Running and Knee Osteoarthritis

English: running
English: running (Photo credit: Wikipedia)

Most people think that osteoarthritis is simply due to “wear and tear” of the joints, and therefore that running would put you at a higher risk, but this is (fortunately) not correct. Runners develop less knee osteoarthritis than the general population and if they do, they usually suffer less from it.

 
What is it?
Osteoarthritis occurs when the normal breakdown and repair of joint tissues becomes unbalanced. It affects the whole joint, even though osteophytes (bone overgrowth) and thinning of the cartilage are the best known signs. It can cause severe pains, but many persons with clear signs of osteoarthritis on radiographs are just fine.
Osteoarthritis can be caused or aggravated by a long list of problems, such as joint infections and genes, and it is still a badly understood disease. In this post we will concentrate on the relationship between running and knee osteoarthritis in people with no underlying problems.

 
The muscles
Many people believe that osteoarthritis is caused by the gradual thinning of the cartilage due to repeated pounding. However, the main shock absorbers are the properly contracting muscles, and therefore exercise can protect the joints. Moving and loading your joints will also stimulate the cells in your cartilage and keep them healthy.
Your muscles can only contract properly if your joint is stable and well aligned.

Injury
Injuries to joint structures, such as ligaments and menisci, are well-known risk factors. There are three ways by which they can lead to osteoarthritis. Firstly, the cartilage can be damaged at the time of the injury and osteoarthritis develops over the years. Secondly, the joint becomes unstable which leads to recurrent cartilage damage. Finally, the muscles do not work properly anymore and therefore they cannot absorb the impact forces appropriately, which results in cartilage damage.

 
Joint alignment
Studies have shown that small amounts of misalignment (bowl-legged or knocked-knees) lead to big differences in force distribution in the joints, and increase your risk.
You could consider improper running technique as a form of misalignment, but as yet we do not know what its effect is, even though experts suppose it is important.

Osteoarthritis

 

Fatty tissue
Being obese or overweight puts you at a higher risk of knee osteoarthritis, but it is not sure if overweight people who exercise increase their risk further.

In 2007, Dr Wang showed that the risk was linked to the amount of fatty tissue, and not to BMI. Fatty tissue produces adipokines, which behave like hormones. If you have too much visceral fat, the adipokine production becomes disturbed and Dr Wang thinks that this puts you at risk. If this is true, running should reduce your risk, as it makes you lose visceral fat even if you do not lose weight.

 
What do we see in practice?
There is agreement between researchers that recreational running does not increase your risks, even if you are running long distances, as long as you do not have an injury and your muscles are strong enough.

 
Theoretically though, running should have a favourable effect. Although some studies show this, others do not. This might be due to the fact that they are so difficult to conduct. They usually rely on questionnaires to determine how physically active the participants are, and how much they suffer from osteoarthritis. People might overreport their training and over- or under-report their symptoms non-intentionally. Radiographic assessment is hampered by issues of measurement and interpretation, and there is not always a good correlation between the radiographic signs and the symptoms. Moreover, the professional occupations of the participants are not always taken into account, although heavy physical work is an important risk factor.

How many people have ever tried to warn you that you are destroying your knees by running? If only they knew…

 

Disclaimer: this article is for general information only, and does not replace medical advice. It cannot be used to diagnose or guide treatment. If you have any concerns or questions, you should talk to a qualified health provider.

References:
B Bruce, J Fries and D Lubeck. Aerobic exercise and its impact on musculoskeletal pain in older adults: a 14 year prospective, longitudinal study. Arthritis Res Ther. 2005; 7(6): R1263–R1270.

D Hunter and F Eckstein. Exercise and osteoarthritis. J Anat. 2009; 214(2): 197–207.

I Shrier. Muscle dysfunction versus wear and tear as a cause of exercise related osteoarthritis: an epidemiological update. Br J Sports Med. 2004; 38: 526–535.

D Urquhart, C Soufan, A Teichtahl et al. Factors that may mediate the relationship between physical activity and the risk for developing knee osteoarthritis. Arthritis Res Ther. 2008; 10(1): 203.

Y Wang, A Wluka, D English et al. Body composition and knee cartilage properties in healthy, community‐based adults. Ann Rheum Dis. 2007; 66(9): 1244–1248.

P Williams. Effects of Running and Walking on Osteoarthritis and Hip Replacement Risk. Med Sci Sports Exerc. 2013 Jan 30. doi: 10.1249/MSS.0b013e3182885f26 [Epub ahead of print]. Accessed on 03/04/2013.

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21 thoughts on “Running and Knee Osteoarthritis

  1. Wonderful response to the common question about weight bearing repetitive sports leading to osteoarthritis. Many people overlook the fact that movement and improving strength is beneficial to the body when done properly. Thank you for this article!
    Amanda Olson, DPT
    runningyourbody.wordpress.com

  2. Great post. I had two knee surgeries in 2009 and my ortho doc told me I had more arthritis than he likes to see in a guy my age (60 next year.) He also told me to cut back on my miles and find another form of cardio exercise, which I did. Somehow, probably more cycling, rest and running on soft trails, I was able to go long again with no pain and ran my first marathon in four years in November. I have an article that will appear in American Fitness Magazine in July I’ll post at some point on my blog.

  3. I was diagnosed with OA when I was 17 due to overweight. My OA was completely healed after I had stem cell therapy with Dr Purita. I have started my own blog about how I was cured and hopefully, I will inspire other arthritis patients too. 🙂

    1. Hi Kirs…I have recently been diagnosed with OA in my left knee. Since its the first case in my family, and also becuase I had an Injured my knee 10 years ago the doc told me its becuase of the injury.
      He straightaway told me to quit gymming,lifting weights,and running.I have stopped all these activities.Quiting Gymn was the hardest part as I am a fitness freak, but harder is to quit running – I am some one who easily gains weight. My height is 5.8 feet. Before joining my fitness program I was 85+, and after the regular runs of 4-5 miles every morning my weight got down to 72.
      But now as I cant run, am again gaining weight very fast.Moreover I really miss my once muscles and the flat tummy 😦
      Please advice if its posssible to run again?
      Here I need to add that the doc I went to wasnt very open and was more intereted in thebill than describing the problem to me and advising what should I do.When I asked “WIll I beable to lead a normal life?” his answer was “Well, it cant be cured for sure.” I havent been to that doctor since then nor have checked in with another.

      Regards.
      CJ

      1. I’m so sorry to hear about your problems.
        The best advice I can give you is to go and see a doctor with a special interest in sports medicine, and a physiotherapist who can analyse your gait. You might have to contact the professional bodies to get addresses, or ask for names at your local running club.
        I would not ignore the problem, as it could get worse and worse!
        Personally I always have doubts about the value of an advice such as “forget about running or going to the gym”. You might have to stop for a short while, and have a lot of physio and/or specific strength training, but you should be able to exercise again.
        Even if osteoarthritis cannot be cured, it can be managed.
        Hope this is helpful.
        Good luck! Please keep us informed.

  4. Hi,
    Sorry for the late response. Have not been able to make time to visit the doc.
    Had completely forgotten that I had posted my query here, thanks to the horrible pain in the knee since yesterday which helped me remember :D.
    Sitting in my office cubicle and this knee is killing me.Its not excatly a pain – but a mixture of discomfort and continuos irriation. 😥
    Guess will have to visit the doc very soon.
    Will keep u updated.

    Regards.
    CJ

  5. Great info! Very simple and easy. Nobody can explain as interesting as this. I appreciate your time and effort on making things simple and easily understandable. I have bookmarked your site. Thanks

  6. I’ll immediately snatch your rss feed as I can not to find
    your e-mail subscription hyperlink or e-newsletter
    service. Do you’ve any? Kindly let me understand in order that I may just subscribe.

    Thanks.

    1. Hi Jeramy,
      Thank you for reading my blog. You can follow it by e-mail if you hit a button on the right hand, about midway down the page. I don’t have a newsletter.

  7. Interesting article. I run an average of 50 miles a week and have yet to suffer any joint pain or injuries. Either way, I believe any risks involved are outweighed by the rewards.

    1. Yes, you are right: for most of us the rewards are so much bigger than the risks. Of course, you have to make sure that you have enough strength and (probably) a good technique. I understand that you must have both!
      Thank you for commenting, and happy running!

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