded that moderate running (25.4 miles/week on average) was not associated with increased incidence of OA.
In another smaller study of 35 older runners and 38 controls with a mean age of 63 years, researchers looked at progression of OA over 5 years in the hands, lumbar spine and knees (Lane et al. 1993) . They used questionnaires and x-rays as measurement tools. In a span of 5 years, both groups had some participants who developed OA- but found that running did not increase the rate of OA in the knees. They reported that the 12% risk of developing knee OA in their group could be attributed to aging and not to running. In 2008, a group of researchers reported results from a longitudinal study in which 45 long distance runners and 53 non-runners were followed for 21 years. Assessment of their knee X-Rays, revealed that runners did not have a higher risk of developing OA than the non-running control group. They did note however, that the subjects with worse OA on x-ray also had higher BMI (Body Mass Index) and some early arthritic change in their knees at the outset of the study.
Is it better to walk than to run?
It is a common belief that it must be better to walk than to run to protect your joints. In a recent study comparing the effects of running and walking on the development of OA and hip replacement risk, the incidence of hip OA was 2.6% in the running group, compared with 4.7% in the walking group (Williams et al 2013). The percentage of walkers who eventually required a hip replacement was 0.7%, while in the running group, it was lower at 0.3%. Although the incidence is small, the authors suggest the chance of runners developing OA of the hip is less than walkers.
In the same study, Williams and colleagues reinforced that running actually helped keep middle-age weight gain down. As excess weight may correlate with increased risk of developing OA, running may reduce the risks of OA. The relationship between bodyweight and knee OA has been well-established in scientific studies, so running for fitness and keeping your weight under control is much less likely to wear out your knees than being inactive and carrying excess weight.
Is there a limit?
Recent studies have shown that we should be doing 30 minutes of moderate exercise daily to prevent cardiovascular disease and diabetes. But with running, researchers still have not established the exact dosage of runners that has optimal health effects. Hansen and colleagues’ review of the evidence to date reported that the current literature is inconclusive about the possible relationship about running volume and development of OA but suggested that physiotherapists can help runners by correcting gait abnormalities, treating injuries appropriately and encouraging them to keep the BMI down.
We still do not know how much is “too much” for our joints. However, we do know that with age, we expect degenerative changes to occur in the joints whether we run or not. Osteoarthritis is just as common as getting grey hair. The important thing is that we keep the joints as happy and healthy as possible.
How do you start running?
If you are not a runner and would like to start running, walking would be a good way to start and then work your way up to short running intervals and then longer intervals as you improve your fitness and allow time for your body to adapt. Therefore, running in general is not bad for the joints. It does not seem to increase our risk of developing OA in the hips and knees. But the way you run, the way you train and how fast you change your running frequency and distance may play a role in future injuries of the joints.
Physiotherapy For Back Pain
Back problems are the third most common reasons for taking time off work behind the common headaches and colds and are also the second most common reason people go and see their GP. It is believed that approximately 8 in 10 people in western countries suffer from some form of back pain at least occasionally.
Back pain or back ache is a symptom that can arise from many causes including arthritis, muscle and ligament strains, disc lesions, osteoporosis, sciatica and stress. Many cases of upper and low back pain and sore backs in general are caused by stresses on the muscles and ligaments that support the spine. Back pain affects patients of in the neck (cervical spine), mid back (thoracic spine) and lower back (lumbar spine).
At Saanich Physio we deal with a high volume of cases of back pain/injuries and have a proven track record to providing good relief! Our staff here are specially trained in dealing with back related issues whereby digital spinal analysis, X-rays and a comprehensive physical exam are utilized to determine the exact cause of the back pain. We know that everyone is different and therefore we tailor a management program that best suits you! A ‘generic’ treatment formula simply won’t work if you want to stop your pain from coming back.
Here at Saanich Physio we also take a research based ‘holistic’ approach to one’s back problems; as such we also consider and give advice on lifestyle factors that can contribute to back pain. Majority of cases of back pain are aggravated by lifestyle factors, including lack of exercise, schoolbags, being overweight/obese, sedentary lifestyles, poor posture, stress and bad work practices. In relation to obesity – we can also provide superior quality weight loss supplements to assist in this area. We address all of the contributing factors to prevent the pain in your back from coming back for good. Many back pain ailments can be addressed easily and quickly but those with serious and chronic back pain often benefit from an ongoing maintenance program.
Physiotherapy to prevent relapses and worsening of symptoms
Simply, our Back Program is a tailored treatment program to address the exact cause of your problems and to get you back to your favourite activities fast! So if your back is holding you back from sport, occupation and other activities or you just simply have pain whilst sitting or getting in/out of your car then our Better Back Program may be the answer for you!
Our Back Program involves an initial assessment with one of our highly skilled physiotherapists. You will also receive a detailed report at the beginning and conclusion of your back therapy to show your progress and your family doctor and relevant specialists will receive a copy also so that everyone in your medical team helps you move towards being fit and painfree.
Whether you are a first time or seasoned full or half marathon runner, post race you will be on a runners high for finishing your event after many months of running training and preparation. The key to a good post marathon, half marathon or running event recovery is what you do in the first few days after your marathon or running event.
The outcome of not following through on a good recovery include risk of injury, increased fatigue, mood swings and extreme muscle soreness.
At Saanich Physiotherapy and Sports Clinic we advise on the following tips to prepare you for your post race recovery.
Drink lots of water
Many of us don’t realise how much fluid can be lost during running. During your running event the wind evaporates a large portion of your sweat – this means that a lot of the fluid you lose is invisible, but can add up to 1-2 litres or water. Some of the signs to watch our for in post running dehydration can be headaches, concentrated urine which appears darker yellow in colour and feelings of being extremely exhausted. A swollen tongue and cracks/indentations in your lips can also be signs of a dehydrated body.
Perform a warm down routine
Warming down will make a huge difference to how your body responds in the first 1-2 days after your running event. This is when DOMS (delayed onset muscle soreness) starts to rear its ugly head. So it’s vitally important to warm down even if you do not feel like it at the time. Stay on your feet and keep moving and walking around the race precinct for about 5-10mins. Do a few light lower limb stretches of your quadriceps, hamstrings and calves immediately after the marathon or running event and keep increasing your light running routine over the next few days.
Book a massage or some hands on physiotherapy
At Saanich Physiotherapy we encourage you to pre-book your post race remedial massage or hands on physiotherapy and dry needling appointment in the first 1-2 days after your event. This will really assist your muscles to re-lengthen and decrease soreness after all the hard work they did getting you over the finishing line.
Wear compression garments
Wear your compression socks, pants or shorts when you get home or even immediately post-race if you can get to them easily. Wearing these can significantly reduce your muscle soreness.
Seven days later have a massage or hands on physiotherapy appointment
It will usually takes 1-2 days for DOMS to kick in. Getting that second massage or hands on physiotherapy appointment a week after a major running event can work wonders. This is quite important if you are looking to continue to run or participate in another event soon (eg the following weekend or fortnight). Our hands on Physiotherapists and registered massage therapists will work over any residual tight knots and bands that developed over the course of your running event.
Legs up the wall
A great way to encourage recovery is to lie with your legs resting up on a wall. This can facilitate blood flow and lymphatic drainage. Adopting this position can improve your mood and energy levels by bringing blood back to the brain. You can stretch in this position for for up to 15mins. Move your gluteals closer to the wall for comfort and to stretch your hamstrings.
Knee pain can affect a large range of age groups, ranging from ‘growing’ pains experienced by young people to ‘arthritic’ pain in older persons, and everything in-between. In this Blog we will examine knee meniscus injuries, what causes them and how to treat these injuries.
What is the Meniscus of the Knee?
The meniscus are C-shaped structures in your knee joint which sit between your femur (or thigh bone) and your tibia (or shin bone). They are made of a type of cartilage called fibrocartilage, which is a little bit different to other form of cartilage in your knee called articular cartilage. Articular cartilage is often more affected with arthritis. Your knee has two menisci, the medial meniscus and lateral meniscus. The medial meniscus is located on the inside while the lateral meniscus is on the outside of your knee.
The menisci have a limited blood supply which rely on movement of the knee to keep it strong and healthy. The best thing you can do to prevent your meniscus from injury, is to keep active and keep the knee moving.
What does the Meniscus do?
The main role of the menisci is to help with absorbing and distributing forces through the knee joint. They work together with knee and hip muscles to act as a shock absorber when the knee is active. The menisci also increases the surface area of the knee joint, so it adds some extra stability to the knee.
How do you injure your meniscus?
The majority of meniscus injuries occur as people age (over 50 years). As you get older the limited blood supply to the meniscus becomes further reduced. As people age they develop wrinkles and grey hair. The aging process also occurs in the knee, the menisci begin to degenerate, lose some of their strength and become more prone to injury.
As the menisci become more susceptible to injury with age, the range and types of movements which can damage it become more prevalent. The majority of meniscus injuries occur when you twist your knee over a planted foot. – Sometimes it can be as simple, as turning to look over your shoulder or stepping off a ladder and putting weight on your foot and twisting your knee. You might notice the knee to slowly swell up.
Meniscus injuries in the younger ager group (under 30) are not as prevalent. Simple twisting movements to the knee are unlikely to cause menisci injury in younger persons. You are more likely to see menisci injuries occur with other knee injuries such as ligament damage caused through sport.
What should I do if I damage my meniscus?
So you have injured your knee and you are thinking, what to do next? Alternatively, you have had a scan on your knee and been diagnosed with a meniscus tear and wanting to know what is the best way to treat it?
A 2002 study involving people who had ‘degenerative’ menisci tears, compared the rehabilitation recovery rates of three groups. The first group had meniscus removal surgery (i.e. arthroscopic meniscectomy), the second experienced joint ‘wash-out’ (lavage) and third underwent ‘placebo’ surgery where the surgeon made skin incisions only. All groups undertook the same rehabilitation program. Amazingly they found no difference in between the 3 groups. All groups had the same levels of pain and function, and all improved at the same rate.
Since the initial 2002 study, further published studies have compared meniscus surgery with placebo surgery and physiotherapy treatment. These studies continue to confirm the same result, that is, there is no differences between all of the groups in terms of rehabilitation other than the surgery group having a higher cost of treatment!
The treatment for meniscus tears in the active, younger population (under 30) is more complex with some individuals needing surgery as soon as possible, while others can manage with physiotherapy and exercise.
What does this all mean?
Degenerative meniscus tears are more common as people age. In some cases people who not have any knee pain may have degenerative menisci and not be in any pain. In other words having a degenerative meniscus correlates poorly pain. The good news is, you might not need to have surgery at all if you are able to undertake a comprehensive physiotherapy rehabilitation program.
Will surgery provide you any benefits? Yes it will in the short term. However, arthroscopic meniscus surgery is associated with a ten-fold increase the risk of knee osteoarthritis.
Although most degenerative meniscus tears don’t need surgery, there are always some cases where surgery is going to be more effective than physiotherapy. Some menisci tears can either ‘stick-up’ into the joint or ‘break-off.’ In cases like these the tear can cause the knee to lock when trying to bend or straighten, and surgery is recommended to remove the tear.
What will my physiotherapist work on during my rehabilitation?
The first thing your physiotherapist will undertake is a full assessment of not only your knee, but your legs and even your back to see if you pain is coming from your meniscus or from somewhere else.
If you have hurt your meniscus recently your physiotherapist will start treatment aiming to reduce the swelling and begin to return it to its full range of movement.
If you have full range of movement and no swelling in your knee joint your physiotherapist will begin an exercise program focused on strengthening the muscles around your knee, and from around your hip. Weak quadriceps muscle has been found to place a greater load on your knee joint and your meniscus. Strengthening these muscle groups can reduce the pressure on the meniscus during movement. Weakness in your bottom (gluteal) muscles can also affect your knee function. Weakness in the gluteal muscles is known to place more load through the inside of the knee, which is where the majority of medial injuries occur. Strengthening the quadriceps and gluteal muscles will contribute to reducing the pressure on the knee.
Degenerative meniscus tears areas common as wrinkles and grey hair as you grow older. Although surgery is sometimes required for some knee injuries it often is not the only or best option in most cases. For most knee injuries involving the menisci the best anti-aging medicine is physical activity and exercise.