Does road running cause knee osteoarthritis?

Oct 26, 2023

A lot of our patients who attend with knee osteoarthritis believe road running is bad for them and it is harmful.  So does road running really cause osteoarthritis?

Knee pain affects nearly 50% of people over the age of 50, and in 25% of those people it become a long-term problem although it can occur at any time of life. The pain caused by osteoarthritis of the knee can significantly reduce your quality of life, your experiences with your family and impact on your daily activities.  It’s one of the common questions I have been getting asked lately in clinic,

Does road running cause knee osteoarthritis?

We understand that many of our patients are keen runners or are considering taking up the sport, and this question is of significant importance. This is especially true of our population who are mostly aged between 40-65, who love running for the endorphin release, the stress release and the freedom that comes with an enjoyable run in the great outdoors.

For years, there has been a prevailing belief that running, especially on hard surfaces, is detrimental to knee health and can lead to osteoarthritis. However, recent scientific evidence challenges this assumption. In this email, we will explore the research and dispel the myth that running causes osteoarthritis in the knee.

So this week I want to answer that question for you.

But first What is knee Osteoarthritis (OA)?

Osteoarthritis is a degenerative joint condition that involves the breakdown of cartilage, leading to joint pain, inflammation and disability. It does NOT mean “bone on bone” or bone rubbing or grinding against against each other. That is because when the cartilage becomes damaged the bone actually heals over and creates a scar which acts as a protective cap to replace the cartilage. It’s not as good or as efficient but it also does the job.

As your body goes through this process it results in pain, stiffness, and reduced joint movement. This usually leads to fear of movemnt, doubts about whether exercise or movement is beneficial and ultimately avoidance of some exercise or activities. This fear is normal and manifests itself in statements like “I’m too old to do that”, or “I’m getting too old to run” when you are only in your 40’s.

This leads to the most common mistake of prolonged rest and consequently more stiffness and pain. Osteoarthritis commonly affects the knees, hips, and lower back, but can also develop in other joints. So does distance or road running cause osteoarthritis?

There’s been a longstanding debate in the literature regarding the impact of distance running on joint health. Over time though research changes and consensus is reached. So here is what 7 recent research articles tell us about running and osteoarthritis of the knee:

  1. Most studies suggest that recreational distance running (5,10 or 20km) does not increase the risk of developing osteoarthritis. In fact, some studies have found that runners may have a lower risk of knee osteoarthritis compared to non-runners. If you have had no previous knee injuries, consistently exercised and enjoy running, then they’re is absolutely no indication that this likely to cause osteoarthritis. In fact it’s more likely to be beneficial for your joint health and PREVENT osteoarthritis.
  2. A study published in the American Journal of Sports Medicine followed nearly 75,000 runners and non-runners for over 7 years. The researchers concluded that there was no significant association between running and an increased risk of knee osteoarthritis.
  3. Another study published in Medicine & Science in Sports & Exercise compared the incidence of knee osteoarthritis between runners and non-runners over a 21-year period. The results indicated that runners had a lower risk of developing knee osteoarthritis compared to their sedentary counterparts.
  4. Intensity matters! While recreational running is not safe, there’s some evidence to suggest that elite-level runners (those running extremely high mileages or at high intensities) could have an increased risk of knee osteoarthritis. This is because they’re running mileage is over 50 miles per week and performed over a long period of time, pushing their bodies close to their maximum level. This is completely different to the recreational runner who operates at a sub maximal pace and typically does less than 30km per week. If you are not sure look at your weekly mileage, if you don’t keep a training journal then it’s a great place to start. Establishing your normal training load can help establish baseline data should you ever run into trouble (no pun intended).
  5. A history of joint injuries (e.g., due to accidents, poor running technique, or other factors) can increase the risk of OA. It’s crucial for runners to address any joint injuries promptly and thoroughly to prevent future complications. This is one of the biggest indicators of osteoarthritis. Most of these injuries originate from sport. ACL injuries or twisting injuries from football, rugby or hockey are the main causes due to the multidirectional nature. If you have had a significant knee or hip injury that led to a meniscal injury, cartilage damage or even an minor surgery with an arthroscopy then the likelihood of developing osteoarthritis is much greater.
  6. Being overweight is one of the biggest risk factors for OA, largely because of the added strain on the joints combined with inactivity and muscle weakness. Running can actually be protective in this aspect, as it can help maintain a healthy weight. Unfortunately in Scotland we have a very overweight population and 1 in 3 are actually clinically obese. This is usually caused by a poor diet, lifestyle choices and a lack of exercise (in particular strength exercise). This is one of the reasons why hip and knee replacements are so common in Scotland.
  7. When we walk we take 3-4 times our body weight in pressure through our knee joint. This multiplies to 7-8 times our body weight when we run. This increase is hugely significant over time. So reducing weight, improving strength and wearing footwear which reduces impact forces is the best course of action for this group. However, it has an impact on us all. If you have knee or hip pain and are carrying 5 or 10 kilos too many then this can soon add up if you multiply it by x 7-8.

SO the conclusion and current evidence strongly suggests that distance running does NOT cause osteoarthritis. In fact, several studies have shown that runners have a lower risk of developing osteoarthritis compared to non-runners. One study even found that runners who had been running for more than 25 years had no more knee pain or osteoarthritis than non-runners.

What are the key takeaways for you:

1. Reducing your weight can reduce your knee osteoarthritis pain and improve your quality of life significantly.

2. Contrary to common perception, exercise does not accelerate cartilage degeneration. A study published in the journal Osteoarthritis and Cartilage demonstrated that moderate-intensity exercise was associated with slower cartilage volume loss in patients with knee osteoarthritis. SO even if patients who already have knee osteoarthritis, exercise has been shown to be helpful and not damaging.

3. If you’re struggling with mild osteoarthritis of the knee and want to get back running then please give us a call and we can help you get back to enjoying a run without the stiffness, discomfort or uncertainty of whether your knee will hold up for the duration of the run.

So there you have it for the majority of people, distance running, when done correctly and in moderation, does not increase the risk of osteoarthritis. However, individual factors such as prior injuries, body weight, running intensity, and surface can play a role, and physiotherapy is the most evidence based treatment to get you back to running.

Should you have any more questions or concerns, please don’t hesitate to reach out to our team.

We are here to support you in your journey to optimal health, running goals and your fitness.

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