Regular running is good for the body and the mind. Studies show that running regularly is associated with reduced heart and lung disease, a reduced risk of stroke and a lower incidence of type II diabetes. Runners also have improved mental wellbeing, with reduced levels of depression (1,2). But is there a potential downside to regular running in the form of developing hip and knee arthritis?

There is a common belief that regularly pounding the roads and tracks increases the likelihood of developing osteoarthritis (OA) and ultimately requiring joint replacement surgery (3). Many people hold this view and on a basic level, there is an obvious line of logic. After all, if the hips and knees are subjected to repetitive high levels of loading, then surely they will eventually wear out and become arthritic and painful? Well, the good news is, that for recreational runners, this isn’t the case. A study of over 600 recreational Marathon runners demonstrated that not only do runners not have an increased risk of developing arthritic pain, but that their risk of developing troublesome arthritic conditions was significantly lower than for age matched non runners (4). Another study (5) looked at recreational runners, and compared their OA risk to that of professional and elite runners. This was a big piece of work that systematically reviewed and meta analysed 25 studies that involved over 100,000 individuals. The findings were that elite runners had a slightly increased rate of developing OA compared to the control group. However there was a significant reduction in OA rates amongst the recreational runners. Another study of over 2,500 runners (6) that investigated equal numbers of men and women, confirmed that there is no clear link between regular running and developing symptomatic knee OA.

So what about people who already have troublesome arthritis? Should they hang up their running shoes? Probably not. There is good evidence that shows how regular exercise is beneficial for arthritic knees, significantly reducing pain and improving function (7,8). In addition, those runners who had developed troublesome knee OA, had reductions in pain and no adverse X ray changes, when they continued their running  (9).

In summary, contemporary research shows that running is not bad for the joints. In fact, there are multiple studies that show how beneficial regular exercise, including running is, not only for non arthritic joints, but also for those knee joints that are symptomatic due to OA changes. Runners with OA related joint pain should consult a Physiotherapist who has experience working with runners. They will be able to advise not only on appropriate running programmes, but also on strength and conditioning exercises that can improve joint function and running performance.

References

1.  Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012 Apr;2(2):1143-211. doi: 10.1002/cphy.c110025. PMID: 23798298; PMCID: PMC4241367
2. Lee DC, Brellenthin AG, Thompson PD, Sui X, Lee IM, Lavie CJ. Running as a Key Lifestyle Medicine for Longevity. Prog Cardiovasc Dis. 2017 Jun-Jul;60(1):45-55. doi: 10.1016/j.pcad.2017.03.005. Epub 2017 Mar 30. PMID: 28365296.
3. Esculier JF, Krowchuk NM, Li LC, Taunton JE, Hunt MA. What are the perceptions about running and knee joint health among the public and healthcare practitioners in Canada? PLoS One. 2018 Oct 1;13(10):e0204872. doi: 10.1371/journal.pone.0204872. PMID: 30273410; PMCID: PMC6166953.
4. Ponzio DY, Syed UAM, Purcell K, Cooper AM, Maltenfort M, Shaner J, Chen AF. Low Prevalence of Hip and Knee Arthritis in Active Marathon Runners. J Bone Joint Surg Am. 2018 Jan 17;100(2):131-137. doi: 10.2106/JBJS.16.01071. PMID: 29342063.
5. Alentorn-Geli E, Samuelsson K, Musahl V, Green CL, Bhandari M, Karlsson J. The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017 Jun;47(6):373-390. doi: 10.2519/jospt.2017.7137. Epub 2017 May 13.
6. Lo GH, Driban JB, Kriska AM, McAlindon TE, Souza RB, Petersen NJ, Storti KL, Eaton CB, Hochberg MC, Jackson RD, Kent Kwoh C, Nevitt MC, Suarez-Almazor ME. Is There an Association Between a History of Running and Symptomatic Knee Osteoarthritis? A Cross-Sectional Study From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken). 2017 Feb;69(2):183-191. doi: 10.1002/acr.22939. PMID: 27333572; PMCID: PMC5179322.
7. Quicke JG, Foster NE, Thomas MJ, Holden MA. Is long-term physical activity safe for older adults with knee pain?: a systematic review. Osteoarthritis Cartilage. 2015 Sep;23(9):1445-56. doi: 10.1016/j.joca.2015.05.002. Epub 2015 May 21. PMID: 26003947.
8. Skou ST, Bricca A, Roos EM. The impact of physical activity level on the short- and long-term pain relief from supervised exercise therapy and education: a study of 12,796 Danish patients with knee osteoarthritis. Osteoarthritis Cartilage. 2018 Nov;26(11):1474-1478. doi: 10.1016/j.joca.2018.07.010. Epub 2018 Aug 2. PMID: 30076884.
9. Lo GH, Musa SM, Driban JB, Kriska AM, McAlindon TE, Souza RB, Petersen NJ, Storti KL, Eaton CB, Hochberg MC, Jackson RD, Kwoh CK, Nevitt MC, Suarez-Almazor ME. Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative. Clin Rheumatol. 2018 Sep;37(9):2497-2504. doi: 10.1007/s10067-018-4121-3. Epub 2018 May 4. PMID: 29728929; PMCID: PMC6095814.