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Does Running Cause Arthritis?

The most common form of arthritis is Osteoarthritis (OA), which is a condition marked by degenerative cartilage at the joint.  Osteoarthritis affects 32.5 million adults in the United States. Cartilage is the soft tissue cushion that protects bones from rubbing where they meet. They help with shock absorption, congruency and help the joint glide easily when moved. In OA, as the cartilage cushion wears down, it can cause pain, stiffness and disability to that joint. OA is often referred to as the “wear and tear” arthritis. So, what gives, doesn’t running wear and tear the joints in the body?
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Do you have that friend or family member who hates running and tells you, “why would I run? It is bad for your knees and hips and leads to arthritis.”  Are they on to something? Isn’t the answer obvious? However, the actual answer does seem to surprise people (and doctors for that matter), that running does not seem to be associated with increased risk of developing arthritis! Let’s dive deeper into this.

What is Arthritis?

The most common form of arthritis is Osteoarthritis (OA), which is a condition marked by degenerative cartilage at the joint.  Osteoarthritis affects 32.5 million adults in the United States. Cartilage is the soft tissue cushion that protects bones from rubbing where they meet. They help with shock absorption, congruency and help the joint glide easily when moved. In OA, as the cartilage cushion wears down, it can cause pain, stiffness and disability to that joint. OA is often referred to as the “wear and tear” arthritis. So, what gives, doesn’t running wear and tear the joints in the body?

Don’t get me wrong, running is hard on the body. It is probably one of the hardest things that we do. Seems easy right? We just throw on shoes (or not for you barefoot runners) and go.  Running is a single leg activity. Running is defined as hopping from one leg to the next in forward motion. However, every time we land, we have an opposite and opposing ground reaction force that our joints must absorb up to 2.5 to 3.5 times our bodyweight. That is a lot of force. One would think that running at those forces would lead to increased wear and tear.  But that is where the research says it does not!

What Does the Research Say About the Relationship Between Running and Arthritis?

  • A study published in 2017 in the Journal of Sports Physical Therapy found that recreational runners had lower rates of hip and knee osteoarthritis (3.5%) as compared with nonrunners (10.2%).
  • In a 2018 study in the Journal of Bone and Joint Surgery, the rate of hip and knee arthritis among 675 marathon runners was half the rate expected within the US population.
  • A systematic review and meta-analysis in 2022 of 24 studies found no evidence of significant harm to the cartilage lining the knee joints on MRIs taken just after running.
  • A 2023 Systematic review of 17 studies in the Orthopedic Journal of Sports Medicine found running is not associated with worsening patient reported outcomes or radiological signs of knee OA and may be protective against generalized knee pain.
  • In a 2023 survey of 3804 marathon runners in the Journal of Sport Health, the most significant risk factors for developing hip or knee arthritis were age, BMI, previous injury or surgery and family history. There was no identified association between cumulative running history and the risk for arthritis.

These are a few of the research studies that have looked at the relationship between arthritis and running, but as always, further research would be needed.

Why Researching Running and Arthritis Can be Difficult

  • Osteoarthritis takes a long time to develop. Convincing research would have to be set up to follow folks for decades.
  • There usually are many associated differences between runners and non-runners (although not always the case). Runners tend to maintain a healthier lifestyle in consistent cardiovascular exercise (running, duh!), good muscle strength and endurance, heathier eating, no/less smoking than non-runners, and healthier weight.
  • Tough to perform the ideal study in what would be consistent of a double-blind, randomized, control study. Researchers would not know what subject is getting the treatment, kind of hard when the treatment is running.

Nevertheless, the trends in research favoring running in that it does not predispose or lead to arthritis, are very promising!  So, the next time that friend/family member discourages you from running, you can share some of these facts with them (or politely don’t listen).

This does not mean that running doesn’t lead to injuries. Quite the opposite, about 75-85% of runners tend to experience an injury at some point in their running journey.

The severity and types of those injuries vary.  That is why it is very important for runners to be sure to follow a safe and progressive training plan, no increasing mileage in a week more than 10%.  Have sound biomechanical running form. Get in the habit of performing a dynamic warm-up routine before runs followed by an active recovery. All runners should add run specific strengthening 2 to 3 times per week. All of this will assist to minimize risk of running related injuries and keep you a healthy and active runner for years to come. Not sure where to start? Come schedule a physical therapy consult with us at Vida!

If you have any questions or want to schedule an evaluation for your run-related injury, feel free to reach out to me and schedule at our Vida Ravenna Clinic (206-315-7998).

Follow me on Instagram @pt4inspiredrunner and/or visit my website at www.pt4inspiredrunner.com

    References

    • Alentorn-Geli E, Samuelsson K, Musahl V, Green C, Bhandari, Karlsson. 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
    • Ponzio D, Syed U, Purcell K, Cooper A, Maltenfort M, Shaner J, Chen A. Low Prevalence of Hip and Knee Arthritis in Active Marathon Runners.  J Bone Joint Surg Am. 2018 Jan 17; 100(2): 131-137
    • Coburn S.L, Crossley K.M, Kemp J.L, Bruder A.M, Mentiplay B.F, Culvenor A.G. 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.  J Osteoarthritis and Cartilage.  Nov 2022; 31(2): 144-157
    • Dhillon J, Kraeutler M, Belk J, Scillia A, McCarty E, Ansah-Twum J, McCulloch P. Effects of Running on the Development of Knee Osteoarthritis: An Updated Systematic Review at Short-Term Follow-Up.  Orthop J Sports Med.  Mar 2023; 11(3)
    • Hartwell M, Tanenbaum J, Chiampas G, Terry M, Tjong V. Does Running Increase the Rist of Hip and Knee Arthtitis? A Survey of 3804 Marathon Runners.  J Sports Health.  Aug 2023; 9:19417381231190876. Doi: 10.1177/19417381231190876
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