Can Running Lead to Osteoarthritis?
Running injuries don't often give a lot of warning before they turn into problems. When you sprain your ankle, there is usually a clear mechanism of injury
that has caused it (rolling over on it, or falling etc.), but when you get pain from running it often feels out of the blue.
Why is that?
Overuse injuries are a problem of excessive load accumulated over a long period of time, creating a series of micro-damage that doesn't often become noticeable until it is too late. But are these injuries short lived? Or are they actually causing long term damage to your joints? Here is what we found...
Benefits of Running
Lets start with the good! The benefits of running are well known, and the list is extensive, but here are the top contenders:
- personally and socially rewarding
- low cost, easy to do, accessible
- improves cardiovascular endurance
- helps control blood pressure, lipid levels, and cholesterol
- may even help to stimulate joint health and healing?
(Willik & Hansen, 2010; Hansen et al, 2012).
Negative Impact from Running
Here are the possible negative associations with running:
- High prevalence of overuse running injuries to muscles, tendons, and bone
- 79% of runners are injured each year ( Van Gent et al, 2007)
- Possibility of mechanical load to a joint causing damage?
(Willick & Hansen, 2010; Van Gent et al, 2007)
What is joint damage?
Osteoarthritis (OA), a type of arthritis, is the degeneration of a joints articular cartilage, and is the most common form of joint disease (Chakravarty et al, 2008). In theory, in vitro lab studies would suggest that stresses from repetitive loading could cause changes to the articular cartilage. It is therefore a reasonable assumption that years of running would result in long term damage of the joints (Willick & Hansen, 2010).
However, several studies over the past two decades on running and the relationship of OA would suggest otherwise. There is strong evidence that development of OA is associated with age, greater BMI, and heavy manual labour - but NOT with low to moderate levels of running. In 2012, Hansen et al. reported that the pressure of normal physical activity ( such as running) on cadaveric hip joints was not enough to cause joint cartilage damage (fibrillation).
Evidence that running DOES cause OA:
There have been a few studies (not that many) which have identified a positive link to knee OA and running. However, these studies have several confounding limitations that question the credibility of their conclusions. For example, an older study by McDermott and Freyene (1983) evaluated 20 distance runners with knee pain and found that 6 of these participants had knee OA. They therefore concluded a positive link between running and OA. As you may have guessed, several review papers have critiqued the vast number of limitations in this study including; the lack of non-running controls, a greater number of runners with genu varum, and a high incidence of previous knee traumatic injuries.
Evidence that Running does NOT have any relationship to OA:
Several more studies have refuted any relationship between OA and running, including a large scale study in 2003 by Hootman et al at the Centre of Disease Control in the USA. They performed a prospective longitudinal study investigating the relationship between physical activity and the development of OA over 13 years of surveys, radio-graphic investigations, and assessments. They concluded there was no association between the development of OA and running. A similar study by Chakravarty et al (2008) investigated long distance runners with age matched controls from the community ( >50yrs old), examining radio-graphic x-rays from 1984-2002. Their results showed that over 11.7 years there was a general increase in prevalence of OA and worse radio-graphic scores, however, the runners did not have more severe OA than their age matched controls.
Still not convinced?
In 2017, Lo et al carried out another large scale cross-sectional study on the association between the history of running and knee OA. They concluded that "a history of leisure time running is NOT associated with increased odds of prevalent knee pain, radio-graphic OA, or symptomatic OA".
There is more credible research to suggest that running, even long distances, does not have any relationship in the risk of developing osteoarthritis. In our opinion, the benefits of running far outweigh the risks, especially as you can reduce your risk of injury with appropriate training, strengthening, stretching, gait analysis, and appropriate footwear. Our advise? Keep running.
There hasn't been as much research looking into the higher volumes of running, such as ultra-marathoners, to see what the difference is. A review study by Willick & Hansen found that most research was inconclusive whether or not high volumes of running had the same effect. More research is needed in this area...
Lo, G., Driban,, J., Kriska, A., McAlindon, T., Souza, R., Petersen, N. et al. 2017, Is there an association between a history of running and symptomatic knee osteoarthritis? Cross sectional study from the osteoarthritis initiative, Arthritis Care & Research, Vol. 69, No. 2.
McDermott, M., & Freyne, P. 1983, Osteoarthritis in runners with knee pain. Br J Sports Med, Vol. 17, 84-87.
Hootman JM, Macera CA, Helmick CG, et al. 2003, Influence of physical activity-related joint stress on the risk of self-reported hip/knee osteoarthritis: A new method to quantify physical activity. Prev Med, Vol 36, 636-644
Hansen, P., English, M., & Willick, S. 2012, Does Running cause Osteoarthritis in the hip or knee?, The American Academy of Physical Medicine and Rehabilitation, Vol. 4, S117- S121.
Van Gent RN, Siem D, van Middelkoop M, et al. 2007 Incidents and determinants of lower extremity running injuries: A systematic review. Br J Sports Med, Vol 41:469-480
Willick, Stuart, & Hansen, P. 2010, Running and Osteoarthritis, Clinical Sports Medicine, Vol 29, pp. 417-429.
Chakravarty, E., Hubert, H., Lingala, V., Zatarian, E, & Fries, J. 2008, Long distance running and knee osteoarthritis a prospective study, American Journal of Preventative Medicine, Vol. 35, No. 2, 133-138.
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