A graduate of Lehigh University in Bethlehem, Pennsylvania, Jennifer Heiner-Pisano holds a bachelor of arts in marketing and economics. Since 2019, Jennifer Heiner has served as the retail director of a New Jersey running company. For many people, one of the greatest appeals of running is its simplicity. Recreational running requires no fancy equipment or extensive training, just a good pair of shoes.
To choose the optimal pair of running shoes, keep the following tips in mind: 1. Choose running-specific shoes. All sneakers may look similar, but shoes specifically designed for running will provide the cushion and shock absorption you need to prevent repetitive motion injury. 2. Make sure they fit. Running shoes should leave about half an inch between the end of the foot and the end of the shoe, and your foot should be centered in the shoe’s platform. The shoe shouldn’t pinch or slide against your foot when you run. 3. Consider your terrain. If you do most of your running on a trail, a trail running shoe will have better grip and improve your footing. If you are a road runner, a lightweight shoe can serve you better, and can also be used for sprints and races. 4. Replace them when necessary. To take care of your feet, replace shoes every 400 to 500 miles of running.
Marathon training, however, does require a bit more than the newest running shoes. Regardless of whether one is coming back from an injury or not, strength training, and understanding your body mechanics, is so important to ensure that your body is working efficiently. This not only helps prevents injuries going forward, but can increase performance levels as well.
Jennifer Heiner recently took part in a Running Assessment at the Hospital for Special Surgery. There, during a 90-minute clinic, the physical therapist doing the evaluation took note of functionality, movement, and reordered Jennifer Heiner while performing these movements and exercises. She was also filmed while running. While the report is forthcoming, this should help provide some insight in ways to fine-tune her training to hopefully keep her injury free going forward.
One of the things that runners hear all the time is questions regarding their knees and knee health. Runners do not develop knee issues more often than non-runners, according to Jennifer Heiner-Pisano. Jennifer Heiner notes that there are a lot of factors that can go into chronic knee issues, and a recent study dove deeper into one theory.
Patients with higher BMI have worse physical function after total knee arthroplasty (healio.com)
According to a new article published by Healio:
“Patients with higher BMI prior to total knee arthroplasty typically experience worse overall physical function following surgery, while those with lower osteoarthritis severity experience more positive outcomes, according to data.
“More than one in five patients do not regain physical function after TKA,” Unni Olsen, RN, MSc, of the department of orthopedic surgery at the University of Oslo, in Norway, and co-authors wrote in JAMA Network Open. “Non-improvement of physical function is a risk factor associated with more expensive revision surgery and an immense burden at individual, health care system and socioeconomic levels.”
To investigate the impact of preoperative factors on physical function following a total knee arthroplasty, Olsen and colleagues conducted a systematic review and meta-analysis of studies published between Jan. 1, 2000, and Oct. 8, 2021. The search included Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library and Physiotherapy Evidence Database, the authors wrote. Eligible studies examined the association between preoperative or intraoperative factors on physical function, as well as physical function performance numbers at 3, 6 or 12 months following the procedure.
Studies were additionally eligible if they enrolled adults diagnosed with OA who were scheduled for a primary TKA and featured prospective, longitudinal observational analyses. Randomized clinical trials providing appropriate information were also included. The authors excluded retrospective studies, case reports and conference abstracts.
The primary outcome was physical function at 12 months following surgery, while the secondary outcomes were physical function at 3 and 6 months following surgery. Data of interest included study design, sample size, patient age, BMI and sex, the country the study was performed in, outcome measures, data collection timepoints and estimates of association between factors and physical function.
In all, the review included 20 studies representing 11,317 patients and 37 distinct factors. In terms of relationships with postoperative function, higher BMI had an estimated mean correlation of –0.15 (95% CI, –0.24 to –.05), while the mean correlation with better physical function was 0.14 (95% CI, 0.02–0.26). Severe OA demonstrated a mean correlation of 0.1 (95% CI, 0.01–0.19).
“This study found that there is evidence (with moderate certainty) that higher BMI was correlated with worse physical function and that better physical function (low-certainty evidence) and more severe osteoarthritis (high-certainty evidence) were correlated with better physical function 12 months after TKA,” Olsen and colleagues wrote. “Our findings suggest that these factors should be included in development of predictive models aimed at identifying patients at increased risk of poor function after TKA.””
Futhermore, Healio also published a study regarding the comparision of knee issues between runners and non-runners:
“Moderate-distance runners and non-runners alike demonstrate similar rates of radiographic knee osteoarthritis, according to systematic review data published in the Orthopaedic Journal of Sports Medicine.
The researchers additionally concluded that non-runners in fact experience a significantly higher prevalence of knee pain, as well as possibly a higher risk for total knee replacement, compared with runners.
“This is kind of a classic question that we get from patients all the time,” Matthew J. Kraeutler, MD, of the department of orthopedics and sports medicine at Houston Methodist Hospital, in Texas, told Healio. “Patients come in with early arthritis of the knee joint and they say, ‘Can I keep running, will running make my knee worse?’ and we wanted to answer that question.”
To determine if runners have a higher incidence of knee pain or OA compared with nonrunners, Kraeutler and colleagues conducted a systematic literature review of the PubMed, Embase and the Cochrane Library databases through Oct. 3, 2021. The search was conducted using the terms “knee and osteoarthritis and (run or running or runner).” Studies that evaluated the impact of running on knee OA formation, or the accumulation of chondral damage, based on imaging or patient-reported outcomes were included. Studies were excluded if they did not evaluate knee damage, investigated knee damage in non-humans or were not in English.
Outcomes of interest included patient-reported and radiological outcomes. Two of the included studies used the Knee Injury and Osteoarthritis Outcome Score. Another study used the Health Assessment Questionnaire Disability Index to report patient-reported outcomes. Regarding radiographic evidence, studies used the Kellgren-Lawrence scale, MRI T2 mapping, the MRI Osteoarthritis Knee score, the Ahlback criteria and the Osteoarthritis Research Society International Atlas.
The researchers included a total of 17 studies, representing 7,194 runners and 6,947 non-runners, in their analysis. Overall, there was a “significantly higher prevalence” of knee pain in the non-runner group, compared with runners (P < .0001), the researchers wrote. Although a single study demonstrated higher levels of osteophytes in the tibiofemoral and patellofemoral joints in the runner group, “multiple” studies showed no real difference in the presence of radiographic knee OA, based on MRI, among runners vs. non-runners. Additionally, one study showed that nonrunners had an increased risk for requiring total knee replacement compared with runners (P = .014).
“The main takeaway here is that in moderate-distance runners, there is no evidence for a higher incidence of knee pain, knee OA, or a need for total knee arthroplasty at some point in life,” Kraeutler said. “In fact, there is actually some evidence that there is a lower risk for generalized knee pain in runners compared to non-runners. I think you need to look at the overall health benefits of running, and not just the effects of running on the knee joint itself. Runners are generally going to have a normal BMI and have an overall better state of health.”
PERSPECTIVE
David A. McLain, MD, FACP, MACR
Osteoarthritis is a leading cause of worldwide disability, with OA of the knee and hip accounting for much of it. It is estimated that 250 million people globally have OA of the knee, more than half of whom are of working age (younger than 65 years). OA is associated with activity-related pain, which makes activity, particularly exercise, a difficult proposition. Physical inactivity, however, is an underappreciated causal factor of many chronic diseases, including type 2 diabetes, cardiovascular disease and dementia, all of which are associated with chronic low-grade inflammation.
Physical activity and exercise therapy not only improve symptoms and functional impairments in OA, but are also effective in preventing at least 35, and treating at least 26, chronic conditions, with one of the potential working mechanisms being exercise-induced anti-inflammatory effects. Convincing evidence from more than 50 randomized controlled trials (RCTs) in knee OA, and 10 RCTs in hip OA, supports the efficacy of land-based — as opposed to aqua-based — exercise therapy in reducing symptoms and impairments.
Aqua-based therapy also works but is less effective than land-based exercise. Compared to the two most common pharmacological pain relievers, exercise therapy seems to be at least as effective as nonsteroidal anti-inflammatory drugs, and two to three times more effective than acetaminophen, in reducing pain in knee OA. Biochemical analyses have been performed in the OA mouse and rat models, and have shown an increase in beneficial factors with exercise (IL-10, TGF-β, maresin-1, and collagen type I and II) and a decrease in detrimental factors with exercise (TRAIL, NF-κB p65, MMP-13, IL-1 β, IL-6, TNF-a, caspase-3, and NLRP3), all in articular cartilage.
Exercise can even change gene expression by micro-RNA transcription. The old expression that “exercise is medicine” has a basis in research. Muscle strengthening and programs that include combinations of strength, flexibility and aerobic exercises are more beneficial for pain and disability than general activity (eg, walking).
In my own practice, I have been remiss in recommending an exercise program for knee and hip OA supervised by a physical therapist that has the correct “dose” — or frequency, duration and intensity — of supervised and home activities. The present study’s analysis of running shows that even this level of activity does not promote OA.”
Rates of radiographic knee osteoarthritis similar between runners, non-runners (healio.com)
