Your questions on walking and running

Q) I'm 39 and went through an early menopause. I have the early stages of brittle bone disease and have just been told I have osteoarthritis in the lower back and both hips. For about 20 years I have been a power walker. My GP, however, tells me to stop walking, especially on roads, as it was very bad for my back and hips. I now only do about two to three miles, three times a week. I find it a little sore when on the road, but that night and the next day I'm in severe pain and feel my joints are very stiff to move. Should I give up or still do it?

Christine, Omagh, Co Tyrone - 2011

A) This is quite a dilemma. On the one hand you have osteoarthritis of the back and hips, and power walking on hard surfaces is likely to aggravate it. On the other hand you have early osteoporosis, and weight bearing exercise is recommended to delay further bone loss. I think you have to find a balance somewhere in between. Exercise has other benefits on the cardiovascular system and generally makes you feel good, so I would not like to discourage you from this. Have you tried painkillers or, dare I say it, anti-inflammatory drugs to enable you to continue your exercise, perhaps less vigorously?

This answer was provided by Dr Philip Helliwell in 2011, and was correct at the time of publication.

Q) Should you run with osteoarthritis of the facet joints? Can you run two to three times a week and also mix with low-impact and strengthening exercises? Or can running damage cartilage in facet joint which means it would be better to avoid it? I am a 53-year-old female and had run for 32 years most days. I had an MRI a year ago, which showed some degeneration in the facet joints with a synovial cyst. There was some stenosis, but for the last six months my symptoms have improved, thanks to the exercises and activity mentioned above.

Sylvia, via email - 2013

A) Well, you have asked a believer! Of course you can, providing you are not aggravating your symptoms. Arthritis of the facet joints in the spine involve the small joints behind the discs that allow you to rotate and move from side to side. It shouldn't necessarily stop you doing what you want to do. I know people who exercise to a high level with all sorts of musculoskeletal problems. Generally, your body will tell you if you are doing the wrong thing, although a certain amount of discomfort is to be expected as you grow older. Keep up the running and combine with core stability exercises, weight control and a healthy diet. This will certainly help you as time goes by and, at the same time, will improve your sense of wellbeing.

This answer was provided by Dr Philip Helliwell in 2013, and was correct at the time of publication.

Q) I hope you can give me some advice. I'm a 67-year-old female who has been teaching fitness classes for nearly 30 years. I've had patellofemoral problems for about 10 years now, with full thickness loss in both knees. Now I've been told I have moderate osteoarthritis in both my hips.

I've signed up for a charity event - a 100km trek that I'm hoping to finish in about 30 hours. My question is – is this a good thing to do? Is this challenge likely to make the osteoarthritis worse? I take co-codamol and am happy to walk through the pain, but don't want to make things worse by taking this on. Thanks for reading this.

Val - 2017

A) It looks like you are someone with a good base level of fitness, but the event you've signed up for would be a very serious undertaking for anyone. Only you know whether this is a realistic ask.

Looking at the total distance your joints and body will cover in a lifetime, 100km isn't a long way. The main issue here is trying to cover it in one go (and in just 30 hours)!

It's critical to allow plenty of time for thorough preparation, to avoid injury and a flare-up of your joint pain. The only way to see whether your body and joints are up for the challenge would be a gradual controlled increase in each training session, so your body becomes accustomed to the additional activity. Mixing walking, flexibility exercise and perhaps some low-impact aerobic exercise should improve your endurance.

If you can set goals and gradually increase your training load and distance walked without causing untoward pain or other problems, then this bodes well for the full event. Things to watch out for are joint swelling and soreness, and pain after exercise that doesn’t settle down in a day or two. These would be a sign that your joints aren't handling the extra training.

Don't forget the importance of well-fitting footwear, hydration and nutrition, both during training and the event itself. If you do decide to go ahead, I wish you the best of luck and hope you raise a lot of money for your chosen charity!

This answer was provided by Dr Tom Margham in 2017, and was correct at the time of publication.

Q) I've just been told that I have osteoarthritis in my ankles and underneath the front of one foot. Will I still be able to go hiking, including hill walking?

Angela - 2017

A) All our joints, including those affected by osteoarthritis, need to move to maintain their function. Therefore, it's important to keep active, particularly by doing things you enjoy, like hiking. The main thing to consider is how you can keep your joints well supported and free from injury. For hiking, good quality, well-fitting and supportive footwear is absolutely essential. Most good outdoor shops can help you find the right shoes or boots for your needs.

One of the main functions of the ankle joint is to help us adapt to uneven surfaces. Some focused exercises to work on the strength, range of movement and sense of balance of the ankle can be helpful to prevent pain and injury.

You may also find using walking poles helpful to help spread the load and help your balance when walking.

Be sure to pack some painkillers in case the joints become sore while you're out on the walk. If you get pain or swelling in the joints after longer hikes, then rest up for a couple of days until the symptoms settle. You can also use ice or cold packs on the joints to relieve pain and swelling.

This answer was provided by Dr Tom Margham in 2017, and was correct at the time of publication.

Q) I've been told after 17 years of hip pain that I have arthritis. I have a torn labrum, which is the ring of cartilage that lines the hip socket, and doctors won't repair it. I'll need a double hip replacement in the future, but at 39 I'm too young.

I want to go out running, but not sure what to do?

Michelle, via email - 2015

A) The question here is whether running will make you need hip replacements sooner, and whether the health benefits of exercise outweigh this.

Our joints and bones need some load passing through them to remain healthy. The cartilage lining our joints responds to this load, and weight bearing exercise keeps our bones strong and healthy. Our joints aren't machine parts that just wear out. There's a constant process of wear and repair happening in all our joints, so running itself shouldn't be seen as harmful.

That said, some simple principles apply:

• Make sure to warm up and warm down properly.
• Start off with short runs and build up gradually to longer distances. A useful rule of thumb to avoid injury is to increase your distance by around 10% each week to let your joints become used to the training load.
• It's worth going to a running shop to get trainers that will help correct any issues you have with your foot position.
• Consider doing some core stability work to give you the stable platform of core fitness you need to avoid injury.

Some aches and pains are normal after exercise. However, if you experience sharp pains during running that don't settle quickly, ease off the running for a few days or consider lower-impact exercise, like cycling, for a bit.

This answer was provided by Dr Philip Helliwell in 2015, and was correct at the time of publication.

Q) I've developed osteoarthritis in my hips (and thumb joints and knees to a lesser extent) so I can no longer go for walks or dig my garden. 

I've been told it's caused by wear and tear, but that trying to keep walking will do no further damage – this doesn't make sense to me.

I used to walk every day for at least 30 minutes and longer at weekends (river and parks) and coastal walking on holiday. I also work out in a gym three times a week and took up Tai Chi four years ago. In other words, I'm much more fit and active than most 65-year-old women (I'm 5'7" and eight stone, and still working).

Is walking (which hurts at every step) really not going to make things worse through more wear and tear? Is it possible to sign up for the trials of the gene/cartilage research I've read about? Or the caterpillar fungus research?

Diana - 2015

A) I'm pinning my colours to the mast here: from now on, I'm taking a zero-tolerance position on the phrase 'wear and tear' – so let's hear no more of it (from doctors as well as everyone else)! It's a horrible term and makes people think of progressive, inevitable destruction of their joints, which doesn’t fit with what we know is happening in joints that are affected by osteoarthritis.

Our joints aren't machine parts that simply wear out. They're dynamic tissues that are constantly responding to the stresses and strains that we put through them.

There's a continuous process of 'wear and repair' happening in our joints. But some circumstances tip the balance more towards wear in the joint, rather than repair. This includes injury or muscle weakness around the joint, which in turn leads to pain and the changes seen in the joint in osteoarthritis.

Addressing problems like muscle weakness or abnormal load passing through the joint can help to bring the balance back towards the repair process. In summary – for most people osteoarthritis isn't an inevitably progressive thing and can be modified by looking for and addressing the problems that tip the balance from wear to repair in the joints.

Being advised to exercise when it hurts to do so is difficult advice to swallow if we think about osteoarthritis as wear and tear. But it's not that exercise will merely cause more wear to the joint. Movement will help to:

• prevent stiffness
• keep the joint moving through its full range
• keep the muscles strong around the joint.

In turn, this will help to prevent symptoms getting worse.

It's great that you're trying to keep as active as possible – working out at the gym and Tai Chi are much more likely to be helping your hips than harming them. And I'm sure you would be having a lot more problems with your joints were it not for the exercise you have been doing for many years. Some input from a physiotherapist may lead to some improvement in your symptoms and give some guidance on other types of exercises that will be beneficial for you.

I’d also be interested in where you're experiencing pain when you walk – is the pain felt in your groin? In which case, it might be coming from the hip joint itself.

If the pain is felt on the outside of your hip, at the side of the leg, it may be caused by a condition known as greater trochanteric pain syndrome (also known as trochanteric bursitis). This is associated with hip osteoarthritis, but can respond well to an injection of steroid and local anaesthetic, combined with some specific exercises.

This answer was provided by Dr Tom Margham in 2015, and was correct at the time of publication.

Q) I'm 44, and due to some depression last year I started walking everywhere. Has any research been done – and if so what are the results – of people who have walked most of their life and do they develop arthritis and suffer in old age, more so than people who've never walked? Does walking cause arthritis in itself? I've been diagnosed with osteopenia due to one of the epilepsy drugs I've taken for 37 years, and have to take vitamin D and calcium supplements to aid the bone strength. Do you think I'm aiding the bones now anyway by walking everywhere? I'm not worrying about old age – just curious to know if walking in earlier years makes arthritis worse. It won't stop me walking everywhere whatever the results – because I'm hooked on it now and do about 44 miles a week.

Amanda, West London - 2010

A) That's certainly a good number of miles to walk on a weekly basis. The link between sport, running and arthritis has been investigated extensively. I'm not sure that this has been done for people who only walk but I would think the situation is comparable. In short (because I could use this whole page to answer your question) there's no evidence that moderate exercise harms the joints. Indeed there's evidence that it's good for the joints, muscles and bones. And, of course, it's also good for the heart and lungs. Only if the joints are injured, such as with football players, does the association between exercise and damage become apparent. So, my advice is to carry on walking.

This answer was provided by Dr Philip Helliwell in 2010, and was correct at the time of publication.