Another Arthritis study ignores the big elephant in the room (hips)

Personally, I haven't noticed a lot of hip problems among the older crowd.

I have seen that as people age their bodies become frailer, have slower rates of healing, and are more injury prone - from the big toe all the way up to the crown of the head.

I'm not claiming any expertise whatsoever, though. I'm in my mid-60s and "run" about 4 miles per day.

How is it I can't sprint as fast as I used to jog?

Arthritic changes can occur with any bad injury, but the general pounding associated with running should not be a risk factor for arthritis. But, if you have a genetic predisposition for arthritis, running probably speeds up the onset and magnifies the problem. I think the studies on running and heart disease/mortality are basically showing the same thing. If you have a genetic predisposition for heart disease, the stress on your heart from running may push the disease over the edge. Studies need to look more at family histories and take into account genetics.

Precious Roy wrote:

Arthritic changes can occur with any bad injury, but the general pounding associated with running should not be a risk factor for arthritis.

Says who? One of these countless studies that compare knee arthritis in runners and sedentary people?

My point is: First you need a better control group. A lot of times sedentary people are overweight, which is probably one of the biggest contributing factors to arthritis. Secondly, I personally believe that the hip is more prone to arthritis due to injury rather than the knee. However, I have never seen a study examining exactly that.

I know two former elite runners, one who made the u.s. Olympic team, who had hip replacement surgery. I also know a 3rd less accomplished runner who required this surgery. All were male and in their 40s. I've wondered if this is a risk for faster runners using a lot of hip extension. Mileage wasn't too high maybe up to 100mpw during base.

Do this before/after/during (breaks) run, and your entire body, especially hips/lower back will thank you forever.

Oltimer wrote:

First you need a better control group. A lot of times sedentary people are overweight, which is probably one of the biggest contributing factors to arthritis.

Runners, on average, tend to weigh less than non-runners -- and that's a consequence of running, not a confounding factor. So any control group SHOULD weigh more than a group of runners, otherwise there are other hidden confounding factors. If you have 100 runners and 100 non-runners and they weigh the same on average, there's something else going on there.

That said, you're absolutely right that being overweight is one of the biggest contributing factors to arthritis. And that's not just on weight-bearing joints like the knees; overweight people are also more likely to develop arthritis in the wrists, for example. Fat tissue itself promotes inflammation and joint damage throughout the body.

Here's one study:

http://www.ncbi.nlm.nih.gov/pubmed/16932832

I think a limitation of most studies is that their bar for "high mileage" is very low. You typically don't get to look at a big group of people who did 80+ mpw for a long time.

Ho Hum wrote:

Here's one study:

http://www.ncbi.nlm.nih.gov/pubmed/16932832

"Osteoarthritis of the knee joint is rare in former elite marathon runners. "

"The risk of osteoarthritis of the hip joint seems to be higher than in control subjects who do not engage in much sport."

Thanks for posting this. This basically confirms my anecdotal findings.

Yet every study ever cited by runners world focuses on knees instead of hips.

I think there is more going on than just knees/hips running and not running. I think the amount of sitting you do has a huge role in hip problems.

As some posters have indicated, accurately identifying the rate of hip arthritis in runners is hard on an individual basis because of confirmation bias and sampling errors. Of course, a lot of your runner friends are going to develop hip arthritis, but they may have gotten it even without being a runner.

The one study which has found a higher incidence of hip arthritis in highly competitive runners versus the general population is this one:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1837113/

This study looked at a group of 42 national-caliber runners. More severe hip OA in the runners vs. bobsledders and nonrunners.

However these two other studies have looked at hip osteoarthritis in runners and nonrunners and did NOT find a difference:

http://www.ncbi.nlm.nih.gov/pubmed/4028541

This study looked at 504 runners who competed at the varsity level in college. No higher risk of hip OA.

http://www.ncbi.nlm.nih.gov/pubmed/9489830

This study looked at 28 members of a running club. No higher risk of hip OA.

***

As you can see, the relatively small sample size of the one positive study is one possible reason for its finding, but the point stands that no other studies have looked at very high level runners who train at high mileage levels for a very long time. There are indeed other studies on runners of this caliber that look at incidence of arthritis, BUT they only looked at knee osteoarthritis. The research on that is pretty clear now: runners, even extremely high mileage runners, are not at a higher risk for knee osteoarthritis than the general population.

As to why many studies do not look for hip osteoarthritis, I'm not sure. It's not THAT much less common than knee osteoarthritis. Seems like a lot of the guys from the '60s and '70s who put in mega-mileage should be getting to the age where you see a lot of hip OA, so it shouldn't be too hard to put together a study of high mileage runners.

One possible confounding factor is the prevalence of femoroacetabular impingement or hip FAI. It's closely associated with labral tears, and research indicates that untreated labral tears and FAI in athletes can lead to early, significant hip osteoarthritis. Hip FAI has only been identified and described in medical literature in the past decade or two, so the Marti study, published in 1989, wouldn't have known about this. It's possible that some of their "extra" cases of hip OA were actually caused by training for a long period with hip FAI, but it's impossible to know for sure. To them, it might've just felt like some groin or hip pain.

Addendum: the one OTHER study. Forgot about that German one. Also suffers from small sample size issues and possible FAI confounding.

Bingo here , 62 high mileage 1970s on through mid 2010s . Ran 1:30 half marathon at 55 ran 18:30 5Ks up until age 57 then the left hip said no more . Diagnosed impinged hip labral tear and 1 mm of cartilage left in that hip . Nice osteoarthritis diagnoses. Now at almost 63 running 10 + min miles is it . Bike riding is kinda fun , no pain .

Northern Star wrote:

One possible confounding factor is the prevalence of femoroacetabular impingement or hip FAI. It's closely associated with labral tears, and research indicates that untreated labral tears and FAI in athletes can lead to early, significant hip osteoarthritis. Hip FAI has only been identified and described in medical literature in the past decade or two, so the Marti study, published in 1989, wouldn't have known about this. It's possible that some of their "extra" cases of hip OA were actually caused by training for a long period with hip FAI, but it's impossible to know for sure. To them, it might've just felt like some groin or hip pain.

I'm 25 and just had surgery for FAI. Joint looked terrible. Surgeon told me I looked like a 45 year old pre-arthritic guy. Hoping that the bone shaving and cartilage cleaning they did help me avoid a hip replacement before I'm 50, but I'm mostly hoping that by the time I (inevitably I guess) need one, they have implants you can run with. Heaven help me if I am reduced to biking.

Continuing to run with torn labrum/FAI is a great way to wreck your articular cartilage and get super early OA, because you basically can keep gradually tearing away labrum and cartilage when it catches in the joint space. Honestly, I think the OP is spot on that hips are probably a bigger problem for runners, especially given that we know a ton of people are walking around with asymptomatic torn labra.

That is exactly my problem. Did not know about the impinged problem and ran for 50 years on it . Hip replacement not yet . If I don’t run I have little ifcany pain . Yea that bike hood god 50 /60 mile rides so suck !!

BRLT wrote:

That is exactly my problem. Did not know about the impinged problem and ran for 50 years on it . Hip replacement not yet . If I don’t run I have little ifcany pain . Yea that bike hood god 50 /60 mile rides so suck !!

No idea how you could bear running on that for 50 years.

That is the crazy , no symptoms until age 58! Then a 5K at 18:48 and trouble walking back to the car . Then nagging pain and then the MRI and the diagnosis. Actually stopped running for about 6 months . It hurt so bad I couldn’t run to the damn mailbox in front of the house . Lots of cross training, biking a more and now able to run slow ugly miles . Ran 4 in 41 mins this morning at Wrightsville Beach NC at sunrise . It was worth it .

Do this wrote:

http://www.yogaoutlet.com/guides/how-to-do-triangle-pose-in-yoga/

Do this before/after/during (breaks) run, and your entire body, especially hips/lower back will thank you forever.

I do the triangle pose and reverse triangle as well as a psoas stretch every run at least once. It is like magic for realigning hips/knees/back.

I had a raging inflammatory joint condition in my 20s. along with a litany of other chronic illness, until I finally quit vegetarianism and began eating meat and somewhat lower carbs. This allowed me to start training again in my 30s and on to a successful masters career until a major achilles injury at 50. Worked back from that, kept tweaking the diet to lower and lower carb, and now in my 60's running up to 60 miles a week with workouts absolutely pain-free. I eat mostly meat/fish/eggs/butter/cheese and one meal a day with a 36-hour fast once a week. I wish I had this kind of health and recovery in my 20s.

In general, structural/imaging findings are pretty poorly correlated with actual pain and dysfunction.

See e.g. note 48 here (and possibly also the discussion immediately below on canine hip dysplasia!) for some hip-specific discussion:

https://www.painscience.com/articles/structuralism.php

There's also this paper that uses MRI as opposed to x-ray:

https://www.sciencedirect.com/science/article/pii/S1063458413009126

I'd also interpret the asymptomatic FAI/labrum tear literature as a sign that structural issues don't matter all that much; it is in fact quite common for people to be vigorously active for many years with nominal hip pathologies that don't actually bother them at all. Of course, one might argue that this could predispose them to osteoarthritis later in life, depending on activity and pathology, but lots of people experience osteoarthritis later in life regardless of mechanical/structural/imaging findings and at a certain point it becomes a question of values, imo.

Many believe humans were born to run long distance

However way back when it’s unlikely we lived past much 40-50, about when an elite/sub elite/sub sub elite ship issues would surface

I do think we are born to run, but like all animals we succumb to our mortality

Happy trails