Running with Osteoarthritis

A question I often hear as a Physiotherapist while working with people who have osteoarthritis is "can I run with osteoarthritis or will I be able to run without causing further joint damage”. Answering this question is not always a simple yes or no, so this article is going to review five key considerations or tips for those wishing to run with osteoarthritis.

1. Marathon Mindset

If you are living with arthritis and have the vision of being able to run an important consideration is to start slowly. A marathon mindset over a sprint mindset. Consider answering these questions to assist you in setting your running goal.

1. When was the last time that you have run?

2. Did you have symptoms of osteoarthritis or was it before you had osteoarthritis?

3. How far or how long did you run for?

4. What other exercise have you been doing?

For example, Jane, a long time runner of 5 years, used to running 5km 2 x per week, who had last run one month ago who had some knee pain secondary to osteoarthritis during the last few runs around 3-4/10. Jane has been doing rehab and knee strength exercises 2-3 times a week over the past month. Since Jane has recently been running, is a long-time runner and has been completing strength exercises to assist with supporting her joints. A good initial goal for Jane might be to run 1-2km with pain levels 3-4/10 over the next 4-6 weeks.

Another, alternative example might be Mary. Mary hasn’t run in a long time, since before she was diagnosed with hip osteoarthritis 3-4 years ago. She can’t remember the last run she went on, but it might have been 1km or so. She remembers being limited by pain and not really wanting to run again because of this and concern that running would worsen the Osteoarthritis. Mary currently walks for exercise about 1km a few times a week, but does not do any other exercise.

Comparing these examples it is likely to take Mary a considerable time longer than Jane to get back to running due to the time since Mary has run and due to having an exercise program of walking as opposed to strength training. The most important factor for Mary over the first few weeks to months is going to be consistency with a training program rather than building up running distance. A good goal for Mary might be to complete 2 x days of 20-30 minute strength training sessions over the next 2-4 weeks, before adding in small jogs of 10-20 meters.

2. Warm up with Rehabilitation Exercises

Warm up with rehab-based exercises. The reason for this is to ensure the muscles that support the joints are activating and engaging prior to starting you run. It may sound obvious but often times, general running warmups like leg swings or light jogs do not specifically target the muscles we want to ensure are engaged during our run.

For example, for a person with knee osteoarthritis, the primary muscle groups that are going to support the joint during running will be the quads and hamstrings. Therefore, some rehab based warm up exercises might be quad activation for the quadriceps and hip bridges for the hamstrings. For a person with hip osteoarthritis this might involve hip bridges along with hip abductions/adductions. For routines including these exercises see this playlist of exercise routines.

3. Strength Training

The third tip for running with osteoarthritis is building on tip one and two and is to

incorporate strength exercises as part of your exercise program. Typically, the strength training portion of the program will be greater than the running portion of the program.

For example, for a person who doesn't have osteoarthritis who is a runner, out of three training sessions a week, a typically exercise program might include two running sessions and one strength training session a week. For a person with osteoarthritis, this could be reversed to one running session and two strength training sessions.

The reason for this is because for those without osteoarthritis the limiting factor on running ability is typically cardiovascular fitness. For somebody who does have osteoarthritis, the limiting factor is usually joint pain. So, the focus for somebody who has osteoarthritis is going to be to build strength in the muscles supporting the joints, whereas for somebody without osteoarthritis, the main focus is to build up cardiovascular fitness.

4. Contingency Weeks

Tip four is to add contingency into your program. For instance, let's say you have a goal of running 1km (1,000 meters) and want to increase 100 meters every week. Your program would be 10 weeks of 100 meter increases in running distance to build up to 1km. Rather than completing this goal within the next 10 weeks, add contingency to the timeline. These are weeks you allocate to rest, knowing you will likely experience some flare ups of pain, or weeks allocated to running but not increasing in distance. In this case you might aim to complete your goal in 12 or 13 weeks rather than in 10 week’s time.

The reason to add contingency in to a program is to reduce the guilt or feeling of failure that often comes along with goal setting and exercise programs. One of the main reasons people don’t like goal setting or setting milestones is because of that feeling of guilt or failure of not achieving them. This is even more prevalent in those who have a chronic health condition like Osteoarthritis due to the sometimes-unpredictable nature of flare ups of pain and symptoms interrupting progress. So if you don't add room for contingency for those weeks where you might be in pain, then you are setting yourself up for failure. So adding contingency is my top tip out of the 5 tips.

5. Vision vs Goals

Tip five is building on tip four and is not only setting, but distinguishing between a vision, goals, and milestones. Again, another reason that people feel like they fail or don’t like exercise programs is the feeling of failure or guilt when not achieving what they hope to achieve or what they picture in their minds. We want to do everything we can to prevent that feeling of guilt or failure.

One of those things is distinguishing between a vision, goals, and milestones. For instance a vision might be to run again like before having Osteoarthritis, a goal might be to run 1km in 13 weeks, and milestones might be to increase by 100 meters each week (excluding contingency weeks).

The differences are subtle but important, the vision of running again like before having Osteoarthritis is a good vision, but not something specific that you could measure, meaning your mind is likely to play tricks on you and keep moving the goalpost of that vision depending on what stage you are at in your program.

The goal of running 1km in 13 weeks, is a goal because it is specific and measurable, but can be difficult to track week to week which can be demotivating. The milestone of increasing the run by 100 meters each week, helps to have something to work toward each week, which will in turn build toward the goal, with the milestones and goals assisting to be nearer to the overall vision we had of ourselves.

To re-iterate, consideration one is to start slow, looking at where you currently sit in relation to your vision, tip two is to complete rehab exercises as a warm up, tip three is to complete strength based training at a higher proportion to running sessions, tip four is to add contingency weeks into your program, and tip five is to distinguish between your vision, goals, and milestones.

If you have osteoarthritis and are unsure if you have the right exercise program put together, make sure to get your complimentary Fit with Arthritis Self-Assessment to identify if you are meeting 10 key components of a successful exercise program.

For additional support make sure to join the Facebook group, book a consultation, or apply for the Fit with Arthritis program.

Tess Halbauer

Physiotherapist (BHlth&RehabSc, MPhty)