Osteoarthritis: Can You Run Too Much?

Osteoarthritis or arthritis

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Can running excessively cause hip and knee arthritis?  

Walking

Running

Running is an excellent form of exercise if your body can take the pounding.  You can burn over 500 calories per hour.  One of the questions many patients ask is if it will increase your risk of degenerative or osteoarthritis (OA).  OA is one of the most common problems that affects our joints.  OA is a wear and tear problem where the cartilage in your joints is becoming thinner.  The more the cartilage thins, the more the cushioning in your joints is wearing away.

It makes perfect sense that the pounding of a high-intensity exercise could cause damage to the ankles, hips, and knees.  Each impact with pavement imparts a lot of force on your weight-bearing joints.  Physicians and researchers are still trying to understand how and if repetitive movements during a run can affect arthritis directly, but it can help with weight loss, and obesity increases your risk of OA by reducing stress on your joints and thus improve the pain caused by it.

So does weight-bearing exercise increase degeneration?  There are many misconceptions about OA, particularly in runners and is overdiagnosed.  Frequently there is another source of joint pain present that is treatable and need not end your activities.  Many runners have been made to believe that arthritis is a terminal diagnosis and that they should stop running at the first sign of degeneration of the joint or cartilage.  As we progress through the following research, you will see that this is apparently not necessary in most cases.

Research on OA and Running:

  1. Marathon running

    Marathon running

    Running might protect against OA.  One study by Cymet from 2006 found that running might be protective against disability from this cartilage and joint damage[1].  They openly admit more research is needed and that they look at signs of disability and not the illness itself.  They also recognize that the research needs to look at other influencing factors and not just the type of exercise.  Because of these influences, subjects at various levels of activity should be included, with controls for confounding factors such as sex, body weight, history of injury to the lower extremities, family history of OA, and occupational risks.  

  2. Running in older runners is not associated with higher levels of arthritic changes  Another study by Fries looked at older long distance runners with a mean age of 58 years[2].  They found that healthy older individuals that run long-distances did experience accelerated radiographic changes associated with cartilage or joint damage. This data raises the possibility that OA may not be more common among runners.
  3. Marathon runners do not have a higher rate of cartilage degeneration  A ten-year longitudinal study looked at seven runners and found no association with joint damage[3].  This a decent study despite the small number of patients followed.  
  4. obesity running

    obesity running

    Obesity is a cause of joint damage seen in arthritis.  The Framingham Knee Osteoarthritis Study looked at a total of 1,420 patients who were over the standard weight as set by the Metropolitan Relative Weight[4],[5].  The research looked at imaging of joints and compared symptoms.  They found that obesity was associated with both an increased risk of symptomatic and asymptomatic OA.  It is easy to see in the image to the right that obesity changes the mechanics of exertion.  The mechanics and the increase in the load on the joints results in cartilage degeneration and joint damage.  

  5. Weight loss reduced arthritis-related symptoms.  This review of the Framingham Knee Osteoarthritis Study looked at 64 patients who already had symptomatic damage and found that weight loss decreased pain and swelling that occurs with knee damage in women[6].  These results are encouraging for those that already have degeneration of the joints, and there is no reason to believe it would not translate to men.  

The bottom line is we know that OA is not caused by running.   The most common causes are from obesity, trauma, and your genetics.  The research above supports the fact that it is not the weight-bearing exercise.  As a matter of fact, runners develop arthritis less commonly than those who do not run.  Also, weight-bearing exercise not only reduces arthritis related symptoms and weight loss will reduce your likelihood of acquiring it.   

Recommendations on weight-bearing exercise and arthritis:

  1. Knee Pain

    Knee Pain

    Weight Loss will reduce your joint pain.  If you have degenerative arthritis, weight bearing exercise will reduce your pain and progression of your joint damage.  If you have lower extremity OA, exercise can be a healthy way to manage symptoms, but there are a few considerations that should be made before you begin.

  2. You do not have to stop exercising.  If you do not want to stop exercising, you do not need to stop.  If you have mild or moderate arthritic changes or damage, it does not mean your days going for a run are over.  Discuss it with you medical provider.  
  3. Moderation is the key to a healthy activity.  Performing any activity every day without a break is not moderation.  If you run too often, the activity puts too much pressure on your joints, and you will be more susceptible to injury and burnout.  Mix it up and enjoy your activity.   
  4. Slow down or change activity when it hurts.  If you have joint degeneration, degenerative arthritis doesn’t have to stop you from weight bearing exercise as long as the activity is done carefully.   Weight bearing exercise can reduce pain associated with arthritis.   If you have joint pain, try a non-weight-bearing exercise such as swimming.  

Run and enjoy the activity!  

Footnotes
[1]Cymet and Sinkov, “Does Long-Distance Running Cause Osteoarthritis?”
[2]Chakravarty et al., “Long Distance Running and Knee Osteoarthritis.”
[3]Krampla et al., “Changes on Magnetic Resonance Tomography in the Knee Joints of Marathon Runners: A 10-Year Longitudinal Study.”
[4]Felson et al., “Obesity and Knee Osteoarthritis. The Framingham Study.”
[5]Felson et al., “Weight Loss Reduces the Risk for Symptomatic Knee Osteoarthritis in Women. The Framingham Study.”
[6]Ibid.
Chakravarty, Eliza F., Helen B. Hubert, Vijaya B. Lingala, Ernesto Zatarain, and James F. Fries. “Long Distance Running and Knee Osteoarthritis.” American Journal of Preventive Medicine. Elsevier BV, August 2008. doi: 10.1016/j.amepre.2008.03.032
Cymet, TC, and V Sinkov. “Does Long-Distance Running Cause Osteoarthritis?” The Journal of the American Osteopathic Association 106, no. 6 (June 1, 2006): 342–45. [PubMed]
Felson, DT, JJ Anderson, A Naimark, AM Walker, and RF Meenan. “Obesity and Knee Osteoarthritis. The Framingham Study.” Annals of Internal Medicine 109, no. 1 (July 1, 1988): 18–24. [PubMed]
Felson, DT, Y Zhang, JM Anthony, A Naimark, and JJ Anderson. “Weight Loss Reduces the Risk for Symptomatic Knee Osteoarthritis in Women. The Framingham Study.” Annals of Internal Medicine 116, no. 7 (April 1, 1992): 535–39. [PubMed]
Krampla, WW, SP Newrkla, AH Kroener, and WF Hruby. “Changes on Magnetic Resonance Tomography in the Knee Joints of Marathon Runners: A 10-Year Longitudinal Study.” Skeletal Radiology 37, no. 7 (July 1, 2008): 619–26. [PubMed]
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About the Author

ChuckH

I am a family physician who has served in the US Army. In 2016, I found myself overweight, out of shape, and unhealthy, so I made a change to improve my health. This blog is the chronology of my path to better health and what I have learned along the way.

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