Physio Blogfrom the team at South Coast Physiotherapy


Displaying items by tag: Sport

Wednesday, 14 September 2016 22:23

Running & Arthritic Knees

Arthritic Knees and Running

Arthritic knee pain is very prevalent in the aging population and can lead to a reduction in activity at the very stage of life when we are trying to remain as active as possible. As physiotherapists a lot of our patient management is directed at keeping activities that will aggravate knee pain to a minimum and, at the same time, trying to keep the patient doing their hobbies and sports.

Old Wives Tales

Some sports and hobbies are more knee friendly than others but it is often not as straight forward as simply branding the ones that involve lots of knee impact as being the most dangerous. The old wives tale stating that too much running will lead to arthritis in the knees does not fit in with current evidence. Current evidence shows that individuals who run and have healthy knees are no more likely to suffer from arthritic changes than individuals who do not run.

Runners Vrs Non Runners

One study which supported this took knee x-rays of 50 year olds over an 18 year period. The subjects were split into a group that ran and a group that did not .The results showed no increased signs of osteoarthritic changes in the either group. Another study took an MRI of 7 runners before and after a marathon and they found that there were no signs of joint stress or deterioration after the race. Both these studies certainly point towards running not causing damage to the knee.

Further investigation into the effect of running on knees in animal studies showed evidence that running may have beneficial effects. A study in 1992 compared a group of dogs that ran to a control group that did not. They found that there was increased cartilage thickness in the groups that ran. Another study looked at mice over a 12 month period and found that a group who were kept active showed less signs of joint degeneration when compared to a group who had limited activity.

The evidence certainly sounds very clear cut but before you dig out your runners and head off to pound the pavements it is important to underline that the positive findings from these studies were mostly on individuals who have healthy knees.

Anecdotally, in the clinic, we certainly find that inactivity, be it spending long hours in the car or at a desk, is generally more detrimental to arthritic knees when compared to regular walking and sometimes even jogging. But I would strongly advise against heading out for a run as a way of attempting to reduce knee pain if you are not a regular runner and if you do not have a clear diagnosis of what is causing the pain.

Take Home Message

As with everything you read in books and on line, whether it is part of a gossip column or from a respected medical journal, the findings need to be related to your individual circumstances. As for arthritic knees we can recommend to people that they can continue running if they are a regular runner with no knee symptoms and that they will have no greater risk of degenerative changes compared to non runners. However if you have knee pain and are keen to start running or you are currently running with knee pain then I would recommend to have an assessment with a health care professional such as a physiotherapist to work on a safe running plan. Addressing factors such as running biomechanics, muscle strength, foot wear and the intensity and frequency of your running program all play a roll in implementing a safe running program. Ultimately, however, there will be levels of knee arthritis where running is not appropriate and in these situations it is important to look into more suitable exercises and activities.

Published in Physiotherapy Blog
Wednesday, 23 September 2015 16:18

To stretch or not to stretch?

One of the most frequent questions I get asked is in regard to the correct stretching protocol when warming up for sports or at the gym. What type is best? When should they be done and for what duration?


Types of Stretches

As with many questions regarding the human body, the answer is dependent upon numerous variables and giving a generic stretch protocol is difficult. As physiotherapists we use many different types of stretches including static, dynamic, ballistic, proprioceptive neuromuscular (PNF)and many more. They are generally used to help the body achieve the necessary movement and mobility needed for the task it is trying to perform. Not only do they often form an integral part of a patient’s treatment, but they are also vital in reducing future injury risk.

As a result of the flourishing fitness, health and wellbeing industries there is ongoing research into all different types of stretches which is giving us an ever increasing knowledge base into this area. As a result advice on the correct stretching protocol is continually being updated.


When deciding what to prescribe for a patient it is important to know what type of activity they are undertaking. For example you would not do the same stretches before you take your first golf swing as you would if you were trying to increase your knee mobility after surgery. On top of this the age of the person doing the stretch needs to be taking into account, as the properties of the structures we are stretching will change with age and therefore will respond differently.

These are only a few of the long list of variables that would need to be addressed when giving advice on stretches and it gives an indication how trying to have a generic ‘one size fits all’ stretch is probably inappropriate.

Static Stretch


One of the most common stretches that are used through gyms and in sport is the static stretch. This involves holding a muscle in an elongated position for a sustained period. Recently these stretches have had some bad publicity with research showing that when undertaken before activity they can lead to reduced muscle strength and can hinder physical performance.

However the negative effects of these stretches are generally only observed when the stretches have been done in isolationand not part of a general warm up routine or when they have been held for over 60 seconds. When shorter duration stretches are undertaken as part of a pre-exercise routine evidence shows no compromise to muscle performance. There is also evidence that shows when, even in isolation, static stretches that are held for under 60 secondshave no negative effects, with one study finding that they actually increased leg extension power. However I think warm up routines are vital in preparing yourself for all levels of activity, whether it is for a morning of gardening or for a grand final and therefore I rarely recommend static stretches in isolation


I do not think there is enough evidence to advise people to stop doing static stretches but when they are used they should be held for less than 60 seconds and should be incorporated in a warm up routine rather than in isolation. Having said that I also do not think they are vital and if you have been someone who has never stretched before activity there is no overwhelming evidence that suggests you should start although I would recommend to do some form of warm up.

This advice is, however, dependent on injury. If you have an injury, either an old one or a new one, certain warm ups or stretches may be inappropriate. Therefore if you are in a position where you are looking for stretches to bring into your warm up routine because of an injury, or if you are returning to sport after an injury, then I would strongly advise to have a full assessment from a physiotherapist and get a diagnosis and a specific set of exercises or stretches.

Published in Physiotherapy Blog

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