Osteoarthritis and Running: Dispelling the Myth

CurraNZ ambassador David Haunschmidt is an accomplished runner and Emergency Doctor. Here David explores the research behind Osteoarthritis and running to help readers to understand Osteoarthritis 'best practice'.  

Dr Haunschmidt writes: Many still believe running is bad for your knees. I had this conversation recently and wanted to dispel the long-held myth, because recent systematic reviews of the literature show there is no evidence that running causes osteoarthritis (OA).

Indeed, the evidence points towards a protective and preventative effect (1,2,3). The state of the evidence is currently low, however a few conclusions can be reached.

1) Knee arthritis is not caused by running.

The main drivers of OA are ageing, obesity, and prior injury or instability. No studies show a causal link between any form of running and arthritis.

2) Running is protective for long term joint health.

OA is a complex and dynamic process. Cartilage and bone are living structures that regenerate and modify based on the stimulus given to them. A sedentary lifestyle will provide minimal stimulus, whereas regular running with adequate recovery helps regenerate and strengthen these tissues(4). Recreational short to long-distance runners seem to benefit from this preservative effect(5,6). As with anything, there is likely a dose-response curve. Too much hard running without recovery is a recipe for injury.

3) What about those who already have OA?

Against the assumptions of many, runners with arthritis report LESS knee pain compared with non-runners(7).

A good saying to remember is: “Rest is rust, Motion is lotion”.

Those with arthritis are encouraged to remain active, maintain their muscular strength and flexibility around joints. Recovery time may be increased as cartilage will take longer to repair.

An important point to remember is that experiencing pain does mean you are causing damage to the joint. Being guided by an experienced physiotherapist is incredibly beneficial. Activity can be tailored to level of discomfort, swelling and recovery time.

A number of things can be done to mitigate any difficulties running with OA. If new to the sport, build up gradually, getting a proper shoe-fit, using well-cushioned shoes, running on soft surfaces (grass, trail, track) rather than road, maintaining a healthy weight, and most importantly doing strength-work to build the muscles around the knee joint.

Stronger muscles lead to stronger bones, ligaments and tendons. Cross training with non-impact swimming or cycling will have huge benefit also. Lack of understanding in the medical community is also common. My friend had been told “you will never run a marathon with those knees”. This was taken as a powerful message to not run, in fear of doing more harm.

Subsequently he has not ran for several years, something he used to love doing, letting his health and fitness deteriorate. The outdated incorrect model of OA featuring phrases such as “bone rubbing on bone” is incorrect and unhelpful, and unfortunately still prevalent. Thankfully, more resources and education depicting the truer picture of OA and encouraging ongoing activity are available.

Summary: Running appears to be protective against knee osteoarthritis. Those who already have knee OA should feel confident continuing to run, as long as they allow adequate recovery, and use a balanced approach, using some or all of the factors addressed above. Given the overwhelming benefits running brings to many aspects of health, longevity, mental and social well-being, it is sound advice to stick with (or find) your love of running.

Dr David Haunschmidt

FACEM, MBChB, DCH, PGCertCPU

References:

1. Dong X, Li C, Liu J, et al. The effect of running on knee joint cartilage: a systematic review and meta-analysis. Phys Ther Sport 2021;47:147–55.

2. Alentorn-Geli E, Samuelsson K, Musahl V, et al. The association of recreational and competitive running with hip and knee osteoarthritis: a systematic review and meta-analysis. J Orthop Sports Phys Ther 2017;47:373–90.

3. Timmins KA, Leech RD, Batt ME, Edwards KL. Running and Knee Osteoarthritis: A Systematic Review and Metaanalysis. Am J Sports Med. 2017 May;45(6):1447-1457.

4. Heckelman LN, Riofrio AD, Vinson EN, et al. Dose and recovery response of Patellofemoral cartilage deformations to running. Orthop J Sports Med 2020;8:232596712096751.

5. Chakravarty EF, Hubert HB, Lingala VB. knee osteoarthritis: a prospective study. American Journal of Preventive Medicine 2008;35:133–8.

6. Esculier J-F , Jarrett M , Krowchuk NM , et al. Cartilage recovery in runners with and without knee osteoarthritis: a pilot study. Knee 2019;26:1049-57.

7. Lo GH, Musa SM, Driban JB, et al. Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative. Clin Rheumatol 2018;37:2497–504