This is a hot topic and one that is very close to my heart, especially the topic of osteoarthritis (OA). My mother recently had underwent a total knee replacement, she has been suffering for years with arthritis, the pain was getting worse and her quality of life had reduced, she had no other choice, it was either continue on this path and keep knocking back painkillers everyday or get something done about it. It was not an easy decision but she did and now going through her rehabilitation, she very motivated, she has to be, we can’t stop, and I’m with her every step of the way.
For many years I thought running or excessive running was bad for my knees. This was not only my thought processes it is believed by many of my friends and associates. I remember having long conversations about this topic before I qualified as a physiotherapist with people who use to get me worried about knee ‘damage’ caused by running. This was the popular belief and still is amongst many people and health professionals. I love running like so many, but I did begin to reduce my running volume not because of injury or pain but because of these beliefs and I was scared especially seeing what my mum was going through with her knee arthritis. It was sad to see some fit and healthy guys give up running altogether because of this fear, and talk about ‘preserving’ their joints. There is a friend of mine who thinks that our joints have a fixed number of uses and ‘bends’ before they ‘wear out’ so it is best to preserve the body as long as we can, very much against intense activity like running.
Today, looking at the evidence of running causing knee OA or a progression of knee OA, it is beginning to support the idea that running is good for knee joint health. Although, joints can show knee cartilage deformation following running and increases with distance (1,2,3), yet our joints at the same time do have high repair processes. This is evident in the research done on highly-trained marathon runners where it did not show any adverse joint deformation in the healthy joint (4,5,6). There is also evidence that shows long term adaptations, such as increases in joint surface area among endurance runners (7), but we are still unsure about running and the overall risk of OA.
Running and risk of progression of OA
We would think that running repeatedly and often, excessive loading on the joint would cause a progression of OA considering the ground reaction forces which multiply many times our bodyweight acting upon our joints. Not having enough rest between runs could damage the joint where it’s not getting appropriate rest for repair causing osteoarthritic changes, in theory this makes sense.
The increasing effect of running does not appear to lead to joint ‘wear and tear’. If this was the case then all runners will get OA but this is found not to be true. There are only a few studies which has studied the relationship between running and OA progression. One group has studied runners and controls at 2, 5, and 9 year follow-up (8-10), with no significant differences between runners and controls in this study.
A prospective study examined 45 long-distance runners and 53 controls with a mean age of 58 years from 1984 to 2002 with X-rays. The runners tended to have worse findings at baseline at 6.7% compared to 0% in controls. A follow up (mean 11.7 years), there was no difference (11). Controls had a greater rate of progression (32%) compared to runners (20%). Another study showed similar findings to this and showed no difference between the joints of runners and non-runners after an 8 year study period (12).
The body has shown to adapt!!
One reason that could explain why runners do not have an increased risk of developing knee OA is that running may increase the capacity of the cartilage to tolerate load (13). So when we run the cartilage in the knee can progressively adapt to the load that is placed upon it as long as it don’t exceed the capacity within the cartilage, it will adapt and this goes for a degenerative knee as well. A bit like a tendon where if you progressively load without exceeding the capacity then the tendon will adapt (please read my tendon blog if you haven’t already).
Conclusion
First of all I would just like to point out that the studies mentioned in this blog do have small sample sizes so larger studies will give us a better picture and also X-ray findings correlate poorly with joint pain.
In general I think we should stop putting fear into people that running will cause knee osteoarthritis, this can make people stop doing what they enjoy the most which is to run and keep fit and improve their health. As health professionals we should be guided by the patients’ symptoms not by their X-ray reports and try to modify activity where we can to reduce painful symptoms to acceptable levels and encourage continuing and staying active. Also, strengthening and conditioning programs to help prevent or reduce injuries is also a good idea for our runners.
References:
1 Mosher T, Liu Y, Torok C (2010) Functional Cartilage MRI T2 Mapping: Evaluating The Effect Of Age And Training On Knee Cartilage Response To Running Osteoarthritis Cartilage 18(3) pp 358-364
2 Eckstein F, Lemberger B, Gratzke C, Hudelmaier M, Glaser C, Englmeier K-H, Reiser M (2005) In Vivo Cartilage Deformation After Different Types Of Activity And Its Dependence On Physical Training Status Annals of Rheumatic Disease 64 pp 291-295
3 Kessler M, Glaser C, Tittel S, Reiser M, Imhoff A (2006) Volume Changes in the Menisci and Articular Cartilage of Runners An In Vivo Investigation Based on 3-D Magnetic Resonance Imaging The American Journal of Sports Medicine 34 (5) pp 832-836
4 Krampla W, Mayrhofer R, Malcher J, Kristen KH, Urban M, Hruby W (2001) MR imaging of the knee in marathon runners before and after competition Skeletal Radiology 30 pp 72-76
5 Hohmann E, Wortler K, Imhoff A (2004) MR Imaging of the Hip and Knee Before and After Marathon Running The American Journal of Sports Medicine 32 (1) pp 55-59
6 Krampla W, Newrkla S, Kroener A, Hruby W (2008) Changes On Magnetic Resonance Tomography In The Knee Joints Of Marathon Runners:A 10-Year Longitudinal Study Skeletal Radiology 37 pp 619-626
7 Eckstein F, Faber S, Muhlbauer R, Hohe J, Englmeier KH, Reiser M, Putz R (2002) Functional Adaptation Of Human Joints To Mechanical Stimuli Osteoarthritis And Cartilage 10 pp 44-50
8 Lane N, Bloch D, Hubert H, Jones H, Simpson U, Fries J (1990) Running, Osteoarthritis And Bone Density: Initial 2-Year Longitudinal Study The American Journal Of Medicine 88 pp 452-459
9 Lane N, Michel B, Bjorkengren A, Oehlert J, Shi H, Bloch D, Fries J (1993) The Risk Of Osteoarthritis With Running And Aging: A 5-Year Longitudinal Study The Journal of Rheumatology 20 (3) pp 461-468
10 Lane N, Oehlert J, Bloch D, Fries J (1998) The Relationship Of Running To Osteoarthritis Of The Knee And Hip And Bone Mineral Density Of The Lumbar Spine: A 9 Year Longitudinal Study The Journal Of Rheumatology 25 (2) pp 334-341
11 Chakravarty E, Hubert H, Lingala V, Zatarain E, Fries J (2008)Long Distance Running and Knee Osteoarthritis A Prospective Study American Journal of Preventative Medicine 35 (2) pp 133-138
12 Panush R, Hanson C, Caldwell J, Longley S, Stork J, Thoburn R (1995) Is Running Associated with Osteoarthritis? An Eight-Year Follow-up Study Journal of Clinical Rheumatology 1 (1) pp 35-39
13 Musemeci J (2016) The Effect of Mechanical Loading on Articular Cartilage Journal of functional morphology and kinesiology (1) pp 154-161
