OA AND RUNNING

a previous knee injury, partial medial meniscectomy with a mild to moderate varus deformity who has not exercised for many years. He has gained some kilos and decides that it is time to exercise again. He buys himself some running shoes and starts training. Things go well but shortly afterwards he notices some pain with running. But being a tough guy, he continues running until he has pain at rest and needs to stop exercising. Constant overload causes microdamage to the articular cartilage, the pre- cursor of OA. No doubt he will experience a progression of degen- eration changes.

On the other hand, gentle continuous exercise, even long-distance running, maintaining a healthy body weight, proper rehabilitation after injuries will, most likely, not overload joints. In fact, muscle mass and cardiovascular health will be maintained and bone mass index will remain within normal ranges. This is certainly support- ed by biomechanical and radiological research especially from the Munich group (4,6,7). Too fast, too fat, too tough, too soon will almost certainly cause osteoarthritis with or without risk factors. But steady, slowly built up, regular exercise, adequate rest and timely recovery from injury will be healthy for your joints. In this case scenario, risk factors will increase the risk of osteoarthritis unless you adjust the level of activity within the individual enve- lope of function.

THE AUTHORS Associate Professor Erik Hohman is an orthopaedic surgeon who trained as an undergraduate in Germany and as a postgraduate at the University of the Witwatersrand, Johannesburg, South Africa. He completed a Fellowship in Orthopaedic Sports Medicine at the Department of Orthopaedic Sports Medicine at the University of Technology, Munich, Germany and since 2002 has been staff orthopaedic surgeon at Rockhampton Hospital and appointed as a senior lecturer at the University of Queensland, Australia. In 2003 Erik helped co-found the Musculoskeletal Research Unit at Central Queensland University and was appointed an associate professor.

Dr Adam Bryant, BHMSc (Hon), is a lecturer within the School of Physiotherapy at the University of Melbourne, Australia having com- plted his PhD in the area of neuromuscular adaptations following ACL injury and reconstruction. His research has examined changes in the mechanical properties of skeletal muscle across the menstru- al cycle. and he is currently working on the development of footwear to compensate for the changes in musculotendinous stiffness across the menstrual cycle. Adam has won a number of major awards including Best Young Investigator (2004 Australian Sports Medicine Conference) and the 2005 Victorian Minister for Sport and Recreation, Research Excellence Award.

References 1. Stephenson J, Bauman A, Armstrong T et al. The costs of illness attrib- utable to physical inactivity. Canberra: Commonwealth Department of Health and Aged Care 2000 2. Paty JG Jr. Running injuries. Current Opinions in Rheumatology 1994;6(2):203-209 3. McKean KA, Manson NA, Stanish WD. Musculoskeletal injury in the mas- ters runners. Clinical Sports Medicine 2006;16(2):149-154 4. Hohmann E, Woertler K, Imhoff A. Osteoarthritis from long distance running ?. Sportverletz Sportsschaden (German) 2005;19:89-93 5. Burr DB, Forwood MR, Fyhrie DP, Martin RB, Schaffler MB, Turner CH. Bone microdamage and skeletal fragility in osteoporotic and stress frac- tures: Journal of Bone and Mineral Research 1997;12:6-15

www.sportex.net

6. Hohmann E, Woertler K et al. Imaging of the hip and knee after marathon running. American Journal of Sports Medicine 2004;32:55- 59 7. Hohmann E, Tittel S, et al. Volume changes of articular cartilage and meniscus introduced by distance running. Proceedings of the 2005 Australian Conference of Science and Medicine in Sport 8. Krampla W, Mayrhofer R, Malcher J, Kristen KH, Urban M, Hruby W. MR imaging of the knee in marathon runners before and after competition. Skeletal Radiology 2001;30(2):72-76 9. Shellock FG, Mink JH. Knees of trained long-distance runners: MR imag- ing before and after competition. Radiology 1991;179(3):635-637 10. Kersting UG, Stubendorff JJ, Schmidt MC, Bruggemann GP. Changes in knee volume cartilage and serum COMP concentration after running exer- cise. Osteoarthritis Cartilage. 2005;13(10):925-934 11. Kujala UM, Kaprio J, Sarna S. Osteoarthritis of weight bearing joints of lower limbs in former elite male athletes. British Medical Journal 1994;22:231-234 12. Spector TD, Harris PA, Hart DJ, Cicuttini FM, et al. Risk of osteoarthri- tis associated with long-term weight-bearing sports: a radiological survey of the hips and knees in female ex-athletes and population controls. Arthritis and Rheumatism 1996;39(6):988-995 13. Drawer S, Fuller CW. Propensity for osteoarthritis and lower limb joint pain in retired professional soccer players. British Journal of Sports Medicine 2001;35(6):402-408 14. Marti B, Knobloch M, Tschopp A, Jucker A, Howald H. Is excessive run- ning predictive of degenerate hip disease? Controlled study of former elite athletes. British Medical Journal 1989;Jul 8;299(6691):91-93 15. Sarna S, Kaprio J, Kujala UM, Koskenvuo M. Health status of former elite athletes. The Finnish experience. Aging 1997;9(1-2):35-41 16. Deacon A, Bennell K et al. Osteoarthritis of the knee in retired, elite Australian rules footballers. Medical Journal of Australia 1997;166(4):187-190 17. Konradsen L, Hansen EM et al. Long distance running and osteoarthrtis. American Journal of Sports Medicine 1990;18(4):379- 381 18. Sohn RS, Micheli LJ. The effect of running on the pathogenesis of osteoarthritis of the hips and knees. Clinics in Orthopedics 1985;198:106-109 19. Panush RS, Schmidt C, Caldwell JR, Edwards NL, et al. Is running asso- ciated with degenerative joint disease? Journal of the American Medical Association 1986;(9):1152-1154 20. Lane NE, Oehlert JW et al. The relationship of running to osteoarthri- tis of the knee and hip and bone mineral density of the lumbar spine: a 9 year longitudinal study. Journal of Rheumatology 1998;25(2):334-341 21. Felson DT, Zhang Y, Hannan MT, Naimark A, et. al. Risk factors for inci- dent radiographic knee osteoarthritis in the elderly: the Framingham study. Arthritis and Rheumatism 1997;40(4):728-733 22. Gelber AC, Hochberg MC, Mead LA, Wang NY, et. al. Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Annals of Internal Medicine 2000;5:321-328 23. Davis MA, Ettinger WH, Neuhaus JM, Cho SA, Hauck WW. The associa- tion of knee injury and obesity with unilateral and bilateral osteoarthritis of the knee. American Journal of Epidemiology 1989;130(2):278-288 24. Wolcott M. Osteotomies around the knee for the young athlete with osteoarthritis. Clinical Sports Medicine 2005;24(1):153-161 25. Roos EM. Joint injury causes knee osteoarthritis in young adults. Current Opinions in Rheumatology 2005;17(2):195-200 26. Sharma L, Song J, Felson DT, Cahue S, et. al. The role of knee align- ment in disease progression and functional decline in knee osteoarthritis. Journal of the American Medical Association 2001;286(7):792 27. Manninen P, Riihimaki H. Heliovaara M, Makela P. Overweight, gender and osteoarthritis. International Journal of Obesity Related Metabolic Disorders 1996;20(6):595-597 28. Spector TD, Hart DJ, Doyle DV. Incidence and progression of osteoarthritis with unilateral knee disease in the general population: the effect of obesity. Annals of Rheumatic Disease 1994;53(9):565-568 29. Holmberg S, Thelin A, Thelin N. Knee osteoarthritis and body mass index: a population based case-control study. Scandinavian Journal of Rheumatology 2005;34(1):59-64 30. Sturmer T, Gunther KP, Brenner H. Obesity, overweight and patterns of osteoarthritis: the ULM Osteoarthritis Study. Journal of Clinical Epidemiology 2000;53(3):307-313

13