Does running cause Osteoarthritis

November 2016

I recently took part in the Herts 10K run. It is a fantastic event; well organised and hugely popular with over 1000 runners of all ages. It is heartening to witness so many people, across the lifespan from childhood to old age, participating in a sport that they enjoy. Just before the race, I was chatting to a fellow runner about my job. He expressed surprise that, as a knee surgeon, I would be risking damage to my own knees by running.

It seems to be a commonly held belief that running causes osteoarthritis. Indeed, a popular medical website states:

"Running two or three times a week is fine but we also have to look at lifetime exposure. Over time, it could do some damage. A high impact, high stress running regimen is associated with a greater risk of joint deterioration, which could lead to osteoarthritis”

But what is the evidence for this belief?

Participating in regular physical exercise feels, intuitively, to be a good thing. This is supported by studies that report increases in general health and well-being measures, reduction in levels of obesity and even prolongation of life. But are there any disadvantages to your health as a result of regular participation in recreational or competitive sports, such as running?

With regards to the knee joint, playing sport may lead to injury of vital structures within the knee, such as the lining (articular) cartilage or the cushion (meniscus) cartilage. Such injuries can increase your chances of developing osteoarthritis in that joint.

But does the action of running itself cause wear and tear associated with osteoarthritis?

There are very few studies that have looked into this. Some are of poor design quality, so their conclusions cannot be trusted. Others are on too few patients, so the conclusions can only be drawn on the runners in the study and cannot be extrapolated to wider population.

A recent review of all the evidence was published in the American Journal of Sports Medicine this year, written by Kate Timmins and others in Nottingham: ‘Running and Knee Osteoarthritis: A Systematic review and Meta-analysis. Unsurprisingly, given the poor quality of the available studies analysed for the review, the authors were unable to identify a role of running in the development of osteoarthritis of the knee.

What does cause osteoarthritis of the knee?

Alex Bastick and his team in Rotterdam examined this issue: “What are the Prognostic Factors for Radiographic Progression of Knee Osteoarthritis?” They concluded that if you already had knee pain, had ‘bandy’ legs (varus knee) or had raised blood markers for osteoarthritis (indicating that osteoarthritis is already present) then knee arthritis is more likely to progress. Factors NOT associated with the development of osteoarthritis in the knee include participation in sport, whilst having a high BMI, associated with obesity does increase the risk.

So what can we conclude?

If there is a risk of running directly leading to osteoarthritis of the knee, then science hasn’t identified it yet. In the absence of known risk factors for the progression of osteoarthritis, the potential risk may be outweighed by the number of health benefits associated with sport participation.

So, in conclusion, if running is your sport of choice, keep at it!