How to help runners steer clear of injury
Assess risk factors, then work to address modifiable ones, such as wearing the right running shoes and building up slowly. Don’t let overweight or OA dampen enthusiasm.
PRACTICE RECOMMENDATIONS
› Counsel runners to cross-train, replace shoes regularly, and use shoes with moderate-to-high (8-12 mm) heel-to-toe drop. C
› Don’t discourage running for exercise, as long as it is tolerated, in patients who have osteoarthritis. C
› Encourage moderation in running distance and intensity, especially in novice runners. C
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Given that there are no high-quality studies suggesting that running contributes to or exacerbates OA, patients with OA can be counseled to start or continue running as tolerated because the health benefit of running likely outweighs risk. Patients with pre-existing moderate-to-severe OA might report knee and hip pain that is already exacerbated by certain activities; if a high-impact activity, such as running, makes that pain worse, exercise counseling that you provide can be tailored to include lower-impact alternatives, such as swimming, cycling, or an elliptical workout.
CASE
In response to Ms. K’s interest in beginning an exercise regimen that includes running, you perform a complete routine pre-participation evaluation and appropriate cardiac screening. You discuss risk factors for running injury, focusing on modifiable risk factors.
Ms. K is perimenopausal but reports a history of regular menstrual cycles. She eats a relatively well-balanced diet. You advise that her BMI should not restrict her from incorporating running into her fitness regimen. Also, you reassure her that she should not restrict running based on a diagnosis of OA; instead, you advise her to monitor her symptoms and reconsider her program if running makes her knee pain worse.
At this point, Ms. K is ready to run. She tells you that, based on your guidance, she feels more comfortable and safe starting a running program.
Preventing injury
After reviewing risk factors for running-related injury with patients, encourage other evidence-based methods of reducing that risk.
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