Running and Osteoarthritis
16 Nov 2023
Table of Contents:
Our current understanding of running & osteoarthritis
Relationship between osteoarthritis & marathons
How to maintain knee joint health whilst running
It is common to believe that movement “wears out a joint” or that increased exercise or sport in early life causes arthritis. Rather, the effect of physical activity and exercise on joint health is primarily positive. Increased sedentary behaviour and not meeting weekly physical activity guidelines are decisive risk factors for OA development.
Joint health is best promoted before the age of 20-25. This is similar to advice on bone density, where it is still possible to improve bone and joint cartilage health at all stages of life, but it is best achieved before reaching adulthood.
Walking more than 6,000 steps per day protects against developing functional impairments in people with or at risk of knee OA. https://doi.org/10.1002/acr.22362
But what about running? Does being a previous or current running athlete contribute to OA? Running is often perceived as detrimental to joint health and over 40% of the public. Nearly one in ten healthcare professionals believe or are uncertain whether regular running leads to osteoarthritis (See https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0204872). Older studies have shown mixed results of running on OA risk, so it makes sense that previous beliefs in either direction of support were common. Negative findings were also impacted by only looking at small groups of endurance runners where statistical anomalies and selection bias misdirect a true conclusion. But what is our current understanding of running relationships with OA development?
A growing body of evidence suggests running does not speed up joint degeneration separate from healthy aging. Most studies agree that long-distance running at recreational volumes (15-30km per week) and intensities do not increase the risk of developing knee OA. https://pubmed.ncbi.nlm.nih.gov/26221016/
Long-distance runners are not immune to the effect of age on the development of radiographic arthritis.
The ankle experiences greater joint stresses than the knee, but ankle OA is much less common than knee OA.
Fluid types that improve lubrication and shock absorption joint content have been seen in greater amounts in recreationally active individuals than in sedentary individuals and greater in high-volume runners than in recreationally active individuals. https://pubmed.ncbi.nlm.nih.gov/12594751/
30 minutes of running decreased the concentration of inflammation-supporting cytokines https://www.ncbi.nlm.nih.gov/pubmed/27699484
A history of joint injury, surgery, genetic relation with OA, and BMI are greater risk factors for OA than any running training parameter. https://www.ncbi.nlm.nih.gov/pubmed/29342063
This review concluded a running history provided a protective effect, with a >50% reduced risk for knee surgery due to osteoarthritis. https://www.ncbi.nlm.nih.gov/pubmed/27519678
There are multiple studies showing that running marathons is not harmful to joints in the short term for people with and without OA. Studies on new runners suggest that the initiation of running training does not negatively affect joint health. Still, these findings do not necessarily generalise to obese adults or people with previously traumatic joint injuries.https://dx.doi.org/10.1007/s00167-013-2686-6 https://pubmed.ncbi.nlm.nih.gov/33279802/
Prevalence in runners seems to be lower than in athletes from other sports, such as soccer, and runners are at much less risk of developing OA than people with no physical activity or sports background. https://doi.org/10.2519/jospt.2017.7137 Delineating the effects of sports participation from sport-related injury is challenging.
The levels of exercise that these long-distance runners achieve are significantly above what is recommended for joint and general health. We don’t have a confident cutoff for what is too much exercise throughout life, but running over >160km per week has been questioned.
Most elite running athletes do not develop symptomatic OA. However, unhealthy lifestyle changes are seen commonly in retired athletes, and not participating in lifelong healthy habits can influence previous joint injury-related OA progression incurred during competition years. Therefore, it is difficult to determine if the previous high levels of exercise are more important to avoid than the change in lifestyle during retirement and the increased rate of joint or ligament injuries seen during competition in elite athletes.
The benefits of running on the prevention of high blood pressure, obesity, type 2 diabetes, and mental illness, which contribute to reducing the risk of early death, hugely outweigh any possible harm from regular moderate doses of running at any age. The benefits of running on your general health outweigh the potential small risks for joint health.
People with a history of athletics generally live longer than non-athletic individuals, so they live long enough to develop and report osteoarthritis.
See these links for more https://doi.org/10.1177/19417381231190876 and https://doi.org/10.1002%2Facr.22939 and https://doi.org/10.1249/jes.0000000000000105
Overall, consider unusual joint loads as something to limit and become tolerant of versus regular or usual high repetitive loads, which might be protective for a joint.
https://journals.sagepub.com/doi/10.1177/19417381231190876
Survey results from the largest cohort of runners to date of over 3800 runners showing the opposite relationship between OA prevalence, pain, and number of marathons completed or years spent running with aging runners as well as the lack of a link between pain and running speed and BMI. Runners with OA (only 7.3% of the runners of all the long-term runners) were twice as likely to have had a physician advise them to reduce or limit their running, yet 91.4% of those with arthritis plan to run another marathon. Born to run.
Schematic of potential mechanisms for maintaining knee joint health when initiating running or increasing training intensity.
Insert “High impact movement”..... “is bad for my joints.” Long-term studies have determined that running, high-impact, and strength training exercise does not negatively affect joints when dosed properly in people with and without OA.
However, more high-impact exercise does not always mean more OA protection. There is probably a middle ground of the appropriate dosage of exercise that is different for different people.
What happens to astronauts' joints when they go to space and have months of limited joint loading or when a limb is immobilised for months after a fracture?
Exercise should always be progressive to counteract the effects of aging and lifestyle-related joint changes and keep you tolerating your hobbies and valued activities.
https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/art.42732?utm_source=OA+Action+Alliance&utm_campaign=5c0a068fca-research+112219_COPY_01&utm_medium=email&utm_term=0_a8b77d1bbb-5c0a068fca-99729334 “Strength Training Associates with Less Knee Osteoarthritis: Data from the Osteoarthritis Initiative” Published October 2023.