While we usually associate fatty liver with excessive alcohol consumption, there is another form of liver disease known as Non-Alcoholic Fatty Liver Disease or NAFLD that develops in people who drink little to no alcohol. NAFLD can remain ‘silent’ for many years, with few signs or symptoms. The prevalence of NAFLD is increasing at an alarming rate. The risk of developing NAFLD in obese people is 75%. With almost 20 million obese Canadians, NAFLD is a growing health epidemic. Eating excess calories causes fat accumulation in the body. One of the locations fat is stored is in the liver. This
Real Talk on Running- Bones and Joints
Avid runners know the thrill of completing a marathon, the overwhelming sense of accomplishment when you cross that finish line after months of training. They will likely also tell you about how running a marathon requires physical and mental focus and strength. And often, over time, the physical toll of training and competition can manifest as various ailments. Through this series we will describe some of the physical implications of training and over training and how you can manage or prevent some of those things from happening.
In today’s post we will focus on one of the biggest concerns for many runners and that is joint and bone health.
Non-runners everywhere have long held the notion that while running may be good for your cardiovascular system, the long term consequences of training and running on hard pavement would eventually destroy your knees, hips and ankles. Science did support this notion for quite some time. However with improved imaging, and more rigorous methodology studies have called this notion into question.
Our skeletal structure is dynamic, we aren’t just bare bones – the muscles, fat and connective tissues attached to our bones have a significant influence on skeletal structure. The mechanical loads and stresses that arise from exercises such as running, induce remodeling and reshaping of bones to compensate and facilitate these activities. One way in which is through increasing bone mineral density. While resistance or loaded exercises are known to be the most significant exercises to increase bone density, endurance exercises such as running, particularly with marathon training, can still slow down bone mineral loss as it still provides a weight bearing stimulus to the bones. Studies also suggest that elasticity of tendons in long distance runners increases with long term training.
Beginners vs. Elite Athletes
An important consideration regarding the physical impact of long distance running is the baseline status. Sedentary individuals seem to incur a more intense acute injury to joints when they initially start training while those who have been training for six months or even for elite athletes. A six month training program examined the effect of marathon training in beginners and found that there was no clinically significant cartilage loss after training. These researchers conclude that cartilage in the knee seems to adapt and recover from repeated loading stressors. Further, overweight individuals have an increased risk of injury and osteoarthritis, and beginners are at risk for injuries from improper technique.
While many studies have shown that the regular marathon runners do have some adaptive changes in their joints as a result of their training, the acute physical stress may be associated with hypervascularity of the patellar tendon but this may not be pathological as there were no associations with joint or tendon pain. These studies lead to conclusions that while there are changes in the joints and connective tissues around them it may not be a pathological change. A 10 year longitudinal study from Austria found that marathon running in individuals without risk factors for arthrosis, did not result in permanent damage to internal structures of the healthy knee joints ( ie. with no pre-existing damage.)
What can you do?
While evidence continues to challenge the notion that long term marathon training is bad for your joints, there are still some risks associated with long distance running. As mentioned above, injuries resulting from improper technique or overtraining are common. Form, ie. foot strike patterns can also lead to exacerbation’s of injury from repetitive stress. Further, pelvic malalignments have been reported in up to 80% of runners. So here are a few tips to help you protect your joints:
- Alter your foot strike patterns- as mentioned above, repetitive foot strike patterns can exacerbate injuries, therefore it is beneficial to alter patterns when possible.
- Allow past injuries to fully heal- repeated stress to an injury can lead to chronic inflammatory states and result in the formation of scar tissue. This can physically alter the joint, affecting mobility, and the inflammation can have systemic consequences.
- Provide bones with all the minerals and supplements that support bone health- it’s important to provide the materials for bone remodeling to occur. Minerals such as strontium and calcium along with vitamins D and K can act as building blocks for bone. By providing a strong foundation we are able to quickly adapt to exercises.
- Manage your weight- as obesity is a risk factor for many degenerative joint diseases, it is important to focus some attention on lifestyle factors that can reduce this risk. We will discuss diet and lifestyle factors in detail in a future post.
- Support muscles- stretching and warming up muscles prevents strain over joints and will be the topic of discussion in our next post of this series.
Guadalupe-Grau A, Fuentes T, Guerra B, Calbet JA.Exercise and bone mass in adults.Sports Med. 2009;39(6):439-68. doi: 10.2165/00007256-200939060-00002.
Krampla WW, Newrkla SP, Kroener AH, Hruby WF.Changes on magnetic resonance tomography in the knee joints of marathon runners: a 10-year longitudinal study.Skeletal Radiol. 2008 Jul;37(7):619-26. doi: 10.1007/s00256-008-0485-9. Epub 2008 May 16.
Valenzuela KA, Lynn SK, Mikelson LR, Noffal GJ, Judelson DA.Effect of Acute Alterations in Foot Strike Patterns during Running on Sagittal Plane Lower Limb Kinematics and Kinetics.J Sports Sci Med. 2015 Mar 1;14(1):225-32. eCollection 2015.
Kubo K, Miyazaki D, Shimoju S, Tsunoda N.Relationship between elastic properties of tendon structures and performance in long distance runners.Eur J Appl Physiol. 2015 Aug;115(8):1725-33. doi: 10.1007/s00421-015-3156-2. Epub 2015 Mar 27.
Drysdale IP, Collins AL, Walters NJ, Bird D, Hinkley HJ.Potential benefits of marathon training on bone health as assessed by calcaneal broadband ultrasound attenuation.J Clin Densitom. 2007 Apr-Jun;10(2):179-83. Epub 2007 Apr 5.
Zilinski JL, Contursi ME, Isaacs SK, Deluca JR,Lewis GD, Weiner RB, Hutter AM, d’Hemecourt PA,Troyanos C, Dyer KS, Baggish AL.Myocardial adaptations to recreational marathon training among middle-aged men. Circ Cardiovasc Imaging. 2015. Volume 8, Issue 2; Pages e002487
Layne JE, Nelson ME.The effects of progressive resistance training on bone density: a review.Med Sci Sports Exerc. 1999 Jan;31(1):25-30.
Fabian Proft,Mathias Grunke, Christiane Reindl, Felix Mueller, Maximilian Kriegmair, Jan Leipe, Peter Weinert,Hendrik Schulze-Koops, and Matthias Witt The influence of long distance running on sonographic joint and tendon pathology: results from a prospective study with marathon runners. BMC Musculoskelet Disord. 2016; 17: 272.
Hohmann E1, Wörtler K, Imhoff AB.MR imaging of the hip and knee before and after marathon running.Am J Sports Med. 2004 Jan-Feb;32(1):55-9.
Schamberger, W. Malalignment Syndrome in Runners. Physical Medicine and Rehabilitation Clinics of North America. 2016. Volume 27, Issue 1