Running (e.g. track and field, marathons, trail running) had become increasingly popular in the recent years. This can be easily demonstrated by the increasing number of participants in major running events in Malaysia (e.g. Standard Chartered Kuala Lumpur Marathon, Penang Bridge Marathon, Putrajaya Night Run to name a few).
Despite its growing trend among Malaysians, many still contemplate the risk of ruining their knees and hips when they start running. Being an avid runner myself, I, Dr Joseph, have always been asked by my practice members, “Aren’t you going to destroy your knees with all that running?” Hence, I thought it would be good to share some thoughts to address these concerns in this month’s post by covering two key areas.
Are runners at greater risk of developing hip and/or knee osteoarthritis than non-runners?
The general perception among the public and medical profession is that running increases your risk of osteoarthritis and that you should stop running once you have been diagnosed with osteoarthritis. This joint disease is commonly viewed as a death sentence to a runner’s career. But is it?
The focus of this post would be on knees and hips osteoarthritis. This is because these are the two most common joints where osteoarthritis often targets, making it the most common form of arthritis and joint disease worldwide. It is considered by many as a “wear and tear” degenerative process that develops slowly as we age; similar to a car after a certain mileage.
The assumption that running increases the risk of osteoarthritis was based on the premise that repetitive joint motion and impact results in thinning and damage to joint cartilage. Earlier studies involving a small number of runners and some animal studies have previously supported this assumption. However, since the 1980’s, newer studies with better design and a larger sample of runners did not demonstrate any association between running and osteoarthritis! In addition, research has shown that runners have fewer long term physical disabilities than non-runners, and on average sought less medical care and weigh less than non-runners.
Recent authors and studies have also concluded that recreational and moderate running actually protects us from developing this painful joint disease. This is because running at a moderate pace for about 30 minutes actually reduces the presence of harmful inflammatory proteins in the knee’s synovial fluid (the joint’s lubricating fluid), further supporting the study that running doesn’t cause osteoarthritis. Unfortunately, these studies did not highlight individuals who are involved in very high mileage running (over 60 miles / >90km per week) or elite runners.
Since running is not a risk-factor for osteoarthritis as highlighted above, then what is? Majority of the documented risk factors for osteoarthritis are unrelated to running. Ageing, however, is a definite risk factor for osteoarthritis. As shared earlier, “wear and tear” happens in every individual as they age. I do regularly advise my practice members that they themselves have complete control over how much wear and tear takes place in their bodies. Wear and tear in the body can be managed through regular exercise, healthy balanced diet and making the right lifestyle choices. Besides ageing, an unhealthy body weight (high BMI) and a history of any joint injury (eg: fractures, labral tears, meniscus tears, ACL or PCL tears) are greater predictors of osteoarthritis than one’s running background.
How Do We Keep Running with Osteoarthritis?
Now that we know that running alone does not lead to osteoarthritis, the next step is to understand how to increase the mileage of your knees and hips without causing further progression of your pre-existing osteoarthritis (if any).
Tip 1: Take it slowly, and listen to your body
Like with any new fitness program, it is vital to start slowly. It is highly recommended that you work closely with your doctor/physical therapist to better understand your body’s threshold and limitations. Use pain as a signal to back off when you are pushing too hard or if you’re doing certain exercises incorrectly. Knowing the right running posture could also help with reducing any possible injuries. Be patient, it is in our best interest to get you running without pain in the knees, but we can only slowly build up distance as your pain reduces.
Tip 2: Pay attention to footwear and choose forgiving surfaces
One of the most important components in managing osteoarthritis pain while trying to run is footwear. It is essentially the only thing that is in constant contact between your feet and the ground. You could always get your doctor of chiropractic/rehab specialist/podiatrist to advise on the right choice of footwear that is suitable for your feet. Try your best to limit the amount of time wearing footwear that has very little cushioning (eg; flip flops, loafers, flats etc). Good footwear will reduce your total daily load on your knees and hips. You could also check with us to see if the addition of in-sole orthotics might be right for you.
As for running surfaces, different surfaces are better to run on than others. Runner’s World placed the following surfaces in order from best to worst: grass, wood chips, dirt, synthetic track, treadmill, asphalt (road), sand and the worst surface to run on, concrete. If you find running on any type of surface is too demanding on your knees, another excellent option is to try deep water running (while wearing a floatation device) or running in chest deep water. This removes tremendous amount of load from your knees and hips, while acting as a form of resistance training for your leg muscles. So, if you have access to the use of a swimming pool, start making full use of it! This will give you a workout similar to running but without the stress.
Tip 3: Eat more fats (the good kind) and anti-inflammatory foods
Proper diet and nutrition not only help us in weight loss management, but it also is one of the best ways to calm any osteoarthritis inflammation. Consume the good kind of fats, for example omega-3 fatty acids that are commonly found in fish (like salmon, tuna, sardines, anchovies, herring and etc). Try consuming foods like olive oil, walnuts, pine nuts, pistachios and almonds as they make great substitutes for those who can’t take fish.
Besides that, nature has blessed us with many fantastic anti-inflammatory foods that will not only alleviate your pain, but will help improve your overall health. These include (but not limited to):
- Tart cherry
- Bok Choy
- Chia seeds
- Flax seeds
You can also seek further advice from your doctor or nutritionist to see how you can include more of these anti-inflammatory foods into your daily diet.
Tip 4: An Effective Strengthening/Stretching Exercise Program
According to the Journal of Sports Medicine, a careful rehabilitation program can enable individuals with mild to moderate knee osteoarthritis to continue running without any harmful effects. As a result, speak to your doctor of chiropractic and/or rehab specialist to develop a rehab program which specifically focus on legs and core strengthening exercises coupled with some stretching. With this personalised guided program, it would prevent and slow the damage to your joints as you continue engaging in your running events. Remember, don’t try to do this without expert guidance!
Dr Joseph Cheah is an avid runner practicing what he preaches, clocking up to an average of about 30-40 kms per week on his days off and taking part in many notable running events throughout Malaysia. He recently completed a brutal 55km Cameron Highlands ultra trail marathon, taking him nearly 12 hours to complete the entire race. This ultra marathon was his first, but we’re sure it won’t be his last!