Running and osteoarthritis

ITLSusan

What is the state of research into running with hip or knee osteoarthritis. What is the Arthritis Care view on this matter? What do they advise?

In 2006 when I was diagnosed it was advised against. Research is now starting to shed doubt upon this line of thinking. I've ploughed through the research as best I can but I don't have full access. What do the experts say in 2015?

A big concern that I have is that research shows that fitness is hugely important in helping reduce symptoms. Yet those that are active are typically advised to reduce activity and thus loose fitness. Running is a huge help with things like weight control, combating age related loss of fitness, muscle mass and bone density - not to mention pumping nutrients through the joints - joints rely on osmosis.

It would be good to get more information on topics like this. Information for highly active people that want to keep getting fitter and healthier with each passing decade despite an OA diagnosis. For many this loss of fitness and athleticism is the biggest fear. I know it was for me. What does Arthritis Care have to offer these people?

Slosh

Have you looked at the Arthritis research website? They have links to this type of information as well as leaflets.

stickywicket

There is fitness and there is running. These are not the same thing even for those without arthritis. Running can be an aid to fitness or it can detract from it. From my years on here I've realised that many people could improve their OA by taking more exercise whereas others can make matters worse by refusing to cut down on sports or pursuits which stress arthritic joints.

Arthritis Care does a great job of supporting people with a wide range of 'arthritises' and championing our cause. I think it's widely known now that keeping fit and active is the way to go after an OA diagnosis whereas being a couch potato will only make things worse. However, there's a huge leap from that to promoting running. Plus, there is more to keeping fit than running.

I'm a bit pushed for time so I've just had a very quick glance at AC's 'news' and 'publications' sections and these are what immediately came up.

http://www.arthritiscare.org.uk/NewsRoom/Latestnewsstories/icfc

http://www.arthritiscare.org.uk/NewsRoom/Latestnewsstories/YtNw

http://www.arthritiscare.org.uk/LivingwithArthritis/Self-management/exercise-and-arthritis

ITLSusan

stickywicket, thank you for taking the time to share those links.

Part of the problem here is that much of the available information is targeted at people that are unfit and perhaps in a bad way. Very many OA sufferers are still in great shape and working hard to stay that way! Information provided for the average OA suffer isn't relevant to all of us.

It used to be the case that doctors told people running caused OA. Research is now showing that it has a protective effect against OA. Doctors put people off doing something that's proving now to protect them from many chronic conditions.

Long term research has shown that older people that ran regularly had less OA than those that didn't. Now given that most older people have degenerative changes in joints that would suggest that if running was pain free then it might well be good for even damaged joints.

I run - I no longer have any OA symptoms. Running makes me feel great. But I DO still (I expect) have degenerative changes in my hip joints. Asymptomatic degenerative changes. I'd like to know what the research tells us (if anything) about the impact that has on my joints. Does it help them (in which case I'll do more) or harm them (in which case I'll do less). If it's not known either way I'll keep doing what I'm doing.

I have a friend diagnosed with severe knee OA. He's still running ultra-distance races, mountain races etc. He's pain free but he too has xray evidence of degenerative changes in joints.

People like us potentially have half our lives ahead of us. It would be crazy to give it up the things that make us feel alive with out evidence to show that it was harmful. Joints get nutrients through osmosis so running could be the reason we're thriving.

Doctors opinions vary. Some say go for it; Some say avoid; Some say it depends upon the individual. There is a lot of myth surrounding the topic. What does the actual research say? Not someone's guesswork but the actual research? I've tracked down some of the research, but as I say, I don't have access to all of it.

And obviously I'm not expecting you to answer that stickywicket!

stickywicket

ITLSusan wrote:

much of the available information is targeted at people that are unfit and perhaps in a bad way.

I would personally have put the emphasis the other way round ie 'in a bad way and perhaps unfit'.

Arthritis Care is a charity and charities are going through very hard times right now. It makes no sense for AC to spend hard-to-find cash on those who are fit and coping well though, if you were to become a member, and so get their regular magazine, you would find it has lots of info for the 'fitter arthritic'.

ITLSusan

Getting back to topic, this is the best research I came up with but it leaves us with a few problems:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535123/

"When considering running with a compromised hip joint, the clinician and the runner must work together to determine whether is it safe to continue the sport with or without modifications."

Who the hell has a clinician? Maybe the needy. But not those that are keeping fit and wanting to get back to full health. We have to pay for any health care we need and I've yet to find anyone with the knowledge and experience to offer valid input on this.

"Our current belief is that individuals who are classified as Tonnis I may still run, provided they do not present with the following static mechanical hip abnormalities: increased femoral anteversion, lateral and anterior femoral undercoverage, and/or increased femoral valgus."

Ummm....yes - but how would we know? Even 9 years ago when they still did xrays all I got was a report saying "degenerative changes in both hips". That's all that was on offer. Couldn't get any more than that. Nowadays I wouldn't get anything.

I'd love to hear other runners experiences.

helpline_team

Hi ITL Susan,

A recent news story in Inspire touched on this. http://www.inspirearthritiscare.org.uk/news/study-claims-no-link-between-running-and-osteoarthritis

But you might like to search at the following archive too http://www.arthritisresearchuk.org/news/general-news.aspx

Kind regards

Guy

Jen

I am unable to run because of another health condition. Even so I've continued gym and walking on a regular basis for over 12 years now. I know some people over 60 years do still run though. But I am thinking perhaps the percentage of the over 60s running, don't have OA in the knees.

I've found with the recent OA pain in the foot that overexercising just makes things worse and much more painful so I would never consider running on it even if I didn't have the other health condition that prevents me. Its just too painful to even walk never mind run.

If only we could all still run over the age of 60 without risk of causing injury. I should think its very much down to the individual self managing their symptoms and what works for them.

Mind you I have Osteoporosis as well as OA so whilst running would have been good before my bones started thinning it would not be suitable now, high impact and high risk of falling, not recommended for thinning bones.

Also I've known people who have run miles each day to have developed bone thinning and excessive wear and tear on the joints. There's no guarantees, whatever a person does. Wish it was a one treatment or exercise routine suits everyone and fixes the problems of all.

ITLSusan

Thank you for those links Guy - much appreciated.

I was aware of research claiming that running is found to protect people from OA. But what's less clear is the situation with regards to people that have been diagnosed already.

This research (from the link you provided - thanks - it's new to me ) concludes that high impact exercise MAY promote cartilage degeneration in early OA.

http://www.arthritisresearchuk.org/news/general-news/2013/april/high-impact-exercise-may-promote-cartilage-degeneration-in-early-arthritis.aspx

That article (2013) includes this quote from Arthritis Research UK:

"Exercise to keep the joints and muscles strong is important in those with or without osteoarthritis, but it's important not to overdo high-impact exercises as this can put a lot of stress on the weight-bearing joints," said a spokeswoman for Arthritis Research UK.

"Therefore swimming and cycling are both excellent forms of exercise for people with osteoarthritis."

Yet in THIS article (2014) a spokes person from Arthritis Research UK says:

"A spokeswoman for Arthritis Research UK commented: We’re very keen to get the positive message across that moderate, recreational running, with mileages of less than 40 to 50 miles a week, is unlikely to cause premature osteoarthritis."

"The benefits of this level of exercise on the bones and the heart will far outweigh any minor running-related problems. With higher intensity running with significant mileage, for example more than 100 miles a week, there is a higher risk of osteoarthritis of the leg joint."

http://www.sportsarthritisresearchuk.org/seoa/news/running-can-help-protect-people-against-knee-osteoarthritis.aspx

It's a real minefield as I think half the time this info is published more as a publicity stunt. It's certainly not 'evidence based' - they're making bold statements about things that are only hinted at by research.

The problem isn't helped by the fact that typically blanket guidelines are given for OA. Yet knee OA and hip OA are two very different beasts. Research into hip OA is rarely done. 'Evidence based' advice is handed out to hip OA sufferers on the basis of sketchy research into Knee OA.

11% of the elderly population have degeneration in hip joints yet only 5% have symptoms. 25% have degeneration in knee joints but only 13% symptoms. This means that 6% have non symptomatic hip OA and 12% have non symptomatic Knee OA. The study that found running to protect us from OA followed elderly runners. It stands to reason that a good number of them would have non-symptomatic OA in knees and hips. Yet the runners faired better than the non-runner control group. This *suggests* running is protective in people with xray evidence of OA but no symptoms.

Yet my experience tells me that much depends upon the precise nature of your condition. I had to be VERY particular about form, take things slowly - NOT because it harmed my hip but because if I ran with bad form (which is the only way I could run due to my muscle imbalances) I made my dysfunction worse by re-enforcing it. My ultra-distance runner friend swore by pushing through the advanced knee OA pain until after a year his body adapted and he could now run crazy mileage at competitive speeds with no pain.

Because I've written a lot about running with OA over the years lots of newly diagnosed runners contact me for info. I like to keep bang up to date on research, opinions etc. That new info you found is helpful.

daffy2

I suspect that for all sorts of reasons there is just insufficient data to make unequivocal statements one way or the other, since it's only relatively recently that such considerations have been seen as either relevant or important. If the general medical view is that OA is wear and tear and mostly affects old people the question of whether an individual could still 'safely' run 50 miles a week doesn't really get a look-in.
Even if there was clear evidence one way or the other it still comes down to the individual to make the decision, and that might well be in defiance of the medical argument (or, if one is cynical, the opinion prevailing at the time, since there is a considerable quantity of less than robust science out there)

ITLSusan

You'd be surprised at the number of elderly runners! In long distance running they stay competitive too! There are even one or two at 100 years old still doing marathons. A couple of years back I took part in the local cross country races. It's generally pretty good runners that enter that so I was always last....which I felt OK about. One time I was beaten by an 80 year old with dementia tho - that was harder to take. He kept forgetting what he was there for and his team mates had to keep guiding him back onto the course to keep running. I was pretty fit too! This has always been a very important topic to runners with a huge amount of annoyance towards doctors (typically unfit couch potatoes) and researchers trying to tell these fit old codgers that what they were doing was bad for them.

You're absolutely right though. There isn't enough research about anything to give recommendations either way. It's much better to make the research available so that people can form their own opinions. Every case is likely to be different. But also there are other factors. I was strongly advised not to run, do karate or weightlifting. Yet I figured - approaching menopause you're going to have the risk of osteoporosis, loss of muscle mass & muscle mass, loss of CV fitness - then there's the benefits of hormonal regulation, mood lifting and so on from running. So far it's proven to be a good choice. I'm in the best shape of my life at age 52.

I think it's a huge mistake for doctors to make recommendations. They scare people into making bad decisions. Much better that they just share available research findings without putting their own spin on it.

Jen

I think its generally recognised and known that for most all illnesses exercise helps. In fact is essential with all my main health issues and I think essential as we get older, however this doesn't mean we have to take up running even if we could. There are other forms of exercise also beneficial.

With OA flares from my personal experience, some exercise was put on hold for nearly four months. If I'd tried to run I'm pretty sure I would have injured myself because when there is pain even snails pace walking was difficult and balance not good. Normally I have excellent balance but that goes out of the window when you can't weight bare without excessive pain.

ITLSusan

I agree that running isn't right for everyone.

But for those that WANT to run and are ABLE to run it is one of the best forms of exercise that you can get. The health benefits are hugely significant. And there's no better way to hold onto good, balanced, joint protecting movement than to constantly re-enforce good gait patterns.

I was told not to run in 2006 - warned that I'd need a hip replacement in a few years if I did do it and would be in significant pain before that.

I didn't believe it and trained up for the Glasgow 10k and a few other races. Running was pain free and I did not too bad for a non-serious runner with a 54 minute 10k and 25 minute 5k.

It did no harm to my hip joint but my muscle imbalance was made worse. The body finds the most efficient way to move and with someone with dysfunction the most efficient way is often a highly dysfunctional way. A year into my diagnosis I could run, deadlift twice my bodyweight, handle tough martial arts training yet couldn't walk 100 yards to the post box without everything seizing up.

So I stopped doing those activities and tried the swimming and cycling route. That wasn't good for my hip so I ended up settling on hill walking. Yet without the intense training I went from fit athlete with a stiff hip to fat, middle aged cripple. I put on 20kg and looked and moved 40 years older. AND I had pain.

I realised that the problem was two fold:

- Running WAS good for my joints, health, well being etc. But it loaded up my dysfunction (muscle imbalance) and made it worse. I needed to stop re-enforcing the faulty movement patterns whilst I fixed them through physical therapy.

- When I stopped running (and other intense training) I lost fitness. It was that fitness that was keeping me pain free and active. Strength and fitness was shoring up the dysfunction and allowing me to achieve a lot physically. Without it the pain and disability took a firm hold and I soon got to the point where I was even unable to do the physical therapy without pain.

Getting back to running proved necessary for me. But being incredibly strict about running form. I couldn't chase after good race times. I couldn't run competitively. It had to be viewed as gait retraining.

Each case is different and needs careful consideration taking account of all available research data. We need data - not generic rules and guidelines. Generic approaches are unlikely to get good results with anyone.

daffy2

You'd be surprised at the number of elderly runners!

No I wouldn't, and that wasn't what I was saying.

I think it's a huge mistake for doctors to make recommendations. They scare people into making bad decisions. Much better that they just share available research findings without putting their own spin on it.

Many, possibly the majority, of patients, will be expecting the medics to make recommendations, on the basis that they have the necessary training and information to make those recommendations, and the patients do not. It's the same reasoning that makes people employ accountants, solicitors etc. Whether it produces the 'right' outcome is a whole other argument, and will depend on the individual and the professional involved. The available research findings may not be any more reliable or relevant than the knowledge of the medic one is consulting - there is a great deal of plain bad science out there.
Apologies if this sounds rather abrupt, I'm not trying to be hostile or negative.

ITLSusan

daffy2 wrote:

Many, possibly the majority, of patients, will be expecting the medics to make recommendations, on the basis that they have the necessary training and information to make those recommendations, and the patients do not. It's the same reasoning that makes people employ accountants, solicitors etc. Whether it produces the 'right' outcome is a whole other argument, and will depend on the individual and the professional involved. The available research findings may not be any more reliable or relevant than the knowledge of the medic one is consulting - there is a great deal of plain bad science out there.
Apologies if this sounds rather abrupt, I'm not trying to be hostile or negative.

It doesn't sound abrupt in the least. And you make excellent points that, for the most part I agree with.

Except....

I have GP friends. They are NOT in a position to give good advise. They admit that freely. Most of what they know in relation to this kind of thing will come down to whether they have personal interest and how much Googling they do.

They really don't have the expertise. They know far less than the type of person that's spent their life involved in sport for example. They're trained to diagnose some things, refer out to others. Detailed knowledge of matter surrounding OA just isn't part of their training. This is why some people get GP advice to avoid running, some are told to just get on with it - that it'll do good.

The trouble is, when we get advise from a GP we assume it's reliable and backed by solid evidence. Yet in matters like this it's really not (as you are well aware!). The reason doctors shouldn't be giving advice over these matters is simply because it does carry more weight than it deserves.

Now we get some statements made by places like Arthritis Research UK. They too are in a position of trust and claim only to provide evidence based info. Yet we both know there isn't the info to make such bold claims either way.

The very best we can do is take the raw data, weigh it up in conjunction with our personal preferences, case history etc and make a personal decision. We need more data and less cookie cutter advice!