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Running with Knee Osteoarthritis-Part 3

by | Apr 28, 2019 | Health Tips

By Lillian Wynn PT, DPT
Physical Therapist

Background

40% of American adults (110 million people) report walking or running as part of a regular exercise routine.  Reports and ‘common knowledge’ about running and its impact on our joints are often conflicting. This is the third of three blog posts designed to look at current medical research regarding running on aging joints.

Article summary

PARTICIPANTS:

This paper is a systematic review and meta-analysis, so the authors compiled research on knee osteoarthritis (OA) and running, and summarized the findings in order to provide a concise recommendation based on the general consensus of research. Articles were included if they: were level I-III evidence, written in English, used physician diagnosed OA with clinical and/or radiographic findings, and running was compared to non-running. Articles that compared running to other forms of exercises were not included in this study.

METHODS:

Literature searches were performed, and 1,907 articles were reviewed. Of those, 25 met their inclusion criteria. Statistical analysis was performed on those 25 studies to come to a meta-analysis, which summarizes and confirms the general recommendations based on significant research.

CONCLUSIONS:

The authors concluded that recreational running was in fact associated with lower levels of OA when compared to sedentary individuals. Competitive running was associated with higher levels of OA than recreational runners. Overall, sedentary subject demonstrated the most symptomatic OA. The study also argues that this simply compares runners to non-runners. So the only conclusion that can be drawn is that running is better than being sedentary. More research should be done into seeing if running vs other forms of exercise is the best for of exercise.

 PTF approach

Here at PTF, we want to keep you active in the activities that matter to you. If walking and running are important to you, and you feel limited by your knees, an evaluation could be useful. There are many factors besides osteoarthritis that could be contributing to your knee pain while running. PTF does a complete evaluation and then designs a treatment plan individual to you and your body to keep you moving.

Original Article

Alentorn-Geli, E., Samuelsson, K., Musahl, V., Green, C., Bhandari, M., Karlsson, J. (2017). The Association of Recreational and Competitive Running with Hip and Knee Osteoarthritis: Systematic Review and Meta-analysis. J Orthop Sports Phys Ther, 47(6), 373-390. doi:10.2519/jospt.2017.7137

Running with Knee Osteoarthritis-Part 2

by | Feb 13, 2019 | Health Tips

By Lillian Wynn PT, DPT
Physical Therapist

Background

40% of American adults (110 million people) report walking or running as part of a regular exercise routine. Reports and ‘common knowledge’ about running and its impact on our joints are often conflicting. This is the second of three blog posts designed to look at current medical research regarding running on aging joints.

Article summary:

PARTICIPANTS:

Men and women 45-79 years old, were grouped into 3 groups.
1: No symptoms of knee osteoarthritis, and deemed low risk for developing knee osteoarthritis
2: No symptoms of knee osteoarthritis, and deemed high risk
3: Symptoms of knee osteoarthritis

METHODS

Patients were labeled as high volume runners, low volume runners, or non-runners. X-rays and pain questionnaires were provided at the start of the study, again at a 2 year follow up. Pain questionnaires were provided at the final 8 year follow up

RESULTS

Any history of running-low or high volume was associated with lower knee pain. There was slightly lower evidence of knee osteoarthritis on the x-rays of runners, but it was not statistically significant. Statistically the highest predictor of knee pain was BMI.

CONCLUSIONS

Other factors besides running seem to have more of an impact on symptomatic knee osteoarthritis. It is possible that wince runners tend to be more active and have lower BMI, that any potential damage is offset by the benefits of regular exercise.

PTF approach

Here at PTF, we want to keep you active in the activities that matter to you. If walking and running are important to you, and you feel limited by your knees, an evaluation could be useful. There are many factors besides osteoarthritis that could be contributing to your knee pain while running. PTF does a complete evaluation and then designs a treatment plan individual to you and your body to keep you moving.

Original Article

Lo, G., Driban, J., Kriska, A. McAlindon, T., Souza, R., Petersen, N., Storti, K., Eaton, C., Hochberg, M., Jackson, R., Kwoh, K., Nevitt, M., Suarez-Almazaor, M. (2017). History of Running is Not Associated with Higher Risk of Symptomatic Knee Osteoarthritis: A Cross-Sectional Study form the Osteoarthritis Initiative. Arthritis care res, 69(2), 183-191. doi:10.1002/acr.22939.

Running with Knee Osteoarthritis-Part 1

by | Jan 29, 2019 | Health Tips

By Lillian Wynn PT, DPT
Physical Therapist

Background

40% of American adults (110 million people) report walking or running as part of a regular exercise routine.  Reports and ‘common knowledge’ about running and its impact on our joints are often conflicting. This is the first of three blog posts designed to look at current medical research regarding running on aging joints.

Article summary

Often of most concern with running is whether the impact is harmful to the knee joint, as the thought is impact could cause and/or worsen osteoarthritis. Osteoarthritis is the term given to changes that occur along a joints surface as we age. The most common way to diagnose osteoarthritis is with an x-ray. A prospective study published in The American Journal for Preventative Medicine investigated whether running as we age increases the severity or frequency of knee arthritis.

PARTICIPANTS

45 long distance runners who were 50 years old or older, and had been running for at least 10 years; and 53 controls who were 50 years or older and did not run for exercise.

METHODS

Initial x-rays were taken of both knees of all participants. Over the next 18 years, 5 follow up x-rays were taken of each patient. These x-rays were graded on a standard scale to quantify the severity of knee arthritis.

RESULTS

Runners did not show higher rates or more severe cases of knee osteoarthritis than non-runners

CONCLUSIONS

Models found that higher BMI, higher initial damage on x-ray, and age to be most strongly correlated with arthritis on x-ray. There was no data to suggest that running, gender, previous knee injury, or total exercise time contributed to osteoarthritis of the knee. In short-go out and go for your run!

 PTF approach

Here at PTF, we want to keep you active in the activities that matter to you. If walking and running are important to you, and you feel limited by your knees, an evaluation could be useful. Often tight and/or weak muscles, stiff joints, and poor movement patterns can contribute to pain while running. PTF does a complete evaluation and then designs a treatment plan individual to you and your body to keep you moving.

Original Article

Chakravarty, E., Hubert, H., Lingala, V., Zatarain, E., Fries, J. (2008). Long Distance Running and Knee Osteoarthritis A Prospective Study. American Journal of Preventative Medicine, 35(2), 133-138. doi:10.1016/j.amepre.2008.03.032.

What effect does hip strengthening have on running and single-leg squatting mechanics?

by | Dec 30, 2018 | Health Tips

by Leah Flamm, PT, DPT

Looking at a study by Richard W. Willy, PT, PhD, OCS, and Irene S. Davis, PT, PhD, FAPTA

Background

Abnormal hip and knee mechanics may be related to a number of running-related injuries, from stress fractures, to IT band syndrome, to patellofemoral pain syndrome (PFPS). PFPS has been linked to abnormal knee movements like excessive hip adduction, hip internal rotation, contralateral pelvic drop (when the opposite side of the pelvis drops), and knee external rotation during running, single-leg squats, single-leg jump landing, and step-downs. Studies suggest that women with PFPS may have weak hip muscles, and though hip strengthening programs have been shown to improve strength, it is not clear whether hip strengthening programs improve abnormal hip and knee mechanics while running and squatting. Though studies have looked at hip strengthening in healthy active females with normal mechanics, only two have looked at that of individuals with abnormal mechanics.

This study by Drs. Willy and Davis aimed to examine the effect of a hip-strengthening program that included movement training for the single-leg squat on hip and knee mechanics during running and squatting in females who exhibited abnormal mechanics during running.

Hypothesis

The researchers hypothesized that peak hip adduction, hip internal rotation, contralateral pelvic drop, and knee external rotation would be reduced during single-leg squats due to the specific neuromuscular reeducation of that activity.

Methods

The researchers included female runners ages 18 – 35, who were running at least 10 km per week, and were required to not do any lower extremity resistance training for at least 90 days before the study. They were assigned to either the control group or the treatment group and were not told which group they had been assigned to. The researchers measured peak hip adduction (HADD) during running and squatting because excessive hip adduction is related to lower extremity injuries in runners. The researchers measured baseline hip abduction and external rotation strength at baseline and after a strengthening program or after the control group.

Physical therapists supervised the exercise progression and ensured participants were activating the hip abductors and hip external rotators. Exercises included side-lying hip extension and external rotation, squats with resistance band targeting hip external rotators, hip hikes against the wall, side-stepping with a resistance band to target hip abductors, and then single leg squats with resistance bands targeting hip abductors.

Results

Results show that the treatment group showed significantly improved hip abduction and external rotation strength, and the control group did not. Though the running data did not show any difference in peak hip adduction between groups or between pre- and post-training, single-leg squat data did show significant improvement in peak hip adduction, hip internal rotation, and contralateral (opposite side) pelvic drop.

Discussion and conclusion

The researchers found that their hip abductor/external rotator strength training program was effective at changing hip mechanics during a single-leg squat. However, no changes in running mechanics were noted, which suggests that strengthening the hip muscles alone may not be enough to change movement patterns while running.

Why go to a physical therapist?

A physical therapist (PT) can examine and evaluate an individual’s mechanics while running, squatting, or performing any physical activity. Then the PT can determine what weaknesses and movement patterns may be present. Physical therapists can provide exercises to strengthen and stretch weak and tight muscles, but they can also work on retraining movement patterns that may be associated with injuries. Pure strengthening may not be enough to change the mechanics that may be underlying some injuries in athletes or anyone. For that reason, we may also focus on neuromuscular reeducation to change movement patterns so that we can address the root cause of the problem.

Original article

Willy, R. W., & Davis, I. S. (2011). The Effect of a Hip-Strengthening Program on Mechanics During Running and During a Single-Leg Squat. Journal of Orthopaedic & Sports Physical Therapy,41(9), 625-632. doi:10.2519/jospt.2011.3470