I’m a 56 year old male and I’ve had numerous knee surgeries over the years - bilateral ACL reconstructions as well as multiple meniscectomies As a result, I have nothing like the full complement of meniscus/cartilage in either knee and now have OA in both. It ranges from mild to moderate to severe in different parts of the knee (I’m bone on bone in places).
My question is: when is it time to stop running?
I realize I’m an excellent candidate for knee replacements in the future - that’s a given - but I want to remain active (i.e running) as long as I can.
I’ve asked my knee surgeon but she is vague: “You can run until it hurts too much”. But what is too much?
Today, I really don’t have that much discomfort when running. Afterward, I get some aching but nothing a couple of Advil doesn’t fix. Same with biking.
Does that constitute “too much”?
I’m also careful to run primarily on forgiving surfaces - treadmills, track, trails. I avoid asphalt and concrete.
Would really like to hear your experiences/thoughts/advice - thanks!
Run.
Running is good for your knees.
Running is protective for osteoarthritis.
Running does not cause arthritis.
It doesn’t matter is you don’t have any cartilage (ie, “bone on bone”).
Run from doctors who tells you not to run.
(I am a doctor).
When 58 had good bit of medial posterior horn removedin one knee. Running did not go well. Not painful, just something off with knee, which seemed to transfer more responsibility/load to other knee. Running just not fun and when i hit 65 thought i tore something in good knee. Turned out no surgery as just potholes from OA. Could not bend knee without pain. Tried stemcells/prp in 2013 and gave it time to take. Cleaned up diet and used Mobilitywod website to get my mechanics/physics squared away plus stronger core. Started racing and running again in 2014 and still going. I don’t do IM type training any more. Can swim and bike seemingly no restriction. But i do run less now 10-14 mi per wk peek traing. Focus on sprints. Since knee is hinge joint you have to make sure hips and ankles are working well. One other thing, despite damage to menisci in both knees when xrayed i had pretty good space between bones which meant i still had some cushion, except that major tear in posterior horn.
I’m a PT and absolutely concur. If you were truly “bone on bone” you would have repeatable excruciating pain the same way every time you run. If pain actually does get worse then find a PT and not an ortho surgeon. There is nothing you’ve said that predicts future knee replacement. As was stated, running does not equal osteoarthritis. In fact, there are many couch potatoes who never ran or worked out who have the same knees on X-ray or MRI as you. Keep running.
I am not a doctor and this info is off the Internet … it is a topic I am interested in as I have one knee that occasionally hurts after running on hard surfaces … even with Hokas.
Provided trauma is avoided, moderate exercise does not lead to acceleration of knee osteoarthritis, whether or not there is evidence of pre-existing disease. In either case there appears to be improved physical functioning and reduction of pain and disability in those who exercise. It is likely that exercise interventions are underused in the management of established knee osteoarthritis symptoms."
I noticed that much of the above information is qualified by ‘individuals condition’ of prior damage and BMI.
When you look at the literature some of the treatments are exercise (running/walking), corticosteroids, platelet rich plasma, hyaluronic acid, and stem cells … and some of the forgoing in combinations … before knee replacement …
I have a friend that is bone on bone and has good results with the hyaluronic acid injections.
Looks like your ‘mileage may vary’ no pun intended … or said another way … ‘you pays your money and takes your chances’ …
What interventions have you found that look promising?
I certainly do not experience excruciating pain when I run…so maybe I’m really not bone-on-bone (although that’s what my ortho is telling me).
Things I have tried - one is dumping my Hokas and switching to zero drop Altras. This has helped me switch from heel striking to midfoot striking and that has definitely helped with discomfort (as well as made me faster).
I also have RunScribe sensors on each shoe and have confirmed that midfoot striking has reduced shock impact to the knees.
(Next I will experiment with barefoot running - there’s some research that suggests this will reduce impact still further)
I did try hyaluronic acid injections (Orthovisc) and these helped for a couple of years but then seemed to stop working for me. Plus my mean-spirited health insurance company stopped paying for them.
In October last year, I shelled out $5000 on stem cell therapy - no appreciable benefit to report yet but I am still hopeful.
I will try ditching my Hokas and see if I can get more of a mid foot strike … although I have tried that before without much success as I run so slowly now.
If I can crank out 2 more years of regular running on Orthovisc that would be great … also I will look into RunScribe …
For the Orthovisc did you get one big injection with 6 month intervals or smaller ones at 6 week intervals? What method is best? And did you use high density hyaluronic acid?
My friend did 6 week intervals for injections with good success.
I am really curious as to how your stem cell therapy will turn out …From what I read stem cell and platelet rich plasma were not so successful with those subjects over 60 years of age.
Please PM me with your progress as I am following in your footsteps I think …
When i got my stem cells (from hip) and follow up prp. The doc said wait a while before running. I could tell within days the oa was better and was able to bend knee fully with no pain. Gave it 9 months no running, just walking. Also went lower carb which seemed to help too. If you had desk job like me then work on hip flexors and hip tilt. The oa in my back improved greatly too.
Re: OrthoVisc - I was getting them every 6 months. Three injections spread a week apart. My experience was that they would take about a month to kick in but then I’d get about 4-5 months of pain-free running by which time I was ready for the next round. However, health insurance company (BlueCross) then stopped paying for them - they said research showed they were not effective after 2 years. I did pay for one more round out of my own pocket ($450) but I did not see much effect. So maybe there is some truth in what the health insurance company claims.
Re: stem cell therapy - probably too early to tell if this has been successful for me (it’s been just a little over 3 months at this time). I started gentle running after 8 weeks (per doc’s instructions) and certainly not pain-free at this time. However, I remain hopeful.
By the way, I had it done at Emory University’s sports medicine clinic in Atlanta.
Got my stem cells too at emory (mautner and x did surgery in 2006). When x did my surgery i started running 8 weeks afterward but probably should have worked on mechanics and core a lot more in prep. Since i was about 65 when got stem/prp i figured last chance or the glue factory. Go slow and maybe someone could look at your mobility and mechanics before you embark on running.
if you are in atlanta, several good pts (athletes potential) also dr. josh glass a chiropractor and experienced runner has a group that shares or used to share his location that did video etc
since i took 9 months to return to running the mobilitywod website opened my eyes to good mechanics (especially the deterioration from sitting and aero positioning)
I took a minute and reviewed WADA USADA TUE requirements for following procdedures … none required …so cortisone injection - OK … stem cell harvest and injection - OK … rich platelet plasma injection - OK … and hyaluronic acid injection - OK
I am 68 years old and have been running endurance-wise since high school. First injured my ACL at age 21 but waited until about age 50 for my first knee op. Had a second clean out about 8 years later and continued to struggle with the knee doing IM and HIM races. The lead up to the 70,3 world champs last year was proving difficult and although I performed creditably in the race, a few training runs afterwards told me I had reached the limit of enjoyable running.
I had hoped to continue running and doing triathlons into my dotage but common sense tells me that if I want to keep walking comfortably into the future I had better take a more conservative approach and stop running completely. After 33 years of triathlon racing I have achieved every goal I would have wanted in the sport. I continue to swim and bike so I remain committed to a lifestyle of fitness and I admit I do not miss the feeling of pervasive fatigue that comes with long distance run training. I will now look to aquabike to satisfy my competitive streak.
“I took a minute and reviewed WADA USADA TUE requirements for following procdedures … none required …so cortisone injection - OK … stem cell harvest and injection - OK … rich platelet plasma injection - OK … and hyaluronic acid injection - OK”
I understand your rationale of not wanting to “cheat”, but lets be realistic here. What WADA says about how you treat your body should be one of the lowest priorities for your health. WADA rules are meant to control doping. They are not a blueprint for treating conditions or navigating the medical system. Do what you need to keep yourself healthy and moving. Worry about WADA later. Much later.
I agree with your that overall health with emphasis on activity and longevity is primary … after survival.
Sports are fun and provide a focus for health and longevity … here in our tiny atmospheric film of life adhering to the surface of Spaceship Earth.
And I agree with you that when considering medical procedures and interventions that health comes first … however thinking about a procedure in the future and taking a few minutes to cross the t’s and dot the i’s is not a burden … more like due diligence … and maybe learn something useful in differentiating/selecting between procedure and intervention options.
You can USADA/WADA check medical procedures and interventions here: http://globaldro.com/US/search and there is a page in WADA/USADA that lists steps to take when doing medical procedures … and they emphasize in bold print number one on the list … first … do what is best in the view of you and your doctor for your health … and then WADA/USADA considerations for a TUE if needed … and a phone number to call with questions.
Run.
Running is good for your knees.
Running is protective for osteoarthritis.
Running does not cause arthritis.
It doesn’t matter is you don’t have any cartilage (ie, “bone on bone”).
Run from doctors who tells you not to run.
(I am a doctor).
Such a great post, as someone who has recently had knee surgery thank you!
I would concur with this. I have had osteochondritis since I was a juvenile and was told never to run. It wasn’t until after college I realized that running actually seemed to improve my condition… with a few caveats.
It is hard to start running, take your time building up mileage and don’t go for extended rest periods if you don’t have to.
Limit your mileage - I can only run 20-25 miles per week, any more and it gets painful
Massage frequently - Your muscles may tense up more to protect the joint. I also get foot massages at the mall they are the best thing in the world
