I was handed an article recently that talks about ‘running and osteoarthritis in the knee’. The article discusses the pros and cons of using running as a form of exercise when you have been diagnosed with degenerative osteoarthritis (OA) in the knee joint. Its a novel idea and one that some running enthusiasts will latch onto with varying amounts of claims that they knew all along that running was beneficial. This article talks specifically about OA sufferers and that perhaps just because they have been given a diagnosis, they should not give up on their essential form of exercise.
Running is easy. You don’t need any specialist equipment. You don’t need to hire a court or have availability. You can do it in the rain if you so choose. It’s not something you need to do with a group so it’s not dependent on others. You don’t even have to get changed for it really? Getting up and going for a run is as fundamental as exercise gets. We should all have it in our capacity to take part in this basic form of movement.
But as we have discussed at length on sites, facebook posts, blogs and amongst professionals (and even in my own clinic) running isn’t for everyone. Not everyone has the functional foot strike and pelvic balance along with stability to always be able to run. For some people, I wouldn’t recommend it. But for others, who are desperately destined to believe it - they WANT to run. They NEED to run. THEY HAVE TO RUN! So when an article comes along saying “Yes - run” you can imagine the vivacity to which runners will cling to anything that says to them ‘YES’.
Information is out there that supports that OA is not associated with running, caused by running or is predisposed to being a condition associated with runners. https://www.ncbi.nlm.nih.gov/pubmed/18550323 . Runners have been shown to be less presdisposed to degenerative conditions due to decreased BMI that running results in, the development of strong and resilient cartilage that has grown strong in response to stress ‘within acceptable loads’ and reduced systemic inflammation that exercise and loading (such as running) illicits in the cellular matrix.
This article talks about runners suffering with OA to continue with their regimen as it may actually be beneficial. Now it’s a long walk from the back alley smoko discussion to the lectern and presentation of factual evidentiary based conclusions, but taking up running when you have OA may not be such a bad idea. However there is evidence to support that running helps with some of the effects of building resilience and strength in the tissues and cells as well as creating optimal conditions that deal with anti inflammatory and anti OA causing cells within the joint itself. New studies released on May 4th in Clinical Rheumatology by the Balor College of Medicine tested over 5,000 OA sufferers and published their findings.
The research concluded that for certain percentages of the test group the effects were more beneficial than negative. Of course, with ageing subjects and a non determined regime or instruction as to how much activity or movement they embarked upon and how regularly (the study was conducted over 3 years), the base line results supported that for up to 50% of the test subjects, there were benefits in OA pain that were a result of the loading and movement gained through running.
“Among individuals 50 years old and older with knee OA, self-selected running is associated with improved knee pain and not with worsening knee pain or radiographically defined structural progression.”
Whilst there were some subjects that suffered pain during the test (20% in the running group and 29% in the non runners) the improvement in knee pain was seen at a ratio of 50% in the control group, suggesting that the ratio of benefits from the activity was beneficial. Whilst not conclusive it does support the notion that your running activities may not be worsened by your usual jogging or active morning run. In fact, it would ‘tentatively encourage it’.
The article raises another broader discussion, does exercise benefit or predispose you to injury? In regards to running it is seemingly obvious and apparent that there are the yes and no camps. That running is a high impact exercise that can be a precursor to painful conditions later in life is a fact that has been disputed and discussed at length. But this could be applied to many sport based activities. Do we continue to play when we start to experience pain? Do we accept our age or defy it? Do we move or do we not move?
In the European Journal of Applied Physiology, researchers at Brigham Young University in the researchers were conducting investigations into the cellular matrix of runners knees vs non runners. Their investigation was to test for precursors to inflammation (inflammation being a key precursor to those suffering from OA). By drawing out Synovial fluid (the viscous fluid that helps to protect our cartilage and articulations with a gliding nature) and testing for molecular makeup within this synovial fluid they found that runners possessed lower levels of two types of cells (two cytokines named GM-CSF and IL-15) that are precursors to inflammation.
They also discovered that levels of cartilage oligomeric matrix protein (COMP) which is a known as an incipient of worsening arthritis were markedly lower in the runners than the non runners. Their test involved the same subjects doing running actions and then sitting and immediately measuring the levels of these cells. Not only were COMP levels inside the knee less, but the levels in the blood around the knee were actually higher - as if the action had pushed the COMP cells into the blood stream and out of the knee joint. It is worth noting that sitting actually increased the amounts of these cellular precursors within the knee joint.
Now the evidence was only able to be concluded on a small amount of participants (amounts of synovial fluid in young able bodied runners is hard to extract) but the conclusion suggests that activity changes the interior make up of the knee reducing cells that are known precursors to damage and inflammation in the joint space. This is more of a supporting evidence that running does NOT preclude you to developing inflammatory conditions in your knee but can actually assist with delaying the onset of the condition.
TO bring it locally - my Mum is a champion knitter. She’s a demon of the knitting needles. Which kind of sucks when you live in Australia and the beautiful wool jumpers that Mum is so fond of creating can only really be pulled out when you do a bi annual trip to the ski fields. However, Mum who still has her original bone knitting needles from the 1940’s has developing arthritis in her knuckles. When the arthritis is in flare, her hands do resemble the Wicked Queen out of Snow White handing over the poisoned apple. BUT Mum goes nowhere without her knitting. She has moved onto crochet (which apparently is easier on the hands) but she continues to knit when she can and this movement and working of the joint spaces does help her to keep the articulations active, strong and resistant to bouts of arthritic flare.
Arthritis Australia promotes exercises on it’s website as an effective and productive way to treat arthritic conditions. It does talk mainly about low impact exercise citing gentler forms of exercise such as tai chi, water aerobics and brisk walking. But if you have a history of being a runner or a jumper or a long distance ice skater, the evidence points that ANY exericise is going to benefit you and the movement associated with joints helps to control the precursors of inflammatory conditions. With that in mind, we need to be aware that each individual has their own level of pain and experience. So you have to be mindful of your levels of pain. During a flare, exercise may be detrimental to the condition whereas when you are in remission, exercise can help to change the cellular matrix to prevent precursors of inflammation from being present in the joint space.
The hard evidence still needs investigation and study over larger and more controlled subject groups. Whilst we are not going to be sending out OA sufferers on long runs and trail tracks in their newly purchased Reeboks, the premise stands that movement and exercise, even in those people who are suffering from acute conditions could be more beneficial than it is detrimental to overall health. The research supports that the benefits such as BMI reduction, and reduction of COMP and Cytokines outweigh the risks that exercise may pose to a sufferer of inflammatory conditions. So get moving kids! And by kids I mean that in the completely irreverent sense - we are never too old to be moving and exercising and fearful that exercise and movement will be cause us pain.
