Runner's hips don't lie: running long distances damages your hip joints, doesn't it!

The marathon is at the top of many runners’ list of “must do” activities. An increasing number of people adopt running for recreational and competitive reasons. Although running eliminates stress and has many cardiovascular benefits, it is presumed to cause lower extremity injuries. Most studies related to running injuries have focused on runners’ knee health, but very little is known about the effect of long-distance running on runners’ hip health. Advances in the treatment and diagnosis of hip injuries have been limited due to the absence of sophisticated diagnostic tools that are sensitive and specific enough for early identification of pathogenesis in the hip joints.

Researchers led by Dr Laura Maria Horga and Professor Alister Hart of University College London, together with Mr Johann Henckel, Dr Anastasia Fotiadou and Dr Anna Di Laura of the Royal National Orthopedic Hospital, London, UK, and Dr Anna Hirschmann of University Hospital Basel, Basel, Switzerland, used an advanced 3.0 Tesla MRI technique to assess the health status of the hip joints of non-inactive runners. runners, moderately active and very active runners. runners. To this end, bilateral 3.0 Tesla hip MRIs were performed in fifty-two asymptomatic individuals. MRI findings were scored by two independent musculoskeletal radiologists using a validated scoring system. Additionally, individuals also rated their perceived hip function on a self-rated Hip Disability and Osteoarthritis Outcome Score (HOOS) questionnaire. This research was published in the journal BMJ Open Sports and exercise medicine.

This prospective cohort study found no significant hip injuries in moderately active and very active runners compared to non-runners. In particular, based on MRI findings, researchers have concluded that there were no significant differences between inactive non-runners, moderately active runners, and very active runners in the number of labral abnormalities, articular cartilage lesions, tendon abnormalities (Figure 1), and ligament abnormalities.

Figure 1: Tendon MRI signal (arrow) of identical size in a moderately active runner (A) and a very active runner (B);

Only a few small bone marrow findings were more common in some runners than in non-runners, but they were painless and not of clinical concern.

Furthermore, in contrast to the popular belief that highly active runners may be more predisposed to subchondral bone marrow and cartilage injuries, in fact, highly active runners were reported to have no articular cartilage injury or bone marrow edema.

Furthermore, HOOS questionnaire scores suggested that there were no self-reported hip symptoms or functional problems among the three groups of participants.

Dr Laura María Horga, corresponding author of the paper, said: “This study is the first to evaluate hip health in asymptomatic runners using a large sample size and high-resolution MRI technology. Only bone marrow edema was significantly more common in moderately active runners than in inactive and highly active runners, while subchondral cysts were significantly more common in runners than non-runners; however, these were smaller/small in size and all asymptomatic. “They are non-specific, so they do not indicate a specific stress related to exercise. “The findings help correct popular misconceptions that long-distance running damages the hip joints and should therefore be taken into account when making health recommendations.”

Magazine reference and image credit.

Horga, Laura María, Johann Henckel, Anastasia Fotiadou, Anna Di Laura, Anna Hirschmann and Alister Hart. “3.0 T MRI findings of 104 asymptomatic adult hips: from non-runners to ultrarunners.” BMJ opens sports and exercise medicine 7, no. 2 (2021): e000997. DOI: 10.1136/bmjsem-2020-000997

Main image credit: Pexel