One of the most dreaded of words your GP could say to you are ‘I think you have arthritis’. Does this mean the end of your running career? Not necessarily. Before you hang up your running shoes, let’s look at the facts.
What is arthritis?
The most common type of arthritis in the UK is osteoarthritis (OA). You might picture this as a destructive process wearing down your joints, but NICE (National Institute for Clinical Excellence) wants us to think about it differently.
NICE describes arthritis as a process that is actually repairing your joints. If a joint suffers damage of any kind, it needs to be fixed to keep the joint functioning and pain-free. Small areas of cartilage are lost and bone shape changes as the joint is ‘re-organised’. It might look different inside, but the joint still works fine and is pain-free.
It’s only when the damage to a joint is excessive, or the repair process cannot keep up, that true joint damage occurs and you get symptoms from OA. So, if you have been told you have ‘early arthritis’, do not panic. Your joint is behaving normally, it is looking after itself and it may never give you any symptoms.
Joints are where bone meets bone. The end of each bone is coated in a hard smooth substance called cartilage. Between the cartilage, a liquid called synovial fluid bathes the joint, acting like oil to ensure all parts of the joint move smoothly.
Ligaments are strips of thick fibrous tissue that connect bone to bone and help to stabilise joints. Finally, muscles surround the joint adding further stability and attach to the bones by tendons.
Running and Osteorthritis
Many studies have examined whether runners have more OA than less active people. Most of these studies focus on the knee joint and ask, ‘Are we wearing out our knees?’ The overriding conclusion seems to be no. Moderate exercise, including running, will not damage your joints or cause OA, and if you already have some arthritis present it will not speed up the process. Exercise is a treatment for established OA and will reduce pain and disability.
Running with an injury, however, may increase your OA risk. The muscles supporting the knee joint are vitally important, since they absorb impact when the foot hits the ground. If they are weak or misaligned, this impact through the bone and cartilage is unevenly distributed, which can lead to cartilage damage and overgrowth of bone. Muscles that have been gradually trained with good biomechanics seem to give the best protection to joints.
What causes joint pain?
Any part of a joint can give you pain, and while OA is not reversible, other causes of joint pain are, so it’s crucial you get the right diagnosis if you’re to receive the right treatment.
Tendonitis, for example, can be confused with OA. This is inflammation of the tendons that attach muscle to bone. It is usually caused by over-use of a joint and can cause pain, swelling and stiffness. It is a treatable and reversible condition. Here’s how to tell the difference:
- OA is more common in the knee and tendonitis in the foot and ankle.
- OA pain gradually builds up whereas tendonitis pain develops fast.
- OA tends to affect older people, while tendonitis is more common in very active people.
- The pain from OA spreads over the whole joint but inflamed tendons cause localised pain.
- OA feels stiff when you first move a joint whereas tendonitis gets worse during or after use.
The right diagnosis
X-rays can show OA changes but they can be very misleading, as the degree of OA on the x-ray often does not correlate with the degree of a patient’s symptoms. Some people with severe changes, for example, are pain-free.
Similarly x-rays are of little use in the diagnosis of simple tendonitis because tendons do not show up on an x-ray. Your GP can usually make the correct diagnosis by listening to your symptoms and examining your joint. Remember: you may have both conditions. If the diagnosis is in doubt, your GP may refer you for an MRI scan.
Running on normal joints is not going to give you arthritis and running on joints which have some OA changes will not speed up the process. Even if you’re running pain-free right now, have a gait analysis (where you’re filmed running) to ensure you are wearing the right trainers. A full physio assessment of your posture and biomechanics might uncover weaknesses and imbalances you were unaware of.
If you are overweight, getting down to a healthy weight will really benefit your joints. The use of nutritional supplements in OA is controversial. Eating a healthy diet is more important than supplements like glucosamine or chondroitin. Research is underway to see if omega-3 fatty acids slow down the arthritic process.
You need to strengthen all the muscles supporting your joints to protect them so aim to include regular cross training and strength work with weights in your routine. Do not run when you’re injured and do not ignore twinges. Now you know the facts, pull on your trainers and get out there.