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Does long-distance running lead to cartilage damage? An MRI study

PainSci » bibliography » Luke et al 2010
updated
Tags: etiology, exercise, arthritis, counter-intuitive, running, good news, knee, patellar pain, pro, self-treatment, treatment, aging, pain problems, leg, limbs, overuse injury, injury

One article on PainSci cites Luke 2010: The Complete Guide to Patellofemoral Pain Syndrome

PainSci commentary on Luke 2010: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Studies have shown that runners probably do not get more knee osteoarthritis than anyone else (see Williams), which is a bit surprising: surely regular pounding wears out joints? Researchers took a bunch of fancy pictures of the insides of knees before and after a marathon, using a new MRI technique that can detect early cartilage degeneration:

Runners showed elevated T1rho and T2 values after a marathon, suggesting biochemical changes in articular cartilage … the patellofemoral joint and medial compartment of the knee show the highest signal changes, suggesting they are at higher risk for degeneration.

Sounds bad, doesn’t it? Also, perhaps some biomarkers of trouble “remain elevated after 3 months of reduced activity” — but it’s arguable that those results were not actually statistically significant.

So, bad biomarkers in the knee after running, oh noes! But I actually see good news for knees here. It’s not surprising that a lot of running has an effect on joints in the first place, of course, and this data confirms that. But this data also shows that the effect is surprisingly minor, and that most knees recover, either mostly or completely, within three months. Which is very important information.

Stressfully loading a joint in itself is probably not a problem per se, and could even be healthy, stimulating, toughening — as long as you allow time to recover. It’s excessive loading without adequate recovery, AKA “overdoing it,” that is likely to be the real hazard for runners. I see this as (more) evidence that the average sane runner is not wearing out his or her knees (and also that runners who do get into trouble really, really need to rest and let their biomarkers simmer down).

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: There is continuing controversy whether long-distance running results in irreversible articular cartilage damage. New quantitative magnetic resonance imaging (MRI) techniques used at 3.0 T have been developed including T1rho (T1rho) and T2 relaxation time measurements that detect early cartilage proteoglycan and collagen breakdown.

HYPOTHESIS: Marathon runners will demonstrate T1rho and T2 changes in articular cartilage on MRI after a marathon, which are not seen in nonrunners. These changes are reversible.

STUDY DESIGN: Cohort study; Level of evidence, 2

METHODS: Ten asymptomatic marathon runners had 3-T knee MRI scans 2 weeks before, within 48 hours after, and 10 to 12 weeks after running a marathon. The T1rho and T2 MRI sequences in runners were compared with those of 10 age- and gender-matched controls who had MRI performed at baseline and 10 to 12 weeks.

RESULTS: Runners did not demonstrate any gross morphologic MRI changes after running a marathon. Postmarathon studies, however, revealed significantly higher T2 and T1rho values in all articular cartilage areas of the knee (P < .01) except the lateral compartment. The T2 values recovered to baseline except in the medial femoral condyle after 3 months. Average T1rho values increased after the marathon from 37.0 to 38.9 (P < .001) and remained increased at 3 months.

CONCLUSION: Runners showed elevated T1rho and T2 values after a marathon, suggesting biochemical changes in articular cartilage, T1rho values remain elevated after 3 months of reduced activity. The patellofemoral joint and medial compartment of the knee show the highest signal changes, suggesting they are at higher risk for degeneration.

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