A scenic race on the Utah-Idaho border with feasibly-moderate elevation, spectacular mountain views, and promise of beautiful fall foliage (hopefully – two years ago the runners encountered a snow storm!) – that’s enough to get me to bite!
But an even better reason…I have a dear friend who is also an ultra-marathoner and who has also had surgeries for hip dysplasia. We met through a PAO Facebook group and we are now life-long friends. We had our first PAOs a few weeks apart in 2015 and talked frequently in the months leading up to our surgeries. A picture of her husband crossing a stream in his running gear and the following message was the last thing I read right before going back to the operating room:
“One last inspirational pic. This is Nate at mile 85 of The Bear 100. You’ll be doing this in no time!”
Clearly, it’s a sign!
But isn’t running going to destroy your hips?
But maybe not.
This is an interesting debate and I have talked to many patients and surgeons who are polarized towards one side of the argument or the other.
Most of the long-term research out there does not find any relationship between long-distance running and increased risk of arthritis. In fact, there is some interesting research out there that supports the opposite! I truly believe that if you have good mechanics, good strength and stability, maintain a healthy weight, and follow good training principles then running can be a wonderful activity.
That said, people with hip dysplasia are not necessarily “healthy runners.” While the healthy hip is a ball and (round) socket, the dysplastic hip is often a ball with a shallow, elongated socket due to how it develops in childhood. Even if you re-orient the bones to provide more coverage, there still is no true round ball and socket joint. That mismatch in shape can still cause uneven cartilage loading and joint damage. Surgery, itself, can increase the risk of arthritis since it is a (controlled) trauma to the joint. Current research looking at ACL repairs is finding that many active/athletic patients are starting to develop early-onset arthritis within 1-2 decades of surgery. PAO surgeries are not nearly as common and haven’t been around long enough to track these outcomes in athletes. Patients with hip dysplasia who undergo surgery are the future data points who are going to pave the way for clinical decision making around surgery and return-to-activity. It’s kind of exciting (from a dorky research perspective) and also frustrating for those of us trying to make these decisions now.
I think the best thing patients can do is be aware of the pros and cons and carefully weigh them when making a return to running decision. From a biomechanical standpoint, it makes sense that if a joint is at risk for early failure, then avoiding high-impact activities may be best for longevity. However, we don’t really know what happens to hips in active people over decades following hip preservation surgery because the research just isn’t there (fortunately, it’s starting to come!) I am hoping that future research will be able to identify variables that can help predict outcomes for patients who want to run after surgery. For example, variables such as age, cartilage health, pre-surgery activity level, pre/post-surgery pain, strength, range of motion, torsional deformities (excessive rotation) in the thigh and lower leg, flexibility/hypermobility, running mechanics, and predisposition to running injuries before surgery, as well as training variables such as footwear, terrain, and intensity of training could all contribute.
I have definitely made some modifications to my running and training since my diagnoses and surgeries. I run mostly on trails since they keep me slower and force more natural walk breaks, are lower impact, and force fewer repetitive movements. I have also come to accept that strength and stability training are going to have to be regular parts of my life if I want to be able to keep running. I started working with a running coach a few months ago (he tells me he doesn’t let his runners get injured, and that certainly is the tag line I needed to hear!) I have been focusing on strength and form and can already can tell than I am a stronger runner than I have ever been before! I am not sure what my outcome will be, but until there’s a fancy clinical algorithm to plug all of my individual characteristics into to make these decisions, the best I can do is be smart, stay strong, focus on my mechanics, be safe, and just enjoy what feels good!