Does running cause arthritis?

Can running cause osteoarthritis?

Running regularly is often widely associated with knee problems and knee arthritis - specifically osteoarthritis (OA). This type of arthritis happens when the smooth cartilage that protects your joints from damage becomes worn out. It can be an immensely challenging condition, because it causes a range of distressing symptoms, including pain, swelling, and stiffness in your joints. Without proper function and movement in your joints, simple activities like household chores, driving and shopping can become difficult to perform, which can have a direct impact on your emotional wellbeing as well as your physical health. Other symptoms of osteoarthritis include:

• Joint tenderness
• A grating or crackling sound or sensation in your joints
• Weakness and loss of muscle that surrounds your joints
• Limited movement in your joints

Many people believe that running puts pressure on your knees, causing your bones to weaken and deteriorate, leading to severe pain and limited mobility. It is absolutely true that you can injure your knee while running, in the same way you can injure any joint or muscle during any sport - particularly a high impact sport. Runners can become injured when they stop suddenly, changing direction rapidly, or collide with another runner. These kinds of movements can often cause your knee to come out of place (you'll likely hear a popping sound if this happens), which is also known as a dislocated kneecap.

However, many scientific studies have been carried out to determine whether running can cause your knee joints to wear down (essentially, whether the activity leads to osteoarthritis). Researchers have compared the long-term effects of running and other more high-impact, strenuous activities with OA, and have concluded that there is no direct relationship between the two factors.

While it is important to do your best to prevent injury and protect your knee health while running, no direct correlation between running and osteoarthritis has been established in the many studies produced to make sense of the alleged connection.

Can runner's knee lead to arthritis?

If you're well accustomed to running, you might be aware of runner's knee - you might have even experienced it yourself. Runner's knee describes pain in the front of your knee or around your knee cap. This pain often feels dull and aching.

If you have runner's knee, you might hear a rubbing, grinding, or clicking sound when you bend your knee, and your knee might feel tender to the touch. This condition can be effectively managed with heat therapy (ice packs to numb your pain and heat pads to reduce swelling and relax the muscles around your knee), anti-inflammatory medication, and stretching as much as possible before you run. You might also benefit from taking a break from running for a few weeks when you first develop symptoms - this initial rest can help eliminate the problem by giving your knee the level of rest and healing it needs.

Runner's knee is usually caused by a structural defect in your knee, weak thigh muscles, or walking or running in a certain way that puts pressure on your kneecaps.

Although runner's knee can be very painful and prevent you from running as regularly as you would like, it does not have any correlation with the development of osteoarthritis. This is a separate condition, and while the two may share symptoms, they do not relate to one another.

An orthopaedic consultant's view

Jonathan Bird, a consultant orthopaedic surgeon at The Blackheath Hospital and Chelsfield Park Hospital, recently took part in the Herts 10K run. We caught up with him in a Q&A session to discuss the risks of damage to your knee by running and if it can cause osteoarthritis.

What sparked your interest in the link between running and osteoarthritis?

"I recently took part in the Herts 10K run. It's a fantastic event - very well organised and hugely popular with over 1000 runners of all ages. It was heart-warming to witness so many people across childhood to old age participating in a sport that they enjoy.

"Just before the race, I was chatting to a fellow runner about my job. He expressed surprise that, as a knee surgeon, I would be risking damage to my own knees by running. It seems to be a commonly held belief that running causes osteoarthritis.

"Some medical sites have stated that running two or three times a week is fine, but that we have to look at lifetime exposure and the effects of this when factoring running regularly into our everyday lifestyle. Many sites and sources speculate that a high impact and high stress running regimen is associated with a greater risk of joint deterioration, which could lead to osteoarthritis."

What is the evidence behind statements such as this?

"Participating in regular physical exercise feels intuitively good. This is supported by studies that report increases in general health and well-being measures, reduction in levels of obesity and even prolongation of life with regular exercise. However, are there any disadvantages to your health as a result of regularly participating in recreational or competitive sports, such as running?

"With regards to your knee joint, playing sport may lead to injury of vital structures within the knee, such as the lining (articular) cartilage or the cushion (meniscus) cartilage. Such injuries can increase your chances of developing osteoarthritis in that joint, but there are very few studies that have looked into whether the of running itself cause wear and tear associated with osteoarthritis. Some are of poor design quality, so their conclusions cannot be trusted. Others are on too few patients, so the conclusions can only be drawn on the runners in the study and cannot be extrapolated to wider population.

"A recent review of all the evidence was published in the American Journal of Sports Medicine, written by Kate Timmins and others in Nottingham. Unsurprisingly, given the poor quality of the available studies analysed for the review, the authors were unable to identify a role of running in the development of osteoarthritis of the knee.

"Orthopaedic surgeon Alex Bastick and his team in Rotterdam examined this issue in 'What are the Prognostic Factors for Radiographic Progression of Knee Osteoarthritis?' They concluded that if you already had knee pain, had 'bandy' legs (varus knee), or had raised blood markers for osteoarthritis (indicating that osteoarthritis is already present), then knee arthritis is more likely to progress.

"A factor not associated with the development of osteoarthritis in your knee was participation in sport."

So, what can we conclude?

"If there is a risk of running directly linking to osteoarthritis of the knee, then science hasn't identified it yet. In the absence of known risk factors for the progression of osteoarthritis, the potential risk may be outweighed by the number of health benefits associated with sport participation.

"So, in conclusion, if running is your sport of choice, keep at it!"

Preventing damage to your knee if you're a runner

While it hasn't yet been proven that running causes osteoarthritis, we know it can cause injury to your knee, and naturally puts stress on these joints. This is especially true if you are overweight.

There are a few measures you can take to prevent injury to your knees from running. These include:

Do your stretches

Always stretch before you run to strengthen your knee and make the most of your run. The most effective stretches strengthen all the muscles supporting your knee and stretch out the iliotibial band, which runs down the outside of your thigh, to prevent knee pain and build maximum strength. The NHS recommends a variety of stretches you can perform before and after your run to protect your knee health. These include knee bends, thigh contractions, leg raises and more.

Get the right gear

Wearing proper footwear is a very important part of running and protecting your knees while doing so. Proper running shoes provide the right flexibility, durability, and support when running. These reduce stress on your ankles, heels, and toes, and can even help improve your running performance.

Pace yourself

Exercise is about balance - if you overdo any exercise, especially if you are doing exercise that is high impact, you run the risk of suffering injury due to overexerting yourself. Remember to take plenty of rest between long runs, hydrate before, during, and after training, and fuel your body with nutritious, healthy food for every run.

Maintain a healthy weight

Being overweight puts pressure on your joints, sometimes causing pain and stiffness in your joints due to weight being placed on your joints. Maintaining a healthy weight can help tackle this issue.

Maintaining a healthy exercise plan - and diet regime - is all about balance. We recommend the Mediterranean diet, which incorporates an eclectic mix of seafood, nuts, and meat to ensure you get all the protein and nutrition you need without depriving yourself of tasty food. Maintaining a healthy weight can help protect your joints from bearing too much pressure, and it is an important way to maintain your overall health.

Tackle your knee pain with our experts

Now you know a bit more about how to protect your knee from injury when running, we hope you'll be able to continue running without causing damage to your knees. Although running can lead to injury to your knees, it is not directly related to the development of osteoarthritis, which is a separate issue with a variety of causes (the most common being ageing).

For more top tips on preventing knee injuries, give us a call to see how our physiotherapy team can help you.