Osteoarthritis : a normal process of aging

Osteoarthritis is commonly considered a normal part of the aging process due to several reasons. Why? And why are some of us more prone to this process?

• Firstly, the prevalence of osteoarthritis increases with age. As we grow older, the wear and tear on our joints accumulate over time, leading to the degeneration of the cartilage that cushions the joints. This gradual breakdown is a natural consequence of the stresses and strains our bodies experience throughout a lifetime of movement. Put simply, the thinning and wearing of the cartilage is a sign of a well used joint, and not much else. (Like my big toe joint from flexing to it get to the ground to correct my Pilates students!)

• Secondly, the molecular and cellular mechanisms involved in osteoarthritis development align with the aging process. The ability of cartilage to repair itself diminishes with age, as the production of new cartilage cells slows down, and the existing cells become less efficient at maintaining the structural integrity of the joint.

• Other factors such as genetics, obesity, joint injuries, and certain occupations can contribute to the development of osteoarthritis. These factors tend to accumulate over time, making the likelihood of osteoarthritis higher as individuals age.

If osteoarthritis is a normal part of aging, why are we all affected differently?

While osteoarthritis is considered a normal part of aging, it does not mean that everyone will experience it or that its impact cannot be managed. It comes down to our lifestyles and our genes. Lifestyle modifications, exercise, weight management, and appropriate medical interventions can help alleviate symptoms and slow down the progression of the disease.

Did you know, that according to Sports Medicine Australia* (SMA), up to 70% of all runners sustain some kind of running 'niggle' over any 12 month period of time? Not surprisingly, most occur in the lower body. 

• 42% are to the knee
• 17% to the foot and ankle
• 13% to the lower leg, such as the calf and shin
• 11% to the hip and pelvis.

Typically, these injuries occur due to training errors, such as increasing the load, the frequency, or the speed too quickly. In addition,  an inappropriate or lack of any cross training for strength and conditioning means our bodies start to break down due to the repetitive nature of the running action. This brings about tissue overuse injuries, and if you're a runner, I bet you have been there, just like me with my Achilles tendinopathy!

The most common overuse injury noted in runners, is 'runner's knee' - also called patello-femoral pain (PFP). This is pain felt anywhere over or around the knee cap or patella. Iliotibial band friction ( pain and ache at the outer knee), plantar fasciitis (like standing on glass under the heel), tibial stress syndrome ( feels like shin stress fractures, but is not) and Achilles tendon issues also force many runners to the sidelines. 

But..these niggles should never be the end of a running career for those who love getting out there on the roads, parks and trails. 

Physios who run (like me!) are excellent at being your 'body coach.' For all injuries, there is a means to keep you exercising with reduced loads. This allows for any inflamed tissues to settle, but to also become stronger and adapt throughout the healing process to prevent re-injury once you return to your beloved running. What's involved?

• Start by assessing the whole person. Injuries and overuse in the knee and lower leg can often stem from the trunk, the pelvis or the hip.There is much evidence out there^ highlighting the important role of hip awareness and strengthening in the prevention of ongoing runner's knee issues. 

• Use all treatment options to help settle the inflamed body part. Massage and other soft tissue techniques, alignment techniques, sports taping, dry needling to name a few.

• Establish a graduated training program as soon as possible. This can happen even in the first weeks of an injury. This may initially involve cross training, cycling or swimming, with a gradual re-introduction of walk/run intervals after healing is well underway ( think 4 weeks). 

• Tissue loading and strength adaptation is essential. How can we make your tissues stronger and better equipped to deal with your running loads? After all,why did you injure in the first place? This rehab is the best part! Plyometrics and running specific dynamic loading, added to proximal hip strengthening will get you back and with decreased risk of re-occurence.

 Catch any running niggle early. As a runner, you know when things don't feel quite right. Book in to see Katrina at The Fix Program.

^References:

^{*https://sma.org.au/resources-advice/running/}

^{^Thomson C, Krouwel O, Kuisma R, Hebron C. The outcome of hip excercises in patellofemoralpain: a systemic review(2016)}

‘Shin splints’ pain is a common cry from many a runner, from your novice to your elite. It is not so much a diagnosis, but rather a general term or the region of the pain. Causes can vary across all tissues in the lower leg - the muscles ( medial aspect), the bone (tibia), the blood vessels (compartment syndrome) or nerves.

• Muscular causes.

This is the most common and is often due to the 'too much, too soon' effect of training, or an imbalance caused by weakness and tightness of the lower leg. The tibialis posterior muscle running down the length and attaching to the back of your shin/tibia can become inflamed due to over loading, causing a pulling on the bone. The tibial bone can feel bruised, and the muscle will feel sorest typically at the lower half of your shin. This pain, initially sore when you begin a run, will usually get better with distance. 

What's really going on? Poor biomechanics is the culprit here, whether it be from your foot over-pronation, ankle and calf stiffness, to unsupportive footwear, or an internal torsion of your upper leg due to hip imbalanced weakness. The right targeted and individualised progfam of strength and mobility to correct ans control these forces will get you back on track.

• Bony causes.

Bone bruising and stress fractures scare the daylights out of most runners. This occurs when the level of stress being placed through them is greater than the rate at which the bone cells adapt and strengthen. An area of bone weakness can occur and become microscopic cracks if training were to continue. This pain is exquisite and very focal. A stretch of 1-2cm of the tibia or shin would be extremely tender. This pain gets worse with activity and can even ache at rest and through the night.  

Whats' really going on? As with the muscular issues, biomechanics and over training increase the risk of stress fractures. Ignoring the warning signs such as tender bone, aches at night can lead to a stress fracture. Running surfaces such as running on concrete, running on a camber, or running around a track can also over load the tibia. Unfortunately, up to 12 weeks rest from running, a strength and mobility program to target imbalances and a graduated return via the Nordic anti-g trainer will see a runner put in the hard yards to get back.

• Nerve and vascular causes.

Irritated and compressed nerves and blood engorgement issues i the calf and lower leg can also cause shin pain. These should be excluded if the presentation is not typical for the more common muscular and bone causes. Further testing, investigations and scans are often warranted here, and your amazing physio would be able to advise you if they feel this is necessary after assessing you.   

With any of your running niggles, whether it be your back, pelvis, hip, knee or lower leg, insist your physio assesses you thoroughly. A holistic assessment of your posture, strength, running biomechanics and training plans will help you to get back to what you love and with reduced risk of re-injury.