Is running bad for your knees?
Is running bad for your knees? Are steroid injections appropriate for arthritic knees? Laura Harman, Senior BOOST PHYSIO, asks leading knee surgeon Mr David Sweetnam these and other topical questions about knee problems in this Consultant Q&A.
Mr Sweetnam is a Consultant Orthoapedic Surgeon at The Whittington Hospital and privately based at the Wellington Knee Unit at the Wellington Hospital in St Johns Wood NW8. You can view Mr Sweetnam’s website here www.davidsweetnam.com
BOOST PHYSIO Q: Running is becoming increasingly popular- is it really that bad for your knees?
Mr Sweetnam: In short, the answer is no. Obviouslyas with all sports it is all about the preparation. I have many patients who have been running for decades and have little, if any problems with the knees at all. However some patients are ill suited to running as a hobby and jump at the deep end; undertaking a relatively un-trained for marathon. These sorts of people are obviously always going to run into trouble, as their sheer weight and body type does not suit long distance running. However I would always advise people who are serious about their running to go and get checked out by a professional such as a physiotherapist to look at their overall biomechanics and see if in any way this is going to predispose them to damaging their knee when training. This, together with a review of orthotics to make sure that the feet are as supported as they should be, is obviously extremely sensible.
BOOST PHYSIO: What is your view on steroid injections for osteoarthritic knees?
Mr Sweetnam: I happen to think that there is a place for steroid injections in arthritic knees, but not in the younger patient. If a patient has a significant degree of acute inflammation of the lining of the joint, then this sort of injection can be very valuable in calming down the surrounding knee and thus allowing an opportunity for the swelling to settle, the range of motion to increase and indeed the muscles to develop. In effect I therefore think of steroid injection as a way of breaking the vicious cycle of inflammation and allowing the patient to help themselves by ongoing treatment. In general one has to be very careful about injecting the knees with steroids, and these days I tend to prefer the use of viscosupplementation; particularly in the younger age group. However in the much older age group where joint replacement surgery is not favoured by the patient then I think it is acceptable to use steroid injections to intermittently produce some short to medium term pain relief.
BOOST PHYSIO Q: Knee surgery has become far less invasive over the past 15 years, particularly with regards to cartilage damage. What does the future hold for knee surgery?
Mr Sweetnam: I think if I knew the answer to that I would be writing the reply to this question from my yacht in the Bahamas! I think that we can only presume that the advances are likely to be biological rather than mechanical. Cartilage surgery has seen some very exciting changes over the last 10-15 years and I can see no reason why the pace of this shouldn’t continue to get faster.
I should imagine that the greatest breakthroughs will come if we learn to control stem cells to improve cartilage regeneration. At present whilst cartilage regeneration techniques are exciting, they haven’t progressed a great deal from the days of microfracture, some twenty years ago.
On a slightly separate note, as engineering technology improves, our ability to perform more and more procedures arthroscopically similarly increases. This means that the trauma of access to knee surgery is diminished and consequently patient’s recoveries after any given operation are equally improved.
BOOST PHYSIO Q: As a leading knee surgeon, you have treated a lot of professional sports people. What is the most common knee injury that you see?
Mr Sweetnam: Probably the most common injury I see is in patients playing five-a-side football or indeed skiers who have either injured their cartilages or ruptured their cruciate ligaments. Both of these injuries present a surgeon with an opportunity make quite a significant difference. However I think it is worth noting that the overwhelming majority of patients I see can be treated conservatively, and surgery must always be considered to be the final option.
With the exception of the clearly mechanical problems such as those I mentioned above, an awful lot of injuries can recover with just good quality physiotherapy advice.
BOOST PHYSIO has for some years now recommended Mr Sweetnam as an excellent knee surgeon. His website is www.davidsweetnam.com
BOOST PHYSIO has private physiotherapy clinics on the High Road in Hendon North West London (NW4) and East Finchley North London (N2).
We treat all aspects of knee injury and post-operative knee rehabilitation. Please call us on 020 82017788
BOOST PHYSIO East Finchley