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Volume 4, Issue 5, Supplement,
, Pages S117-S121
Running is an excellent activity to promote general health and well-being. However, running injuries are common, and concern is sometimes raised that running might lead to osteoarthritis in weight-bearing joints. This article reviews the relevant in vitro and in vivo literature that looks at possible associations between running and the development of osteoarthritis. Also reviewed is the limited literature on running barefoot and with minimalist footwear. Low- and moderate-volume runners appear to have no more risk of developing osteoarthritis than nonrunners. The existing literature is inconclusive about a possible association between high-volume running and the development of osteoarthritis. The early literature on running barefoot and running with minimalist footwear has primarily focused on biomechanics but has not yet focused on any effect on cartilage health. Experienced and beginner runners should be encouraged to allow the body adequate time to adapt to changes in gait biomechanics caused by changing footwear, which can be done by slowly increasing running mileage in the new footwear. Clinicians can improve the health of runners by encouraging appropriate treatment of musculoskeletal injuries, encouraging maintenance of an optimal body mass index, and correcting gait abnormalities caused by deficits in flexibility, strength, or motor control along the kinetic chain.
Running has a low participation cost and can be performed almost anywhere, which makes it an ideal activity to combat the negative effects of physical inactivity and obesity . The well-known benefits of running include improved cardiovascular fitness, strength, and endurance . Running also decreases the risk of stroke , decreases the risk of developing hypertension , improves bone density , has a positive effect on mood , and improves cognition . However, running is not without risk. The annual incidence of incurring a running injury has been reported as high as 59% by Van Mechelen  and 79% by Van Gent et al . Overload injuries that affect muscles, tendons, ligaments, and bones are common. The effect of running with knee osteoarthritis has been extensively studied, and, more recently, barefoot running has been suggested as a strategy to reduce the risk of acquiring running injuries. This article reviews the existing literature that examined the association of running and osteoarthritis. First, we review pertinent in vitro studies on cartilage breakdown. Second, we provide a limited review of in vivo animal studies that have explored the relationship between running and osteoarthritis. Third, we present a broader discussion of the in vitro human epidemiology literature, divided into a review of studies that support and refute an association between running and osteoarthritis. We then include a brief discussion about running barefoot and running with minimalist footwear.
In Vitro Studies on Articular Cartilage Degradation
Multiple intrinsic and extrinsic factors affect a joint's ability to withstand destructive forces. Intrinsic factors include the thickness of the articular cartilage, the composition of the articular cartilage, the strength of the bone adjacent to the joint, periarticular ligament strength, muscle strength, neuromuscular control of the joint, and the body's ability to repair damage to the joint. Extrinsic factors include nutrition; training technique; and the magnitude, direction, duration, and
In Vivo Animal Studies
A complete review of in vivo animal studies that investigated running and osteoarthritis is beyond the scope of this article. Some caution must be exercised with in vivo animal studies, because changes to articular cartilage may be interpreted as either osteoarthritic changes or normal tissue adaptation. Several of the more salient in vivo animal studies are presented here. Results of 2 studies by Kiviranta et al [19, 20] suggest that low- and moderate-volume running increases articular
Barefoot (or Minimalist Footwear) Running
Barefoot running and minimalist running shoes, which feature much less cushioning and support than traditional running shoes, have received considerable media attention in recent years. Lieberman et al  compared foot-strike patterns of persons in the United States and Kenya who were either habitually barefoot or shod. They found that the habitually barefoot individuals tended to run with a forefoot or mid-foot strike pattern. Habitually shod individuals tended to run with a rear-foot strike
Limitations of the Existing Literature
The existing literature regarding running and osteoarthritis has several limitations. First, the majority of studies focused primarily on the hips and knee. Limited information exists regarding the effect of running on the development of osteoarthritis at the ankle or the lumbar spine. Comprehensive studies that control for common variables such as type of running surface, type of footwear, foot-strike and gait pattern, presence of biomechanical deficits, and cross-training are difficult to
The existing literature fails to support an association or causal relationship between low- and moderate-distance running and osteoarthritis. Increasing age, previous joint injury, and greater body mass index have consistently been associated with an increased risk of developing osteoarthritis. Inconclusive evidence exists regarding high-volume running and the development of osteoarthritis. Further research is needed to clarify the relationship between high-volume running and the development of
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Am J Med
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Am J Prev Med
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J Clin Epidemiol
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Clin Geriatr Med
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- S. Willick
Running and osteoarthritis
Reduction in incident stroke risk with vigorous physical activity: Evidence from 7.7-year follow-up of the national runners' health study
Lower prevalence of hypertension, hypercholesterolemia, and diabetes in marathoners
Med Sci Sports Exerc
Running injuriesA review of the epidemiological literature
Incidents and determinants of lower extremity running injuries: A systematic review
Br J Sports Med
Running and osteoarthritis
Clin Sports Med
Direct measurement of local pressures in the cadaveric human hip joint during simulated level walking
Ann Rheum Dis
Survival of articular cartilage after controlled impact
J Joint Bone Surg
Articular cartilage: Biomechanics
A second study of tensile fatigue properties of human cartilage
Ann Rheum Dis
Mechanical disruption of human patellar cartilage by repetitive loading in vitro
Clin Orthop Relat Res
Joint changes after overuse and peak overloading of rabbit knees in vivo
Acta Orthop Scand
Effects of mechanical loading on the tissues of rabbit knee
J Orthop Res
Analysis of acute mechanical stress in an animal model of post-traumatic osteoarthritis
J Biomech Eng
Moderate running exercise augments glycosaminoglycans and thickness of articular cartilage in the knee joint of young beagle dogs
J Orthop Res
- Knee injuries in runners
2019, Clinical Care of the Runner: Assessment, Biomechanical Principles, and Injury Management
Knee injuries are likely most commonly seen in runners. Patellofemoral pain syndrome, iliotibial band syndrome, and patellar tendinopathy are three very commonly encountered conditions that make up the majority of knee-related running injuries. In addition to accurately diagnosing the injury, a careful assessment of the runner's biomechanics along the kinetic chain is key to resolving the problem and preventing future injuries. The vast majority of treatment for running-related knee injuries revolves around appropriate rehabilitation.
- Is physical activity, practiced as recommended for health benefit, a risk factor for osteoarthritis?
2016, Annals of Physical and Rehabilitation Medicine
The existing literature supports that older runners are generally healthier than their non-running counterparts. Evidence is inconclusive regarding the association of high-volume running and the development of OA . Consistently, when considering the general population, in the absence of significant joint injury, risk of knee/hip OA is not increased with daily general PA or recreational sport activity, with moderate level of practice .
In this critical narrative review, we examine the role of physical activity (PA), recreational and elite sports in the development of knee/hip osteoarthritis (OA), taking into account the role of injury in this relationship. The process of article selection was unsystematic. Articles were selected on the basis of the authors’ expertise, self-knowledge, and reflective practice. In the general adult population, self-reported diagnosis of knee/hip OA was not associated with low, moderate or high levels of PA. For studies using radiographic knee/hip OA as a primary outcome, the incidence of asymptomatic radiographic OA was higher for subjects with the highest quartile of usual PA than the least active subjects. The risk of incident radiographic knee/hip OA features was increased for subjects with a history of regular sports participation (for osteophyte formation but not joint space narrowing). This risk depended on the type of sport (team and power sports but not endurance and running), and certain conditions (high level of practice) were closely related to the risk of injury. The prevalence of radiographic OA was significantly higher, especially the presence of osteophytes, in former elite athletes than controls. The risk of OA was higher with participation in mixed sports, especially soccer or power sports, than endurance sport. However, the prevalence of clinical OA between former elite athletes and controls was similar, with less hip/knee disability in former athletes. Moderate daily recreational or sport activities, whatever the type of sport, are not a consistent risk factor for clinical or radiographic knee/hip OA. Risk of injury in different sports may be the key factor to understanding the risk of OA related to sport.
- Evaluation and Management of Hip and Pelvis Injuries
2016, Physical Medicine and Rehabilitation Clinics of North America
The articular cartilage of the femoral head and acetabulum can be prone to breakdown, causing arthrosis. However, no study has clearly defined an association between hip arthrosis and running.88–90 In fact, a reduced incidence of osteoarthrosis and hip replacement has been found with long-term recreational running,91 corresponding to a lower rate of disability progression among runners.92,93
- Joint contact forces when minimizing the external knee adduction moment by gait modification: A computer simulation study
Gait modification is often used to reduce the external knee adduction moment (KAM) in human walking, but the relationship between KAM reduction and changes in medial knee joint contact force (JCF) is not well established. Our purpose was to examine the limiting case of KAM-based gait modification: reducing the KAM as much as possible, and the resulting effects on JCF.
We used musculoskeletal modeling to perform three optimal control simulations: normal walking, a modified gait that reduced the KAM as much as theoretically possible (Min(KAM) simulation), and a second modified gait that minimized the KAM plus the metabolic cost of transport (Min(KAM+CoT) simulation).
The two modified gaits both reduced the peak KAM from normal walking (−82% for Min(KAM) simulation, −74% for Min(KAM+CoT) simulation) by increasing trunk lean, toe-out, and step width, and reducing knee flexion. Even though the Min(KAM+CoT) simulation had the larger KAM, it had a greater reduction in peak medial JCF (−27%) than the Min(KAM) simulation (−15%) because it reduced the KAM using less knee muscle activity. These results were qualitatively robust to a sensitivity analysis of the knee joint model, but the magnitude of changes varied by an order of magnitude.
The results suggest that (i) gait modification can benefit from considering whole-body motion rather than single adjustments, (ii) accurate interpretation of KAM effects on medial JCF requires consideration of muscle forces, and (iii) subject-specific knee models are needed to accurately determine the magnitude of KAM reduction effects on JCF.(Video) Does Running Cause Osteoarthritis
- Knee osteoarthritis: Clinical connections to articular cartilage structure and function
2015, Physical Therapy in Sport
Most notably is aging, with a higher prevalence of OA in the elderly population (Buckwalter & Martin, 2004; Buckwalter, Martin, & Mankin, 2000; Ghosh & Smith, 2002; Zhai et al., 2006). Body mass index (BMI) and sex appear to be contributors, and other factors such as dietary intake have been implicated (Amin et al., 2008; Beavers, Serra, Beavers, Cooke, & Willoughby, 2010; Berenbaum, Eymard, & Houard, 2013; Griffin, Huebner, Kraus, Yan, & Guilak, 2012; Hansen, English, & Willick, 2012; Lohmander, Ostenberg, Englund, & Roos, 2004; de Luis, Izaola, Garcia Alonso, Aller, Cabezas, & de la Fuente, 2012; Muraki et al., 2013; Nguyen, Zhang, Zhu, Niu, Zhang, & Felson, 2011; O'Conor, Griffin, Liedtke, & Guilak, 2013; Shen et al., 2013). Hereditary factors also contribute to the problem.
Articular cartilage is a unique biphasic material that supports a lifetime of compressive and shear forces across joints. When articular cartilage deteriorates, whether due to injury, wear and tear or normal aging, osteoarthritis and resultant pain can ensue. Understanding the basic science of the structure and biomechanics of articular cartilage can help clinicians guide their patients to appropriate activity and loading choices. The purpose of this article is to examine how articular cartilage structure and mechanics, may interact with risk factors to contribute to OA and how this interaction provides guidelines for intervention choices This paper will review the microstructure of articular cartilage, its mechanical properties and link this information to clinical decision making.
- The epidemiology of osteoarthritis
2014, Best Practice and Research: Clinical RheumatologySee AlsoIncreased VA Disability Ratings for Joint Pain and Arthritis5 Top and Strongest Marijuana Strains of 2022Can Chiropractic Help Psoriatic Arthritis - ArthritisDaily.net
A recent review by Hansen et al.  failed to find evidence to support an association or causal relationship between low- and moderate-distance running and hip and knee OA in general population studies defined as incident radiographic or symptomatic OA. The review also produced inconclusive evidence regarding high-volume running and OA development  suggesting that, in the absence of joint injury, the risk of OA development due to running and exercise is minimal. Limited information exists regarding the effect of running and the development of OA at the ankle and the lumbar spine.
Osteoarthritis (OA) is a leading cause of disability and its incidence is rising due to increasing obesity and an ageing population. Risk factors can be divided into person-level factors, such as age, sex, obesity, genetics, race/ethnicity and diet, and joint-level factors including injury, malalignment and abnormal loading of the joints. The interaction of these risk factors is complex and provides a challenge to the managing physician. The purpose of this review is to illustrate how each of these factors interact together to instigate incident OA as well as to outline the need for ongoing epidemiologic studies for the future prevention of both incident and progressive OA. It is only by understanding the impact of this disease and the modifiable risk factors that we will be able to truly target public health prevention interventions appropriately.
Research articleThe relationship between peak knee extension at heel-strike of walking and the location of thickest femoral cartilage in ACL reconstructed and healthy contralateral knees
Journal of Biomechanics, Volume 46, Issue 5, 2013, pp. 849-854
Reports that knee cartilage health is sensitive to kinematic changes, combined with reports of extension loss following ACL reconstruction, underscores the importance of restoring ambulatory knee extension in the context of preventing premature osteoarthritis. The purpose of this study was to test the relationship between individual variations in peak knee extension at heel-strike of walking and the anterior–posterior location of thickest cartilage in the medial and lateral femoral condyles of healthy contralateral and ACL reconstructed knees. In vivo gait analysis and knee MR images were collected from 29 subjects approximately 2 years after unilateral ACL reconstruction. Knee extension was measured at heel-strike of walking and 3-D femoral cartilage thickness models were reconstructed from MR images. The ACL reconstructed knees had significantly reduced knee extension (−1.5±4.2°) relative to the contralateral knees (−4.6±3.4°) at heel-strike of walking but did not have side-to-side differences in the anterior–posterior location or magnitude of thickest medial and lateral femoral cartilage. The anterior–posterior location of the thickest medial femoral cartilage was correlated with knee extension at heel-strike in both the healthy contralateral (R2=0.356, p<0.001) and reconstructed (R2=0.234, p=0.008) knees. These results suggest that ACL reconstruction can impair terminal extension at periods of ambulatory loading known to be related to cartilage morphology in healthy joints. The fact that the femoral cartilage thickness distribution had not changed at 2 years post-op, even in the subset of subjects with extension loss, suggests that loads may be shifted to thinner cartilage regions, which could have important implications on long-term joint health.
Research articleThe influence of footwear on knee joint loading during walking — in vivo load measurements with instrumented knee implants
Journal of Biomechanics, Volume 46, Issue 4, 2013, pp. 796-800
Since footwear is commonly used every day, its influence on knee joint loading and thereby on the development and progression of osteoarthritis may be crucial. So far the influence of footwear has been examined only indirectly. The aim of this study was to directly measure the effect of footwear on tibiofemoral contact loads during walking.(Video) Does jogging cause arthritis?(You Won't Believe The Answer!)
Instrumented knee implants with telemetric data transmission were used to measure the tibiofemoral contact forces and moments in six subjects. The loads during walking with four different shoes (basic running shoes, advanced running shoes, classical dress shoes and shoes with a soft rounded sole in the sagittal plane (MBT)) were compared to those during barefoot walking. Peak values of all six load components were analyzed.
In general, footwear tended to increase knee joint loading slightly, with the dress shoe being the most unfavorable type of footwear. At the early stance phase all load components were increased by all shoe types. The resultant force rose by 2–5%, the internal adduction moment by 7–12% and the forces on the medial compartment by 3–5%. Significant reductions of the resultant force were solely observed for the advanced running shoe (−6%) and the MBT (−9%) shoe at late stance. Also the medial compartment force was slightly yet non-significantly reduced by 2–5% with the two shoes. It is questionable whether such small load changes have an influence on the progression of gonarthrosis. Future research is necessary to examine which factors regarding the shoe design, such as heel height, arch support or flexibility are most decisive for a reduction of knee joint loading.
Research articleBody mass index affects knee joint mechanics during gait differently with and without moderate knee osteoarthritis
Osteoarthritis and Cartilage, Volume 20, Issue 11, 2012, pp. 1234-1242
Obesity is a highly cited risk factor for knee osteoarthritis (OA), but its role in knee OA pathogenesis and progression is not as clear. Excess weight may contribute to an increased mechanical burden and altered dynamic movement and loading patterns at the knee. The objective of this study was to examine the interacting role of moderate knee OA disease presence and obesity on knee joint mechanics during gait.
Gait analysis was performed on 104 asymptomatic and 140 individuals with moderate knee OA. Each subject group was divided into three body mass categories based on body mass index (BMI): healthy weight (BMI<25), overweight (25≤BMI≤30), and obese (BMI>30). Three-dimensional knee joint angles and net external knee joint moments were calculated and waveform principal component analysis (PCA) was applied to extract major patterns of variability from each. PC scores for major patterns were compared between groups using a two-factor ANOVA.
Significant BMI main effects were found in the pattern of the knee adduction moment, the knee flexion moment, and the knee rotation moment during gait. Two interaction effects between moderate OA disease presence and BMI were also found that described different changes in the knee flexion moment and the knee flexion angle with increased BMI with and without knee OA.
Our results suggest that increased BMI is associated with different changes in biomechanical patterns of the knee joint during gait depending on the presence of moderate knee OA.
Research articleMinimalist shoe injuries: Three case reports
The Foot, Volume 23, Issues 2–3, 2013, pp. 100-103
Running in minimalist shoes continues to increase in popularity and multiple mainstream shoe companies now offer minimalist shoes. While there is no evidence that traditional running shoes prevent injuries, there are concerns that the designs of minimalist shoes may increase injury risk. However, reports of injuries in runners wearing minimalist shoes are rare. We present three injuries occurring in runners that were wearing minimalist shoes at the time of injury. All three of the runners switched immediately to the minimalist shoes with no transition period. We recommend that any transition to minimalist shoe gear be performed gradually. It is our contention that these injuries are quite common and will continue to become more prevalent as more runners change to these shoes.
Research articlePosterior Sliding of the Femur During Stair Ascending and Descending in a High-Flex Posterior Stabilized Total Knee Arthroplasty
The Journal of Arthroplasty, Volume 28, Issue 10, 2013, pp. 1707-1711
This study investigated the anteroposterior stability of the femur during stair motions. We examined 18 knees with a clinically successful high-flexion posterior stabilized total knee arthroplasty to evaluate the in vivo kinematics of stair ascending and descending using two- to three-dimensional registration. Posterior sliding of the femur was observed while shifting weight to the leg during stair ascending and descending in almost all knees. Anterior tibial post impingement was observed in 10 knees when the knee was extended in stair ascending, whereas in stair descending, the impingement was observed in 14 knees when posterior sliding of the femur occurred. The impingement contributed to the stabilization of the knee during stair motion; however, impingement may result in additional polyethylene wear and tibial post failure.
Research articleImpact of knee flexion on patella length in osteoarthritic patients undergoing total knee arthroplasty
Journal of Orthopaedic Science, Volume 18, Issue 4, 2013, pp. 547-551
This study used magnetic resonance imaging (MRI) to evaluate in vivo preoperative changes in the length of the patellar tendon (LPT) in patients undergoing total knee arthroplasty (TKA). We sought to answer two questions: first, does the LPT change with flexion? Second, does the LPT show a gender-specific pattern?
Eighty-five knees in 76 consecutive osteoarthritic patients were evaluated. The age range was 56–90years (mean 70). The study included 62 females and 14 males. MRI was performed at full extension and at 30°, 60°, 90°, and full flexion.
There were significantly different patterns between genders (p<0.001). The main shortenings occurred earlier, at 30°, in females and later, at 60°, in males. In females, LPT values in full extension were significantly longer than those measured at other flexion angles. In male subjects, significant differences in LPT values were found between full extension versus 90° (p<0.001) and full flexion (p<0.001), and between 60° versus 90°(p=0.030) and full flexion (p=0.030).
These differences might influence the gender-specific complications related to the extensor mechanism after TKA. These data provide useful information for surgeons attempting to achieve a satisfactory balance between joint gaps in the patellar reduced position intraoperatively.(Video) Running with Osteoarthritis // Physiotherapist Top 5 Tips
Copyright © 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.