Running and Osteoarthritis (Updated (2026):

Many people may be concerned that being a former or current runner or athlete in a running sport contributes to the development of osteoarthritis (OA). Running is often perceived as detrimental to joint health, even by health care professionals (Adults with chronic low back pain hold negative beliefs towards running: a mixed methods study - ScienceDirect + Do the General Public and Health Care Professionals Think That Running Is Bad for the Knees? A Cross-sectional International Multilanguage Online Survey - PubMed).

Over 40% of the public and nearly one in ten healthcare professionals believe or are uncertain whether regular running leads to OA (What are the perceptions about running and knee joint health among the public and healthcare practitioners). Misinterpreted research has contributed to concerns about running leading to OA risk, so it makes sense that previous beliefs in either direction of support were common.

Running, even just 20 minutes per week, has vast benefits, so it should be encouraged for most individuals (Is running associated with a lower risk of all-cause, cardiovascular and cancer mortality, and is the more the better? A systematic review and meta-analysis - PubMed), but the old-fashioned fear of running is still common. Here is some info to be aware of if you are concerned about running "causing" or "worsening" lower limb joint osteoarthritis (OA).

A growing body of evidence suggests running does not speed up joint changes or “grey hairs and wrinkles” that occur with healthy ageing. Most studies agree that long-distance running at recreational volumes (less than 50 km per week) at any intensity does not increase the risk of developing knee OA (Does running protect against knee osteoarthritis? Or promote it? Assessing the current evidence - PubMed + Is There an Association Between a History of Running and Symptomatic Knee Osteoarthritis?). 

•  Survey results from the largest cohort of runners to date, of over 3800 runners, show the opposite relationship between OA prevalence, pain, and number of marathons completed or years spent running, as well as the lack of a link between pain and running speed and BMI. Runners with OA (only 7.3% 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 planned to run another marathon (Does Running Increase the Risk of Hip and Knee Arthritis? A Survey of 3804 Marathon Runners) Another win for those saying we are “born to run.”

• Some studies have even concluded that running at these weekly dosages is protective.

  • This study showed a >50% reduced risk of knee joint replacement surgery in runners (Running and Knee Osteoarthritis: A Systematic Review and Meta-analysis - PubMed). 

• Suppose the stress of running was bad for you. The ankle experiences greater joint stresses than the knee, So, why is it less common for the ankle to become symptomatic with OA than for the knee ? (Population prevalence and distribution of ankle pain and symptomatic radiographic ankle osteoarthritis in community dwelling older adults).

• The total daily “stress” of walking normal distances each day might be similar to the total peak “stress” experienced during running (Why don't most runners get knee osteoarthritis? A case for per-unit-distance loads - PubMed) 

• The release of joint fluid chemicals into the joint during running enhances lubrication and shock absorption. These chemicals are higher in recreational runners compared to non-runners (Is running good or bad for your knees? A systematic review and meta-analysis of cartilage morphology and composition changes in the tibiofemoral and patellofemoral joints). Also, 30 minutes of running has been shown to decrease the concentration of inflammation-supporting cytokines within the knee after running (Running decreases knee intra-articular cytokine and cartilage oligomeric matrix concentrations). 

• A history of joint injury, surgery, genetic relation with OA, and BMI are greater risk factors for OA having a running history (Low Prevalence of Hip and Knee Arthritis in Active Marathon Runners - PubMed). 

So why has running been speculated to cause OA in those who run more than is encouraged by our health guides each week? What explains the small but still increased risk of OA development in elite runners compared to being a non-runner, such as an increased risk of 13.3% in competitive runners versus 10.2% in non-runners, and a 3.5% in recreational runners in this study (The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis)

• Competitive runners or running athletes are at increased risk of joint injury (such as joint dislocations, ligament sprains, and bone breaks) compared to recreational runners. Joint injury is a much more potent risk factor for OA development than running (Arthritis Web Seminar).

• Competitive runners also push themselves beyond what is considered leisurely and encouraged by our National Physical Activity Guidelines, likely reducing the ability for the joints to recover in time before the next training session. The levels of exercise that these long-distance runners achieve are significantly above what is recommended for joint and general health. So running at a dosage you can't recover from makes sense to be a contributor to poor joint health.

• People with a history of athletics generally live longer than non-athletic individuals, so they live long enough to develop and talk about having OA (All-cause and disease-specific mortality among male, former elite athletes: an average 50-year follow-up | British Journal of Sports Medicine).

• We think elite athletes are the epitome of health, and if something happens to them health-wise, it will happen to us. Competitive athletes, retired or not, are not commonly experts at maintaining good joint health for life (Influences on the mental health and well-being of retired professional athletes from high contact team sports: a mixed methods systematic review | British Journal of Sports Medicine + Mortality and health-related habits in 900 Finnish former elite athletes and their brothers | British Journal of Sports Medicine). Unfortunately, athletes, when desperate, just like non-athletes, may consent to well-intended but unproven elective procedures, like surgery and unproven injections, placing them at increased risk of worsened joint health. Don’t assume care for elite athletes, or quality of care by "specialists" (Doctors with a special interest in back pain have poorer knowledge about how to treat back pain) is “elite.” 

• Many elite athletes themselves believe running is bad for them and that their career in sport has “inevitably caused their OA,” so have behave in ways for decades after retirement reducing joint health, such as moving less to “delay the need for joint replacement” or becoming inactive and overweight, which all contribute to worsening joint health. 

• “But what explains elite athletes being at a higher risk of joint replacements?” Elite athletes with high incomes have greater access to imaging and orthopaedic surgeons, increasing their risk of unnecessary interventions. Also due to their higher fitness and identity of being “elite”, changes in function are more likely to be felt as “reduced function,” leading to seeking care sooner (Do people with knee osteoarthritis use guideline-consistent treatments after an orthopaedic surgeon recommends nonsurgical care? + I know what the imaging guidelines say, but). 

“What about if I have never run before? Is it safe to start?” 

• 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. However, these findings do not necessarily generalise to overweight adults or people with prior traumatic joint injuries as we have less research on these categories of people (The effect of a six‐month training program followed by a marathon run on knee joint cartilage volume and thickness in marathon beginners + The effect of running on knee joint cartilage). 

• The benefits of running on your general health outweigh the potential small risks for joint health. The benefits of running to the prevention of high blood pressure, obesity, type 2 diabetes, and mental illness, which in turn contributes to reducing the risk of early death, hugely outweigh any possible harm from regular moderate doses of running at any age (Outrunning the grim reaper: longevity of the first 200 sub-4 min mile male runners | British Journal of Sports Medicine + Is running associated with a lower risk of all-cause, cardiovascular and cancer mortality, and is the more the better? A systematic review and meta-analysis | British Journal of Sports Medicine).

Schematic of potential mechanisms for maintaining knee joint health when initiating running or increasing training intensity (Joint Loading in Runners Does Not Initiate Knee Osteoarthritis).

• See these links for more encouragement to take up or continue running for leisure and your joint health.

  • Osteoarthritis Optimism for Runners | E19 with Dr Greg Lehman, Chiropractor, Physiotherapist 

  • Rethinking running and knee health with Dr Jean-Francois Esculier - Joint Action | Acast

  • Does running cause knee osteoa…–Joint Action – Apple Podcasts

  • Running and Knee Osteoarthritis | Barbell Medicine