Newsletter: February 2003

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WILL RUNNING CAUSE ARTHRITIS?

What is arthritis?

According to the Arthritis Foundations Primer on Rheumatic Diseases, there are 100 + classifications of arthritis and/or rheumatic diseases. The most common of these is known as osteoarthritis. Osteoarthritis is caused by degeneration of the articular surfaces which cover the ends of bones in any given joint. As the disease progresses, the joint surfaces become roughened which causes tiny cracks (fissures). When the surfaces of the bones lose the protection of the articular cartilage, the body responds by producing (overproducing) bone to compensate for the weakness. The body produces little projections or spurs of bone known as osteophytes which may extend into the joint space.

The major assumption is that the constant pounding of the joints in running are too much for the body and its weight bearing joints to handle. From my review of the literature, I have located two qualified, independent authors who deal with this most intriguing question.

According to Ross Hauser, M.D.. and Marion Hauser M.S., R.D. :

"The notion that sports and recreational activities cause an inevitable wear on the joints just does not hold up when the scientific studies are evaluated. Few competitive, or recreational long distance runners suffer severe joint injuries and many regular runners can recall how long and how often they have run. Therefore, retrospective studies of these people provide some of the best opportunities to examine the relationship between exercise and osteoarthritis.

In one investigation, 41 long distance runners were compared with 41 matched controls. Runners with a mean age of 60, who had run an average of 180 minutes per week for 12 years ,did not have a greater prevalence of osteoarthritis although they did have a 40% greater density of their vertebral bones. Another investigation compared 17 people with a mean age of 56 who had run an average of 28 miles per week for 12 years with 18 non runners. Runners had no more complaints of pain and swelling of the hips, knees, ankles and feet than non runners. An X-ray examination of the joints did not show any differences."

"Inactivity was once thought to prevent arthritis and protect fragile arthritic joints from further damage. More recent research has demonstrated the opposite. In the absence of use, the joints lose flexibility, without stress the matrix of the articular cartilage is gradually modified and weakened. Furthermore, numerous studies have clearly demonstrated that moderate exercise improves the symptoms of arthritis without causing further damage.

Joints are in fact strengthened and modified by exercise. These adaptations explain the utility of physical activity in the treatment of arthritis, and the ability of joints to endure years of running without permanent damage. Ligaments and muscles, which support joints, are strengthened and reinforced. "

Dr. Ebert's excellent article can be viewed at: http:/www.runningtimes.com/issues01nov/osteoarthritis.htm.

It is not uncommon for athletes to injure joints. It is this injury, or the non healing of it, that causes the degenerative process to start in the joints. People who participate in sports that subject weight bearing joints to more intense impact and torsional loading than moderate long distance running may have an increased incidence of osteoarthritis.

The SPORTS WITH the highest level of impact torsional loading that have the highest rate of injury are: baseball, softball, basketball/volleyball, football, handball/racquetball, competitive running, squash, lacrosse, soccer, rugby, singles tennis, water skiing and karate. PARTICIPANTS IN SPORTS WITH A HIGH DEGREE OF TORSIONAL LOADING AND LEVELS OF IMPACT MUST BE EXTREMELY CAREFUL THAT ALL OF THEIR SPORTS RELATED INJURIES HEAL COMPLETELY OTHERWISE DEGENERATIVE JOINT DISEASE( OSTEOARTHRITIS) IS LIKELY TO OCCUR. (Source: Hauser and Hauser)

I have treated people like Uncle Fred over the years and they all have one big regret: " I wish I would have treated myself better and let my body heal."

In other words, continuing to train and "run through the pain" while injured is a great way to increase your chances of getting osteoarthritis.

It is surprising, to most runners, that the leading cause of knee pain is a condition called patellofemoral pain syndrome (PFPS) and not arthritis. PFPS is essentially a malalignment of the knee caused by abnormal tracking of the patella (knee cap) For an outstanding review of chronic knee pain in the runner, I would recommend reading " Chronic knee pain in the Runner" by Dr. Jeffery Ross D.P.M.,F.A.C.F.A.S. from Baylor University.

http://www.merlinofitness.com/articles.rehab.kneepain.htm.

The basic premise is, that to diagnose the underlying cause of a knee problem the health professional must consider many factors: The relationship of the pelvis to the knee and then the lower extremity to the foot (referred to as Q angle) is an important biomechanical consideration. As a chiropractor, I find that in many cases the proper balance and motion of the whole pelvis region, particularly the sacrolilac joints, is virtually ignored.

The most impressive and comprehensive research to date comes from the Stanford Arthritis Centre in the USA. The following information comes from Owen Andersons contribution to the Peak Performance library. (A very large, FREE training resource for athletes on the Internet.) The benchmark Stanford study was published under the titles:

'Aging, Long-distance Running, and the Development of Musculoskeletal Disability', The American Journal of Medicine, vol. 82, pp. 772- 780, 1987; 'Running and the Development of Disability with Age', Annals of Internal Medicine, vol. 121, pp. 502-509, 1994. It can be viewed at:

http://www.pponline.co.uk/encyc/0223.htm

The most comprehensive study concerning running and disability was begun in 1984 at the Stanford Arthritis Center in the US. Initially, 863 people (632 males and 231 females) ranging in age from 50 to 72, took part in the research. 498 individuals were long-distance runners, while 365 subjects did not run at all. The runners averaged about 210 minutes (27 miles) of running per week; had been running for an average of 12 years; and weighed considerably less than their sedentary counterparts (147 versus 161 pounds). Some of the runners had logged as many as 17,000 total miles during the 12 years leading up to the study.

Over an initial five-year period, the benchmark Stanford study found that runners did NOT experience higher rates of arthritis, compared to 'average' individuals in the overall population. In fact, runners actually had a lower risk of disability in their muscular and skeletal systems, despite all of the aches and pains which are usually associated with a regular running program. Runners made fewer visits to the doctor, spent about 33 per cent less time in the hospital, missed half as many work days, and - as expected - had lower blood pressures and resting heart rates, compared to non-runners. In addition, runners gave themselves higher perceived health ratings. To put it simply, runners FELT healthier than non-runners, and in fact they were.

What about the notion that knees and legs are damaged by the miles and miles of hard pounding associated with running? Well, disabling problems in the legs were actually five times as likely to occur in sedentary individuals, compared to runners. Running was also linked with fitter upper bodies. Disabling conditions in the arms and shoulders were 20 times as likely to develop in non-runners !

Please note that this study did have its share of detractors and criticism and I invite the reader to peruse the entire article at: http://www.pponline.co.uk/encyc/0223.htm

Some of the criticism of the research protocol and scientific design is fair and legitimate. However, it is my (un)biased opinion that the Stanford study is a relatively sound piece of research which should be able to be reproduced even when some of the biases of the study are eliminated. See for yourself.

The bottom line?

At present, it seems relatively certain that running and other forms of exercise are linked with positive health outcomes, including the well-being of the muscles, connective tissues, and joints.

At the risk of being politically incorrect, I cannot resist the urge to voice my opinion about the direction our health, and our health care, is going in Canada.

The recent Romanow report is asking the federal government to inject 15 billion dollars into our ailing health care system. There is mention of preventative strategies to help Canadians become healthier while saving our tax dollars at the same time. A national vaccination program and education to help Canadians quit smoking are two excellent ideas.

However, I feel that Mr. Romanow is still placing far too much emphasis on costly technology and expensive prescription drugs while virtually ignoring the proven benefits of exercise and the tremendously cost effective approach of chiropractic care. Yes, we do need more C.T. scans and MRI units and necessary prescription medications. However, it is my opinion that if we spent 10% of our health care budget on prevention strategies, we would save hundreds of millions of dollars every year.

What can we do as Runners to run healthy and prevent injury?

1. Choose a shoe with good stability and proper motion control.
2. Change shoes at least every 500 miles or 6 months.
3. Keep weekly mileage increases to 10% or less.
4. Cross train to keep in shape and give overused muscles and knees a rest. (Swimming, cycling, and skiing are excellent choices.)
5. Don't ignore pain. Seek help from a qualified health professional. (Preferably a health professional who is serious about exercise himself.)
6. Take time off between running days. When we run every day, we do not allow the body to rest and heal.
7. Make your rehab and preventative exercises fun. (I personally use a wobble board for retraining my weakened ankles.)
8. Try some yoga exercises. The Sun Salutation is a great warm up and cool down for long distance runners.

Conclusion:

From my personal participation in sports and through my work with injured athletes, it is my opinion that there is very little scientific evidence to suggest there is a correlation between long distance running and osteoarthritis. In my article of February, 1998, I quoted Dr. Lyle Michelli of the department of Orthopedics at the Harvard Medical School in Boston. He stated that "there is no association to moderate long distance running and the future development of osteoarthritis."

Furthermore, the Stanford study concludes that running and other forms of exercise are generally associated with positive health outcomes, less usage of medications and less money spent on health care.

Let's set an example for our community by keeping healthy through exercise.

Happy Running.

Larry Smith, D.C., B.P.E.

Dr. Larry is supporting the ORCA running club. With his involvement, he is offering to give initial spinal examinations to all members for $20.00 (regularly $45.00) and he will then donate that $20.00 back to the running club.

This offer is good until February 15, 2003.

Please call for an appointment and tell Nancy that you are a member of the Oceanside Running Club Association.

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Contact the office:
Dr. Larry Smith D.C., B.P.E.
Chiropractor

P.O. Box 307
255 Island Highway
Parksville, British Columbia
Canada V9P 2G5