Running and osteoarthritis, myth or reality?

Running is a very popular sport at all ages and has been classically associated with injuries especially in the articulations of the articular (knees, ankles) and tendinous (plantar fasciitis, tendinitis) structures. In particular, running is often advised against for those suffering from knee’s osteoarthritis  (gonarthrosis) or hip’s osteoarthritis (coxarthrosis), i.e. the thinning of the articular cartilage commonly associated with ageing; however, it is not clear whether running is associated with an increased risk of osteoarthritis  or the onset of complications of osteoarthritis  or for the need for arthroplasty.

Based on the available evidence, we cannot provide a unique answer to these major issues, indeed much depends on the individual’s characteristics and from the intensity with which running is practiced. Several studies have tried to reveal if running is correlated with an increased risk of arthrosis, nevertheless, the evidence is conflicting. On the one hand, a study of more than 2,500 people between 45-79 year who have reported knee pain or had a Rx knee osteoarthritis  diagnosis has revealed that running does not increase the risk of osteoarthritis. It is of note that runner was defined as a person who runs at least 20 minutes a day for at least 10 times in a life period, a threshold that can be considered rather low, whereas only 200 persons included in the study have reported more than 2000 running episodes in life. (GH L, et al. Arthritis Care Res 2017).

On the other hand, some systematic reviews, or rather works that merge various studies in order to extrapolate facts with greater impact, have demonstrated that occasional runners have a lower risk of developing knee and hip osteoarthritis , compared to the so-called elite runners or sedentary subjects as opposites. (Alentorn-Geli E, et al. J Orthop Sports Phys Ther 2017). Further, the occasional runners also have nearly halved risk to need knee prosthesis, although this could be explained by a procrastination of a surgery to continue the sports activity despite the pain. (Timmins KA, et al. Am J Sports Med 2017). Nonetheless, the intensity of physical activity is equally important, as a matter of fact, elite runners, who run long distances, or very often, have an increased incidence of knee or hip osteoarthritis (Driban JB, et al. J Athl Train 2017; Alentorn-Geli E, et al. J Orthop Sports Phys Ther 2017).

It is not clear whether traumatism is related to running or personal predisposing factors to increase this risk (Miller RH. Exerc Sports Sci Rev 2017); in fact, ultrasound studies have not revealed dissimilarities amid runners and persons that walk regularly in the cartilaginous thickness. (Harkey, MS, et al. Osteoarthritis Cartilage 2017).

In conclusion, the connection between running and osteoarthritis is not entirely clarified, however, the facts reveal that occasional running at moderate-intensity in itself is not linked with an increased risk of knee osteoarthritis, and helps to reduce cardiovascular risk, and osteoporosis, whereas high-intensity running is associated with an increased risk of knee’s arthrosis. (Roberts WO. Br J Sports Med. 2018).


(C) 2018 Carlo Selmi, MD PhD

Assistant Professor of Rheumatology, University of Milan
Head, Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center
Assistant Professor of Medicine, University of California, Davis