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Navigating Knee Osteoarthritis: A Physio-Centric Pathway to Strength and Mobility Before Surgery

Navigating Knee Osteoarthritis: A Physio-Centric Pathway to Strength and Mobility Before Surgery

by | Apr 22, 2025 | Knee, Reformer Pilates

Knee osteoarthritis (OA) is one of the most common causes of chronic pain and mobility restriction in Australians over 45. Whether you’re a weekend warrior, an active grandparent, or someone just trying to keep up with the daily demands of life, OA can slowly erode your confidence in movement — long before X-rays show the full extent of joint degeneration.

At Praxis Physiotherapy, we take a forward-thinking, collaborative approach to managing knee OA. Working closely with renowned orthopaedic knee surgeon Dr. Kelly Macgroarty and drawing from our extensive experience with high-performance athletes and everyday patients alike, we believe the journey toward better knees starts well before surgery — and, for many, might even avoid or delay it altogether.

What is Knee Osteoarthritis?

Knee OA is a progressive condition involving the breakdown of joint cartilage and underlying bone, typically leading to:

  • Pain during or after activity

  • Morning stiffness or stiffness after rest

  • Swelling and inflammation

  • Loss of flexibility and range of motion

  • Difficulty with stairs, kneeling, or prolonged standing

Radiographic OA becomes more common with age, but symptoms often precede visible changes on X-ray. Up to 30% of people over 65 show radiographic OA, yet many remain functionally capable — highlighting the importance of early, movement-based interventions (Naja et al., 2021).

Why a Physio-Led Model Before Knee Replacement?

Surgery is not the first or only option. A large systematic review of 19 randomized controlled trials found that non-surgical interventions such as physiotherapy, platelet-rich plasma (PRP), and structured exercise were associated with meaningful improvements in pain and function over 12 months (Naja et al., 2021). Physiotherapy, in particular, is consistently supported by international guidelines as a first-line treatment (Fransen et al., 2015; Bennell et al., 2014).

Traditionally, knee OA rehab has emphasised quadriceps strengthening — and for good reason, as quadriceps weakness is strongly linked to OA-related pain and disability. However, more recent research suggests that focusing exclusively on the quadriceps may be too narrow. Programs that include hip (gluteal), hamstring, and calf muscle strengthening are now shown to be superior in improving functional outcomes, especially for activities like walking, stair climbing, and maintaining balance (Bennell et al., 2014). This broader approach addresses the full kinetic chain around the knee, optimises joint load distribution, and better supports long-term movement efficiency.

At Praxis, our physios:

  • Assess gait, strength, joint mobility, and function

  • Design individualised exercise programs targeting quadriceps, glutes, and calf strength

  • Implement manual therapy techniques to restore joint mobility

  • Provide pain education, load management advice, and real-world strategies

  • Monitor progress and adjust programs over time

This proactive approach not only builds resilience in the knee but also prepares the joint and surrounding muscles should surgery eventually be required.

Booster Sessions: Keeping Gains, Lowering Costs

An often-overlooked strategy is the use of booster physiotherapy sessions — structured follow-ups after an initial rehab program. Research by Bove et al. (2018) showed that exercise programs with booster sessions at 3, 6, and 12 months were not only more clinically effective but also more cost-effective over a two-year period compared to standard physiotherapy care.

At Praxis, we now embed these booster sessions into long-term OA management. They help patients:

  • Maintain strength and conditioning gains

  • Stay accountable with home programs

  • Troubleshoot new symptoms early

  • Reduce future health care costs and medication reliance

What About Injections and Other Adjuncts?

We often collaborate with GPs and orthopaedic specialists to incorporate adjunct treatments where the evidence supports it:

  • Platelet-rich plasma (PRP) injections showed significant long-term benefit for pain and function, with improvements of ~20 points on the WOMAC index. PRP ranked just behind stem cells as the most effective non-surgical treatment in a large 2021 network meta-analysis (Naja et al., 2021).

  • Hyaluronic acid (HA) injections have shown mixed results. A review of overlapping meta-analyses concluded that HA is likely safe and modestly effective, especially in early-stage OA, although guideline recommendations remain inconsistent (Xing et al., 2016).

Ultimately, our philosophy is to build strong knees first, and complement physiotherapy with interventions like PRP or HA only when clinically indicated and appropriately timed.

Surgical Collaboration 

In more advanced cases, where conservative management fails, we work closely with Dr. Kelly Macgroarty, one of Queensland’s leading knee surgeons. Our relationship allows:

  • Streamlined triage for surgical consultation

  • Shared prehabilitation planning to improve surgical outcomes

  • Integrated post-operative rehab, using in-clinic gym equipment and reformer Pilates to accelerate return to function

This continuity ensures you’re never left navigating knee OA alone — whether your journey stays entirely within physio care or progresses to surgical management.

Why Praxis Physiotherapy?

At Praxis, we’ve built our care model around best-practice guidelines, decades of elite sport and private practice experience, and a shared goal of keeping our patients active, independent, and thriving.

Our Teneriffe, Carseldine and Buranda clinics offer:

  • In-clinic rehab gyms

  • Reformer Pilates for joint-friendly loading

  • Real-time strength testing technology

  • Physios with elite sports and post-surgical rehab experience

Take the First Step

If you or someone you love has been told you’re “heading for a knee replacement,” don’t wait. There is so much we can do to reduce pain, improve function, and build confidence in your knees — surgery or not.

Book an appointment today at one of our Brisbane clinics and start your journey to stronger, more resilient knees.

Interested in ACL specific rehab? Check our guide on return to sport after ACL injury

Until next time, Praxis What You Preach!

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

References

  • Bove, A. M., Smith, K. J., Bise, C. G., et al. (2018). Exercise, manual therapy, and booster sessions in knee osteoarthritis: cost-effectiveness analysis from a multicenter randomized controlled trial. Physical Therapy, 98(1), 16–27.

  • Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee: a Cochrane systematic review. British Journal of Sports Medicine, 49(24), 1554–1557.

  • Bennell, K. L., Dobson, F., & Hinman, R. S. (2014). Exercise in osteoarthritis: moving from prescription to adherence. Best Practice & Research Clinical Rheumatology, 28(1), 93–117.

  • Naja, M., Fernandez De Grado, G., Favreau, H., et al. (2021). Comparative effectiveness of non-surgical interventions in the treatment of patients with knee osteoarthritis: a PRISMA-compliant systematic review and network meta-analysis. Medicine, 100(49), 

  • Xing, D., Wang, B., Liu, Q., et al. (2016). Intra-articular hyaluronic acid in treating knee osteoarthritis: a PRISMA-compliant systematic review of overlapping meta-analyses. Scientific Reports, 6, 32790.

ACL Rehabilitation: The Role of Physiotherapy in Returning to Life, Activity, and Sport

ACL Rehabilitation: The Role of Physiotherapy in Returning to Life, Activity, and Sport

by | Apr 22, 2025 | ACL, Gym and Strength, Knee, Return to Sport, Running Injuries

On today’s Praxis what you Preach, we cover a very common injury here in Australia – the Anterior Cruciate ligament (ACL) injury. At Praxis Physiotherapy, we understand that recovering from ACL reconstruction is more than just healing a knee — it’s about restoring confidence, movement, and returning to the activities and lifestyle that matter most to each person. Physiotherapists are uniquely placed to guide this journey from surgery through to return to everyday function, recreation, and sport.

What is an ACL Rupture?

The ACL is one of the key stabilising ligaments of the knee, crucial for controlling rotation and forward movement of the tibia. An ACL rupture typically occurs during sudden changes in direction, pivoting, or awkward landings — common in sports like AFL, soccer, basketball, and netball. It most often affects young, active individuals, particularly females, due to biomechanical and hormonal factors. While not all ACL injuries require surgery, those with complete ruptures who wish to return to cutting or pivoting sports usually undergo ACL reconstruction. Regardless of the surgical decision, structured rehabilitation guided by a physiotherapist is essential for a successful recovery and long-term knee health.

The Importance of Physiotherapy in ACL Rehab

Research shows that while around 80% of individuals return to some form of sport after ACL reconstruction, only 65% return to their preinjury level and just 55% to competitive levels (Andrade et al. 2020). Physiotherapy plays a vital role in improving these outcomes by guiding progressive rehabilitation and using structured criteria-based progressions.

Physiotherapy-led rehabilitation should begin early, with emphasis on knee mobilisation, weight-bearing as tolerated, and initiation of neuromuscular training (Andrade et al. 2020). The BJSM systematic review of clinical guidelines for ACL rehab supports early kinetic chain exercises (both open and closed), strength training, cryotherapy, and neuromuscular stimulation when indicated (Andrade et al. 2020).

From Healing to Performance: A Continuum

Recovery after ACL surgery should follow a continuum from impairment-based care to performance restoration. This includes early pain and swelling control, progressive strength and range of motion restoration, motor control retraining, and sport-specific preparation. At Praxis, we follow a phase-based rehabilitation model tailored to individual needs. These needs may include the type of surgical graft used, concurrent injury (e.g meniscus / MCL), the operating surgeon’s post-op protocols, the patient’s goals, sport-specific demands, timelines for return to competition, and previous levels of function — all of which require thoughtful and collaborative clinical decision-making.

Unfortunately, studies show that many patients are discharged before meeting strength or performance benchmarks — particularly in strength-focused exercises like the split squat, squat, or deadlift, which play a vital role in ACL rehab progression. For example, performing around 22 single-leg sit-to-stands is one such late-stage benchmark that reflects adequate quadriceps strength and control before return to sport (Welling et al 2018). Nichols et al. (2021) found that most published rehabilitation protocols emphasize endurance and hypertrophy without progressing to the strength or power needed to reduce reinjury risk. This underlines the need for physiotherapists to include high-intensity, sports specific strength training and late-stage performance metrics as patients near return to sport.

Addressing Muscle Atrophy and Weakness

Quadriceps atrophy remains a key barrier to recovery post-ACL reconstruction. Evidence supports adjunct interventions such as neuromuscular electrical stimulation and blood flow restriction (BFR) training to combat muscle loss, particularly in the early post-operative period (Charles et al. 2020). BFR combined with low-load resistance exercise has been shown to reduce muscle wasting and promote strength gains when higher loads are contraindicated — we explore this more in our Blood Flow Restriction Training blog. We use this frequently at Praxis Physiotherapy in both reformer pilates and early gym based settings. 

The Role of the Physio: More Than Just Exercise

Our job as physiotherapists goes beyond prescribing exercises. We support patients through the emotional and motivational challenges of recovery, address fear of re-injury, and help them develop the confidence to return to sport or physically demanding jobs. We tailor plans based on functional goals, sport-specific needs, and personal circumstances.

At Praxis, this also means working closely with coaches, GPs, surgeons, and families to ensure clear communication and aligned expectations. For sporting patients, this might include on-field rehab or comprehensive return-to-play assessments in collaboration with clubs and teams.

A Collaborative, High-Performance Rehabilitation Environment

At Praxis Physiotherapy, we bring high-performance rehab principles to all patients — not just elite athletes. Our team has provided physiotherapy services to the Aspley Hornets AFL Club since 2014, giving us deep insight into the physical and mental demands of competitive sport. We apply this same standard of care to everyday athletes, weekend warriors, and anyone seeking to return to an active lifestyle.

We also work closely with orthopaedic knee and shoulder surgeon Dr. Kelly Macgroarty, including in-room triage consulting, ensuring a seamlessly integrated, evidence-informed rehabilitation pathway. This collaboration allows us to align surgical timelines, post-op considerations, and physiotherapy progressions — from day one to return to sport.

Our clinical culture is shaped by exposure to elite-level sports environments, including AFL, representative athletics, and professional national cricket programs. But rather than highlight individual accolades, we’re most proud of the high clinical standards and systems-based approach that ensure our entire team delivers the same quality of care — no matter who walks through the door.

Each of our Brisbane based clinics includes access to gym facilities and reformer Pilates equipment, allowing for real-world, function-driven exercise. These resources support patients to not only recover structurally but also return to high levels of strength, coordination, and performance in line with the latest evidence-based guidelines.

A Message to Our Patients

Whether you’re an athlete aiming for competitive return or someone wanting to run after your kids again, we bring the same level of care and attention to your ACL rehab. Recovery is not just about timelines — it’s about building back strength, movement, and trust in your knee. Ready to get started with your own recovery plan? Explore the ACL physiotherapy services at Praxis and book an appointment today.

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Buranda, and Carseldine
💪 Trusted by athletes. Backed by evidence. Here for everyone.

For more insights into long-term knee health, including non-surgical rehab, check out our Knee Osteoarthritis blog.

References

Andrade R, et al. (2020). How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of clinical practice guidelines. Br J Sports Med, 54(9), 512–519.

Kochman M, et al. (2022). ACL Reconstruction: Which Additional Physiotherapy Interventions Improve Early-Stage Rehabilitation? Int J Environ Res Public Health, 19(23), 15893.

Charles D, et al. (2020). A systematic review of the effects of blood flow restriction training on quadriceps muscle atrophy and circumference post ACL reconstruction. Int J Sports Phys Ther, 15(6), 882–889.

Nichols ZW, et al. (2021). Is resistance training intensity adequately prescribed to meet the demands of returning to sport following ACL repair? A systematic review. BMJ Open Sport Exerc Med, 7(1), e001144.

Welling W, Benjaminse A, Gokeler A, Otten E, & Seil R. (2018). Low rates of patients meeting return to sport criteria 9 months after anterior cruciate ligament reconstruction: a prospective longitudinal study. Knee Surg Sports Traumatol Arthrosc, 26(12), 3636–3644.

Stress Fractures in Young Cricket Fast bowlers: A persistent challenge

Stress Fractures in Young Cricket Fast bowlers: A persistent challenge

by | May 16, 2023 | Lower Back, Return to Sport

Lumbar stress fractures are a common and persistent injury among cricket fast bowlers, particularly adolescents. The repetitive and high-intensity nature of the bowling action places tremendous stress on the lower back, leading to the development of stress fractures in the lumbar vertebrae. With several years of cricket physio experience, I’ll explore the causes, symptoms, treatment, and prevention strategies associated with these usually season ending injuries.

Causes and Symptoms:

The primary cause of lumbar stress fractures in fast bowlers is the high volumes of repeated hyperextension and rotation of the lower back during the bowling action. This repetitive motion places excessive strain on the bony structures of the spine (pars interarticularis), eventually leading to small cracks or fractures. Adolescent fast bowlers are of particular risk as this strut of bone has yet to fully develop (as with most of their surrounding musculature) and thus is more susceptible to overload. Symptoms of lumbar stress fractures may include lower back pain, stiffness, tenderness, and discomfort, particularly during bowling.

Treatment and Rehabilitation:

The management of lumbar stress fractures requires a comprehensive approach. Initially, rest and avoiding activities that exacerbate the pain are essential to allow the bone to heal. A period of complete rest from bowling, coupled with appropriate pain management is usually recommended. A structured rehabilitation program focusing on core stability, flexibility, and strengthening exercises on the lumbar spine, pelvis and lower limbs is crucial for a safe return to bowling. Once a players has reestablished the requisite physical attributes, a graduated bowling plan is established.

Prevention Strategies:

Prevention is key in mitigating the risk of lumbar stress fractures. Fast bowlers should maintain a balanced training regime that includes multi-joint strength training, flexibility exercises, and proper warm-up and cool-down routines. Regular monitoring of workload and ensuring adequate recovery time between bowling spells can also minimize the likelihood of injury. Of particular note, is avoiding back to back days of fast bowling in adolescent cricketers.

In summary, lumbar stress fractures pose a significant challenge to cricket fast bowlers, especially those in their teen years or as they transition to junior cricket to senior cricket. A diagnosis typically requires extensive time away from bowling and requires a targeted rehabilitation plan and a cautious return to the sport. By understanding the causes, recognizing the symptoms, and implementing effective prevention and strengthening strategies, bowlers can continue to bowl fast and trouble the batsmen down the other end!

If you wanting to minimise your risk of a stress fracture, or think you may have one, feel free to consult with one of our expert physiotherapists, well versed in the cricket literature.

Until next time,

Praxis What You Preach

About the author. Stephen is an experience Cricket Physiotherapist having spent 15 years working in elite and semi-elite cricket. He was fortunate enough to have Dr Marc Portus as his mentor early on in his career. Dr Portus is an authority on stress fractures in fast bowlers having completed his PhD in the area and helped shape modern day workload parameters. Stephen’s particular area of interest is in the high performance pathways (U16-U20’s) cricket where stress fractures are often first experienced. To read more about Stephen or book, click here

Chronic Groin Pain (Athletic Pubalgia)

Chronic Groin Pain (Athletic Pubalgia)

by | Oct 26, 2019 | Gym and Strength, Hip, Pain, Return to Sport, Sports Injury

GROIN PAIN

Groin pain, referred to also as athletic pubalgia, is a common problem for a number of athletes, particularly those who engage in sports that require specific use (or overuse) of lower abdominal muscles and the proximal muscles of the thigh. Predominantly, these activities centre around kicking sports such as AFL and soccer, as well as long distance running. Ice hockey is also a well renowned sport in which chronic groin pain occurs. All these sports involve repetitive energetic kicking, twisting, turning or cutting movements, which are all risk factors for causing pubalgia.

SUMMARY:

  • Four structures are commonly implicated in the causes of groin pain
  • Adductor muscles
  • Pubic bone
  • Abdominal wall
  • Iliopsoas
  • Understanding which of these four structures is causing your pain is key in effective management
  • Exercise therapy and activity modifications should be the mainstay of treatment
  • Absolute rest has been shown to be ineffective
  • Steady gradual progressions through strength and function, tailored to your goals, is key to successful management
Mid Potion Achilles Tendinopathy Location

ROLE OF HIP ADDUCTORS (groin muscles)

Similar to other joints in the body, the hip relies on muscular control for stability and movement. At the hip, there are five key planes of movement; flexion, extension, abduction, adduction and rotation.

The adductor muscles are a large group of muscles located on the inner side of the thigh, attaching from below the knee, along the shaft of the femur and into the pubic bone of the pelvis.

While acute tears of the adductor muscle is common, more long standing pain is usually the result of an overload of the adductor tendon that attach to the pelvis. This is called an adductor tendinopathy. Adductor enthesopathy is common disorder which effects the bony attachment point of the tendon, with a slight structural difference from tendinopathy, however, management is similar in both cases

MANAGEMENT OPTIONS

Exercise:

Strength and functional based exercise are the core management strategies for adductor tendinopathy, and have been shown to increase function, decrease pain and reduce likelihood of injury [4].

Activity Modification:

Activity modification, especially in the acute phase or when symptoms are significantly affecting function, is key in reducing load on the affected structures and allowing tissues to adapt. [1]

Rest:

While activity modification is important, absolute rest has been shown to be ineffective in the management of adductor tendinopathy, and does not promote adequate tissue repair. [1,2]

Other:

Other conservative measures such as manual therapy, electrotherapy and stretching have been [1] explored, with reduced effect compared exercise prescription. Surgical management is also a potential option, with some positive results emerging for groin pain, though specific evidence [10] around adductor tendinopathy is limited. [10]

WHY IS EXERCISE IMPORTANT?

Exercise has been shown to increase tendon turnover, meaning in the first 24-36 hours there is a reduction in tendon integrity, but after that there is an overall increase in integrity and strength. Other benefits include: increased blood flow, increase in growth factors, and a reduction in altered pain processes in the brain [14].

WHAT’S THE BEST EXERCISE?

Isometric exercise has been shown to be effective in short term pain relief. Current evidence is unclear as to the best long term exercise strategies, with evidence supporting both eccentric and heavy-slow isotonic exercise. [12]

EXERCISE PLAN

The Copenhagen Adductor Program [9], with the below dosage, has been shown to significantly improve adductor strength, as well as being effective in groin injury prevention. It is important to note that though the program is eight weeks long, most effective tendon[12] adaptations take ≥ 12 weeks, and a tailored dosage should be discussed with your physiotherapist towards the end stage of rehabilitation.

Depending on how the symptoms affect your function, a reduction in training, running and kicking may also be required. Example progressions are noted below in the running program, in order of loading on adductors.

ADDITIONAL STRENGTH AND PROGRAMS

While targeted strengthening to the adductors is key, global strengthening around the hip may also aid in a reduction of loading to the tendon. Thorough assessment of your strength through all five movements noted previously is needed, as well as a tailored training program to resolve any discrepancies.

As symptoms reduce and function improves, part practice of painful activities, can be beneficial to reload structures, for example, banded kicking movements in preparation for return to soccer.

SUMMARY

In chronic adductor tendinopathy, tendon adaptations take time. It is important to understand this as you begin your rehab journey and not progress more than your body can tolerate. Steady gradual progressions through strength and function, tailored to your goals, is key to successful management.

As always, if you have a history of groin pain or are concerned about performance in your chosen sport, contact us today and chat to one of our friendly and knowledgeable physiotherapist to ensure you can Prevent. Prepare. Perform. Alternatively you can book online here

Till next time, Praxis what you Preach

Team Praxis

 

References: 

  1.  Almeida, M.O., et al., Conservative interventions for treating exercise‐related musculotendinous, ligamentous and osseous groin pain. Cochrane Database of Systematic Reviews, 2013(6).
  2. Bohm, S., F. Mersmann, and A. Arampatzis, Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults. Sports Medicine – Open, 2015. 1(1): p. 7.
  3.  Brukner, P., Brukner & Khan’s clinical sports medicine / Peter Brukner … [et al.]. Sports medicine series, ed. K. Khan. 2012, North Ryde, N.S.W: McGraw-Hill Australia.
  4. Charlton, P.C., et al., Exercise Interventions for the Prevention and Treatment of Groin Pain and Injury in Athletes: A Critical and Systematic Review. Sports Med, 2017. 47(10): p. 2011-2026.
  5. Frizziero, A., et al., The role of eccentric exercise in sport injuries rehabilitation. Br Med Bull, 2014. 110(1): p. 47-75.
  6. Griffin, V.C., T. Everett, and I.G. Horsley, A comparison of hip adduction to abduction strength ratios, in the dominant and non-dominant limb, of elite academy football players. Journal of Biomedical Engineering and Informatics, 2015. 2(1): p. 109.
  7. Haroy, J., et al., The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med, 2019. 53(3): p. 150-157.
  8. Harøy, J., et al., Infographic. The Adductor Strengthening Programme prevents groin problems among male football players. British Journal of Sports Medicine, 2019. 53(1): p. 45.
  9. Haroy, J., et al., Including the Copenhagen Adduction Exercise in the FIFA 11+ Provides Missing Eccentric Hip Adduction Strength Effect in Male Soccer Players: A Randomized Controlled Trial. Am J Sports Med, 2017. 45(13): p. 3052-3059.
  10. Jorgensen, S.G., S. Oberg, and J. Rosenberg, Treatment of longstanding groin pain: a systematic review. Hernia, 2019.
  11. Kohavi, B., et al., Effectiveness of Field-Based Resistance Training Protocols on Hip Muscle Strength Among Young Elite Football Players. Clin J Sport Med, 2018.
  12. Lim, H.Y. and S.H. Wong, Effects of isometric, eccentric, or heavy slow resistance exercises on pain and function in individuals with patellar tendinopathy: A systematic review. Physiother Res Int, 2018. 23(4): p. e1721.
  13. Machotka, Z., S. Kumar, and L.G. Perraton, A systematic review of the literature on the effectiveness of exercise therapy for groin pain in athletes. Sports Med Arthrosc Rehabil Ther Technol, 2009. 1(1): p. 5.
  14. Magnusson, S.P., H. Langberg, and M. Kjaer, The pathogenesis of tendinopathy: balancing the response to loading. Nat Rev Rheumatol, 2010. 6(5): p. 262-8.
  15. Rio, E., et al., Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. British Journal of Sports Medicine, 2016. 50(4): p. 209.
  16. Thorborg, K., et al., The Copenhagen Hip and Groin Outcome Score (HAGOS): development and validation according to the COSMIN checklist. Br J Sports Med, 2011. 45(6): p. 478-91.
  17. Wei, A.S., et al., The effect of corticosteroid on collagen expression in injured rotator cuff tendon. The Journal of bone and joint surgery. American volume, 2006. 88(6): p. 1331-1338.
Is running bad for your knees?

Is running bad for your knees?

by | Nov 28, 2018 | Knee, Pain, Return to Sport, Running Injuries, Sports Injury

Running. Probably one of the most maligned exercises when it comes to knees and overuse injuries. The thought that running ‘wears’ out your knees and causes osteoarthritis (a chronic disease often associated with joint pain and stiffness, reduced mobility and reduced quality of life) is one of the most common comments I hear as a physiotherapist – typically by non-runners. But do we have it right? Is running actually bad for your knees?

I recently attended the University of Queensland Sports Masters presentation day. The keynote speaker was a Dr Jean-Francois Esculier, a Postdoctoral Fellow at the University of British Columbia on the topics of running and knee osteoarthritis. Originally trained as a physiotherapist, Dr Esculier gave us an excellent overview of his latest research his take on whether or not running is detrimental to knee health.

First, there was an acknowledgement that echoed the sentiments in the opening paragraph. A study in which Dr Esculier undertook attempted to ascertain the perception about running and the knee joint health among the public and health care professionals. The results suggested that many non-runners perceived running as detrimental to knee health. Understandably, with no clear guidelines, health care professionals displayed high rates of uncertainty regarding running as a risk factor to develop knee osteoarthritis (KOA), and about the appropriateness of running with pre-existing KOA [1].

Mid Potion Achilles Tendinopathy Location

Osteoarthritis often results in cartilage loss, in bone rubbing on bone, which can cause inflammation, pain, stiffness, reduced mobility and reduced quality of life [7].

The paucity of clear training parameters for runners also has a knock on effect with a staggering 75% of runners report being injured whilst running each year with the knee being the most common region of complaint [2]. From my experience as a clinician, the factor that is most often associated with an injury are training errors. Too much too quick. Boom bust. No physical preparation. No listening to your body or allowing adequate recovery time. No periodisation or plan – just run and run.

The remainder of the talk that covered many interesting relatable topics (that will likely be areas for future blogs) but the information that most interested me and should answer the question as to whether running is bad for your knees was the following:

Cartilage change with running:

With the improvements in MRI scanning, more papers are looking at the cartilage volume of knees immediately after a long distance run. According to current evidence [3], cartilage may exhibit short-term decreases in thickness, volume and cartilage water flow (T2 relaxation time) secondary to temporary loss of fluid following repeated compressions associated with running. However, cartilage size tends to return to baseline within hours suggesting that cartilage may well tolerate mechanical loading sustained during running and adapt to repeated exposure.

The response of cartilage to longitudinal load is exactly what Van Ginckel et al [4] investigated. After providing a 10 week “Start To Run” program to novice runners, the reserachers looked at the glycosaminoglycan (GAG) content before and after the running intervention and compared to sedentary controls, who did no running. For those of you (like me) who had no idea what glycosaminoglycan / GAG content is, it is essentially a surrogate marker for cartilage quality (specifically, GAG is an important structural matrix compound in regulating the cartilage tissue’s endosmotic swelling pressure and thus, the tissue’s compressive strength).

The results suggested that a gradually built up running scheme appears to positively effect GAG content, and thus cartilage quality. In fact, running appears to be a chondroprotective effect on the knee when compared to a sedentary lifestyle in a female asymptomatic subjects. The author’s went onto say that running schemes like this might be considered a valuable tool in osteoarthritis prevention strategies [4].

Osteoarthritis (OA) rates in competitive vs recreational vs non-runners:

The body’s ability to adapt to considered and appropriate load is likely explanation as to why when we look at the rates of lower limb osteoarthritis (OA) across the population, we find some interesting results. A systematic review [5] of the literature looked at the association of recreational and competitive running with hip and knee OA. The overall prevalence of hip and knee OA was 13.3% in competitive runners, 3.5% in recreational runners, and 10.2% in controls. Exposure to running of less than 15 years was associated with a lower association with hip and/or knee OA compared with non-runners.

Recreational runners had a lower occurrence of OA compared with competitive runners and controls. These results indicated that a more sedentary lifestyle or long exposure to high-volume and/or high-intensity running are both associated with hip and/or knee OA. However, it was not possible to determine whether these associations were causative or confounded by other risk factors, such as previous injury [5].

SUMMARY

Running appears not to cause osteoarthritis in your knees unless you are a competitive long distance runner. Even then, you are only slightly above the average for non-runners but enjoy the myriad of other benefits that exercise brings. Further, increased mileage in recreational runners appears to be actually protective for your knees and reduces your risk of needing a knee replacement [6]. Caution however must be taken to monitor detailed training parameters such as frequency, speed and distance, so that an optimal dosage for knee joint health tailored to the individual patients with knee osteoarthritis.

So the next time someone tells you that you shouldn’t be running because you’ll get OA, or if your health expert recommends to stop all activity because you have been diagnosed with mild / moderate osteoarthritis of the knee, we can help! As always, we at Praxis are more than happy to help you navigate your way back to performing – whatever that may look like! Give us a call (07) 3102 3337 or book online www.praxisphysio.com.au today

Until next time, Praxis What You Preach

There is no need to accept knee pain as ‘normal’. Call us now on (07) 3102 3337 or book online to have one of our physios develop a plan to reduce your pain and restore your function!

To read more about how running can help your knees (that’s right – running!) check out our related posts on running written by our published principal physio, Stephen.

Team Praxis,

PREVENT | PREPARE | PERFORM