by Comp Ortho | Mar 14, 2023 | Anti-aging, arthritis, Knee
New research offers up some good news for diehard marathon runners: You don’t necessarily have to give up running if you are experiencing hip or knee pain.
Contrary to widespread opinion, running marathons does not increase your risk for developing hip or knee osteoarthritis, the wear and tear form of the disease, a new study of seasoned Chicago marathoners showed.
“You don’t develop knee or hip osteoarthritis simply because of how fast you run or how many miles you put on your body,” said study author Dr. Matthew James Hartwell, an orthopedic surgery sports medicine fellow at the University of the University of California, San Francisco.
So, what does increase a runner’s risk for hip or knee arthritis?
Basically, the same things that up these risks in non-marathoners, Hartwell said. This includes advancing age, family history of hip or knee arthritis, and previous injuries or knee surgery, as well as higher body mass index (BMI), a measure of body fat based on height and weight.
For the study, more than 3,800 Chicago marathoners (mean age: nearly 44) answered questions about their running history, including number of marathons, number of years spent running, and average weekly mileage. They also answered questions about known risk factors for knee and hip arthritis.
Participants completed an average of 9.5 marathons, ran 27.9 miles per week, and had been running for around 15 years, the survey showed. Fully 36.4% of runners had knee or hip pain in the past year, and 7.3% received a diagnosis of hip and/or knee arthritis.
The bottom line? Running history wasn’t linked to the development of knee or hip arthritis on its own, the study showed.
Most runners planned to run another marathon, even though 24.2% said their doctor told them to run less or stop running altogether.
Health care providers should rethink this blanket advice, Hartwell said.
“Telling someone to stop running for sake of joint health is not the answer,” he said. “Even with small aches and pain, you don’t have to stop running.”
If you have persistent pain in your hips or knees, talk to your doctor and see if you need an X-ray to check for signs of arthritis, Hartwell recommended.
The new research is scheduled for presentation Thursday at a meeting of the American Academy of Orthopaedic Surgeons (AAOS), in Las Vegas. Studies presented at medical meetings are considered preliminary until published in a peer-reviewed journal.
The findings reinforce the advice that Dr. Matthew Matava gives his patients who run. He is a professor of orthopedic surgery and physical therapy at Washington University School of Medicine in St. Louis and an AAOS spokesman.
“A long-held myth is that cumulative running mileage causes osteoarthritis of the knee and hip, [but] distance running doesn’t cause osteoarthritis in an otherwise healthy person without prior joint injury or surgery,” said Matava, who was not involved with the study.
Running can make preexisting arthritis worse in folks who already have it to some degree, he noted.
Most causes of lower extremity joint pain in runners are due to overuse and follow the “rule of toos” — too many miles, too little rest and too fast, Matava said.
“Treat the pain symptomatically with ice for no more than 20 minutes at a time and use Tylenol or an over-the-counter, anti-inflammatory medication for a short period of time,” he said.
It may also be time to invest in a new pair of running shoes.
“Each pair of running shoes can withstand 350 to 500 miles of running before their outsole [rubber sole] loses its cushioning effect,” Matava said.
If a runner experiences swelling, catching or locking in the joint or doesn’t improve with conservative care, Matava said he or she should see an orthopedic sports medicine specialist to see what may be going on.
More information
The American Academy of Orthopaedic Surgeons provides more on knee osteoarthritis.
SOURCES: Matthew James Hartwell, MD, orthopedic surgery sports medicine fellow, University of California, San Francisco; Matthew Matava, MD, professor, orthopedic surgery, physical therapy, Washington University School of Medicine in St. Louis; presentation, American Academy of Orthopaedic Surgeons meeting, Las Vegas, March 9, 2023
Copyright ©2023 HealthDay. All rights reserved.
by Comp Ortho | Nov 3, 2022 | Anti-aging, arthritis
For many people, it is possible to slow the loss of joint cartilage as they age and avoid surgery to boot.
Certain steps can help with that, said one orthopedic surgeon from the Mayo Clinic in Rochester, Minn., who offered tips for maintaining joint health and also for managing pain in those who are already experiencing osteoarthritis.
Dr. Joaquin Sanchez-Sotelo said cartilage, that shock-absorbing, slippery tissue at the ends of bones, degenerates for various reasons.
Those reasons include being born with abnormally shaped bones or a tendency toward weaker cartilage. Obesity, overuse and injuries from accidents also can damage joints and cartilage.
“When cartilage degenerates, the body forms bone spurs,” Sanchez-Sotelo said. “This is a reaction to the main underlying problem, cartilage degeneration. Bone spurs can hit each other and become painful. Many patients get obsessed with bone spurs, but just taking them out won’t cure the problem, except in very rare circumstances.”
Osteoarthritis can cause symptoms such as achy and painful joints, stiffness and loss of movement. Sanchez-Sotelo often sees patients with osteoarthritis when they reach their 60s.
In the years before that, people can protect their joints by building strong muscle, which can take some of the pressure off joints. But those muscles should be built without intense exercise such as football or bodybuilding because those sports come with higher risks of developing arthritis.
“You have to exercise within reason,” Sanchez-Sotelo said. “Find that point where your muscles are healthy, flexible, strong and will protect the joints, but don’t overdo it.”
Sanchez-Sotelo also suggests maintaining a healthy weight. He’s not so sure about glucosamine and chondroitin, which are popular supplements for joint pain, because of a lack of evidence that they actually work.
People with arthritic pain can modify their activities. If the trouble is a knee or hip joint, try bicycling instead of running, the doctor suggested.
Use a cane to lighten the load on a sore hip, knee or ankle joint. A type of knee brace worn outside of clothes can shift the load to the healthier side of the knee joint, Sanchez-Sotelo advised.
Consider over-the-counter medications — including acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) — for persistent pain. These can lead to ulcers, kidney or heart issues, he warned. Avoid narcotics for osteoarthritis.
Someone whose pain persists could consider injections into the affected joint with cortisone or Toradol (ketorolac) to relieve pain. In addition, hyaluronic acid can help lubricate joints when injected, especially in the knee.
Although some choose injections with stem cells and platelet-rich plasma, referred to as “regenerative medicine,” they are experimental without firm evidence that they work, he said.
“In the past, older people just accepted joint pain,” Sanchez-Sotelo said in a Mayo Clinic news release. “Now people are living longer and want to remain active as they age. We are not all destined for joint replacement. There are some people in their 80s and 90s who have great joints.”
More information
The U.S. Centers for Disease Control and Prevention has more on osteoarthritis.
by Comp Ortho | Feb 8, 2022 | Anti-aging, arthritis, Knee, Wellness
Cortisone injections have gotten a bad rap in recent years as a treatment for arthritis pain, because steroids are known to damage cartilage and could potentially cause the joint to further deteriorate.
But a new study suggests that if used wisely, cortisone shots are as safe as another type of injection used to treat knee arthritis.
Occasional cortisone shots don’t appear to cause knees to deteriorate any faster than injections of hyaluronic acid, a substance injected to lubricate joints stiffened by arthritis, the researchers said.
“Knee replacement rates were, if anything, a little bit less in the group that got the cortisone injections,” said senior researcher Dr. David Felson, a professor of medicine and epidemiology at Boston University School of Medicine.
However, Felson added that the study only looked at people who’d gotten infrequent cortisone shots to their knee, and shouldn’t be interpreted as giving the green light to regular injections for years to come.
“What we know from the study that we can trust is that a few cortisone injections won’t really cause much trouble,” Felson said. “It’s conceivable that repeated injections every three months for years won’t cause any trouble, but you can’t say that.”
Steroids are known to be toxic to cartilage, the connective tissue that keeps your bones from rubbing against each other, explained Dr. Melissa Leber, director of the Emergency Department’s Division of Sports Medicine in the Icahn School of Medicine at Mount Sinai in New York City.
“If you use it enough, it will damage the cartilage,” said Leber, who had no role in the study.
A 2019 study reported a threefold increased risk of knee arthritis progression in people who’d received repeated cortisone injections, compared with people who’d never gotten the shot, Felson and his colleagues said in background notes.
Comparing two types of shots
However, no clinical trials had ever compared the two most common types of knee arthritis injections, cortisone jabs and hyaluronic acid shots, Felson said.
The two types of shots do different things in the joint, and are sometimes used in combination, Leber said.
Cortisone shots are anti-inflammatory and help reduce pain, while hyaluronic acid injections are like a gel that provides lubrication in the ailing joint.
“You’re injecting WD40 almost into the knee. That acts to allow smoother gliding in the joint,” Leber explained.
Unlike cortisone, hyaluronic acid gel isn’t harmful to cartilage.
The latest study looked at nearly 800 people with knee arthritis, of whom 4 out of 5 reported getting cortisone shots for their knee pain. The rest had reported receiving hyaluronic acid injections.
After seven years of follow-up, researchers found that those who got steroid injections had no greater cartilage loss than those treated with hyaluronic acid.
In fact, people who got cortisone shots were about 25% less likely to need a total knee replacement than those who got hyaluronic acid.
The message to knee arthritis patients regarding cortisone shots is simple, Felson said: “Don’t be scared.”
“There’s nothing bad that’s going to happen with one shot or even a few shots,” Felson said. “People should be reassured. They shouldn’t avoid getting an effective treatment.”
Wise use is crucial
The findings bolster the approach orthopedic specialists already take in handing out cortisone shots to treat knee arthritis, Leber said.
“If someone already has a ton of damage to the cartilage in their knee, a lot of arthritis, then we don’t worry as much about using a steroid to help with pain control because they already have a lot of arthritis in the knee,” Leber said. “Damaging it a touch more just to give them good pain control is a very minor thing. It’s not as risky.
“In someone who’s young, in their 20s to 40s, who has very little cartilage damage but has pain, we try to use it sparingly,” she continued. “Would you use them on occasion in a young person? Yes. That’s only as a one-time thing. You don’t want to use it repetitively.
“Steroid is bad for cartilage, but that doesn’t mean it’s bad for every patient,” Leber concluded. “It’s a case-by-case situation.”
Regardless, you wouldn’t expect any patient to receive frequent cortisone injections, whatever their condition, added Dr. Jeffrey Schildhorn, an orthopedic surgeon with Lenox Hill Hospital in New York City.
“If you give someone a shot in January and they come back in April saying they want another one, and they come back in August and want another one, how well are they working?” said Schildhorn, who was not part of the study. “They’re not working, if you’re only getting two or three months of relief.”
The new study was published recently in the journal Arthritis and Rheumatology.
More information
The Cleveland Clinic has more about knee arthritis.
SOURCES: David Felson, MD, professor, medicine and epidemiology, Boston University; Melissa Leber, MD, director, Emergency Department’s Division of Sports Medicine, Icahn School of Medicine at Mount Sinai, New York City; Jeffrey Schildhorn, MD, orthopedic surgeon, Lenox Hill Hospital, New York City; Arthritis and Rheumatology, Dec. 1, 2021
Copyright ©2022 HealthDay. All rights reserved.
by Comp Ortho | Nov 16, 2021 | Anti-aging, arthritis, Exercise, Knee
Dr. Kim Huffman, an avid runner, gets a fair amount of guff from friends about the impact that her favorite exercise has on her body.
“People all the time tell me, ‘Oh, you wait until you’re 60. Your knees are going to hate you for it’,” Huffman said. “And I’m like, ‘That’s ridiculous’.”
Next time the topic comes up, Huffman is well-armed: An extensive British analysis of prior study data has found no link between a person’s amount of exercise and their risk for knee arthritis.
The research team combined the results of six clinical trials conducted at different places around the globe, creating a pool of more than 5,000 people who were followed for 5 to 12 years for signs of knee arthritis.
In each clinical trial, researchers tracked participants’ daily activities and estimated the amount of energy they expended in physical exertion.
Neither the amount of energy burned during exercise nor the amount of time spent in physical activity had anything to do with knee pain or arthritis symptoms, the researchers concluded.
“This helps dispel a myth that I’ve been trying to dispel for quite a while,” said Huffman, an associate professor at the Duke University Medical Center’s division of rheumatology.
“If you add up the amounts of activity that people do and also the duration of activity, neither of those is associated with knee arthritis,” added Huffman, who wasn’t involved in the analysis.
Dr. Bert Mandelbaum is chief medical officer of the Los Angeles Galaxy soccer club and team physician for the U.S. Soccer Men’s National Team.
He agreed the study “further corroborates the fact that levels of exercise in one’s personal life do not increase the risk, the onset or progression of osteoarthritis.”
So where did this misconception come from?
Huffman thinks it’s because people mistake exercise-related injuries for the effect that exercise itself has on your joints.
“Right now, the clear risks for knee arthritis are genetics, injuries and female sex,” Huffman said. “People who exercise more may be more likely to injure their knee. That’s where I think the myth comes from.”
In fact, exercise can help ward off knee arthritis in several ways, Huffman said:
Flexing and extending the knee during exercise promotes the diffusion of fluid into the joint, promoting better nutrition.
An elevated metabolism created by exercise helps control inflammation in the knee joint.
Weight loss reduces the amount of load placed on the knee.
Exercise strengthens the muscles surrounding the knee, stabilizing it and reducing the risk of injury.
“I don’t think we’re finding that simple overuse or using your joint is a problem. It’s more an association with injuries and perhaps in the setting of obesity or high genetic risk,” Huffman said.
Your best bet is to choose an exercise that poses the least risk of a knee injury, Huffman said.
“If you want to go snow skiing, I don’t think that’s a huge problem but you’re probably going to be more likely to injure yourself downhill skiing than, say, walking in your neighborhood or training for a marathon,” Huffman said. “It’s not soccer or football or skiing itself. It’s just the risk for injury during those activities.”
On the other hand, exercise provides benefits that go far beyond healthy joints, said Mandelbaum, co-chair of medical affairs at Cedars-Sinai Kerlan-Jobe Institute at Santa Monica, Calif. He played no role in the research review.
“Physical activity is essential to optimize both physical and mental health and plays a central role in facilitating life’s quality and quantity,” Mandelbaum said. “The list of benefits includes decreased anxiety, better mood, decreased levels of coronary disease, hypertension, diabetes and obesity, and therefore a longer life.”
The analysis was published recently in the journal Arthritis and Rheumatology.
More information
The Arthritis Foundation has more about knee osteoarthritis.
SOURCES: Kim Huffman, MD, PhD, associate professor, Duke University Medical Center, division of rheumatology; Bert Mandelbaum, MD, co-chair, medical affairs, Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, Calif.; Arthritis and Rheumatology, Nov. 3, 2021
