A review of the most recent running research Osteoarthritis (OA), also referred to as degenerative joint disease, is one of the most prevalent medical conditions in the United States. Osteoarthritis is the breakdown and stiffening of protective tissue in a joint that can lead to pain and impaired function 1,2. This can occur in any joint throughout the body but is most commonly found in the joints of the hand, hips, and knees 1,2. According to the Center of Disease Control, about 1 in 4 US adults are diagnosed by a physician with OA 3. Historically, it had been thought that OA was a disease caused by “wear and tear” or excessive mechanical loading of the joint, however, recent research has shown that osteoarthritis is an intricate multifactorial disease 1,2,4. Factors such as genetics, obesity, metabolic disease, ethnicity, activity level, and previous joint injury are all associated with the development of OA 1,2. Due to the previous belief that osteoarthritis was a disease caused by
excessive mechanical loading, it has been long believed that participation in long distance running would increase the risk for developing osteoarthritis in the weight-bearing joints of the hips, knees, and ankles.
Many researchers have sought to explore the relationship between long distance running and its effect on joint health. Numerous in vitro studies have been performed to understand the response of joint cartilage when exposed to mechanical loading. These studies have demonstrated that cyclic compression of cartilage actually increases the synthesis of specific biomarkers important for cartilage health 4,5. This cyclic mechanical loading will also facilitate the transfer of nutrition from synovial fluid to the cartilage and meniscus 4,5. Other studies have also shown that specific markers for joint lubrication are increased in high level runners 4,6. These in vitro findings suggest that recreational running, and its inherent cyclic mechanical loading, may provide a protective effect and long term benefits for joints.
Other researchers have explored the association between long distance runners and the prevalence of hip and knee OA. A recent study performed by Ponzio et. al. 2018 aimed to
describe hip and knee health in marathon runners compared to the general US population 7. The study included a group of 675 adult active marathoners from over 31 countries. Their inclusion
criteria included a completion of over 5 marathons and running a minimum of 10 miles per week. The group that was included had a mean age of 47.9 years old and a mean weekly running distance of 36.4 miles per week. The analysis found that this group of 675 active marathoners showed a rate of arthritis that was significantly below the rate of arthritis found in the matched general US population (8.8% versus 17.9%). The study also found that there was no significant risk of developing OA associated with running duration, mileage, intensity, or number of marathons completed. These findings are supported by a recent meta-analysis performed in 2023 by Burfield et. al. The analysis reviewed 9 research studies and also concluded that there was no difference in knee OA prevalence in runners undertaking varying weekly running mileage when compared to controls 4.
A meta-analysis performed by Alentorn-Geli et. al. 2017 reviewed 17 studies aiming to review the association between hip and knee OA and distance running 8. The meta-analysis also aimed to review the prevalence of knee OA in runners completing increasing levels of weekly running. The authors found that recreational running was not associated with the development of OA. In this analysis, recreational runners were classified as non professional, non elite runners. Furthermore, the study found that recreational runners had lower odds of hip/knee OA when compared to sedentary non-running individuals (3.3% prevalence in recreational runners vs 10.23% prevalence in control individuals). The authors state “these systematic reviews and meta-analyses have not been able to demonstrate an association between running and hip and knee OA… In fact, running at a recreational level was even found to have a protective effect on hip and/or knee OA.” The authors did find that competitive runners (professional, elite, or ex-elite runners) had a higher likelihood of developing OA when compared to sedentary non-runner counterparts (13.3% prevalence of OA in competitive runners vs 10.23% prevalence in control individuals). The authors conclude that while recreational running may have a protective effect on joint health, higher mileage and more exposure to running may very likely be correlated to the development of knee and hip OA, however, more studies need to be completed to further understand the relationship between weekly mileage, running intensity, and OA.
The principal finding in the most recent literature was that participation in recreational distance running was not associated with an increased likelihood of developing knee or hip osteoarthritis. In fact, most studies have found that recreational running actually provides a protective effect and may even help reduce the risk of developing OA when compared to non-runner sedentary individuals. These studies are further back by in vitro studies that show positive cartilage response to cyclic mechanical loading. Other factors, such as running intensity and weekly running mileage, seem to have more inconclusive findings in the literature. Some studies found an increased prevalence for hip and knee OA in professional and elite runners (individuals inherently running significantly higher and more intense weekly mileage) while other studies have found no association between weekly mileage, running intensity, and the development of hip or knee OA. These specific factors can be difficult to isolate since osteoarthritis is a complex and multifactorial disease. Numerous factors such as genetics, diet, and previous joint injury are hard to control during research studies. More research is required to fully understand the association between these factors of volume and intensity and the development of hip and knee OA in runners. While we may not fully understand how weekly mileage and intensity impacts long-term joint health in runners, it seems that we can be very confident that participation in long-distance running has a beneficial effect on joint health for the vast majority of the population. These findings are crucial in how we talk about the effects of running to other individuals. Many individuals seem to continue to have fear avoidant behaviors
against recreational running because of the fear of potentially causing long-term joint damage. As fellow distance runners and coaches, we can use this knowledge to educate other individuals and motivate others to engage in recreational running to promote better health and wellness in our communities.
References:
- Johnson, Victoria and Hunter, David. (February 2014). The Epidemiology of
Osteoarthritis. Best Practice and Research Clinic Rheumatology.
https://www.sciencedirect.com/science/article/pii/S1521694214000059 - Vina, Ernest and Kwoh, Kent. (March 2018). Epidemiology of Osteoarthritis: Literature
Update. Current Opinion in Rheumatology.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5832048/ - Centers of Disease Control. National Statistics.
https://www.cdc.gov/arthritis/data_statistics/national-statistics.html - Burfield, M, Sayers, M and Buhmann R. (May 2023) The association between running
volume and knee osteoarthritis prevalence: A systematic review and meta-analysis.
Physical Therapy in Sport.
https://www.sciencedirect.com/science/article/abs/pii/S1466853X23000238#preview-sect
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onset and progression of osteoarthritis. Exercise and Sport Sciences Reviews
https://pubmed.ncbi.nlm.nih.gov/16239837/ - Tiderus, Carl, Svensson, Jonas et. al. (January 2004). dGEMRIC (delayed
gadolinium-enhanced MRI of cartilage) indicates adaptive capacity of human knee
cartilage. Magnetic Resonance in Medicine.
https://onlinelibrary.wiley.com/doi/full/10.1002/mrm.10714 - Ponzio, Danielle et. al. (January 2018). Low Prevalence of Hip and K.ee Arthritis in
Active Marathon Runners. The journal of bone and joint surgery.
https://journals.lww.com/jbjsjournal/abstract/2018/01170/low_prevalence_of_hip_and_kn
ee_arthritis_in_active.6.aspx - Alentorn-Geli, Eduard et. al. (May 2017). The Association of Recreational and
Competitive Running with Hip and Knee Osteoarthritis: A Systematic Review and
Meta-Analysis. Journal of Orthopedic and Sports Physical Therapy.
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