Arthritis and Running

Originally published in the March 2017 issue of the Knoxville Track Club's "Footnotes" Magazine.

 

I’m sure you have at some time been told that the more you run, the more likely you are to get arthritis in your knees and hips.  You’ve probably had people tell you that years of running will just lead to you “tearing up your joints”.  In fact, you may have even had a doctor tell you this.   I’m also guessing that you’d like to keep running, find it rather enjoyable, and think that it imparts numerous health benefits.  So what is a runner to do?

Fortunately, there have been numerous high-quality studies published in the last decade that have started to give us a more definitive, evidence-based answer to this question.  And if you’re a runner, I’m guessing you will like the answer!

The research looking at runners and degenerative arthritis, or “osteoarthritis”, began in the late 1970s.  Initially, the studies were small and the resulting data was of poor quality.  This tends to be common with early research into any topic, but then it started to grow.  While the initial publications looked at 15-20 runners at a time, the subsequent studies began to include hundreds, and then thousands of runners.  Evaluation of outcomes improved as well, using x-rays, MRI, and even samples of joint fluid from runners or cartilage from animals.

In 2010, Drs. Stuart Willick and Pamela Hansen published a review paper in the Clinics of Sports Medicine.  Their article looked at the large body of research which was available to that point, and the conclusions (to save you a lot of dry reading) were:

  • The literature did “not support an association or causal relationship between low- or moderate-distance running and osteoarthritis.”
  • The literature was considered “inconclusive” with respect to high-volume running and osteoarthritis of the hip or knee.
  • “Older runners tend to be healthier than their non running counterparts.”

 

So, in 2010 we could say with fair certainty that reasonable amounts of running did not lead to osteoarthritis of the hip and knee.  Running is also known to convey many other health benefits.  Since that time though, some very large studies have given us even more insight intothis issue.

In 2013, Paul Williams, PhD, published an article in the journal of the American College of Sports Medicine which looked at the effects of both walking and running on osteoarthritis and hip replacements.  The study included nearly 75,000 runners!  In the end, runners had a “significantly reduced…risk” of both osteoarthritis and hip replacement.  This seemed to be due primarily to the maintenance of a lower body mass index.

Even more recently, a group from Brigham Young University conducted an experiment to evaluate the levels of inflammation in the blood and joint fluid of healthy runners immediately after running.  Though it was a very small study, the findings were interesting.  These subjects had lower levels of inflammatory markers in the joint fluid after running and higher levels after sitting.  This is early research, but it seems to suggest that there is something about running that is inherently protective to joints.  Sitting seemed to be more inflammatory and potentially damaging!

Despite all of this, it is certainly the case that some runners develop osteoarthritis of the knees and hips.  Some runners need joint replacement surgery due to severe degeneration of these joints.  While no one would suggest that running is entirely protective against arthritis (it’s not!), it is just as unreasonable to say that running was the sole cause of a person’s arthritis.  In fact, a runner who has a knee replacement at age 65 may have needed that same surgery at age 55 had they not been a runner.  There are many variables at play!

Most runners hope to enjoy the sport late into life, but it is an activity that is not without a risk of injury.  There are some things you can do to increase your chances of enjoying running, pain-free, for many years.

  • Maintain a healthy body weight.  Overloading your joints and soft-tissues with added weight can be a recipe for disaster.  For those with knee arthritis, we know that losing 10 pounds of body weight provides more pain relief than prescription anti-inflammatory medication!  As a runner, your health and performance are directly impacted by your weight.
  • Address biomechanical imbalances.  A runner whose knees collapse inward with every step and whose hips drop from side to side throughout their gait will surely have pain.  They are more likely to develop osteoarthritis because they are loading their joints in an unnatural manner.  Additionally, such a runner will surely have repeated bouts of tendinopathy, fascial strains, bursitis, and the like.  Running well is crucial.
  • Strength training affords you the stability and endurance needed to maintain proper form.  If you are not engaging in regular strength training, especially as you age, your running performance and overall health will suffer.  Proper form and strong surrounding musculature will keep a joint running pain-free!
  • Proper nutrition is key.  If you don’t support your body’s processes as it deals with the training load you place on it, the body will start to fail.  A nutrient-rich diet is requisite for any runner.  Additionally, there may be a role for dietary supplements.  Glucosamine and chondroitin have been shown to aid in joint health, as have glycine, Vitamin C, and possibly collagen protein.

Ultimately, a runner’s risk of developing arthritis is probably less than that of a non-runner, but the risk is not zero.  We cannot forget that genetics surely play a role as well.  Some people are predisposed to osteoarthritis of their hips and knees, but there are things that can be done to delay the onset and decrease the severity of joint injuries in any runners.  A runner with a healthy body weight, proper form, a regular strength training program, proper nutrition, and a reasonable training plan can feel confident that their running is contributing to the longevity of their joints rather than leading to arthritis.