KNEE ARTHRITIS AND RUNNING: BREAKING DOWN MYTHS (NOT CARTILAGE)
By Lee Schneider
Running is a popular way to keep fit, healthy and happy. But is it something that can be explored at all stages of life?
I recently came across a story about a 97 year old man named George Etzweiler who, once a year, summits Mount Washington which is 1,400m of elevation over 12km. Impressively, George only started his running career at the age of 47. Prior to running he says he was unfit and overweight and his wife Mary urged him to take his health into his own hands. 50 years later, he’s still running.
Is George just some freak of nature? Is he just a statistical anomaly and very lucky to not be injured and have dodgy knee’s? I would say he’s just an ordinary guy with the right mindset, in the right environment which helped him build, the right body.
Not only is this story inspirational, it’s full of insights into the adaptability of the human body as well as the relationship between tissue ageing and pain. So, does running run down your knees?
The opposite story is true.
Despite their being a lot of confidence in the clinic about the relationship between running and knee osteoarthritis, there doesn’t appear to be any high quality evidence to draw that conclusion. Mostly, it’s an intuition by health-care professionals and the general public, which mistakenly think about the body like a machine and not a complex and adaptable biological system.
Quite often I’ll meet people who’ve been told to stop running as its “bad for their knees” and that they need to start exercise that is low impact like swimming or cycling. This is usually in response to the person presenting to the clinic with some knee pain, followed by scans of the knee which find nasty sounding things on their scan such as joint degeneration, meniscal tearing or joint space narrowing.
Health care professionals and patients have been sold the story of knee’s that break down (like a car might break down) to repetitive loading. This dogma is not only outdated and untrue, it’s potentially harmful, in that it can create fear and ultimately avoidance of something that the person enjoys doing and is actually good for them. Also, if you go on to experience pain whilst running (something that is very common and more often than not, completely normal) then you are more likely to interpret that pain as the result of your “dodgy knee’s” playing up again. This unhelpful interpretation of the normal pain’s associated with running can confirm the unhelpful beliefs around the capacity of your knee’s as well as the idea that running is bad for them.
The likely story is that knee’s, and the other joints of the lower limb’s, adapt to running in such a way that they get stronger and better able to handle physical loading, such as running, in future. That is, if you follow a program that starts small and gradually builds then your knee’s will slowly increase their capacity to handle the loads associated with running. Here’s how it happens:
The bone and cartilage in your knee is not made of passive inorganic material. Rather, the bones and cartilage of the knee is comprised of millions of cells that respond in complex ways to the way they are stimulated. These cells get stimulated mechanically by the way that we use the knee, as well as chemically by the various things that are circulating through the body. When the body is loaded, these cells are in the business of making sure the knee is able to handle the environmental and behavioural demands placed upon them. Just think about that. If you use the knee, as in running, the cells are stimulated to build cartilage, make the joint more supple and juicy and proliferate (multiply) so that there are more cells to work with. The alternative is not using the knee. What do you think happens when there is no stimulus for the cells to adapt to? Well, to put it simply, they stop building a healthy knee joint.
This understanding is in stark contrast to the kind of information given in the clinic. We now know that weight-bearing exercises appear to be helpful for osteoarthritis and are associated with a whole host of other benefits like increased strength, functional capacity and less pain.
What should I do with this knowledge?
The above story paints running in a more optimistic light and suggests that it is helpful for your knees, not harmful. Despite this optimism, there are still some considerations that are important if you want to get back into running and you have a history of “dodgy” knees.
Your body adapts on its time, not yours.
If you’ve not been running for a long time, then you’ll need to take your time starting up again. The cells that build don’t magically replenish the stocks after one session, you need to slowly expose yourself to running so that your body can adapt properly. This means it’s ok to start small, you’re in it for the long haul.
The cells need support.
Adequate nutrition, stress management and restorative sleep all contribute to the healthful adaptation of these cells and the tissues they construct. So try to maximise these too. As a little perk, you may find that physical exercise is really great for things like sleep and stress, thus creating a helpful feedback cycle.
Pain can disrupt, but need not obstruct.
Pain is almost inevitable when challenging the body physically. You need to be respectful of the pain (even though it may disrupt progress at times), but it need not prevent you from achieving your goals of getting running again. It’s often as simple as asking yourself “what can I do” rather than “what can’t I do”. If it hurts to run, have you tried a walk? Maybe walking up and down stairs. Or if your knee starts to hurt 15 minutes into your run, have you tried walking 5, running 10 and then walking the last 5?
I believe that most people have the tools to judge this for themselves, but it may be helpful to seek help from a trained professional if you need some guidance and advice to manage pain when getting back to running.
It needs to be enjoyable.
Sure, you can run because of the health benefits alone, but I feel as though a movement practice should be performed because you are intrinsically motivated to do it.
I love running. I love the feeling I get when my feet pound the floor, the elevated heart rate, the laboured breath, the fatigue in the muscles and the acute sense of being alive. Plus, I normally run on trails through the bush and find myself connected to nature each time I lace up my trainers and hit the path.
There are many different ways to move your body, running is one of them but it’s not the pinnacle of human movement experience for everyone. You can dance, surf, do Yoga, climb, squat, and deadlift, walk, swim, play squash and the list goes on. If you don’t enjoy running, find something else that you love and do that!
Set backs are normal.
Lastly, challenge yourself, but don’t be hard on yourself if you have set backs! I often say that running is a two steps forward, one step back kind of game, and you need to be in it for the long haul. If you have a setback it can be helpful to look at where you are now, compared to where you started. Or, where you are now, to where you can be in a few months’ time.
Even though it’s common-tongue in clinical settings, running probably doesn’t lead to osteoarthritis. In fact, the opposite is probably true in that avoiding healthy activities like running, that load the joints and stimulate adaptation of the tissues involved, may increase the rate at which these tissues age and lose their strength and capacity. Running is a great way to get moving and if you want to do it, just be smart and slowly introduce it so that your body can adapt to meet the demands of running. If you have pain and it’s impeding your ability to run, that might be a point at which you contact a local physio and try to get some guidance. Till then, keep calm and keep moving!
Leech, R. D., Edwards, K. L., & Batt, M. E. (2015). Does running protect against knee osteoarthritis? or promote it? assessing the current evidence. British Journal of Sports Medicine, 49(21), 1355-1356. doi:10.1136/bjsports-2015-094749
Mueller, M. J., & Maluf, K. S. (2002). Tissue adaptation to physical stress: A proposed “Physical stress theory” to guide physical therapist practice, education, and research.Physical Therapy, 82(4), 383. doi:10.1093/ptj/82.4.383
Timmins, K. A., Leech, R. D., Batt, M. E., & Edwards, K. L. (2017). Running and knee osteoarthritis: A systematic review and meta-analysis. The American Journal of Sports Medicine, 45(6), 1447-1457. doi:10.1177/0363546516657531