Running and Arthritis
Here’s a topic I am continually asked to comment about: does running cause osteoarthritis (OA)? The answer is that no one knows for sure. However, I will first review some interesting studies that shed some light on the answer to this question. Then I will describe my own personal opinion, from the perspective of a runner and an orthopedic surgeon.
There is absolutely no doubt that running causes injury. Two studies published in 1989 from Canada and California surveying large numbers of competitive runners found that they reported injury rates of 48 and 50% within the prior year.1,2 Also in 1989, a survey of participants of the Hawaii Ironman event revealed an astounding 91% rate of injury during the prior training year!3 Therefore, it seems intuitive that with rates of running injuries being so high, and with so many injuries involving the weight-bearing joints of the lower extremities, repeated injury must predispose to arthritis over a lifetime of running!
However, I am happy to report that the majority of the relevant literature during the past decade finds little or no basis for such a conclusion. Here are some highlights. 1995: Panush, et al, in "Is Running Associated With Osteoarthritis? An Eight Year Follow-up Study", conclude that runners with "reasonable" exercise levels had no increase in risk of arthritis, after reviewing detailed histories, exams, and X-rays in an update of a 1984 study of the same cohort.4 1993: Lane, et al, in "Risk of Osteoarthritis With Running and Aging: Five Year Longitudinal Study", looked at older runners (age 50-72), and noted no acceleration of degenerative joint disease in runners versus controls, similar to their previous study in 1989.5,6 1990: Konradsen, et al, also evaluated a possible association between long-distance running and OA, via retrospective evaluation of former competitive runners who ran 20-40 kilometers per week for 40 years average, versus sedentary controls. They found little to no risk of OA with lifelong long distance running.7 Interestingly, a recent MRI study indicates that the prevalence of knee meniscus abnormalities in asymptomatic marathon runners is no different than sedentary controls.8
To be fair however, there are some reports of association of OA of the hip and an athletic lifestyle. Vingard, et al, in 1993 and 1998, found that both men and women with "high exposure" (>800 hours/year) to athletic activities in early life demonstrated 4.5 and 2.3 times the risk, respectively, of development of OA of the hips versus controls. The risk was even higher if they also endured high occupational workloads, 4.3 and 8.5, respectively!9 ,10 In 1989 and 1993, studies from Switzerland and Sweden found correlations between prior elite track and field competition and OA of the hip.11,12 There is virtually no mention of a positive correlation of knee OA and running, though a 1990 MRI study found that of 10 asymptomatic runners volunteering for MRI knee exams, 5 demonstrated transient changes in meniscal signals, usually interpreted as degeneration, after 30 minutes of running, versus resting baseline images.13
So what does it all mean? Until we know more, common sense must prevail!
At local races, I look around and recognize faces of many runners from whose knees I have removed torn cartilage. I have told these competitive distance runners that there is increased risk of arthritis after loss of meniscus cartilage from the knee. My feeling is that if there is a strong family history of OA, and/or if there is persistent and consistent pain and swelling in the knee in response to running, they are probably better off switching to low impact activities. These include swimming, cycling, cross-country skiing, or at the very most, treadmill running. The same would apply to the patient with an arthritic hip or knee. Pain in the area of the joint line or back of the knee, or in the groin, or front of the hip, means an angry and irritable joint! Swelling is always a bad sign, but it is nearly impossible to appreciate hip joint swelling. Hip stiffness is a better indicator. However, we are ultimately the masters of our own bodies. As a physician and surgeon, I treat people, and not just knees. Therefore, an educated patient may decide to pursue running despite loss of the cartilage, and the potential for arthritis.
Next time, for those with cartilage damage or early arthritis, what’s the scoop on cartilage supplements? Is this a panacea?
References abbreviated to save space: 1- Walter, et al. Arch. Int. Med. 1989. 2- Macera, et al. Arch. Int. Med. 1989. 3- O’Toole, et al. AJSM. 1989. 4- Panush, et al. J. Clin. Rheum. 1995. 5- Lane, et al. J. Rheum. 1993. 6- Lane, et al. JAMA. 1989. 7- Konradsen, et al. AJSM. 1990. 8- Shelloch, et al. AJR. 1991. 9- Vingard, et al. AJSM. 1993. 10- Vingard, et al. AJSM. 1998. 11- Marti, et al. BMJ. 1989. 12- Vingard, et al. AOS. 1993. 13- Kargunoglu-Brahme, et al. AJR. 1990.
Dan Wnorowski, M.D.