Running with Osteoarthritis: the Art of Creativity

BY JORDAN MCAMMOND

The philosophy I grew up getting hammered into my brain as an age group swimmer was always the more the better. You are sick? Well, get in the water and train it out of you. You are tired? That's the best time to train! Injured? Well, as we all know this gets a little trickier.

Even as a kid you can only get away with so much injured without having to modify things a bit. As the years have gone by, I have made it my goal to work with my athletes and patients in physical therapy to develop ways to keep going despite being injured. I have to say that I have been the guinea pig through it all!

There really isn't an injury that I have not encountered in the process of attempting to transform my swimmer body into that of a runner.  It hasn't been pretty, and to this day when I see pictures of myself running I cringe and quickly look away. But what I have determined is that creativity is the key. When there is a will there is a way, and I do firmly believe there is always a way to keep moving even when you can't be out on the road running.

For as long as I can remember my knees have hurt while running. When I was younger and running to supplement the hours in the pool I just thought that was what running was all about. Since then, through my studies and career as a physical therapist , I now know that boney pain is not a normal training pain. It is what has now been diagnosed as severe patellofemoral osteoarthritis.

Severe arthritis? How is that possible at my age? Well the combination of genetics(thanks Mom!), instability at my ankles from swimming since I could walk, and poor running form as well as continuing to run despite all these factors has led to first what we call patellofemoral syndrome and now full blown arthritis.

Patellofemoral syndrome­ a catch phrase used to describe pain in and around the knees often brought on by poor joint mechanics and patellar maltracking. All of the above describes my ugly, continuously swollen knees!

So you ask ­aren't there some exercises for that?  Come on Ms P.T. This is your job.  Just do some squats and gets those legs stronger to tolerate all that pounding. Well I have been doing ankle/hip stability work and medial quadriceps strengthening to help with the patellar tracking problem for years and, yes, it has helped but nothing can outrun genetics ultimately.  

What about running on trails you ask? Yes, yes that's the answer I determine! No, no that's not the answer ­more ankle sprains than I can count later and more knee pain...How is that possible?!??. Well, take a chronically unstable ankle from years of swimming and put it on an unstable terrain like a trail and just count how many face plants you can perform! While very entertaining for those around me, not ideal for a knee that needs a stable surface to push off of in order to minimize torquing and twisting at the knee joint. Therefore trail running= more knee pain.

So you say, Jordan, suck it up and run through it. Well I can say I have given that a full blown try and at this point arthritis is not that forgiving. Pain I can tolerate, knee replacements at the age of 40, I will not.

Arthritis is not just about pain­ it is about a joint that won't always support you and may give out whenever it likes, it is about squatting down to help a patient and wondering if you can get up let alone help them up, it is about hobbling around the rest of the day after a run because of stiffness and locking up of the structures around the joint. And the list continues.

So now is the point where the creativity steps in. Woohoo!!!  Cross training is the name of the game! Smart training and racing is the name of the game!

What I have learned arthritis does not like:

  1. Repetitive squatting and lunging
  2. Steep uphills and steep downhills
  3. Unstable running surfaces
  4. Skipping warm ­up

Well, that list is not too long and definitely something we can work around.  So this doesn't mean if you have arthritis your running days are over, it just means you have to be smarter about the decisions you make.

Training modifications I have made:

  1. Warm up well on my bike before I head out to run. Yes I spin pretty much every time before I run to increase blood flow to my joints before heading out. For me, running slowly and more to warm up is not a warm up but time spent putting impact on my knees with no quality result...
  2. Performing low impact stability work to strengthen my core and legs using a bosu ball and stability ball rather than squats and lunges. If I do these I do them in the water where the impact is hugely minimized. And I do this work religiously. No slacking here!
  3. Choose courses that do not have extreme ups and downs. Sucking it up is just no longer an option while training and racing and just leads to delayed recovery and potential injury. This has been the hardest piece for me because I feel like I am being weak but enough poor performances and prolonged post ­race recovery has taught me to put aside my ego...
  4. Embrace the treadmill­ this is a surface I can run on that rarely causes knee pain. So this is what it feels like to run with no pain?? There are days I head outside and have to turn around and hit the treadmill instead. No knee pain = higher quality training sessions
  5. Running alone more often....Unfortunately I have found running with someone who is not running my speed on any given day causes my knees to hurt more. On any given day I have to succumb to what signals my body is giving me so this makes it hard to run with someone when you have to say­ look, I'm sorry I have to turn around and hit the treadmill. Most likely I would not make that call and just suck it up running outside with pain the whole time. Too many years of this has contributed to where I am now... So more solo running it is!
  6. Swimming­ there are some advantages growing up as a swimmer. Swimming post long hard runs is like heaven on my knees ­it practically dissolves the pain away! So my training regimen involves a lot of my swimming sessions to follow long runs and speed workouts.
  7.  General cross training ­ I can not emphasize enough how crucial it is to have other options when you just can't run.  Hitting the bike and hammering out some hard intervals can be just as hard as a run workout. Climbing on the bike can give you leg strength without the knee pain that running hill repeats may. Creativity, creativity, creativity....

Do I have regrets? Do I wish I had listened to my body better all these years? Well, life is just too short to spend time worrying about what we should have done. I am just so grateful that I have found ways to continue running now and for the years to come. I also hope that I can continue being the guinea pig for others and help runners of all levels continue to run!

Jordan McAmmond is a doctoral Physical Therapist with her own practice, Core Physical Therapy.  She is a formal professional triathlete, Division 1 college swimmer, ironman competitor and Boston Marathon qualifier.

 

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