Today Brodie is interviewed by PT Alyssa Kuhn about all things Osteoarthritis & running. We start with highlighting some common misconceptions around the cause, prognosis and development of Osteoarthritis. A lot of runners are told that OA is due to wear & tear of your joints and eventually the cartilage in your joints will pass their expiry date and lead to pain, stiffness, disability and eventually needing replacement. This is far from the truth! Brodie covers the fact that joint cartilage is not static with an expiry date and in fact reality is quite the opposite. Even pain and scan results are often misleading. Other key points we cover are: Can we still run with knee OA? How do we know if we are ready to run if pain exists? What contributes to pain sensitivity? Are run/walk programs effective? Click here to visit keeptheadventurealive.com or follow Alyssa on YouTube & Instagram (Apple users: Click 'Episode Website' for links to..) Become a patron! Receive Run Smarter Emails Book a FREE Injury chat with Brodie Run Smarter App IOS or Android Podcast Facebook group Run Smarter Course with code 'PODCAST' for 3-day free trial.
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on today's episode, empowering runners who have osteoarthritis. Welcome to the Run Smarter podcast, the podcast helping you overcome your current and future running injuries by educating and transforming you into a healthier, stronger, smarter runner. If you're like me, running is life, but more often than not, injuries disrupt this lifestyle. And once you are injured, you're looking for answers and met with bad advice and con... conflicting messages circulating the running community. The world shouldn't be like this. You deserve to run injury free and have access to the right information. That's why I've made it my mission, to bring clarity and control to every runner. My name is Brodie Sharp. I am a physiotherapist, a fighter, and a fighter. former chronic injury sufferer and your podcast host. I am excited that you have found this podcast and by default become the Run Smarter Scholar. So let's work together to overcome your injury, restore your confidence and start spreading the right information back into your running community. So let's begin today's lesson. We are switching gears a little bit this episode because I am being interviewed by Alyssa. She is a physical therapist and has the keep the adventure alive website and YouTube channel. And she specializes in addressing osteoarthritis and helping people raise awareness of what it is, how to manage it. And she has a good YouTube channel and website. And she reached out to me and said, do you mind if we put together? an interview, um, we can throw the interview onto my YouTube channel and then you can choose if you want to produce it as a podcast episode. And yeah, it was a good collaboration. It was good to combine forces and put some great content onto two different platforms and two different channels. And I was very glad we did this in the end result is really, really awesome. We kind of feed off each other and our knowledge and chat about osteoarthritis. We chat about what the misconceptions are. We chat about exactly what causes osteoarthritis. If you do have osteoarthritis, can you continue running? And yeah, it's just a wealth of knowledge. We also delve into assessments and strengthening stuff that you can do if you do have OA. What do you do if even just low levels of running is starting to flare you up? What contributes to pain sensitivity? Why is there a rollercoaster of symptoms and flare ups? What do anxiety, like beliefs, frustration, stress? where does this fit and does it have any influence on management and symptoms? So yeah, I think it's a very illuminating liberating conversation. If you do have osteoarthritis and it can help allay a lot of fears with some practical takeaways as well. I will include Alyssa's YouTube and website in the show notes as well. If you want to learn more about that. And she does have resource books and things around osteoarthritis. And she obviously has a lot of YouTube videos. So check her out. So without further ado, let's dive into the interview. Okay, hello guys and thank you so much for joining us. So I have a special guest with me today because we've been really talking a lot about knee arthritis and running. And there's lots of common misconceptions about running. Can I run even if I have knee arthritis? And we're gonna dive way into all that kind of stuff because I know that there are a lot of people out there who want to keep running and don't want to give up their dream of running. And so... I am joined with Brody Sharp and he is from Australia. So he is joining us from across the world. So I'm actually going to have him introduce himself, but my name is Alyssa. For those of you that don't know, I'm a doctor of physical therapy and the founder of Keep the Adventure Alive, where we primarily specialize in knee osteoarthritis. And so I'm going to let Brody tell us a little bit about him and kind of what he's got going on. Sure. Thanks, Alyssa. Thanks for the opportunity to have a chat. Yes. Uh, my name is Brody. I'm from Melbourne, Australia. I am a physiotherapist and at the moment my, um, I'm also the host of the Run Smarter podcast and the idea or my main mission is to help runners, help educate runners, help them make smarter training decisions, help bust a lot of running misconceptions and myths that are out there. and just help bring clarity and control to runners who are either injured or want to reduce their risk of injury or want to increase their running performance. Because a lot like OA, there's a lot of misconceptions and there's a lot of, I guess, there's a lot of information out there that's very confusing. You hear one thing, then you hear another, and you're just not too sure where the truth lies. And so, yeah, I'm excited to dive into today's topic. I'm excited to... help potentially some runners out there or at least just shine some light on some osteoarthritis myths. Yes. So how did you get into running? Cause I know running is kind of your niche. And so how did you kind of get into that or get started with that? Yeah. So I started off as a generic physio first, and I was just in clinics training patients. And then it was a couple of years into my physio career that I became a recreational runner and was training with my sister to help. her prepare for a half marathon. And then I just loved seeing runners. Once I was a runner myself, as soon as a runner would come into the clinic, I would have this heightened passion. I'd just want to bring out my better self to help these runners. And it was then treating a lot of these runners that I recognize that there's a lot of, um, they're a bit puzzled about certain foundation principles to reduce their risk of injury, and I was constantly educating them, constantly repeating the same. principles over and over again. And so I just thought I'd, um, help these out because this population brought out my better self and it brought out my better clinically, clinical outcomes. And we're seeing those really helping me also serve a purpose and helping me delve into research and learning more about running and interviewing more people about running. And so I just, I just like gained momentum from there. And that's where we find ourselves now. That's awesome. And I really think that it's important to kind of be able to not only specialize in kind of a niche, because then you can get like really deep into and you'll find yourself like reading the research for fun and like finding new ideas and all that kind of stuff, because I kind of feel the same way about arthritis. And it's just like you start to help some people and then it starts to really kind of build on itself and it's like, oh, I really like this. So that's awesome. Yeah, it's really, I'm sharpening your skills. Once you find a niche, you can then really delve into it. And it's a lot of repurposing my stuff. Like if I have to review an article and learn more about it myself, I'll, if I find it really interesting, I'll just create a post and share it with everyone who follows my social media. And so it's, it's generating a good flow because it's sharing that information in the world and I'm working on my clinical skills and sharpening those skills as well in the process. Exactly. And that's the thing that a lot of people, I mean, like you were just saying, I mean, there, it is so noisy out there with all, especially in like the health and fitness realm of things, there's lots of people posting information and it's, you know, is it true? Is it not sort of thing? And I like that you actually put out a lot of research and I try to do the same thing. put out a lot of like evidence-based research type stuff, but make it so that like the lay person can understand or a person that doesn't necessarily have a background in anatomy and physical therapy and all these things that they can actually kind of understand that and actually use it versus, you know, making it scientific and, you know, being able to actually apply it to real life. For sure. It's a bit of a skill too. Because when you read it, when you read an article, Like half of it doesn't make sense if you're not trained in like knowing what it is or reading that language or having that physical therapy jargon and being trained in that. So it's a skill to kind of use the times it's like, yeah, a few times. Of course, of course. So I want to kind of get a little bit deeper into first, just kind of a generic arthritis, because I actually found you. on Instagram and then I started delving into your podcast and I actually listened to the one and I did post into my Facebook group of the one that you kind of delved into osteoarthritis and then kind of tacked it onto the running and things like that, which I thought was super interesting. And I think that we share a lot of the same ideas and I know that, and it's always good to get a different perspective on things. And so... What do you find are kind of some of the common just misconceptions about arthritis, just in osteoarthritis in general, and then we can kind of take it from there. Yeah, there's a ton, but I think the main one that we need to start with, that we need to open the conversation with is like the, what actually causes osteoarthritis and how it progresses as a disease. And the, a lot of people have been educated on or I'm convinced that osteoarthritis is this progression of a pathology that's irreversible, that's wear and tear on your joints, that's cartilage that's slowly being degenerated, and it will get to a certain point where it's bone on bone rubbing against each other, and then it'll eventually get to a point where it needs to be replaced because the function or the pain just gets too much and needs to be replaced. That's what we've been told. That's similar to what I got told back when I was at uni, and which is almost 10 years ago. And it's, it's what patients have been told. It's what patients look at when they're at scans and they get scans and say, Hey, you have moderate OA. You have this wear and tear of this cartilage. It's, um, due to overusing the joint. It's due to maybe in the past, when you were a dancer or you played a lot of team sports, you know, the, the. joints themselves have this finite amount of load that goes through them. And if you overuse it, they're gonna start getting this wear and tear and you're gonna eventually need to get it replaced. And they think of it like a car. They think a car has a certain amount of mileage and you do need to replace joints. It has a certain mileage before it starts to slow down, before it starts to have these hiccups and you need regular maintenance, but eventually it's going to get so old that you need to get a... an engine replaced or those sorts of things. And they think it's very mechanical. They think there's finite expiry dates on these joints when in fact, it's quite the opposite. We now know that cartilage itself is this living breathing tissue that breaks down and builds up, breaks down, builds up. And when we start delving into the research, we start to find this reality of what the pathology actually is and how it progresses. And a lot of these, if we had that car analogy in our mind, and we start looking at all these research topics and things that come up, a lot of what they find in the research doesn't make a lot of sense. Cause you find runners don't actually have a lot of osteoarthritis and people still run with osteoarthritis and the symptoms don't get worse. And you it's puzzling. If you think of that car analogy, why this research is showing these results. Um, when in fact, what the reality is, is that cartilage does build up, it does break down. And if you load up the body enough, it actually strengthens up your muscles. It strengthens up the cartilage and actually triggers cartilage growth. And it triggers bone growth and it's actually very healthy for you to load the joints. And it's actually very protective for you to load the joints to reduce the risk of osteoarthritis and reduce it worsening when you do have osteoarthritis. Yes. And I mean, I feel like you're like inside my head because I literally just did a workshop on this. Because it's so it's that wear and tear and it's that mindset that, okay, if this is because I have wear and tear, I have so many people that come to me that say I stopped exercising. I stopped running. I even stopped like walking recreationally because I thought that I was continuing to make my knee worse. I didn't know that, you know, even if I had some discomfort with it, I thought I was doing more damage. So that's why I stopped. And actually it's when you stop, that's when the damage starts to really kind of go on top of each other and really start to kind of exponentially get worse and you then your pain gets more severe because you're losing that muscle support. You're losing that cartilage, you're losing that. cartilage strength. And I think that is one of the most common misconceptions. And I think another way to look at it is through imaging. There's been a lot of imaging studies that people can have the same two X-rays or the same X-ray, but one of them has pain and the other doesn't. And so it's figuring out, okay, why does this person have pain, but this person doesn't. And I think that also highlights kind of that wear and tear bone on bone that just because you have that doesn't necessarily correlate with pain. Yeah, I think we can't blame it on the runners or the people either because doctors and surgeons tell them these exact same things. They tell them that running's bad for your knees. They tell them that their knee's finite. They tell them that eventually you're gonna need to get it replaced. And it's coming from such a big authority figure that like you can't not help but believe it. And we tend to educate someone. and they take it on board, but then a doctor or a surgeon says something and it trumps everything that we say. And unfortunately that that's how people take on that information. And like you said, it is, we do want to keep our knees strong. We do want to keep the body active and a very, a very common presentation that we see is let's just say, um, John goes into, uh, he starts running and he's preparing for a marathon. And he bumps up his mileage too much and his knees start hurting. And he goes to the doctor and he says, look, I'm running, I'm preparing for this marathon. The doctor says, Oh, I think running's bad for your knees. Maybe let's have, maybe let's get some scans and see what's going on. Maybe he's in his mid fifties and they get scans and the scans show you he has mild osteoarthritis. And they say, look, running's bad for your knees. You've got osteoarthritis. You probably shouldn't run. And so he says, Oh Jesus, maybe. maybe I should stick to cycling, maybe I should stick to walking. I knew running was bad for my knees. And what happens? They get fearful of running. And so they back off that they do some other fitness routines. They go hiking, they go walking, they do swimming and cycling, which doesn't put a lot of load through their knees. And so over time, over five, six, seven months, the structure becomes weaker. And then let's just say they go for a long hike and then their knee flares up again. They say, Jesus, maybe I've done too much. Maybe this osteoarthritis is getting worse. Um, but in reality, it's just getting weaker. That tolerance to load is actually getting weaker. So they go back to the doctor and they say, Oh, let's do a scan. Oh yeah. There's still mild to moderate osteoarthritis. You're probably going to have to get a knee replacement in 10 years time. Um, we're not looking, it's not looking good, but we're seeing on the scans. And then this feeds a lot more fear into them. and feeds, oh, maybe I should avoid those long hikes again. Maybe I should just do some regular walking and some swimming. Maybe that's, and then that fear and that belief leads a year down the track when they get significantly worse. And maybe they put on weight and maybe their lifestyle changes and they're not focusing on those healthy habits. And this just only confirms their belief because now all of a sudden they're so weak and they've put on a bit of weight and the ability for those knees to tolerate a lot of strength. is nowhere near what it used to be when they were running. And so now a lot of things are flaring them up. A lot of things are sparking a lot of pain. And it just confirms in their mind this false belief that yes, I know, but it's osteoarthritis. I can't do anything about it. It's, you know, if I go for a long walk, it's gonna get sore. If I go for a long bike ride, it's gonna get sore. And, you know, maybe I can hold out for five more years and then get it replaced. And this is a very, very common pattern that happens with a lot of people. And... It's quite the opposite. They're going down this detrimental path when they don't need to. It's a, it's a path that you don't need to take, but they're listening to these health professionals and they're getting the wrong advice. Exactly. And I always tell people it's kind of like digging a hole. Like once you kind of start to like give up things, you're digging a little bit deeper and then you start to kind of give up activity in general and you're digging a little deeper and then it makes it a lot harder to get out once you have all these beliefs in. I mean, I think one of the biggest things that we miss with arthritis is the mindset, because if somebody comes to us and their hole is like 10 feet deep, and then we try it, like no matter what exercise we do, they're probably still going to have pain. If we don't push through some of these beliefs that it's not wear and tear and that exercise is going to help and you know, all these things that you can move and you can strengthen the cartilage, if they don't actually believe that. No matter what we do, it's not going to make a significant change to that pain. And so I think that that's a big thing too, is that it kind of goes along with what you were saying, the mindset part. And we kind of get that early on those things that we hear. And then that just kind of, again, like you said, sends us down that path or digs our hole a little deeper and then it makes it really hard to get out. Agreed. Yeah. And that's why education is the first step and it's providing the right education, settling down there. addressing their beliefs, settling down their fears, because we know usually by the time they get to us, maybe they've had scans. We know that like getting an X-ray or getting any type of scan holds a lot of weight. People are really attached to their scans. And if they get scans and told they have arthritis, they're like shoving it in your face. They're like, look, this is my knee. Like this is the damage that's done. And you say, well, let's backtrack and let's start talking about a few things because we do know that if you're in your 50s, It's very, very common for there to be early signs of osteoarthritis. Mild osteoarthritis is very normal in people who don't have pain and people who are fully functioning. So it can be an incidental finding. And it's, yeah, people like to hold on to those results. They like to say, look, this is my knee. This is the damage that's being done. But if you educate them that way, like, hey, I could go scan Bill down the road I know his fit and healthy, I know he's in his fifties that will show mild osteoarthritis. And he hasn't had any knee issues his whole entire life. And so we need to find the correlation causation and help settle down those fears that they have. Yes, 100%. And I think that is one of the big, and if somebody, if you're seeing somebody who's in their mid fifties and they did have an X-ray, do you look at it? No, I wouldn't, especially straight off. If they come to me with their scans, I will look at it because if I don't look at it, they're gonna dismiss everything I say. They're like, he's not even looking at my scans. He doesn't even care. He doesn't even care about me as a person. So I will take it on board. I will like take it as a bit of information. And sometimes it is nice to look at it and correlate with their symptoms because, but you only just take it as a small bit of information. We're not heavily relying on these things. And if we go back to our example with John in the past, if he was training for a marathon and he had knee soreness and he got the scans, I would look at the scans and then I'd say to him, hey, you know, usually the very first signs of osteoarthritis isn't really pain, it's stiffness. It's like stiffness in the morning, moving around, that's usually the first sign. It's a very gradual onset. With you, you've gone from running 20 miles a week to running 30 miles a week. And you're a new runner. Maybe that's just been a bit too much of a jump for you. And that's why the onset is like quite sudden. Maybe you've just done too much for that knee and maybe just need to back off a bit, do some strengthening and then slowly build you up a little bit more gradually. Um, and then he says, yeah, but look, this is osteoarthritis. This is what the scan shown. I say, well, you're in your fifties. Um, this is very common for it to be in the healthy population. We do know that mild osteoarthritis is extremely normal. And maybe this is just an incidental finding because how you're presenting currently fits with just the knee itself, just being overloaded rather than it just being a, an arthritic joint. And hopefully communicating that way can help settle down a few things so they can say, okay, where to next. And then that's when we come up with a better sort of rehab management plan. Yeah, no, absolutely. And I think it's, um, a good point because I usually don't look at them unless they've had like a previous ACL, MCL, like some sort of injury. But a lot of people really kind of perseverate on the imaging. Like I want to know what's going on. So I want to get an MRI or I want to get an x-ray. And I mean, again, it's one of those kinds of misconceptions that it doesn't necessarily correlate with pain. And I think that that's important. And sometimes it's hard to understand and it's really hard to kind of conceptualize, because you look at this and you see, and the doctor explains like, oh, this is the worst knee I've ever seen. I can't wait for it walking, like that sort of thing. And it just kind of fuels into things, but switching into kind of more of a mindset with running. So a lot of times people stop running because they start to have pain. And so what do you kind of tell people as far as, Like what type of pain is okay and what type of like, when should they stop running? So say John is running and he starts to have some pain, but he went to you first instead of going to the doctor kind of what would your, um, kind of, uh, maybe initial evaluation or what are some of the things that you would look at or tell him? Cause I have a lot of people that have come to me and said, okay, I'm having, you know, a little bit of knee pain. Like what should I do? And so I just kind of want to get another perspective on that. Yeah. I would first of all, start off with getting, having a deep look at to his running, his running mileage, his training habits, especially at the time that the knee issues arose. And so that would be say, uh, looking at his weekly mileage, looking at his intensity, looking at if he's changed shoes, looking at his, um, if he's changed terrain, like started doing a lot more hills than usual, and just seeing if there's any abrupt changes. Um, if he is one that has had like symptoms of osteoarthritis in the past, I would also have a look at what are some things that might increase tissue sensitivity, like what is his sleep? Like what's his diet? Like, is there any change to his stress? Is there any lifestyle factors that are going on that could increase tissue sensitivity? Uh, and then just like addressing what I find if there's, if symptoms have a very mild and we have identified some sort of training error, then it might just be as simple as backing off the total mileage for a week. You can still run, but let's back off the intensity a little bit. Let's back off the overall mileage, way for symptoms to settle down and slowly build back up. And in an ideal world, if we have caught that at a mild stage, if he's come and seek help very early, then that's all that needs to be done. However, reality doesn't really work that way. People come in with... having it, it's worse and worse and worse. They continue to run on it. Then it's, then it's a lot worse. And then it's so bad that they're unable to run. Then they see me. And so that's the unfortunate reality. And that's just what sparks motivation in people to see a physio. If they can run with a little bit of pain, that's not enough motivation to seek help unless they've had some sort of issues in the past. Like they've learned from their past mistakes and they jump on it straight away. But in reality, it's when symptoms get worse and worse and worse to the point where they're unable to run. That's when they come in. And so it's usually a bit sensitive. We usually have to take a couple of days off, maybe a week off running. Um, but we usually try and start with something that they can manage. Like it might be some sort of strengthening exercises. Cause we know that complete rest doesn't really serve us well. We know with osteoarthritis, complete rest doesn't really serve us well. We want to do some form of loading that you respond well to, and that still the strength and the overall tolerance or the, yeah, the load management of the knee. So that could be say wall sits or some light squats or some light lunges or doing step ups or some sort of strengthening exercise until they're able to jump until they're able to hop and then say, okay, now you're probably ready for some levels of running. But we also know that they don't need to be totally pain-free when they run. We know that they can have low levels of pain. Uh, it may be like a two or a three out of 10 pain. that doesn't get worse during the run. We wanna make sure it stays at that stable low level. We wanna make sure there's no severe flare ups 24 hours after that run. So we don't have it really sore, really stiff the next, or like that night. And we know there's no hangover effect when you wake up in the morning and there's this nagging kind of stiffness or soreness. If there's an exacerbation of that, then we know that the running you've done is too much. But it doesn't need to be zero. We can continue staying fit and healthy. We continue stimulating the joint and the rest of the body, we can continue loading up the body and preserving a lot of that strength by following these pain guidelines. Because a lot of tricks or a lot of mistakes that people make is they completely avoid running. They say, let me take two weeks off running and then once symptoms settle down, let me go back into it. And usually in those two weeks, you're slightly getting a little bit weaker. But then when you go back into running, they go back to their previous levels, which is too much because you've had two weeks off, then things flare up again. Then it's followed by another two weeks of no running. And then they're by that stage, they're quite weak. They're not really handling a lot of load and they need a lot of strengthening and they need like a lot of walk, run programs or like a very, very gradual buildup back into their running. Um, so that could be some, some advice, making sure trying to keep them as fit and as strong as they can as the knee can possibly tolerate and make sure that, or just keep in mind that we don't. to keep everything at zero level of pain. It's tough teaching and learning these concepts through a purely audio format. So combining the podcast with these video courses is a great way to enhance your learning. And once you sign up through my website, you'll have access to the course videos, both on the Run Smarter website and through the Run Smarter app. And to say thanks for being a podcast listener, enter the coupon code podcast at checkout and get a three day free trial. This unlocks all the content within my injury course. and unlocks my other two courses, all to do with injury prevention and boosting running performance. You won't even be automatically charged at the end of this three day trial. So head to the online course hyperlink in the show notes to begin. No, absolutely. And I think that that's a really important point. And I think that a lot of times we associate pain with more damage. And I think that's kind of where some people get hung up. And also when people continue to kind of go back into running, like if you then you take two weeks off and then you go back, then you start to get that frustration and then you start to, like it starts to plan you psychologically too, which is huge. Cause it's like, well, I can't run. And then I had one person tell me the other day that then she got to the point she cannot run. And I'm seeing her in a couple of days, but she got to the point where she's like looking at runners and jealousy. And it's just like, and because she's been told that she can't run and she can't do these things. And so she's jealous of all these people that can, when in reality, it doesn't have to be like that. And I know that, um, especially when people maybe have given up running, how do you feel about walk, run intervals? Cause I know that those can be very effective and that's a good place for people to commonly start, especially if they've taken some time off or maybe are having some of that tissue sensitivity. So do you commonly use those? Absolutely. I love those. Before we touch that, you did mention, I think it's worth reiterating that yes, pain doesn't equal damage. We know that this is a fact. And we know if we go back to that, Oh, a car analogy of, you know, things will eventually just wear out over time and everything has an expiry date and the pathology would just get worse and worse. Why do we see people with osteoarthritis that have these flare-ups and then they feel better and then they have these flare-ups and they feel better. It doesn't fit the correlation of the pathology when symptoms are just flared up here and there. And that's why we need to have the discussion around. sensitivity rather than this pathology, like it's just getting worse and worse because it doesn't correlate with damage. It doesn't correlate with scans. We can have people with very mild OA in a lot of pain, a lot of people in severe OA with no pain. And we do need to understand that there are certain lifestyles, there are certain life influences like diet, like stress, like emotions, like, you know, just worries, frustrations that do spark and do... contribute to pain sensitivity. And so when you mentioned that someone might be extremely frustrated because they can't run and they're seeing all their friends running and they just wanna get back. They just wanna be back. They're missing a part of their life. They identify themselves as a runner and they're not able to do it. It can be extremely frustrating. It can contribute a lot of stress, which in fact increases pain sensitivity. And so those symptoms... what you're experiencing is actually heightened and is actually more sensitive, which makes things worse unless we educate them and address these issues. So I think that's worth highlighting, but the walk-run programs I use for a lot of, not just knee issues, I use for a lot of injuries. I know I've been injured a lot in the past and I've found walk-run programs really effective. It's really good at breaking up the speed of things and giving these like little micro breaks for you just to interpret, let's see how things are going. during those walks. So you actually felt, I feel pretty good. But it gives the body a bit of time to catch up. And then just overall throughout the run, you might've been exercising for 30 minutes, but you've only been running for 10 of those 30 minutes. So you can still get out and have a decent exercise. You can get out in the sunshine and get out in nature for a decent amount of time, but just not load the body or reduce the risk of overloading the body. If you do mix in these fun walks and it's a, it's a good way to structure things. when someone's returning back from an injury and we want to find out where their tolerance is, it's good to have a really systemized plan of saying, okay, you can run for two minutes, but then walk for one minute and do that five times and then let's see how you go after 24 hours. And if that's fine, then we just tweak the numbers a little bit. We massage the numbers and say, okay, let's do a three minute run, but then let's do a two minute walk and then slowly build up their load and slowly progress from there. And that's why. catch to 5K is very successful. And I do follow, I do like advise people follow that if they want to, but yeah, there's magic with there. And there's, there's reason behind why it works. Yeah. And I think it's also important that people have options because that's a big thing too. Like if somebody is used to going out and running five, six miles, but at mile like two or three they start to have some significant knee pain. And so they don't have to necessarily give up running completely. It's okay. Now we can maybe use these walk around intervals or use these other options where you can still get out and run and do those things, but make it into more of a tolerable or more of a digestible chunks. So that way you can actually be successful at it. And then that's going to feed into the confidence to kind of continue to go back. Cause I think, especially with chronic pain, just in general or arthritis, options are super helpful because immediately people are kind of thrown into this cycle and swim. These two subgroups, the second they're told they have arthritis and it's like, okay, well, I can't run anymore. I'm just going to need to get a recumbent bike, but it's important to kind of highlight there are options and that our joints can tolerate these things. We just have to make sure that they're prepared. And so I think options are definitely good for the mind and then also good for the joints too. Yeah. And also keep in mind that if you go to only doing cycling, you're not getting that ground reaction force that the body loves and the body that stimulates his cartilage growth and definitely swimming, definitely is good. Swimming is good for your cardio. Swimming is good for like upper body and like just getting a good workout, but gravity, you're just taking away gravity. You're taking away. Yeah. Well, we're. we're removing like a stimulus that the body needs to like remain strong and to build up strength. And so you're going to follow that John story of just slowly getting weaker, you know, month by month, you know, year by year until you're not tolerating a lot and symptoms are going to spark and then you're going to be, Oh, I do need a joint replacement. And yeah, so keep that in mind. If low levels of running at this moment in time is causing a flare up, then just go for a walk and then go for a bike ride, um, or go for a short jog and then go for a swim. But we want to still stimulate the body and get that ground reaction force and, um, trigger that cartilage growth as much as we can, as much as you can currently tolerate. And then if we improve your diet, if we remove the stress, if we, um, start to reduce this pain sensitivity, then you slowly get back to more running and more jogging. And, uh, then. We're only just being extremely proactive and like practicing these long-term solutions rather than just avoiding everything that triggers pain and avoiding everything just year over year, just getting weaker and weaker and weaker. Exactly. And I think that that's kind of, we have to keep ourselves out of that cycle. And one of the ways is with cross-training and doing other exercise. I'm going to put you on the spot here for a second. So what are, what would you say like the, maybe the top three movements that people should be really good at before they attempt like a long run or before they, um, especially if they've gotten weaker before they can run successfully. What would you say are kind of like the top three? Uh, they definitely need to be doing some level of jumping. I think like double leg jumping, just if I have an athlete who wants to do faster running or just. a non shuffle like they do need to have some sort of bounding, some sort of reaction force. So we get them skipping for 30 seconds. We can try them hopping and seeing if they're tolerating that if they are, then they're ready for running. Like it's skipping is quite tough. Hopping is even tougher, but if the knee can tolerate that for 30 seconds, then running low levels of running is you'll be able to start doing that. Not to say you're ready to run for 20 minutes. We'll have to start. at a low dose and then build their way out from there. If we're like in the gym or if we're assessing someone's step-ups or like weighted step-ups, so we're putting someone through a little bit more knee bend because when you skip, you don't go into, your knee doesn't bend a lot. It does absorb a lot of that ground reaction force and it is quite forceful, the amount of quick firing kind of action of hopping and that recoil plyometric style. Step ups go through a little bit more range of movement. We can put on weights. We can have them holding onto dumbbells and see how they start tolerating that. The other one would just be like squats, just seeing how they tolerate deeper levels of knee flexion. And even though it's not mimicking the range of movement that running is required, it's at least assessing them because if you can bend down and if you can, it's quite functional. So if you're going through a deep level squat and you're tolerating that quite well, then you'd be able to say, look, your knee is pretty resistant. Um, we can put a lot through it. And if they're extremely painful going through, say half a squat, then I'll probably say they're probably not ready for running. Uh, we should probably address this issue and make sure they're pain free with doing a half squat before we even discuss low levels of running. Yeah, no, absolutely. And I think that that's important. Um, because I know a lot of people, again, that's a common misconception. No high impact, no jumping, no, um, leaping, no like none of that stuff, but if you can prepare your joints then this makes it when you start to be able to jump and skip and those sorts of things, not only just for running, but I mean it opens up so many doors because then that means you can climb stairs like usually without pain and you can do these other things without pain, but jumping is so important, but if you have a lot of pain just kind of walking. or just doing simple things, like maybe even the squat, then joints probably aren't ready for jumping. But it's so possible because I've had people jumping that have mild, moderate osteoarthritis and are able to recover and things like that. So I think one of the biggest things is just that it's possible and that can do it. It's just a lot of times we don't even think about running, especially when you're like 50. I mean, we're not really... jumping around or jumping in daily life. And so people haven't jumped in like years. And then it's that fear that really kind of plays into it too. And so I think that that's really important. Um, one to just show that it's jumping as possible, but then two, you should be able to do it if you're running. And if you can't, that could be a reason why you're in pain. And again, with squats and the step ups, if you can't do those things without pain, then kind of no wonder why you're in pain running. Do you have any other tests you do yourself, Alyssa? Do you do any like open chain or theraband exercises or something to, um, assess whether someone's ready for running? So I actually do a modified, a single leg, um, uh, kind of like a five second sit to stand, but a single leg in it's modified in the fact that one leg is back in the other leg is out straight, but still touching the floor. and then being able to stand up and down five times in less than seven seconds. That's kind of one that I've just kind of found and kind of made my own. But I think single leg strength is really important too in power. So being able to do it quickly without pain, I think is big. And obviously it's a lot harder to like actually have your leg all the way in the air or do it without a chair. but kind of in that modified version, then that way we can, you know, have, be able to tolerate that joint reaction force and things with running. And I actually had a guy who was having some back pain and some knee pain, and he didn't necessarily want to get back to running, but wanted to get back to like climbing stairs and things like that. And we had to work together for a while. He hadn't worked out in years and you know, he was in his 50s and he got, he is able to do that test in six seconds on each side. And it's crazy. And now he has no pain, virtually no pain. And it's just, it's kind of amazing, but a lot of people can't even stand up on one leg from once. And so that is another test that I use, but also jumping is a big one. And then some sort of, I usually do a lot of lateral movements, not necessarily in a test per se. but lateral movements is kind of a big thing that I see just because a lot of people don't have variety. It's always forward and backward, rarely backwards even. It's always kind of forward. We're always walking forwards, running forwards, cycling forwards. And so we kind of negate some of those other stability muscles that are really important for running in higher impact things. And so lateral movements is another thing, but I don't necessarily have a particular test I use. but also balance. I look at balance a ton, especially like a single leg deadlift, cause people are like, oh, I can stand on one leg, but okay, can you stand on one leg and then move? I have people like standing on one leg and pass a dumbbell back and forth because you have that lateral displacement that not only works the stability forwards, but also sideways too. Like the guy I saw today had some lack of stability sideways. And so he wanted to get back to tennis and running and things like that, but we need that lateral stability too. And so I think that that's important. So balance is another test I do that you should be able to do five single leg deadlifts in control without any support or anything. Yeah, nice. I think the variety is extremely important, but also someone could be doing, say, their lunges, their deadlifts, their squats, and they think they're doing really well because they're starting to improve on weight or they're starting to get heavier and starting to get easier. But... As soon as you say, well, can you do it? Can you do five in five seconds? And you start to incorporate a little bit of that speed work. Um, they might be so apprehensive or they might be shocking at doing that because they haven't triggered their body enough to have those quick fire reactions. So I think that might actually be the, when you're talking about that sit to stand in a, do five and seven seconds. I think that might even be bridging the gap towards jumping. Uh, I think that's like a nice way to. get them to say, let's start working on this a little bit. If they're really fearful of jumping, let's do this really quickly. And once you start getting really good at that, then that the fear of doing some sort of quick firing jumping, um, might subside and then, you know, you can bridge that gap. And then obviously if you're hopping, then you'll have a lot of confidence running. Absolutely. And that honestly is a test. I probably do like. visit five or six. So we kind of are a little bit past that we've kind of gained some confidence. And so that way, then we kind of test that that's not necessarily something I usually do like on the first or second visit, we usually kind of gain a little bit of confidence first, and then kind of go into that. But yeah, it's definitely building that confidence kind of working through those fears, as you're doing some of these initial things, and then being able to kind of progress. to something like that. And I mean, it's definitely preparing the joints for whatever you're doing. So running, climbing stairs, I mean, whenever it is. And so what are kind of maybe the top three takeaways? Like if somebody comes to you and has knee pain or has a diagnosis of arthritis and they want to get back to running, kind of where are the three places that you would tell them to kind of start just generally. So we can kind of wrap some things up. I guess it would depend a lot on the individual. It depend on like what their current level is like in terms of what I give them. So like some takeaways, but a lot of it is gonna be advice. A lot of it's gonna be education. A lot of it's gonna be, first of all, what we discussed, pain does not equal damage. So letting them know that. So that'd be a real key takeaway to letting them know that rest and avoidance makes, can make the pain worse. Knowing this, we're just making those structures weaker and just knowing that it's safe to start applying load. It's safe to start like doing things like challenging the knee. And if it's, if it gets a bit sore then we just know where their ceiling is. And we know that we need to back off a little bit and build up from there. But yeah, like we said, low levels of pain is totally fine. So those takeaways would be really nice. If they are an individual that is quite, say, sedentary or is quite maybe overweight, it's educating them around the factors that like obesity has been strongly linked with osteoarthritis and like the lifestyle factors do have direct correlation with pain levels and decreased levels of functioning. And so building them up that way, but. The rest is just trying to bridge the gap from where they currently are and where they want to be. So not everyone wants to go back to running. A lot of people want to get back to just walking for an hour or hiking or cycling. And so we say, okay, this is where you're currently at. This is where your knee can, what your knee can currently tolerate. And then you just build a management plan from there. This is where you want to get to. This is how we're going to bridge the gap to get to where you want to. And if they do strike like one of those myths and they think that rest is helpful if they think that pain equals damage, if they think that surgery is the only fix, if they think that the scans, the results of their scans indicate like this worsening level of function, just trying to address those along the way. But that's just the best thing we're trying to, the biggest takeaways were reducing the amount of like this low value care, these passive treatments. So like, yes, massage might feel nice. maybe dry kneeling might feel nice. Maybe some other hands-on therapies or some machines that they put on, it might feel good in, pardon? Creams and supplements. Yeah, like they can feel good, but it's a trial and error basis and it's only short term. So we need to make sure that we adjust to the individual. If they say massage makes me feel so much better, we say, fantastic, let's do a massage, but then let's do your exercises afterwards while you're feeling really, while you're feeling quite good. giving them the opportunity to start being more active and engaging in activity and just being more physically active, um, rather than just saying, Oh, your massage feels better. Fantastic. Go have a rest and we'll come back next week and see if it makes it feel a bit better. It's avoiding that, that low value care, the passive treatments, the short-term solutions, um, and then just trying to provide that high value care, the long term solutions and the right advice, right education. Exactly. And that's what I mean, because I think that people get, um, a lot of times get on this hamster wheel of temporary relief. And I totally agree using those passive treatments. We don't have to completely get rid of them, but using them to our advantage and using those things to show your body actually how to move because you're going to move better when you feel better. And so using some of those things and then moving and showing your body how to move because In life, we have to move. And so if we just keep kind of covering up with these medications and supplements and all these sorts of things, we have to be able to move without that sort of thing. We can't just become reliant on those. And so I think we can absolutely use them to our advantage, especially with higher levels of pain, but we have to be able to show our body that we can actually move without those things too. But initially those things can be very helpful, but definitely not something that we're going to rely on. And, you know, because that is not down a good path. Yeah. I think it's also worth discussing that if you do have say mild to moderate osteoarthritis, you can still run. Like there's been studies to show that running actually reduces the progression of osteoarthritis actually helps symptoms in the long run. And so. If someone has mild away of their knee or their hip, and they're really fearful, you can say like, you should keep running because running is going to actually help you moving forward. There's, there's studies done to show that it won't make things worse. And in most cases, it makes things better. It makes the, it slows down this progression, but actually starts to form some sort of cartilage growth, as long as you train sensibly, as long as you don't have these spikes in training load. And as long as you foster this. training load within your adaptation zone, especially within the knee. Um, yeah, you'll feel better because of it. And that's encouraging. And along the way, we do know that if you maintain a very active, active lifestyle, your, your weight management is a lot better, which is so good for the management of osteoarthritis. We know that you're staying strong. We know that running does wonders for the muscles around the knee and around the hip and around the rest of the body, which is extremely beneficial for the management of OA. And so we need to know that, you know, first of all, running to itself isn't bad for your needs. We know that runners have a very low prevalence of osteoarthritis because you're triggering that, that cartilage growth. But if you are one of those runs that does have a way, continue running. We want to be sensible. We want to continue running to start to maintain that strength and trigger that cartilage growth. And so try to Be very skeptical if people were to tell you that running is bad for your knees or that you should avoid this and you should, um, yeah, again, back to that low value care, we want to be very skeptical of that and try and focus on being proactive being and maintain that active lifestyle. Yes, absolutely. And just one more quick question. So when shouldn't you run? You shouldn't run if there is one, a spike in your training load. Like if you're waking up, if you go for run and yeah, you've followed low levels of pain, but the next day it's extremely, it's extremely sore and it's just hard to move around. It means you've done too much. If you've gone and done a really low level of running and you're still getting that response, it means currently at this stage, you're not tolerating running. And so we go back, we find things to reduce that pain sensitivity. So we want to make sure they're sleeping well. We want to make sure that their stress is addressed. We want to make sure that they're eating well. And then that pain sensitivity. sensitivity settles down. And then if returned back to running still sparks things up, then they're just not ready. They might just be, um, they're the load through the body is just too much. And so that's when we need to take a step back and bridge that gap. We need to start with squats lunges. We need to start with low impact stuff and build up till the point where we've crossed that bridge and then they're able to tolerate levels of running. And so that would be the case if you, if you are getting spikes in, in symptoms, um, then that's when we need to start reevaluating the management plan and say, you're probably not there yet. Let's do X, Y, Z to get you to there. Instead of just being like, oh, it's got to the point where it's so bad that I just can't run anymore. I shouldn't be a runner anyway. And then just saying, I'm done for the rest of my life. Let me do something else. Yeah. And I think that that's really important to note that. I mean, it's gonna take a lot to say you have to give up running. I mean, it can be possible in a lot of situations and a lot of severities in arthritis, even if it's moderate, even if it's even a little bit progressed than that, as long as you prepare your joints, I think it's still possible. And I mean, you might not be able to run 20 miles or run a marathon, but you can at least do a little bit because I think running for a lot of people is also mental and emotional and people use it to like a skateboard. use these things as kind of a, able to free their mind and stuff like that. So that's kind of a motivating factor to get back to it. And when they lose that and think they have to lose it for good, that can play on us psychologically as well, which we know then feeds into more pain and that sort of thing. Yeah. That's the, um, the, the factor that we're always weighing up, especially when I'm dealing with a runner with any injury, like if they are a runner that loves running and they get that, um, they do it for mental health reasons as well. As soon as they're so injured that they're unable to run, that's when they really get affected because they're so frustrated, they're so stressed and their stress relief is now gone, which contributes to pain as we now know. So it can be extremely frustrating, which is why one of the steps that we have when I treat a runner is can we still run? Like, is there any, can we even just do a small amount and just keep them out and about, keep them engaged, keep them settled, reduce the frustration, reduce the stress? Um, it's a big part of their management. And if you go to say a health professional or a doctor who isn't a runner, they'll quickly say, just don't run, don't, don't run for two, three weeks. Um, and then see how you go, which is usually very, very detrimental. Right. Absolutely. And it's all, I always tell people that usually when you go see somebody who, you know, is not necessarily super progressive is more conservative in their treatments and things. You just get this long list of things that you can't do, but you don't ever get a list of things that you can do that's outside of like cycling and swimming and low impact sorts of things. And so this long list of cants then really starts to kind of play into it and can really kind of send you down that path of giving up everything that you love. And I think that's the biggest thing that we have to stop that and really kind of. push some quality information out there, which is why I'm so glad that you have joined me today. And so where number one, the name of your podcast and then to the, your Instagram handle. Yeah. So the name of podcast is called the run smarter podcast. Uh, you can listen to it wherever you listen to your podcasts. My Instagram are interested in it. Yes. So we do help like runners make smarter train decisions. So if you, if that's you, um, jump on board. And my Instagram handle is at run smarter series, where I pretty much just do the same. I follow the same mission that I do for the podcast. I help educate people. I post like research papers. I do blogs, snippets of podcasts and things like that. So if you're interested, you can follow me there. Yeah, absolutely. And then my Instagram is at adventure alive. If anybody isn't following that's watching this. And then I will also put a link down below. in, if you're watching this on YouTube, I'll put a link down below to his podcast and then to his Instagram as well. Um, and then if anybody has any questions, feel free to just put them in the comments. If you're watching this on YouTube and we will get back to you. Anything else, any parting words before we take off? I think we've covered a lot. I think I'll part off by saying thanks for all you do and the right information that you do on your YouTube channel. I had to listen to a fair few YouTube videos to prepare for this one and Yeah. What you're doing is incredible. So thanks for all you do. Yes, absolutely. And I, like I said, I feel like you were in my head, just saying the things that I'm thinking, which is really awesome to hear because this is not necessarily the norm of arthritis and the norm of like really kind of tackling chronic pain. And so I think that we need to kind of continue to together push through and push out good information. And so I appreciate you as well. Thank you. Thanks once again for listening. 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