Can You Run with Knee OA?

Can You Run with Knee OA?

Here's What You Need to Know!

So you’ve just been diagnosed with knee osteoarthritis (OA)…this is how you might be feeling (Pic 1)…

Pic 1 - This is a common reaction to being diagnosed with knee arthritis…!

There may be many questions running through your head

• What exactly is knee osteoarthritis (OA), and how did I get it?

• What are the best treatment options for managing knee OA?

• Will I need surgery at some point, or are there other alternatives?

• Can I use knee OA as an excuse to skip leg day at the gym forever?

• Can I blame knee OA for my newfound ability to predict the weather with my knees?

But if you’re like me, your most important concern will be:

“Can I still lace up my running shoes and hit the pavement?”

Running: the only sport where you are willing to suffer, sweat, and swear, but somehow still come back for more.

Well, you're not alone!

Many folks in your shoes (pun intended) are curious about the same thing.

Let's dive in and explore whether running with knee OA is a good idea, and how it might even help ease your knee pain.

Understanding Knee Osteoarthritis (OA):

First off, let's talk about knee OA.

The old view of OA is that it a result of wear and tear and inevitable joint degeneration.

This is known as the biomedical model and it offers an overly simplistic view that OA happens when the cartilage in your knee joint starts to wear down, causing pain, stiffness, and all-around discomfort.

It's not exactly an inspiring way to view the problem.

New view of OA:

Thankfully some very smart researchers, clinicians and doctors have come together to provide an updated explanation for knee OA and this involves taking a broader view of knee OA as an integrated whole body problem - that involves inflammation, metabolic health, immune system, diet, nutrition and even things like our beliefs and knowledge.

Essentially we have updated our model from a simple mechanical system (body is a machine that needs fixing) to seeing the body as an ecosystem (complex adaptive system) that is capable of regenerating given the optimal environmental conditions.

This new approach is no shortage of a revolution and paradigm shift in how we see the body and it’s potential for healing.

It opens the door to many treatment options that were previously not even considered until very recently.

Benefits of Running with Knee OA:

Believe it or not, running can actually have some perks for folks with knee OA:

1. Improved Joint Function: Running can help keep your knee joints flexible and moving smoothly, which is super important when you've got OA.

2. Strengthening Muscles: When you run, you're not just working out your legs – you're also giving those supporting muscles around your knees a good workout. It's like building a sturdy support system for your knees!

3. Weight Management: Running is a great way to burn calories and keep your weight in check. And when you're carrying around less weight, there's less stress on your knee joints.

4. Mood Boost: Ever heard of a runner's high? It's a real thing! Running releases feel-good hormones in your brain, which can help lift your mood and ease stress – definitely a win-win!

Considerations for Running with Knee OA:

Before you lace up those shoes and hit the pavement, here are a few things to keep in mind:

1. Talk to a Pro: It's always a good idea to chat with a healthcare pro before starting any new exercise routine, especially if you've got knee OA. They can give you the lowdown on whether running is safe for you.

2. Take It Slow: Start with a gentle jog or brisk walk, and gradually build up your speed and distance over time. Rome wasn't built in a day, and neither is a runner!

3. Shoe Game Strong: Invest in a good pair of running shoes with plenty of cushioning and support. Your knees will thank you!

4. Watch Your Form: Pay attention to your running technique – aim for a mid-foot strike, keep your posture upright, and try to land softly to reduce impact on your knees.

5. Mix It Up: Running is great, but it's not the only game in town! Mix in some strength training and flexibility exercises to give your knees a well-rounded workout.

Could running actually be the BEST way to protect your knees?

A recent study with 14,000 participants revealed some fascinating insights:

• Non-runners had a HIGHER prevalence of knee pain.

• Running could actually PROTECT your knees by inducing beneficial adaptations through mechanical loading.

But here’s the kicker:

When we try to shield our knees by avoiding movement, we might actually be reinforcing a cycle of pain and fear.

Running, under proper guidance, sends a powerful message to the brain that everything’s OK!

Here are three tips to keep you going strong:

- Maintain a high cadence of 170-180 steps per minute to reduce stress on your knees.

- Invest in well-supported shoes to cushion impact and provide stability.

- Strike a balance between walking and jogging to build endurance while minimizing strain.

"Back to the Body": Charting a New Course in Physiotherapy

In the dynamic field of physiotherapy, a transformative wave is reshaping our traditional approaches to pain and injury.

This evolution, termed "Back to the Body," represents a significant departure from past practices, integrating modern science's revelations with a renewed focus on the body's intricate signals.

As we delve into this shift, it's essential to appreciate the context from which we're moving and the promising direction in which we're headed.

The Traditional Paradigm: A Focus on the Physical

Historically, physiotherapy has been deeply anchored in a biomedical model, concentrating on the body's physical aspects—its joints, muscles, and tissues.

This approach, while foundational, often adopted a reductive lens, aiming to "fix" what was perceived as broken or misaligned.

Diagnoses frequently highlighted deficiencies: a "weak" core, "tight" muscles, or "improper" posture.

While these assessments were made with the best intentions, they inadvertently introduced a nocebo effect, where the negative framing of conditions could exacerbate patients' perceptions of pain and disability, sometimes with minimal relevance to their actual experience of pain.

The Shift Toward Mind and Emotion

The field's expansion to encompass beliefs, emotions, and the broader neurocentric model—largely influenced by the pioneering work of researchers like Lorimer Moseley and David Butler—marked a significant leap.

This phase brought to light the brain's integral role in pain perception, advocating for a more comprehensive understanding that transcends mere physicality.

However, this shift, for all its merits, occasionally led to an overemphasis on the psychological at the expense of the physical.

Patients sometimes felt their pain was being dismissed as purely a construct of the brain, leaving them feeling invalidated and overlooked.

"Back to the Body": A Holistic Reintegration

Today, we stand at the precipice of a new era, inspired by Bud Craig's insights into homeostatic emotions and the complex interplay between mind and body.

"Back to the Body" advocates for a return to a more integrated approach, where pain is recognized as an interoceptive signal—a cue from our body indicating a need for attention and care.

This perspective sees pain not as a mere symptom to be eradicated but as a critical piece of feedback within our body's attempt to maintain balance.

With advancements in technology—such as heart rate variability monitors, blood glucose tracking, and sensors for lactate and inflammatory markers—we're now equipped to decode the body's signals with unprecedented clarity.

This technological leap, combined with principles of load management as outlined by Tim Gabbett, empowers us to identify and respond to the body's cues more effectively, fostering an environment where positive adaptations are more likely.

Empowering Through Understanding

This shift towards an integrated mind-body model is about empowerment and education.

It's about guiding patients to tune into their bodies' messages, recognizing the signals of overload and stress.

It encourages a response to discomfort informed by understanding and mindfulness, rather than fear or the pursuit of immediate fixes.

This approach demystifies the sensations we've labeled as pain, reframing them as part of our body's broader context of response.

Moving Forward

"Back to the Body" heralds a return to physiotherapy's roots, enriched by our journey through the realms of psychology and neuroscience.

It's a call to embrace the body's complexity, leveraging science and technology to deepen our connection with ourselves.

As we chart this new course, we embrace a model of care that is both empowering and educative, one that places the patient's experience at the forefront of the healing process.

In doing so, we not only address pain more effectively but also foster a holistic sense of well-being.

Daniel O’Grady

Unraveling the Metabolic Basis for Tendon Pain

Tendon pain, particularly chronic Achilles tendinopathy, is a challenging condition that can disrupt an active lifestyle especially for runners.

In recent years, researchers have delved into the metabolic underpinnings of tendon pain, shedding light on the role of lactate concentrations.

The Lactate Connection

Lactate, a compound associated with muscle fatigue and soreness, has emerged as a crucial factor in the study of painful chronic Achilles tendinopathy.

A study utilizing microdialysis techniques revealed higher concentrations of lactate in Achilles tendons afflicted by tendinopathy compared to healthy, pain-free tendons.

The significance of this finding lies in the revelation of anaerobic conditions within the painful tendon area.

Understanding the Results

The study's results are a piece of the intricate puzzle of tendon pain.

Let's break down what we can glean from this research:

1. Lactate Accumulation: The higher concentrations of lactate in painful tendons suggest that anaerobic conditions prevail in the affected area. This accumulation of lactate reflects a metabolic imbalance within the tendon, which may contribute to pain perception.

2. Tendon Structure: The study noted structural changes and widening of the tendon in cases of tendinosis. These observations are vital in understanding the pathological processes at play in chronic Achilles tendon.

A Holistic Approach to Tendon Pain Management

Understanding the metabolic basis of tendon pain is just the first step.

To effectively manage and alleviate this pain, we must take a holistic approach:

1. Training Load and Periodization: In the world of sports and physical activity, it's essential to adopt a balanced training load. The 80/20 principle, where 80% of training is in zone 2 (aerobic), can help minimize the risk of overuse injuries like tendinopathy.

2. Lactate Clearance: Optimal lactate clearance is key. Encourage activities that enhance lactate clearance, such as low-intensity exercise, adequate recovery periods, and proper hydration.

3. Therapeutic Modalities: Various therapeutic modalities can play a role in tendon pain management. These include massage, dry needling, and foam rolling, which can aid in reducing muscle tension and promoting blood flow to the affected area.

4. Liver and Kidney Health: Metabolic health is crucial. Liver and kidney health is vital for efficient metabolite clearance, including lactate. Ensure a balanced diet, stay hydrated, and minimize excessive alcohol consumption to maintain these organs' well-being.

5. Hydration: Proper hydration is essential to support overall metabolic processes, including lactate clearance. Staying adequately hydrated aids in reducing the risk of metabolic imbalances contributing to tendon pain.

Conclusion

The metabolic basis for tendon pain, as revealed in the study, offers valuable insights into the pathogenesis of chronic Achilles tendinopathy.

However, it's only one piece of the puzzle. To effectively manage tendon pain, we must adopt a holistic approach.

This approach includes optimizing training load, prioritizing lactate clearance, and utilizing therapeutic modalities to promote pain relief.

Furthermore, maintaining overall metabolic health through hydration and balanced nutrition is paramount.

As we continue to unravel the intricate nature of tendon pain, adopting a holistic approach can help individuals regain their active lifestyles and harmonize with their bodies' natural healing mechanisms.

Research link: High intratendinous lactate levels in painful chronic Achilles tendinosis. An investigation using microdialysis technique

Soleus Trigger Points: The Achilles' Heel of Running Pain

"Where you think it is, it ain't."

As the great massage therapist Ida Rolf once said, "Where you think it is, it ain't."

This profound statement holds a lot of truth, especially when it comes to understanding and managing pain in the world of running.

Many runners have experienced Achilles tendon pain, and often, the source of this discomfort can be quite elusive.

Surprisingly, it may not always originate from the Achilles tendon itself.

In this blog post, we'll explore the concept of soleus trigger points and how they can refer pain to the Achilles.

We'll also discuss strategies to manage and prevent this type of discomfort.

The Soleus: A Hidden Culprit

The red area around the achilles and heel is known as ‘referred pain’ from the soleus muscle

The soleus muscle is a powerful calf muscle that plays a crucial role in running.

It is often overshadowed by its more prominent counterpart, the gastrocnemius, but the soleus is no less important.

When it comes to running, the soleus carries a substantial load, approximately 6-8 times your body weight with every step. Over weeks and months, this load can accumulate and cause various issues, one of which is trigger points.

Trigger points are hyperirritable knots or tight bands within a muscle that can cause pain locally or refer pain to other areas. They commonly are a result of excess waste products/metabolites (such as lactate) build up in the muscle when the muscle has worked harder than usual.

In the case of the soleus, these trigger points can lead to discomfort that radiates to the Achilles tendon, even when the tendon itself is healthy.

The New Runner's Dilemma

New runners are particularly susceptible to developing soleus trigger points.

The tightness in the soleus may have been building up gradually, and with a lack of experience, they may inadvertently make mistakes in managing their running-related discomfort.

Often, new runners tend to focus on stretching, but this can be counterproductive, especially when stretching with a straight knee, which primarily targets the more superficial muscle known as the gastrocnemius.

Understanding the Pain Pathway

The referral of pain from the soleus to the Achilles tendon occurs due to the shared neural pathways and the close proximity of these structures.

It's crucial to recognize that the Achilles pain can be a result of metabolic waste buildup in the soleus, not a direct issue with the tendon itself.

This insight can be transformative in managing and preventing such pain.

An assessment with an experienced running Physiotherapist who uses a load management approach (rather than a short sighted purely biomedical approach) early on can save you a lot of time and hassle down the track.

Albert Einstein is quoted as having said, “If I had an hour to solve a problem I'd spend 55 minutes thinking about the problem and five minutes thinking about solutions.” The point he makes is important: really listening and deeply understanding the context of the problem has great value in effectively solving the problem.

Tips for Managing Soleus Trigger Points and Achilles Pain

1. Dry Needling: Dry needling by a trained healthcare professional can be effective in releasing trigger points in the soleus muscle, reducing pain, and restoring normal muscle function.

2. Load Management Advice: Avoid overloading the calf muscles, especially if you're new to running. Implement the 80/20 rule, where 80% of your training is at a comfortable pace (Zone 2) to build your mitochondrial capacity while limiting high-intensity workouts.

3. Foam Rolling: Use a foam roller to massage your calf muscles after your runs. This can help release tension and prevent the buildup of trigger points.

4. Shoe Maintenance: Ensure your running shoes are well-maintained and provide the necessary support. Proper footwear can reduce excessive stress on your calf muscles and Achilles tendon.

5. Running Technique: Pay attention to your running form. Avoid overstriding with a heel strike, as this places a significant load on the Achilles. Aim for a midfoot strike (as opposed to forefoot strike) with a cadence of 170-180 steps per minute. When walking, avoid heel striking and aim for a cadence of 120-130 steps per minute.

6. Avoid Compression Loads: Be cautious about using hard massage tools, rolling balls, or aggressive stretching on your calf muscles and Achilles. Overdoing it can lead to further irritation, which would only present 24 hours later. Don’t win the battle but lose the war.

Conclusion

The Achilles' heel of running pain often resides in the soleus muscle, with trigger points causing discomfort that radiates to the Achilles tendon.

Understanding this relationship is crucial for effective management and prevention.

By incorporating the tips mentioned above, you can help alleviate pain, improve your running experience, and keep your Achilles tendon healthy.

Remember, sometimes where you think the pain is, it ain't – it might just be the soleus!