Seeing words such as spondylosis, enthesopathy and impingement on x-ray reports tends to set off alarm bells in most people. However, this is simply the language used by radiologists to describe what they see. It does not tell us what the patient will actually present with. In a nutshell, what you see on imaging may in fact have little or no correlation to your symptoms.

It is possible to see very severe arthritis on x-rays and yet the patient will have little or no symptoms. Conversely, few arthritic findings can be quite debilitating for some people. The key to interpreting what your x-ray/imaging findings mean to you is called “clinical correlation”.

Clinical correlation is finding agreement between the imaging and the patient’s presentation. In many cases, we find arthritis incidentally when we are looking for other things such as pathology or trauma. The arthritis is present, but does not produce any symptoms for the patient. In these situations, the arthritic change is clinically insignificant.

In other cases, where the patient has symptoms of arthritis such as stiffness, deformity, or crepitus (grating or grinding joint sounds) there can be good clinical correlation with the imaging.

The point I want to make is that I have come across patients with no arthritis symptoms who feel that they are somehow “damaged goods” because they have been told they have arthritis. In many of these cases, there was little or no clinical correlation nor explanation to the patient as to the significance of the arthritis. The result was a lot of these people discontinued physical activities for no good reason and they lost fitness, muscle tone and strength.

The irony is that treatment of arthritis focuses on the preservation of movement, strengthening muscles in the affected areas and activity to tolerance. We may modify our activity so as not to aggravate an arthritic joint, but rarely is activity discouraged. Symptomatic arthritis is managed and the patients are encouraged to be part of the solution by actively participating in their own care.

For those of you who have had x-rays or other imaging that show you have arthritis but you do not have symptoms- carry on. What you see isn’t necessarily what you’ve got!

Having just recently celebrated my 38th birthday, I got asked more than once if I was already dreading the big four-zero coming along. “On the opposite,” I usually replied. “I can’t wait to get the chance to finally win an age group award.” While this usually got a few laughs, it was also a blatant lie. Not only will I still be too slow to get anywhere near those awards, when I checked the results of some of my recent races, I noticed that the times for age awards are sometimes faster, not slower, as you move up.

The 2007 USA Marathon Report tells us that the average marathon finishing time for the men’s age groups are getting faster, not slower, all the way from M20 to M40. I found this hard to believe when I read it the first time, but the M40 age group had the fastest average finishing time of them all! The equivalent female age groups do not show the same pattern.

It’s not only the average time that gets better. The same applies even for the competitive end of the field. To pick an example, at my most recent half marathon in Blarney, Ireland, the third runner in the M40 category finished in 1:18:05, when the third M35 runner still had a minute to go. Of course this doesn’t always follow the same mould (I could easily have found a race result where the M40 runners were slower than their M35 counterparts), but it definitely happens much more often than you would think.

Personally, I find this fact truly astonishing. The only explanation I could come up with is that a lot of men start running (or, in case of many college runners, re-start running) sometime in their mid-30s and will therefore not reach their full potential until they are in their 40s. As someone who followed that very itinerary, I know it is very common, and I do indeed know a lot of runners who followed the same course. What makes us pick up a rather strenuous hobby like this as we get older? The fear of getting old and fat? An early onset of midlife crisis? Or, are our wives kicking us out of the house to enjoy some peace and quiet?

I have a very ambitious target. I want to finish in the top ten in Ireland’s longest race (and only ultra), the stunningly beautiful 39.3 mile Connemara Ultra in April. To achieve this goal, a lot of training will be required and, in the beginning, all went well. When I got a slight cough in the middle of December, it didn’t really faze me.

My advice to anyone with a cold is always the same: run if the symptoms are all above the neck, otherwise stay at home. This is an important rule that you should always heed, but unfortunately it is very much a case of do as I say, not as I do. Despite having a chesty cough, I continued with my single-minded, obsessive training regime. It might sound rather obvious now, but running with a chest infection in the middle of a wet winter is not the best idea. By the end of December, I felt bad enough to visit a doctor. She diagnosed a severe lung infection and prescribed some antibiotics and rest. The medicine seemed to help and, after a few days, I was back on the road again.

It is important to know when to make your comeback after a lay-off. In my case, I got it spectacularly wrong. Within 4 days I had a very high fever, felt absolutely awful and the left side of my chest hurt so much I thought I had cracked a rib from all the coughing. When I managed to get to a hospital for a chest x-ray, the prognosis was confirmed as pneumonia. I have since had three weeks of complete rest, and have only recently been allowed to resume running, but only easy running at short distances. It’s not exactly what I had in mind to prepare for an ultra.

Most bouts of illness are less severe than mine, but you can learn from this lesson anyway. A few days off in December, when my cough first developed, would most likely have cured the problem there and then and I would be happily doing high mileage weeks now. Instead I’m uncertain if I will even make the start line of my race, never mind the finish. Training hard is usually good, but training smart would have been a lot better.

This kind of doctor is a rare commodity. My running friends and I pass around the names of the few running doctors we’ve found as if we’re handling the Dead Sea Scrolls. Any doctor who keeps us on the road and off the couch is a keeper. But, the question remains: Does a doctor who runs actually take better care of patients who are runners? My own experience aside, the answer seems to be—not necessarily.

The New York Times recently took a look at this question, talking to a number of athletes and doctors who are also runners. The patients said that for the most part, athletic doctors work harder to find ways to keep them active, looking for alternative solutions to nagging injuries and not reflexively playing the “stop-running” card. And the runner-doctors said much the same thing and said that they themselves seek out doctors who are also athletes.

But there are plenty of examples on the other sides of the fence, too. According to the article,

That is what Patricia Sener, 43, an open-water swimmer who lives in Brooklyn, discovered when she had a problem and went to a doctor who specialized in treating athletes. The doctor pointed to a gray spot in an MRI of her knee and told her she might need a major operation to replace her anterior cruciate ligament. But he said he would not know for sure until she was on the operating table.

“I’m training for the English Channel,” Ms. Sener said. “I’m on a time line. I can’t afford six months off.”

She went to a different doctor, a swimmer, for a second opinion.

“He pointed to the exact same spot on the M.R.I. and said: ‘See this. It’s normal.’” All she needed, she said, was physical therapy to strengthen the connecting muscle and ligaments around her knee and stabilize it. She recovered.

I’ve had relatively few serious injuries, but I tend to get a lot of persistent aches that make running uncomfortable for a few weeks or months at a time. I’ve seen plenty of doctors in the last few years and my experience has been that as soon as I mention that I’m a runner, they stop taking notes and just wait for me to finish talking so they can say, “Stop running for X number of weeks.” This has been true of every doctor I’ve seen, save one, who essentially has become my primary care physician despite the fact that he’s a rheumatologist. He’s a runner, and a pretty good one and as a result, he has an idea which problems actually do need rest and which ones can be worked out while continuing to run. But he also knows how stubborn runners are and isn’t afraid to tell me when I need to chill for a while. In other words, he’s not simply an enabler; he’s a doctor who listens.

Finding a doctor like that is tough, but it’s worth the extra effort. Ask around with your running partners and clubmates to see who they use and then check them out. Or check the major marathons and other races in your area to see who the official race doctors are. But find one, and stick with him. You’ll be much happier in the long run.

It’s that time again. The gyms will be bursting at their seams again for about four weeks, as hordes of people try to get rid of excess weight. Unfortunately, the majority of them will have given up by the time February comes round. Fortunately, we are runners, and therefore already fit, slim and healthy, aren’t we?!

New Year’s resolutions will do the rounds in our circles nonetheless, so here are a few suggestions:

• Set a mileage goal for 2008. No matter if it’s 500 or 300 miles, try to beat your 2007 marker, but remain sensible. Don’t double your mileage in one go.
• Involve your family in your next race. I don’t mean let them stand shivering in the freezing cold while you zip by. I mean take them for a weekend to a race a bit further away, and make a family break out of it.
• If you have children of the right age, get them involved in running. Share a mile or two with them, obviously at their pace, not yours. Don’t use any pressure, chances are they will enjoy running with mummy or daddy and will soon ask to come again.
• Do you want to run your first marathon this year? Great, welcome to the club. But don’t wait with your training until it’s too late. Even if it’s for a fall marathon, start running twice or three times a week right now. Cold? What cold? It’s not cold if you’re running (ok, maybe in Minnesota it might be).
• Set a time goal for a distance, be it 5k, 10k, or a marathon. Remember that in running, you will get out of it what you put into it. You won’t break that 40 (or 50 or 60) minutes 10k by hoping for a miracle. Steady, consistent training will get you there, though.
• Have fun. Running is neither out profession (apart from the odd elite runner) nor is it a chore. It’s simply one of the best ways to keep fit and healthy, as long as you’re sensible.

Am I not training “right”? Maybe I’m just not running hard enough. Occasionally, I feel a bit cheated by this. But, it’s not a big deal. It’s certainly not my motivation to run. If that were the case, I would have stopped a long time ago.

However, a study published recently online in the American Journal of Physiology’s Heart and Circulatory Physiology has got me thinking again about this phenomenon. It seems that not only can endorphins and other opioids released during exercise lead to the runner’s high, but they might also be prime players in the mechanism that keeps our hearts healthy.

While delving further into the questions of why and how exercise benefits the heart, a team at the University of Iowa looked to see whether the opioids released during exercise might be involved in the cardio-protective effects of exercise in rats. In the study, they compared exercised with non-exercised rats and found that exercised rats experienced less heart damage from a heart attack than the non-exercised rats. When they then injected rats with a chemical to block their opioid receptors, the exercised rats lost all the heart-healthy benefits of exercise.

Additionally, the team noted an association between exercise and a rise in opioid system gene expression in the heart, and also a change in the expression of genes which are involved in inflammation and cell death.

The rat results suggest that the endorphins and other opioids that are released when we exercise may be involved in the body’s mechanism for keeping our heart’s healthy. If this proves to be the case, I’m hoping that, runner’s high or not, my body is releasing these chemicals when I am exercising hard, and they are working their magic to protect my heart. I’d be happy knowing my heart was reaping the benefits, even if I don’t necessarily feel like I am walking on air.

Within a month of resuming running, the weight had piled back on.

There are numerous physiological reasons why I lost weight once I stopped exercising, and some of them are explained in a recent New York magazine article (“The Scientist and the Stairmaster,” Sept. 24, 2007) that questions the role exercise plays in many weight maintenance and weight loss programs. As author Gary Taubes puts it: “The one thing that might be said about exercise with certainty is that it tends to make us hungry. Maybe not immediately, but eventually. Burn more calories and the odds are very good that we’ll consume more as well.”

Sure, if you reduce the calories you take in and increase those you expend, you will lose weight, at least initially. But the article explains that our bodies will attempt to do an end-run around that initiative and override willpower through the hormonal regulation of fat cells. As Taubes explains:

Ultimately, the relationship between physical activity and fatness comes down to the question of cause and effect. Is Lance Armstrong excessively lean because he burns off a few thousand calories a day cycling, or is he driven to expend that energy because his body is constitutionally set against storing calories as fat? If his fat tissue is resistant to accumulating calories, his body has little choice but to burn them as quickly as possible: what Rony and his contemporaries called the “activity impulse” physiological drive, not a conscious one. His body is telling him to get on his bike and ride, not his mind. Those of us who run to fat would have the opposite problem. Our fat tissue wants to store calories, leaving our muscles with a relative dearth of energy to burn. Itís not willpower we lack, but fuel.

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Taubes also contends those who do lose weight after adopting a strenuous exercise regime probably also made a concerted effort to eliminate the kinds of foods that stimulate insulin production. “Rare is the person who decides the time has come to lose weight and doesn’t also decide perhaps it’s time to eat fewer sweets, drink less beer, switch to diet soda, and maybe curtail the kind of carb-rich snacks—the potato chips and the candy bars—that might be singularly responsible for driving up their insulin and so their fat,” he wrote.

So if you find you’re gaining, or at least no longer losing, weight while upping your mileage, it may be what you’re consuming after a workout or later in the day or week.

But, less noticeable is the impact on bone health. Our bones respond to certain exercises in the same way as muscles—doing them makes them stronger. And stronger is good because it can diminish the risk of developing osteoporosis, a disease where bones become less dense and fragile, prone to fracture.

Although women are four times more likely to develop osteoporosis than men, both sexes can suffer from the disease. According to the National Osteoporosis Foundation, an estimated 2 million men in the United States have osteoporosis.

A study performed by researchers at the University of Missouri-Columbia looked at bone mineral density and osteopenia, a condition where the bone mass reduction is not as severe as that in osteoporosis, in men. The results suggest that weight-bearing activities, such as running, dancing and jump-roping, are important for healthy bones.

In the study (to be published in a forth-coming issue of Metabolism), researchers measured the bone mineral density of 43 competitive male road cyclists and runners ages 20 to 59. The cyclists had significantly lower bone mineral density of the whole body than the runners. Cyclists were also seven times more likely to have osteopenia of the spine than runners, and 63 percent of the cyclists had osteopenia of the spine or hip compared to 19 percent of the runners.

Pamela Hinton, one of the study’s co-authors and an associate professor of nutritional sciences in Missouri University’s College of Human Environmental Sciences, believes these results “will ultimately serve as education and motivation.”

So men, it looks like for the sake of healthy bones, you best keep on running.