THE CLINIC: Must Running Cease?

Wed, 12 June 2013 - 1:42 a.m. MT
Credit: ARA Staff - American Running Association



Is impact always bad for osteoarthritis of the back and ankles, or might stopping impact lead to accelerated deterioration of the bones and cartilage? And what about degeneration of spinal discs? Might recent research question the traditional advice?

I am almost 71 years old, and want to keep running but wonder about my back and ankle (both of which have post-trauma osteoarthritis).

In 1979, I experienced a fall on concrete with a heavy weight that pushed me down. As a result, I have two degenerated areas in the spine and what I was told is “ordinary degenerative osteoarthritis.” Most degeneration showed up on the first CT scan taken in 1989. Of course, I don't want to create a cascade of degeneration.

Regarding my ankle, I experienced a break and dislocation in 2000. I now have arthritis in the tibia, with what looks to me like canyons coming up from the bottom. I'm worried about cartilage becoming even thinner if I stop doing impact activity. Two of three measures of my bone density, performed over the last 20 years, have actually gone up (in measurement, not relative to that of my age peers) after I started running 12 years ago. I'm afraid the density may go down if I stop running.

Most advice, including that from a neurosurgeon I saw recently, is to stop impact activity. I currently run 25-30 miles per week, on three mornings. I qualified for the Boston Marathon, and my podiatrist advised me to just cut down on miles and let pain and swelling be my guide.

Sara Jonas

Eaton, MI



A moderate level of loading force actually promotes healthy cartilage in the normal joint. The best data on this is old, and oddly enough, from a series of German dog studies. Dogs were divided into three groups: cage, moderate running, and high-volume running. After three months, their cartilage was histologically and radiographically examined. [Ed. note: Histology is the anatomical study of the microscopic structure of plant and animal tissues.] The moderate running dogs had the healthiest cartilage, followed by cage dogs, and in last place was the high-volume running dogs. That means loading force is good in otherwise healthy joints. But even moderate forces, when involving combined vectors (compression and shear, for instance) can be harmful to normal joints.

In your specific case, you won't be happy that I agree with your other doctors. Decreased impact forms of exercise such as elliptical training and walking seem to give almost the same bone density “bang for buck” as running. I still encourage and allow my patients to run no matter what their x-rays look like as long as they don't have joint pain or swelling. But pain can indicate cartilage damage and the fluid in a swollen joint contains degradative enzymes that chew up cartilage like candy.  If you're having pain/swelling with running as you seem to indicate, I would look for good deals on an elliptical trainer and/or learn to enjoy fast walking.

Anthony Beutler, MD
Bethesda, MD




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(RUNNING & FITNEWS® January / February 2012 • Volume 30, Number 1)



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