Osteoarthritis of the knee does not always end a long running career.
Many runners believe that osteoarthritis is a terminal diagnosis and their running days are numbered.
Osteoarthritis is one of the most prevalent issues that affects our knees. Osteoarthritis means that the cartilage in your knee is becoming thinner. As the cartilage thins, the cushioning in your knee is dissapearing.
We know that osteoarthritis is not caused by running. As a matter of fact, runners develop arthritis less commonly than their non-running counterparts.
The most common cause of arthritis is because of your genetics or DNA. The second most common cause is arthritis following trauma to the knee. We call that post-traumatic arthritis and it can occur years following an injury.
Runners do not want to stop running. For runners who find out they have early or moderate arthritis, it usually does not mean your running days are over.
There are many misconceptions about osteoarthritis, particularly in runners. First off osteoarthritis can be over-diagnosed … it’s not always the source of your pain. It’s easy to look at the X-ray of a runner and say you have arthritis. But, frequently there is another source of knee pain present that is treatable and should not end your running career. Another danger is simply that people tend to label themselves. They do not understand osteoarthritis well and why their knee is hurting them. Many runners believe that osteoarthritis is a terminal diagnosis and their running days are numbered.
There are often other causes of knee pain in runners that are the source of pain, despite the fact that your x-rays show that arthritis is starting to develop.
Knee pain is due to inflammation. It is incumbent upon us to find out why there is inflammation in your knee. It’s not always due to the arthritis. I’ve seen patients with horrible looking X-rays yet they have little pain and no swelling. Yet, I’ve seen people with mild arthritis who have severe inflammation. As I’ve said over and over, you treat the patient and not the X-rays.
In many runners, once the knee pain and knee swelling starts and the running stops running— a vicious cycle follows. You stop running, your muscles weaken further and your symptoms will return immediately if you try to return after a period of rest.
There are many issues at play when trying to address knee pain or inflammation in runners. One of the keys to improving knee pain in runners is to change the load or stress across the knee. That could mean a change in your schedule. It could mean a shoe change. It could also be that you need a change in your running form. For example, a heel striker will feel better if you can get them to cushion their landing better by landing on your toes or mid-foot. Running re-education is possible. Working with a running coach or experienced PT to alter your running style to one which is less stressful on your knees could have a significant impact on your ability to return to the trails.
Once diagnosed with osteoarthritis, the majority of us should be taking Glucosamine and Chondroitin Sulfate. It has an exceptionally low risk profile and has benefited many.
Once a runner rests due to pain, weakness sets in. It happens a lot faster than you think. That can worsen the pain you are experiencing upon an attempted return to running. Strengthening your legs, hips, pelvis and core is of paramount importance. Weakness around the hip and pelvis will lead to knee pain, even in those of you without osteoarthritis. Improving your core strength, and hip strength will usually significantly improve your chance of running pain free.
A strong butt is key to a happy life as a runner
If arthritic pain is affecting your ability to run and you’re still trying to finish a 5k under 25 minutes then you may simply need to come to grips with the fact that you need to adopt a lower pace, more style aerobic run. If you’ve run a mile, you’ve run a mile. It really shouldn’t matter what the pace is. Your cadence or how many steps you take each minute is important. Shorter strides, with a higher cadence (170-180) combined with a load sharing mid-foot strike could improve your ability to remain an active runner despite the degenerative changes in your knee.
Show your body some variation, and respect its need to recover.
Rest… or recovery is also critically important for the runner with knee osteoarthritis. An 8 mile run day should be followed by a cross-training day, a day in the pool, or a strengthening day in the gym. Long or hard runs take their toll on our joints, muscles as well as our cardiac physiology. Show your body some variation, and respect its need to recover. Another very important variable which affects your recovery is how stressful your day was in general — this includes how well you slept, your overall stress level and your diet. Diets high in sugar leads to an increase in systemic inflammation. A large daily stress load, and poor sleeping leads to increase in your cortisol level, a stress hormone, which throws off your insulin levels and blood glucose levels. Again, this leads to a poor recovery and an increase in systemic inflammation.
I have found apps like HRV4Training very useful in this regard. It enables you to keep up with your physiology and it can help you quantify your ability to handle physical and emotional stress and determine if your recovery period is complete or not.
Osteoarthritis isn’t always a terminal diagnosis for runners. Eventually the arthritis and inflammation might be too much for your knee to handle and it will finally come to the point where you need to consider another aerobic activity such as cycling or swimming. Until that day arrives, respect your recovery, work hard at your strengthening, adjust your running style, cadence and speed and you should be running for many more years to come.
Disclaimer: this information is for your education and should not be considered medical advice regarding diagnosis or treatment recommendations. Some links on this page may be affiliate links. Read the full disclaimer.