Running Does Not Increase the Risk of Knee Osteoarthritis
Running does not increase the risk of developing knee osteoarthritis (OA) and may actually have protective effects against knee pain and joint degeneration. Recent evidence consistently shows no increased risk of symptomatic knee OA among runners compared to non-runners, with some studies suggesting running may be beneficial for joint health 1, 2, 3.
Evidence on Running and Knee Osteoarthritis
Protective Effects of Running
- Running is associated with reduced odds of knee pain, with prior runners and current runners showing lower rates of symptomatic OA compared to non-runners (adjusted odds ratios of 0.81 and 0.64, respectively) 1
- Self-selected running in individuals over 50 years old with existing knee OA is associated with improved knee pain (adjusted odds ratio 1.7) and does not worsen structural progression of OA 3
- In the short term, running is not associated with worsening patient-reported outcomes or radiological signs of knee OA and may be protective against generalized knee pain 2
Mechanisms Behind Joint Protection
- The cumulative load on joints during running may be surprisingly low despite high peak forces, which is more important for OA risk assessment than peak load alone 4
- Running may condition cartilage to better withstand mechanical stresses, potentially creating a protective adaptation 4
- Long-distance running might have a protective effect against joint degeneration in healthy individuals 5
Occupational Activities vs. Running
Activities That Increase OA Risk
- Strong evidence exists that occupational activities such as kneeling, squatting, and bending increase the risk of developing knee OA 6
- Heavy physical demands in occupational settings show strong evidence for increased knee OA risk 6
- For hip OA, occupational lifting, cumulative physical loads, and full-body vibration show strong to moderate evidence of increased risk 6
Activities That Don't Increase OA Risk
- Strong and moderate evidence exists for no increased risk of knee OA related to sitting, standing, and walking activities 6
- Climbing stairs or ladders shows strong evidence for no increased risk of knee OA in women 6
- Driving as an occupational activity shows moderate evidence for no increased risk of knee OA in both men and women 6
Common Running Injuries vs. Osteoarthritis
Bone Stress Injuries
- Tibial bone stress injuries (BSIs) are common among distance runners due to repetitive loading, with annual incidence as high as 21.1% in track and field athletes 6
- BSIs have one of the highest recurrence rates of all running-related injuries, with prior BSI increasing recurrence rate sixfold in females and sevenfold in males 6
- These acute injuries differ from the degenerative process of osteoarthritis and represent a separate concern for runners 6
Clinical Implications and Recommendations
For Healthy Individuals
- Running does not appear to be detrimental to knee joint health in individuals without pre-existing conditions 1, 2
- The cardiovascular and mortality benefits of running likely outweigh any potential joint risks 1, 3
For Those with Existing Knee OA
- Self-selected running (likely influenced by knee symptoms and resulting in lower intensity and shorter duration) need not be discouraged in people with knee OA 3
- Running is associated with improved knee pain and not with worsening knee pain or radiographically defined structural progression in those with existing knee OA 3
Risk Factors to Consider
- Previous joint injury significantly increases OA risk and should be considered when evaluating running safety 5
- Low energy availability (LEA) or Relative Energy Deficiency in Sport (REDs) can contribute to impaired bone health and risk of bone stress injuries in runners 6
In conclusion, current evidence does not support the notion that running increases the risk of knee osteoarthritis. Rather, running may have protective effects against knee pain and joint degeneration when performed appropriately, even in those with existing knee OA.