Posted on June 18 2018
Running and Arthritis: Dispelling the Myth
Running is a fantastic sport for your overall health and wellbeing. Not only does it reduce the risk of heart disease, stroke and certain cancers, it can also improve symptoms of anxiety and depression. Another benefit is that running in a group promotes social inclusion.
But most runners seem to have been warned - usually by non-runners - that they are damaging their knees and they will end up with arthritis. So let's explore whether there's any truth in this claim.
What is Arthritis?
The knee is one of the largest weight-bearing joints in the body. It’s where the bone in the thigh, the femur, comes together with the bones of the calf, the tibia and fibula, and the kneecap, the patella.
The ends of the bones are covered by cartilage, which acts as a shock absorber, and the joint is stabilised by ligaments and muscles. As we get older, the knee joint is commonly affected by arthritis, it is found in approximately one in five adults over the age of 45 in England.
The term ‘arthritis’ simply means inflammation of a joint. When we talk about the common arthritis affecting the knees, we are describing a type of arthritis called osteoarthritis. Osteoarthritis occurs as a result of wear and tear to a joint. The cartilage deteriorates and the underlying bones become irregular. Patients with arthritis suffer from pain, stiffness and a reduced range of movement.
There are certain factors known to increase the risk of osteoarthritis. These include being female, being obese and having a previous injury to a joint. So should running be added to the list of risk factors?
Running and Arthritis
Several studies have looked at the effects of running on the knee. These have had conflicting results. Whilst a few have found that running can damage the knee, most have found the opposite - that running does not increase the risk of arthritis and may actually be a protective factor.
An investigation looking at 20 distance runners with knee pain found that six individuals had the X ray findings of arthritis. However, this study didn’t take into account that the runners had a high rate of traumatic knee injury. The runners who were found to have arthritis also had exaggerated knee angles — their shins were pointing inwards to a greater extent than is seen normally reviewed in 1.
Another study of 17 000 patients found there was an association between arthritis and physical activity, including running more than 20 miles per week in men younger than 50 years reviewed in 1.
In contrast, 41 long distance runners were compared with 41 controls. Runners with a mean age of 60 years, who ran three hours a week for 12 years did not have higher rates of arthritis than the non-runners. In addition, the runners had 40 per cent greater bone density. reviewed in 1 and 2.
Another study compared 17 runners who ran 28 miles every week for 12 years with 18 controls. The runners had no more complaints of sore knees than the non-runners reviewed in 1 and 2.
In a different study, 27 former competitive runners who ran 12 to 24 miles per week for 40 years had no higher rates of arthritis than sedentary controls reviewed in 1. An investigation looking at 45 long-distance runners followed them for 18 years, taking knee X rays every year. There was no higher rate of arthritis than in a control group reviewed in 1. Interestingly, 46 people with severe arthritis were compared to age-matched controls. The investigators found that twice as many runners were present in the control group than in the arthritis group, suggesting that running may have a protective effect reviewed in 1.
In yet another study, 504 former college cross country runners were compared to 284 former college swimmers. Subjects were observed for an average of 25 years. They found that moderate- long distance running, that’s to say running an average of 25.4 miles per week, was not associated with a higher incidence of arthritis of the hip or knee. In addition, there was no evidence to suggest that higher weekly distances of running or more total years of running were associated with a higher incidence of arthritis reviewed in 3.
Running is an effective and fun way of improving overall health. There have been conflicting results in studies which have looked at the effect running has in the development of arthritis. However, the majority of data suggests that moderate levels of running do not increase the risk of osteoarthritis of the knees in healthy people with normal joints, and it might even have a protective effect 1, 3. The evidence about high volume running is inconclusive, however the literature does support the assertion that older runners are generally healthier than non-runners 1.
The risks of running must be balanced against its tremendous benefits — reduced risk of cardiovascular disease, reduced risk of diabetes, reduced risk of depression, reduced obesity, reduced loss of bone density and reduced mortality.
Surely it is better to be a fit, active, healthy 90-year-old, possibly with a bit of knee pain, rather than an overweight 60-year-old with diabetes and angina?
- Hansen P et al (2012) Does running cause osteoarthritis in the hip or knee? PM&R 4:S117-S121
- Buckwalter JA and Martin JA (2004) Sports and osteoarthritis Curr Opin Rheumatol 16:634-639
- Cymet TC and Sinkov V (2006) Does long distance running cause osteoarthritis? JAOA 106(6):342-345
About the author
Dr. Emma Short is a mum of two girls, a doctor and a huge fan of running, fitness and Tikiboo! She’s a big advocate of lifestyle medicine – addressing how factors such as what we eat, how active we are and how well we sleep impact upon our lives, our health and our well-being.
As well as working as a doctor in the NHS, she set up and runs a not-for-profit running club in Wales, Sirius Running, which aims to get the community active and have fun. She is also training to be a fitness instructor and personal trainer.
Follow her at @Emma_thefitnessdoctor