My name is Maryke, for those of you who don't know me. I'm the physiotherapist
from sports-injury-physio.com, where you can get online physiotherapy treatment. So tonight's topic
is about arthritis and whether you can run with osteoarthritis in your knees. And what I'm gonna
do is, I'm gonna first of all look at whether you can make your arthritis worse or whether running
actually causes arthritis of the knees. And then I'm gonna give you eight tips that you can apply
to help you run if you do have knees that aren't that pristine. Excellent! So let's jump right in.
Now, one of the most common things that I hear probably on a weekly basis from people is that,
“Ooh, running isn't good for your knees! Ooh, all the impact of running isn't great for your knees!”
Well, if you like running, you'll be happy to know that actually, what the research shows is that
that's not the case. So, there are two key studies that have investigated this. And the first one,
they looked at whether … they looked at people with arthritis in their knees and they
scanned them and they also made them fill in pain questionnaires and things, and then they looked at
them four years later and they scanned them again – so, X-ray studies – and they found that those that
continued to run had no increase in their symptoms seen on X-ray. They also didn't report more pain.
In fact, they actually had less pain in their knees than the guys with arthritis who didn't run.
So … But the important bit of this study is that they didn't tell people what speed to run at; they
got them to decide what speed they want to run at, how often they want to run, and what terrain;
everything was their own choice. So for that study, no increase in arthritic symptoms. In fact,
decrease in pain. Then, another study where they actually waited 18 years to see what happens. They
looked at people who run and people who don't run and used the ones who don't run as
a control. And what they found was that 18 years later, when they rescanned the people's knees,
that both groups had shown a little bit of wear-and-tear, because arthritis is like part
of the normal aging group. But the runners showed less increase in arthritic changes in their knees
than the non-runners. So, there wasn’t anything to show that running actually made arthritis worse or
make you develop arthritis more quickly. So definitely, it is absolutely
fine to run if you have arthritis in your knees if it allows you to run. So, moving on … Oh
I'd forgotten that I have a picture here. This picture is from the sports physio Adam Meakins;
and you can find him on Facebook, you can find him on Instagram, as well as on Twitter. And if
you – especially if you’re a physio and you like research things – he summarises it really well.
This is just a representation of the results of that study where they scan people 18 years later.
So, you can see that in both groups – the runners as well as the non-runners – they had more signs
of osteoarthritis in the knees when they scanned them 18 years later. But can you see that the runners,
actually their changes increased slower than the non-runners? So, one could deduct from this
that running can even protect your knees from osteoarthritis. Now, let's get onto the juicy
bits: the tips for if you do have painful knees. Now remember that osteoarthritis … you can also
call it a little bit of wear-and-tear in the knee, and I want you to think about it as part
of the normal aging process. So, just like you get wrinkles on your skin, your joints,
your muscles, and everything changes a little bit with age. So your … For instance, where the joints
are concerned, your cartilage becomes a little bit thinner, you can get little cracks in it;
there's bony points that can grow out, your bones can become a little bit softer. But it's absolutely
normal for everybody. And if you want to know if you … if you're thinking, "Well, if all of that
happens to you, then you surely shouldn't run." Have you seen the records that's being set by
people of a hundred years of age, deep in their 90s, in their 80s? I mean,
there's a person in his 80s who ... I looked at his marathon time; it's faster than mine, by loads! So ...
It can definitely be done. Hi Gemma! Okay, so my first tip is … let me get it: Start slow. This
is for anybody who is not currently running who wants to start running or somebody who has maybe
had a long break from running. If you want to get into running, you have to start very slowly. So,
always remember that the natural process that happens in the body when we exercise is that you
have a little bit of muscle damage and things that happen as well as joint damage, but then
the body repairs this damage and adapts to it, and that's how it grows stronger. But if you're
unfit and you haven't trained for a long period of time or you're older, this adaptation process
takes longer. So, you've got to make sure that you start really slow and don't push too quickly too
much and give it enough recovery time. So, doing run-walking is a very good way of getting into
it. And on this point I will say, don't follow any programme like a slave. Every person is different.
So by all means, get a programme and look at it, but also listen to what your knees tell you. If
you need more walking periods or longer walking periods than running periods, play with it;
there's no right or wrong. You've got to find what's right for your knees. But definitely make
sure that you don't up the training too quickly. Even if you've been doing it for three, four months,
that's actually still a very short period of time to be running. So make sure that you
don't increase it by more than 10 percent per week, that you really keep it down and err on the side of
caution, because if you do have a little bit of osteoarthritis in your knees, they won't recover
as quickly as somebody who doesn't have it or who is younger. Then the second tip is strength
training. When we run, our muscles are meant to absorb a great part of the force that is created
through running. So the stronger your muscles are, the less force your joints have to take. There's
very good research to back up that strength training in general can prevent injuries;
it's one of the best ways to prevent injuries. I think it's something like … Some of the research
studies say that you can prevent up to 80% of overuse injuries if you do strength training. But
it can definitely also help to offload arthritic joints. And for the knee, the quadricep muscles
or your thigh muscles are the most important. But to be honest, you have to strengthen your glutes,
your quads, your hamstrings, as well as your calves, because they all work as a unit when you
run to absorb the force. Then the third tip is … if I can just get it up here … You've got to alter
your volume. This especially is important for people who have been really good runners when they
were younger and used to really large training volumes. If you have a bit of arthritis in your
knees, those knees will not be able to tolerate the same amount of training as you could before.
Because remember, your cartilage and things aren't necessarily as strong, or they won't be as strong
as they were when you were 20 years younger. So you have to look at your training volume. Feel
what your knees are telling you and adjust it to the point where you can feel that it can cope with
it. If you feel that your knees are painful at the end of every week that you do your training, then
that's a good sign that actually your training may be too much and you're gonna have to adjust your
volume of training a bit. So, don't try to just follow your training like you always had like a
slave and then think, “Why are my knees hurting? I can't ever run again!” That's not the case. It may
just be the case that you can't run as much as you want to run; so you'll have to adapt it a little
bit. Then fourth – really important – is recovery. And this is probably one of the key factors that
will allow you to keep on running is if you can keep your … or figure your recovery out, that ...
what you need for that. So, people who are fit and who are highly trained and who are young recover
really quickly; people who are less trained – so, don't train as often or at such high intensities and
things – and who are slightly older and have a bit of arthritis in their knees recover much slower. I
often see runners make the mistake of looking at other people and what they’re doing; and
some people can get away with running five days a week, but it doesn't mean that you can do the same
thing. You've got to find out what recovery period your body needs to adapt to the training you've
done and recover fully before you train again. And the only way you can do that is by really
observing what you feel in your body the days after you've done a run or a training session. So,
make sure that you leave enough recovery time between sessions. Then, if we get to number five,
it's cross-train. Now, I know this video is about running with arthritis in your knees,
so you may be thinking, “Why are you telling me to cross-train?” Well, painly, because if you do
work in a bit of cycling and a bit of swimming, your knees will recover quicker and it will allow
you to run better. So remember, joints don't have arteries going into them; they need movement to
get fluid and nutrients in and out. So if you do a run, really good feeding of the joints
but also a lot of impact. Now, if you just rest for the days following that until your next run,
they may not recover as well as when you go do a bike ride, where you have loads of
movement without the impact, or you go swimming – again, loads of movement, no or low impact. So,
by using cross-training, you can one, up your fitness, but two, really help your joints recover
quicker and actually allow yourself to run better in the end. So consider cross-training on the days
that you don't run. Then, tip six is shoes. I have also fallen into this trap of not really liking to
throw shoes away if I feel they've still got a few miles in them. But to be honest, by the time that
you start wondering about them, they’re usually way too old. So make sure that you don't run with
shoes that are worn out. Now, rule of thumb, they usually say something like six to seven hundred
kilometres on a pair of shoes or about a year, maybe a year-and-a-half if you don't use them
that often. But if you feel that the spring is gone and they don't feel as they used to feel,
then replace them. There's no exact science to what shoes are best, but I usually tell people to
look for cushioned, supportive shoes if they've got knee issues. Stay away from minimalist shoes
because we want a bit more shock absorption. And then, what the research shows with shoe selection
is that actually, if you choose trainers according to what's comfortable for you when they're on your
feet and when you’re doing a run or walking with it, that's the best way to know what's
right for you. So maybe go to a shop where you can try them on and run on a treadmill, or some
of the shops here in Brighton actually allow you to run down the street and back. So definitely
try before you buy, because that's important that the shoes actually support your knees
and your whole body properly. Tip seven, we're looking at running terrain. And again, this is
an interesting one because honestly, you'd think that soft surfaces … Everybody always says, “Oh,
the treadmill is best”. But I've had patients come in and swear by different training terrains.
So, the one will be able to run on a treadmill, the next will say no, it kills them off, they've
got to be on flat tarmac, and the next will say no, can’t do tarmacs, got to be slightly uneven
offroad. So go and try different terrains and see what works best for you. But again, it's useful
to keep a diary about this type of thing, because you want to look at the 24-hour response from any
training session you do as well. Don't just think about how the session felt when you did it; look
at how you feel in the hours after that, and then also the next morning when you get
out of bed. Do your knees feel more stiff? Are they more sore? Anything like that? What I will say is,
downhills are usually a lot harder on knees, so what I tell my patients with knee pain is,
try to stay away from a lot of downhill running. Uphills are often quite okay; it's more to do with
the downhill. It's okay to do some downhills, but if they're really steep or there's a lot of them,
I would prefer you do a little bit of a walk down them. Yes. So go and play with it,
but it may be different for different people what terrain they prefer to run on. Now the eighth tip
is actually all of these together. It's get to know your knees. It's as simple as that. So,
it's quite easy … We all get this reaction when we've got an injury or we're being diagnosed
with something like arthritis to be in denial and just go, “I shall do what I always want to do and
absolutely not compromise on anything.” But I can tell you what, if you're gonna try and run at the
high volumes and heavy intensity and on the rough terrains as you used to run and not adapt to your
knees, then you may likely get to the point where they’re so painful that you can't run anymore. So
please, please, please, get them to calm down and then observe how they react to different
things you do, because that will tell you what it likes and what it doesn't like. And often,
if you've had a flare-up of knee pain, it doesn't mean that that little bit of running that you can
do at that point is all you're ever going to do. If you can get it to settle down, you can often
build it up slowly that you can get to a decent amount of running. So you've just got to really
play with it and not push it into where it's really, really uncomfortable. Now, this video actually
was inspired by somebody asking in the Group … She's got osteoarthritis in the knees, and she
likes to run on a treadmill, mainly for weight loss as well. And she was asking if there's any
hope that the discomfort and occasional pain that she was getting would go away as she loses more
weight and gets stronger. And absolutely! Because first of all, if you're carrying extra weight,
all you have to do to see the effect of that is carry some shopping bags up the stairs and see
how it feels if you've got five kilos extra on you to go upstairs; it really works on your knees. So,
the lighter you can be, the better, or the less stress through the knees. And then definitely, as
you get stronger, your muscles will absorb more of the force. But also remember, the longer you train
for and that you train sensibly, the healthier the cartilage in those knees will become,
the stronger the ligaments will become; everything becomes stronger and adapts to the exercise. So
definitely, there's a very good chance that you can be pain-free. The occasional pain would be an
indication that that's when you overcook things; that's likely when you've gone and done too many
things at the same time. So, it doesn't have to be the running alone that's the culprit when
your knees flare up; it may be that you've done a lot of strength training as well that day,
like things like squats and stuff, and really tired them out, and then did your normal run.
But because your legs were so tired, that run was actually harder than before, than when you
do it on fresh legs, and that's why your knees flared up. So make sure you track everything
in your training week that, if you're having a flare-up of knee pain and you think, “But I've
just done the same type of things”, just look at the spacing of them, think about that recovery,
think about, “Are my knees actually strong enough? Have I built them up enough to cope with
what I'm putting together”. And sometimes it's as easy as just kind of shuffling what you want to be
doing so that it's spaced out a bit more, that it calms the pain down. But if you're able to
train most of the time with just a bit of a niggle and then suddenly you get ups and downs and pain,
there's definitely something in those eight things that you're not paying attention to
that has caused it to flare up. And then also, don't just look towards your training;
don't forget the things that you do day-to-day, so things like kneeling in the garden, carrying boxes
up and down stairs. Have a think about anything like that, because that can often also cause an
increase in pain, because it all counts towards overload. And then lastly, remember I said that
joints don't have arteries going into them; they need movement to get fluid in and out. If you've
got a bit of arthritis or wear-and-tear in your knees, then sitting still for prolonged periods
and doing less movement than normal can actually cause your joints to hurt more, because you then have
decreased circulation; so, you're getting the chemicals, the low-level inflammation that's been
going on in the knees to actually accumulate. So it's a really good thing to keep moving, because
it actually do … it oils your joints for you. Great! So let me know if you've got any questions;
I'll keep an eye on the comments of the video. Also, if you're watching this on replay, feel free
to ask your questions or message me with them. And remember, if you need any help with an injury,
you can have a look at sports-injury-physio.com (hyphens between them), where you can consult me online
via video call for an assessment of your injury and a treatment program. Excellent! Take care!