Joint health is the centre point of a musculoskeletal physiotherapist’s daily life! We are often asked what the ‘right amount of running’ is and if it can cause damage. Before answering these questions it’s important to remember a few key points about joints.
Starting with; joints they are made up of a lot of structures! Muscles, ligaments, tendons, bones, and the most talked about, cartilage. Osteoarthritis is wear and tear of the articular cartilage over time, which can cause inflammation and pain. The cartilage is there to absorb forces during activities, so high impact twisting and poor overall joint stability can increase the risk of this breakdown. To focus on the cartilage alone would be a grave disservice to the joint complex! The other structures are there to stabilise and protect. This enables the joint to move smoothly and efficiently, reducing the risk of pain and damage.
As of 2016, a meta-analysis of running and risk to joint health found no evidence that moderate levels of running in itself was detrimental. In fact, we can reduce the risk of osteoarthritis by maintaining a healthy weight, building muscle, flexibility and balance. All of which, can be achieved through activities such as running, swimming, and Pilates.
Being overweight and running
The World Health Organization (WHO) defines overweight as Body Mass Index (BMI) greater than or equal to 25, overweight 25 – 30 and obesity as BMI greater than or equal to 30. Several studies have looked at the effect of being overweight on osteoarthritis and have found the risk is increased. The John Hopkins Arthritis centre notes “being only 10 pounds (4.5kg) overweight increase the force on the knee by 30-40 pounds with each step”. This is generally put down to the physics of increased force that the joint needs to distribute. Giving more evidence that training the joint to stabilize it is of significant benefit and a healthy weight will equal a more comfortable run.
Running, osteoarthritis and genetics
Genetics are often to blame for ‘bad knees’. However, no studies have been able to conclude the exact genetics of osteoarthritis and research is ongoing. Papers published in 2004 and 2008 demonstrated that genetics may be a factor in the disease process of osteoarthritis but most important is to recognise that environmental factors can be influenced. For example, the modifiable factors are the critical points – such as obesity, occupation and diet all contribute to joint health and are easily changed. So the risk of joint problems can be reduced.
Family history of osteoarthritis and running
Running is part of a person’s identity and the current evidence isn’t strong enough for someone to abandon their lace ups because of family history. There are lots of factors in running that can be modified to suit the individual. This may be running style, specific exercise programmes, stretching, footwear …. A moderate amount of running seems to be the best approach. Like the goldilocks and the three bears – not too much, not too little, but just enough. If they did want to race half marathons and beyond, it would have to be based around their fitness levels and a tailored program that suited the individual and their goals.
Treadmills or green green grass?
Both treadmill running and flat grass running have been shown in biomechanical analysis to reduce stress and load on the lower limb joints compared to the road. Whether this reduces the overall impact on joint health for runners isn’t clear. Numerous anecdotal sources however, advise running around parks in bright leggings boost endorphins, the smile factor and potential interaction with pugs. Another reason to go green!
Varying running routes
Shaking up your run is excellent for many reasons. Biomechanically, keeping ourselves alert during a run will reduce the fatigue we translate into our running style. This is important as absent minded running increases stress and poor technique which increases overall injury risk. All running is impact based and therefore an element of constant repetition. If the concern is to reduce long term damage then a better focus would be on modifiable factors such as weight and gait analysis to look for any deficits in strength or flexibility. Avoiding concrete and tarmac surfaces would be desirable but not to the detriment of not running at all! Mentally, new routes and the feel good factor of new achievements are one of the best reasons to get out there!
What’s great about running is that it is accessible to everyone – you just need some good trainers, a good sports bra and some space (paisley leggings are preferable but optional). Everyone’s running technique is different though and spending a small amount of time with a physiotherapist who can analyse your gait and provide feedback will significantly reduce the risk of injury in the longer term. Don’t forget the rest, recovery and nutrition are also important factors in feeling great and enjoying your run.
Knee pain when increasing running?
Some knee pain isn’t necessarily their body’s way of telling you that a limit has been reached, but more likely that training has increased far too quickly and the body (joints, muscles and heart!) needs some time to adapt. Going from regular 5 mile runs to 7 mile runs is an increase of 40% in distance! Your tendons will likely report back to you as much. 10% weekly increase in distance is a good starting point. Bigger distances can certainly be achieved with smart training and injury prevention. Talk to your physiotherapist or doctor about any sharp pain and get a balanced programme in place.
Overall, we are all special in our own way – just like we were told as kids! Running has a vast array of benefits (neon leggings notwithstanding) and can actually help maintain good joint health, not to mention the cardiovascular, healthy weight, stress busting and sleep assisting…need I go on…benefits! Like all activities, balance is the answer. We must run to suit our own needs and style, mix up running with flexibility and low impact activities such as yoga and swimming, invest in good footwear and if you are unsure – ask a physiotherapist, they are always willing to provide some interesting exercises to achieve that amazing run!