On my continuing mission to correct Physiotherapy Myths I’ve gone for one of the biggest out there today. It’s either a myth or a very convenient excuse! In this article we’ll translate relevant research into normal English so you can understand that the opposite is in fact true. Running is good for your bones and joints!
Running is, after all, what we’re designed to do. Unless Sainsbury’s is about to close admittedly we don’t have run to chase our dinner anymore. But surely we should be able to do a trot every now and then without fear of future crippling injury? It wouldn’t speak very well for evolution if otherwise.
Wear And Tear On Joints
So the classic scenario is this. You get pain in or around a joint. You go to see the doctor. They tell you it’s wear and tear on the cartilage and there’s nothing they can do. You stop running for the rest of your life.
If you’re very lucky you may get an x-ray or even an MRI scan which confirms there is wear and tear on the cartilage and that it is the most likely the cause of your pain. What if we told you that most of the more recent literature (and we’re talking last 20 years here) suggests this isn’t the case? How about the idea that cartilage is not the cause of the pain. This means the amount of wear and tear on a joint is a lot less significant than previously thought. I believe wear and tear on cartilage is just a normal part of ageing and shouldn’t necessarily be painful.
What Does Running Do To Cartilage?
Of course another base assumption here is that running wears out your cartilage. Now I have to admit, briefly taking off my Sports Therapy hat, I can see how this would seem reasonable. Or my new favourite expression: this would be “biologically plausible”.
What if I told you this was not the case for all but the elite athlete and the morbidly obese? Again modern research suggests that running is indeed good for cartilage regeneration rather than bad. In fact this fantastic piece of research here suggests that physical activity increases cartilage volume and decreases the number of cartilage defects.
This is down to a fabulous concept called meachanotransduction. I try to drop this word into as many conversations as possible as it makes me sound considerably more intelligent than I am! This is how physical forces are translated into biomechanical and biological responses. Simply put, doing something stimulates the right response in the tissues to be able to do more of it. In the case above if you’re causing more impact within the joint the body lays down more cartilage as part of it’s adaptation.
The same is true for osteoporosis. Many years ago advice would have been not to run. Whereas now it is recommended to build up to running by gradually increasing the intensity and amount of impact based exercise you do. This is also why cycling are at increased risk of osteoporosis as compared to runners.
Is It Really Cartilage That Causes Pain?
If we look to our knowledge of physiology pure theory would suggest not. In the physiotherapy world we talk about nociceptors as specialised sensory receptors that relay signals back to the brain giving the sensation of pain.
They can be stimulated by thermal, mechanical or chemical means. But if we have a look at this article here it states that there are no nociceptors in cartilage. Therefore can it be the cartilage that is causing the pain?
Now if could reasonably be that perhaps the cartilage wear and tear may have an impact in triggering a chemical response to nociceptors surrounding the joint. But there’s lots more ‘stuff’ in the biological soup around the joint that may well be more culpable for the pain that we feel. Let’s look at this ‘stuff’ is and how we can affect it in a positive way.
So What Does Cause The Joint Pain?
The previously mentioned article also states that nociceptors lie in the joint capsules (the bit that keeps the lubrication in the joints), ligaments, bone, periosteum (the sheath around the bone), fat and around the blood vessels serving the joint. Not the cartilage itself.
This would seems to tie in nicely with this catchy title for a paper: Yet More Evidence That Osteoarthritis Is Not A Cartilage Disease. This suggests that the ligaments around the joint are a more effective predictor of the pain people feel in or around their joints.
What Can I Do About It?
All of the above makes sense from our day to day observations at our clinics. It is quite a common occurrence for people who have confirmed osteoarthritis to become pain free after a course of treatment.
This is due to the fact that ligaments, tendons, muscles, nerves and fascia are entirely continuous with each other. In real terms that means that if we release the right muscle which is putting excess strain on the ligaments of the joint that is feeling the pain then symptoms will reduce.
In the early part of my career I didn’t fully understand what was happening. I just knew that it was. Now we have some science to back up what we regularly see. At least we think that is what’s happening! I’m sure as research progresses we’ll have to rethink our beliefs in a few years time… again.
So of course you’re best bet is to come and see us at lovely Brighton Sports Therapy so we can identify which other physiological features are contributing to your pain. It usually works a treat. We’ve even seen significant improvement on people who have grade 4 osteoarthritis. This is the bone on bone (in lay speak) form of osteoarthritis and the one most likely to end in surgery.
And if you don’t want to come and see us? Lose some weight! No I’m not being abusive. This is the conclusion of this Australian research. I guess it makes sense too. We look to reduce load on the the joint by optimising bio-mechiancs. This approach just literally will reduce load!
Our Beliefs About Joints
Hopefully reading this today will have changed your mind a little bit about wear and tear. Maybe even make you less fearful of developing arthritis in later life as result of running or any other impact sport. When there is less fear we feel less pain and move more efficiently. For the competitive runners amongst you: more efficient means faster!
What I don’t want this article to do is appeal to all of those unhinged runners out there! The ones that just smash their bodies into the ground until they can do no more. It may not be the cartilage that is causing your pain. But there are plenty of other structures that will do!
The best advice, and I know I’m biased, is to take action to treat any niggle, pain as you go. Make your body more efficient and enable to absorb the forces as best it can. Is anyone ever going to be the perfect bio-mechanical machine. No. But we can always be better than we are today.
If you’re not sure whether you should be running or not or are simply in too much pain to continue please gives us a call on 01273 921831 or mail to info@BrightonSportsTherapy.co.uk and we’ll be happy to help.
If you enjoyed this article you may also enjoy are previous post: Does Arthritis Really Exist?