Do the General Public and Health Care Professionals Think That Running Is Bad for the Knees? A Cross-sectional International Multilanguage Online Survey

'The right advice': a qualitative study examining enablers and barriers to recreational running and beliefs about knee health following knee surgery

OBJECTIVES

To examine the experiences, knowledge and beliefs of recreational runners with a history of knee surgery regarding (i) enablers and barriers to running participation, (ii) the association of running and knee joint health, and (iii) perceived benefits and motivations for running.

METHODS

17 runners (≥3 times/week, ≥10 km/week) with a history of knee surgery (7±7 years post-surgery, 9 women, age 36±8 years) participated in one-on-one semi-structured interviews. Interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis. Trustworthiness was built by following established qualitative research guidelines and by participant validation of findings in the final analysis stages.

RESULTS

We identified 9 themes (5 subthemes) for aim (i); 3 themes (10 subthemes) for aim (ii); and 2 themes (4 subthemes) for aim (iii). Positive health professional support including education, exercise rehabilitation and a tailored return-to-run plan enabled participants to return to running following surgery. Effective load management either independently or with coach assistance, and consistent strength training were considered key to maintaining participation. Barriers to running following surgery included unhelpful health professional encounters, persistent knee symptoms and muscle weakness, new running-related injuries, anxiety and fear about reinjury, and difficulty finding time. Participants had varying beliefs about running and knee joint health, although most believed that running benefited long-term knee health. Improved mental health and social connection were the most common motivators to run.

CONCLUSION

Our qualitative findings may inform strategies to support adults to commence, or return to, and maintain running participation following knee surgery.

An Online Evidence-Based Education Resource Is Useful and Can Change People's Perceptions About Running and Knee Health

OBJECTIVES

To (1) create and evaluate the usefulness of an online evidence-based education resource about running and knee health (eg, knee osteoarthritis) for the public and health care professionals, and (2) assess the online resource's effects on perceptions about running and knee health.

DESIGN

Cross-sectional survey.

METHODS

We created an online education resource (series of infographics) in 7 languages with community input. Then, we conducted a single-round online survey in which participants rated its usefulness and answered questions on perceptions about running and knee health before and after reading the infographics.

RESULTS

Two thousand six hundred ninety-four participants (1291 members of the general public and 1403 health care professionals; 45.7% with knee osteoarthritis and 67.6% runners) from 60 countries viewed the infographics and responded to the postinfographics questions. The online resource was considered very useful, with a median rating of 9 out of 10. 23.2% of participants reported no change in their perceptions about running and knee health, 46.2% changed a little bit, 19.3% changed a moderate amount, and 11.3% changed a lot. Perceptions of running were more favorable after reading the infographics, especially about the effects of regular and frequent running on knee health, and running in individuals with knee osteoarthritis. Perceptions about running long distances were less favorable after the infographics.

CONCLUSION

Our free online education resource was considered useful by both the public and health care professionals. Overall, the online resource led to more positive perceptions about recreational running and knee health. However, its effects on behavior change and running participation remain unknown.

Return to Running after Knee Arthroplasty: A Case Report

Individuals who have undergone knee arthroplasty may still want to run, but no study has reported a progression to guide patients and clinicians. The objective of this case report is to document the process of returning to running after total knee arthroplasty with a 1-year follow-up. The client was a 55-year-old woman, former triathlete, who underwent unilateral knee arthroplasty 1 year prior to consultation. She alternated slow running with walking and increased based on symptoms. She also performed a lower limb exercise programme. The client was a low-impact forefoot striker, ran with a high step rate and wore minimalist shoes. During the 1-year follow-up, she reported no knee pain but experienced minor episodes of calf strains. Towards the end, her comfort level was best when alternating running and walking for 3-4 km, three to four times per week. The client reached her objective of finishing an olympic distance triathlon. The exercise programme also helped to increase lower limb strength and improve physical performance. This case report suggests that it is possible to return to running up to 1 year after total knee arthroplasty. Future research should study bigger samples and monitor implant wear to provide better guidance to patients and physiotherapists.

Injury patterns and healthcare utilisation by runners of the New York City Marathon

Objectives

The purpose of this study was to describe injury patterns and healthcare utilisation of marathon runners.

Methods

This was a previously reported 16-week prospective observational study of runners training for the New York City Marathon. Runners completed a baseline survey including demographics, running experience and marathon goal. Injury surveys were collected every 4 weeks during training, as well as 1 week before and 1 week after the race. Injury details collected included anatomic location, diagnosis, onset, and treatment received.

Results

A total of 1049 runners were enrolled. Injuries were reported by 398 (38.4%) during training and 128 (14.1%) during the marathon. The overall prevalence of injury was 447/1049 (42.6%). Foot, knee and hip injuries were most common during training, whereas knee, thigh and foot injuries were most common during the race. The most frequent tissue type affected was the category of muscle, tendon/fascia and bursa. The prevalence of overuse injuries increased, while acute injuries remained constant throughout training. Hamstring injuries had the highest prevalence of diagnosis with 38/564 injuries (6.7%). Of the 447 runners who reported an injury, 224 (50.1%) received medical care. Physical therapy was the most common medical care received with 115/1037 (11.1%) runners during training and 44/907 (4.9%) postrace.

Conclusion

Runners training and participating in a marathon commonly experience injuries, especially of the foot and knee, which often are overuse soft tissue injuries. Half of the injured runners sought out medical care for their injury. Understanding the patterns of injuries affecting marathon runners could help guide future injury prevention efforts.

Trajectory of knee health in runners with and without heightened osteoarthritis risk: the TRAIL prospective cohort study protocol

INTRODUCTION

Running is one of the most popular recreational activities worldwide, due to its low cost and accessibility. However, little is known about the impact of running on knee joint health in runners with and without a history of knee surgery. The primary aim of this longitudinal cohort study is to compare knee joint structural features on MRI and knee symptoms at baseline and 4-year follow-up in runners with and without a history of knee surgery. Secondary aims are to explore the relationships between training load exposures (volume and/or intensity) and changes in knee joint structure and symptoms over 4 years; explore the relationship between baseline running biomechanics, and changes in knee joint structure and symptoms over 4 years. In addition, we will explore whether additional variables confound, modify or mediate these associations, including sex, baseline lower-limb functional performance, knee muscle strength, psychological and sociodemographic factors.

METHODS AND ANALYSIS

A convenience sample of at least 200 runners (sex/gender balanced) with (n=100) and without (n=100) a history of knee surgery will be recruited. Primary outcomes will be knee joint health (MRI) and knee symptoms (baseline; 4 years). Exposure variables for secondary outcomes include training load exposure, obtained daily throughout the study from wearable devices and three-dimensional running biomechanics (baseline). Additional variables include lower limb functional performance, knee extensor and flexor muscle strength, biomarkers, psychological and sociodemographic factors (baseline). Knowledge and beliefs about osteoarthritis will be obtained through predefined questions and semi-structured interviews with a subset of participants. Multivariable logistic and linear regression models, adjusting for potential confounding factors, will explore changes in knee joint structural features and symptoms, and the influence of potential modifiers and mediators.

ETHICS AND DISSEMINATION

Approved by the La Trobe University Ethics Committee (HEC-19524). Findings will be disseminated to stakeholders, peer-review journals and conferences.