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Am J Phys Med Rehabil. 2019 May;98(5):416-421. doi: 10.1097/PHM.0000000000001082.

Conservative Management and Rehabilitation in the Older Runner With Knee Osteoarthritis: An Evidence-Based Review.

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From the Physical Medicine and Rehabilitation Department, MossRehab, Elkins Park, Pennsylvania (BC); and Physical Medicine, Rehabilitation and Sports Medicine Department, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico (FS, WM).


Osteoarthritis is an age-related condition that commonly affects the middle-aged and elderly population including individuals who continue to pursue an active and athletic lifestyle. Running is an easily accessible activity with many health benefits; thus, it is becoming a popular form of exercise, even in older individuals. Studies evaluating the correlation between running and osteoarthritis show conflicting results; however, most studies show an increased risk of osteoarthritis in runners with a combination of modifiable and nonmodifiable risk factors. This study reviews the current literature to provide an overview of conservative (nonpharmacological and pharmacological) management strategies including patient education, therapeutic modalities and exercises, mechanical measures, dietary factors, oral and injectable pharmacotherapies, and orthobiologics. Rehabilitation considerations and return-to-sport guidelines are discussed, emphasizing the notion that a return to running activity requires reduction in mileage and formulation of a structured exercise program that includes strengthening, flexibility, and stability exercises, as well as modifications in the running technique.

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