This document discusses research on running and degenerative disc disease. It summarizes several studies that found short term effects of running like temporary loss of disc height and volume but recovery within weeks. One study found no increase in degenerative changes on MRI in long term runners. Another study found that running in rats for 3 weeks stimulated production of extracellular matrix proteins in discs. The document also discusses potential benefits of activities like climbing, tai chi, yoga and mindfulness for chronic low back pain.

1. Running and degenerative
disc disease
Upper Chesapeake Medical Center spine Conference
Friday March 3, 2017

2. Is running detrimental for LBP?

9. Sagittally oriented
safranin-O–stained
sections of an adult
human lumbar
intervertebral
disk (top) and a
degenerated
intervertebral disk
(bottom). Disk
matrix stains purple
and collagen
blue. In the adult
disk, the peripheral
annulus fibrosus,
containing collagen,
stains blue
(arrowhead).
The inner annulus
fibrosus and nucleus
pulposus,
containing GAGs,
stains purple. The
central portion
of the nucleus
pulposus, where
reticulin, collagen,
and elastin fibers
are located, stains
faintly blue.
The degenerated
disk has lost purple-
staining GAGs
from the nucleus
pulposus and
annulus fibrosus. It
conforms to
Pfirrmann grade IIII
degeneration.
Loss of GAG in NP
GAG staining

10. Pfirmann: Spine 2001 Sep 1;26(17):1873-8.

19. Collagen fibrils 140,000x mag

20. Collagen: most abundant protein
• Table 22-3Major Collagen Molecules
• Type Molecule Composition Structural Features Representative Tissues
• Fibrillar Collagens
• I [α1(I)]2[α2(I)] 300-nm-long fibrils Skin, tendon, bone, ligaments, dentin,
interstitial tissues
• II [α1(II)]3 300-nm-long fibrils Cartilage, vitreous humor
• III [α1(III)]3 300-nm-long fibrils; often with type I Skin, muscle, blood vessels
• V [α1(V)]3 390-nm-long fibrils with globular N-terminal domain; often with type I Similar to type I; also cell cultures, fetal
tissues
• Fibril-Associated Collagens
• VI [α1(VI)][α2(VI)] Lateral association with type I; periodic globular domains Most interstitial tissues
• IX [α1(IX)][α2(IX)][α3(IX)] Lateral association with type II; N-terminal globular domain; bound glycosaminoglycan
Cartilage, vitreous humor;
• Sheet-Forming Collagens
• IV [α1(IV)]2[α2(IV)] Two-dimensional network All basal laminaes
• SOURCE: K. Kuhn, 1987, in R. Mayne and R. Burgeson, eds., Structure and Function of Collagen Types, Academic Press, p. 2; M. van der Rest and
R. Garrone, 1991, FASEB J. 5:2814.

21. Glycosaminoglycan

22. PG: Chondroitin Sulfate

23. PG: Keratan Sulfate

25. Annulus Fibrosus

27. Herring

28. Fine fiber nerve ending staining in a rabbit disc
The outer 3mm is innervated

29. Load with respect to posture of spine

33. Schmorl Node

35. Age versus degenerative changes on MRI on
ASx patients

38. 1% loss of
height during
the day ie
6 feet 72”
equals ¾ inch

39. British astronaut Tim
Peake in action
running the London
marathon while
strapped to a
treadmill at the
International Space
Station. While the
official 2016 London
Marathon was being
run in London, Peake
ran 26.2 miles on a
treadmill in three
hours 35 minutes 21
seconds, while aboard
the apace station in
orbit 250km above
the Earth

41. 6 NASA astronauts, IVD, L3L4 level, 6 months,
4x HNP probability in one year, 2-3 hr day treadmill,
Bike, weights, in the past 5 cm height increase, nl
Height variation 1-2 cm

43. Decreased area by 19%;
mostly recovered 68% in 6
weeks

44. 8 young subjects (18-23y male)
30 minutes running (70%HR) with MRI pre and post
Measurement of disc volume thoracic and lumbar

48. 6.3% loss of IVD height
similar to marathon
runners 6.9% loss o
IVD volume

49. 17 males (20-27y) and 14 males (50-57y) from Duke or the area
C7 to s2 were measured with a plumb line, skin marked and measure with a special tape
Measure
6 mile paved run at a comfortable pace

52. Studying the effect of running on the
intervertebral disc extracellular matrix
Q: can 3 weeks of running stimulate matrix
production and cellular proliferation
Methods: 12 running rats 12 nonrunning rats,
measured cell count, protein expression,
apoptosis, proteoglycan expression
Results: 25% increase in cells, collagen 2
strongly expressed in runners, increased
proteoglycans.

54. 30 patients chronic LBP, 2 groups, climb routs 10 sessions in 8 weeks, at least one
hour a week
Closed chain,

57. Oswestry
Disability Index

60. Tae Chi
Yoga
Mindfullness based
Stress reduction techniques

62. thanks