John Seivert: Myth buster: Does a diagnosis of osteoarthritis mean I have to quit running?
I dedicate my monthly Health & Wellness Column to providing evidence-based information to inform and empower you in the community to be the healthiest version of yourself. I have written about many local events and activities. I have discussed how many musculoskeletal diagnoses can be managed with self-treatment ideas. My favorite topic is to dispel many medically based treatments and their belief systems with no scientific evidence. For example, I dispelled the notion that repeated bending and lifting with a flexed back will not cause low back pain but create a stronger back. I also touched on that rowers have solid backs and do not have back issues later in life. And I have also been able to demonstrate that sitting with poor posture/slouched sitting does not cause back pain, even if done for hours at a time. The research does not support sitting erect to correct or alleviate back pain. The strongest indicator of adolescents and young adults with back pain was emotional well being and overall fitness. So, if you see your kid sitting on their phone in a slouched posture for hours on end and they are happy and playing sports regularly – your kid’s going to be just fine.
Running does not cause osteoarthritis (OA) in the hips and knees. Well, unless you are someone like me who ignored the warning signs. I have significant OA in my knees and was forced to stop running in 2005. I redirected my hobbies of competing in triathlons and road racing to racing anything on a bike. Let me back up here a bit and explain why some people may get OA and others will not.
How do we get Osteoarthritis (OA)?
Poor biomechanics of the lower limbs and pelvis
If a runner has poor biomechanics in their running gait, they may be susceptible to abnormal wear and tear on specific knee structures. The articular cartilage is a structure that can take a great deal of load for long periods. Intermittent loading of the joints is what keeps our joints healthy and strong. Intermittent loading is what patients with Osteopenia or Osteoporosis need the most to maintain healthy bones and prevent fractures (More on osteoporosis next month). However, too much load at any one time or for prolonged periods can lead to damage. I had overactive lateral (outside) quad muscles and a poorly tracking patella (kneecap) in the femoral groove. Over dozens of marathons, Ironman’s, and one Western States 100-mile race, I slowly and methodically created damage to the articular cartilage, and as a result, running is painful. I am now a cyclist. Had I looked into my crystal ball in the early 1980s, I would have decided to stick to short running races, 5Ks and 10Ks, and spent more time cycling.
Traumatic Osteoarthritis (OA)
Traumatic OA is the most common and easiest to understand. We have all heard “Uncle Eddie” make some big excuse for not participating in the family annual picnic relay races due to that old football injury in high school. Uncle Eddie might have a point that that first of three insults to his knee did cause some joint damage. However, getting the proper PT early on in these cases could have given him a bit more function than he has now. Repeated joint strains, compressions and twists can lead to traumatic arthritis. Lindsey Vonn, the retired USA downhill snow skier, had six major surgeries to her knee with several ACL reconstructions. She will likely have a bit of discomfort and stiffness in her knees as a senior. I’m sure she will participate in the family relay races each summer without a glitch.
Genetic or hereditary link is real
Sometimes the warning signs (pain, stiffness and loss of joint motion) don’t show up for many years but recognizing these early factors is a key to staying healthy. Osteoarthritis can have a genetic link. It is not to say that if “Dad had bad knees, so you will have bad knees.” However, it should alert us that maybe since you look like your dad in many ways, you might pay attention to exercising with diversity to protect those knees. It is OK to run but make sure you cycle, lift weights, practice Pilates, Yoga, or some other form of lower quarter exercise program that involves a balance of strength, flexibility and mobility.
Last summer, I had a very active 45-year-old woman come into the clinic with groin region pain. She stated she strained her groin while running trails. After my exam, I told her that she had all the signs and symptoms of early-stage hip OA and that I would help her return to running with some modifications. She was in disbelief and rather upset with me because I told her she might have hip OA, and she had X-rays stating it was “normal.” I proceeded to show her that she had a marked loss of motion in the hip joint, especially internal rotation, flexion and adduction. She had difficulty crossing her legs, clipping her toenails, and tying her shoes (classic findings of hip OA). She also had weakness in the hip abductor muscles that keep us walking without a limp and very tight hip flexor. It wasn’t until I asked about her family’s musculoskeletal history that she figured it all out. She paused and said, “Oh my goodness, my mom had a right total hip replacement, and her pain started in her early forties.” We proceeded to treat the acute pain, addressed her hobbies, sports, and managed her condition well on her own. In her case, the normal imaging findings did not help come up with an accurate musculoskeletal assessment. The value of a thorough musculoskeletal examination allowed us to find the subtle changes seen in her hip joint and the surrounding structures to address these early signs of hip OA. She now knows her body and the function she needs to maintain to continue to do all the things she wants to do athletically with an intelligent exercise program.
The take-home message about any genetic/hereditary link to an arthritic joint should shed light on making good choices in exercising instead of a reason you have pain and can’t exercise. The detailed patient interview helps all parties see the whole picture with the various factors.
We all have body parts that hurt — a sore or stiff shoulder, neck, back or knee, to name a few. Our community is full of very active seniors, and it is our job as Doctor of Physical Therapy (DPT) to help you manage these issues. If you can’t exercise, you may not be getting the proper aerobic exercise and movement your body needs to function optimally. If you have a problem, see your doctor for a referral to your physical therapist. Your DPT will perform a detailed musculoskeletal examination and then provide a treatment plan complete with a specific set of exercises to address your problem. Seeing a DPT may be the best decision you have made all year.
John Seivert is a doctor of physical therapy and he has been practicing for 34 years. He opened Body Logic Physical Therapy in Grass Valley in 2001. He has been educating physical therapists since 1986. Contact him at bodylogic2011@ yahoo.com
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