Does Running Cause Knee Arthritis (Osteo)?

We Hear That Running is Bad For Knee Arthritis (Osteo) - But Is That True?

Please be aware that this information is general in nature and does not replace advice from your medical and allied health professionals.

I’ve been hearing this for most of my life.

“Don’t run too much because it’s bad for your knees – you’ll get arthritis!”

A quick note here: This article is all about Osteo-arthritis, but I will use the general term arthritis throughout the article.  To learn more about arthritis in the foot click here.

But, in an article in The Journal of Sports Medicine earlier this year James Alexander , Richard W Willy , Adam G Culvenor ,Christian J Barton published an infographic article which stated:

“It is currently not sound advice to tell a runner with knee osteoarthritis who is managing their symptoms to cease running.”

A massive change from what we often hear. You can read more of their quotes here.

Ok, I don’t run these days, but back in my youth I ran Cross Country at GPS out in the Nudgee College forrest as it was then, and I was in a runner’s club too.

I wasn’t a great runner, never up near the front of the pack, but I certainly knew what the runner’s high is. That feeling of euphoria you get as your body is flooded with endorphins due to the amount of effort you are putting it through.

Every now and then it would come up, do you think running is bad for your knees, especially when running down hill?

Well I’ve done some research of peer reviewed articles and a systematic review of many articles to get some answers to this age old question.

In this article I will discuss:  (jump to any section by clicking on the heading)

Important Note: The Harvard Medical School article did list running as an activity to avoid if you already have arthritis in the knee. This was the only reference I could find that mentioned this warning.

What is Knee Arthritis?

Osteo-arthritis is often called a “wear and tear” condition.

On the end of each bone involved in a joint is cartilage – material which is softer than bone and has an amazing ability to absorb compression, and torsion (twisting).

A man running on the road and an arrow is pointing to the lateral of his right knee

 

But every type of material has it’s limits, and this is where the process of osteo-arthritis begins.

If you take a rubber band, it has an incredible ability to stretch and then return to it’s normal shape, until too much stress is applied too often, and then it breaks.

Well all body tissues are similar in this way – they have a certain ability to absorb different types of forces: stretch, compression, torsion etc., but once the force becomes too great they break.

Inside the joint is synovial fluid. Like oil lubricates an engine, synovial fluid lubricates the joint and helps to prevent damage.

When too much force is placed on a joint through weight, or extreme activities including twisting and jumping, the cartilage can tear. 

Unfortunately the weakness of cartilage is that it has poor blood supply, especially in the menisicus of the knees. 

Poor blood supply means poor healing, and this is when the process of osteo-arthritis begins, damage to the cartilage which does not heal.  This can lead to the rate of damage to exceed the rate of repair, leading to permanent damage.

These damages build up over time and wear the cartilage down, at it’s worst the cartilage is gone altogether, usually on one side of the joint, causing what is know as “bone on bone,” meaning that there is no longer any cartiage to protect the bones and they begin to form lips and spurs.

An illustration of two knees. The one on the left is a healthy knee with good cartilage cover, the one on the right is an arthritic knee with lots of cartilage damage

Can Running Cause Knee Arthritis?

Most of the evidence that I found was quite surprising with almost all of them stating that running does NOT lead to knee arthritis!

In fact many suggest quite the opposite – running can actually prevent you from getting knee arthritis as early as people who don’t run.

There are of course a number of factors that contribute to people developing arthritis in the knees.

The most common are the following in no particular order:

  •  previous injury to the knee – one of the most common causes, damage can come from contact sports, falls, and accidents,
  • being over-weight or obese. This is another huge factor in development of knee arthritis. In fact many knee surgeons will ask a patient to lose some weight before they will conduct the surgery,
  • Age – the older we get, the worse our body gets at healing damaged tissues such as cartilage. Causing the rate of damage to exceed the rate of repair,
  • high occupational workload – some jobs put undue pressure on knees, especially those where the person is required to carry large loads and perform twisting motions to move things around.
 

How can I Prevent Getting Knee Arthritis?

Thankfully there are a number of things that you can do to reduce the risk of developing knee arthritis in the knee.

Here are some of the top things to do:

  • Maintain a healthy weight range – this will go a long way towards prevention,
  •  Try to avoid activities that are likely to put a lot of pressure on the knees.  Bending and twisting the knees whilst lifting heavy objects is one to avoid,
  • Keep active and healthy in general. the better blood supply you have, the better your body can provide the cartilage and synovial fluid in your knees with what they need,
    Strengthen the muscles around your knees.
  • Especially the quadricep muscles (front of thigh). These muscles work as brakes and control the movement of the knee when running, thus protecting knees from excessive forces.
  •  
A well developed quadriceps muscle on a man

What About Running Following Knee Surgery?

This one is quite complex. Mainly because of the different types of knee surgery and how the effects of them are vastly different.

James Alexander , Richard W Willy , Adam G Culvenor ,Christian J Barton published an infographic article earlier this year stating that: Runners with knee osteoarthritis should feel safe continuing to run but may benefit from running less frequently to allow for sufficient cartilage.”

And they added: Running does not appear to accelerate the progression of existing knee osteoarthritis in runners ≥50 years of age. 

And even went further to say: It is currently not sound advice to tell a runner with knee osteoarthritis.”

who is managing their symptoms to cease running.

recovery time between running bouts

The three most common types that we see our patients get are:

  • arthroscope – this is like  a “tidy up” of the knee joint. Performed using keyhole surgery it is often performed on young, active people. 
    Usually when they need to repair either ligament such as the ACL (Anterior cruciate ligament) or some of the mensiscus is torn and they will neaten it up by trimming away damaged cartilage.
    Many people will continue running after this procedure especially if they are just running. Sideways movement can present a problem for some people and damaging an ACL or meniscus can end a professional sporting career.
A patient who has had right knee surgery
  • The second type is an osteotomy. This surgery is often done on patients who are under the age of 65 and have significant cartilage wear (meniscus) on one side of the knee. 
    This surgery involves taking a wedge out of the bone just below the knee on the appropriate side to make the knee joint more even and remove stress from the worn side. This is a significant surgery because bone is being cut. It is best to take the advice of your surgeon, physiotherapist and podiatrist when considering running following this surgery.

Total Knee Replacement for Knee Arthritis

  • The most common we see is the total knee replacement commonly known as a TKR. This is usually performed in patients who are 65 years and older as the surgeons don’t want the patient to have to undergo further surgery as it becomes a lot more complex.
    This condition will often rule out running, but patients are encouraged to do a decent amount of walking several times per week to keep the muscles around the knee strong and for general health and well-being.
Important Note: This information is definitely NOT a replacement for advice from your medical practitioners. Make sure you get personalised expert advice before beginning any new exercise regime.

What Can a Podiatrist do to Keep You Active with Knee Arthritis?

Knee arthritis does not mean an end to your active life.

In fact continuing to be active is key to enjoying many more years of life.

As podiatrists, our main goal is to help you to lead an active healthy lifestyle with little to no pain.

We can help you to do this in a number of ways:

  • Exercise program – we can devise a personalised exercise program keeping your osteo-arthritis in mind which will strengthen the muscles around your knee and help to keep good cardio-vascular health as well,
  • In-shoe appliances and orthotics – these can vary from very simple wedges to reduce the load on the affected side of the knee right up to full custom orthotics which can stabilise your feet and allow your body to find the path of least resistance to move you forwards. This means relieving any areas under increased load and make sure that you are less likely to have a fall.
    To learn more about custom foot orthotics click here.
  • Assessment of your running footwear to make sure they are fit for purpose. Many people who start running will get sold the “best running shoe.” Unfortunately they are the best running shoe for SOME people, but everybody’s feet and biomechanics (alignment) are different. So an anti-pronatory shoe could be counterproductive if you have medial meniscus issues, or medial compartment knee arthritis.
    To learn more about running shoes click here.

Conclusions

So the overwhelming verdict is that running will not cause knee osteo-arthritis.

In fact you are LESS likely to get knee arthritis if you are a runner.

It is believed that this is because running helps to supply better blood flow to the tissues within your knee including the cartilage of the meniscuses and the synovial fluid.

An even bigger factor is that running develops those muscles around your knee that help to decelerate and generally control the amount of movement in your knees rather than let them go wherever forces take them.

So if you’ve never run before and you want to – get some advice first.

It’s not something that you can just dive into and expect it to go well.

You’ll want to get your cardio-vascular status checked as excessive stress on a diseased heart can cause a sudden heart attack.

So see your GP and then see your podiatrist, physiotherapist, or exercise physiologist so that they can first assess your biomechanics for any risk factors and address those, and then help you to slowly build up your movement until you are ready to start running.

One of the great programs is the “Couch to 5k” which endeavours to get more people off the couch and out pounding the pavements in the name of better health throughout the community.

To make an appointment with our experienced podiatrists call: 3351 8878 or click the book now button below to book online.

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