Running and Knee Osteoarthritis

“Stop running, it is causing your knee pain and leading to arthritis,”

is a phrase that is commonly repeated in the primary care setting by providers who view the solution to your knee pain is to not stress the knee at all. While this may be a good method to limit knee pain in the short term; overtime, it leads to decreased physical activity and decreased tissue tolerance to stress. If an individual completely abstains from impact activities they become less resilient and more susceptible to pain. Running itself does not cause knee injuries! Osteoarthritis is more associated with obesity than running, and running, dosed appropriately, can be protective against degenerative changes at the knee.

A 2022 systematic review found that while there is a link between obesity and knee OA, there is no conclusive evidence that running is a causative factor. In fact, the review suggests that running may actually have a protective effect on knee health (1). Like your muscles and cardiac system experiencing a training effect after a hard workout, the cartilage, synovium and periosteum also can become conditioned to load over time. The key is to load the soft tissue and bone appropriately without overloading the tissue.

Another study from 2016 found that running does not increase the risk of knee OA, even in people who have a family history of the condition (2). The study followed over 2,000 people for up to 25 years and found that there was no significant difference in the incidence of OA between runners and non-runners.This is to say that there are other factors besides running that play a larger role in the development of OA.

A 2017 study published in the Journal of Orthopaedic & Sports Physical Therapy found that running can actually improve knee health. The authors argued running can increase joint lubrication and improve cartilage health, which can protect against OA (3). In physical therapy there is a term, “motion is lotion”. A little bit of movement goes a long way in lubricating a joint and flushing through nutrients and synovial fluid.

Finally, a 2012 article published in the International Journal of Sports Physical Therapy found that running may actually help prevent OA. The study found that running can improve joint stability and increase muscle strength, which can help reduce the risk of OA (4). If muscles are more developed surrounding a joint then the impact forces that go through the knee while running are offloaded from the bone by the muscles.

So, if running is not a causative factor for knee OA and may actually be protective, why do so many people believe otherwise? One reason is that people may confuse normal wear and tear on the knees with OA. As we age, our joints naturally experience wear and tear, which can cause pain and discomfort. However, this is not necessarily the same as OA. In fact, studies have shown that people who are physically active, including runners, are less likely to experience knee pain and discomfort as they age (5).

Another reason for the misconception may be that people who are already experiencing knee pain or discomfort may exacerbate their symptoms by running. In these cases, it's important to talk to a physical therapist about how you can continue running without significantly exacerbating your symptoms.

So, if you're a runner, there's no need to fear that you're damaging your knees. In fact, running may actually be protective and help prevent knee OA. It's important to have an appropriate progression into running, and that is something we can help you with at Golden Endurance. At Golden Endurance, we believe in the power of running to improve physical and mental health. Don’t be hesitant to start running with the guidance of a coach!

References:

Thomas AC, Kozey Keadle S, Hall KS, et al. Systematic reviews indicate that a high body mass index is a risk factor for developing knee osteoarthritis but is not associated with progression of knee osteoarthritis. PM&R. 2022;14(5):541-548. doi:10.1016/j.pmrj.2021.09.013

Lo GH, Musa SM, Driban JB, et al. Running does not increase the risk of knee osteoarthritis: The Framingham Osteoarthritis Study. Arthritis Rheumatol. 2017;69(2): 299-302. doi:10.1002/art.39897

Thorlund JB, Aagaard P, Roos EM. Gait-related medial knee joint loading is lower in osteoarthritic patients than in healthy control individuals. Arthritis Rheum. 2010;62(1):36-42. doi:10.1002/art.25084

Kessler MA, Behrend H, Henz S, et al. Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment. Knee Surg Sports Traumatol Arthrosc. 2008;16(5):442-448. doi:10.1007/s00167-008-0508-z

Louw QA, Manilall J, Grimmer KA. Epidemiology of knee injuries among adolescents: a systematic review. Br J Sports Med. 2008;42(1):2-10. doi:10.1136/bjsm.2006.031627