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Does running cause arthritis

running woman

Does running increase the risk of arthritis?

A common question that comes up during office visits at my sports injury clinic in Portland OR is does running increase the risk of me developing arthritis in my knees or hips? This is an important question because joint pain due to arthritis commonly affects millions of Americans especially those over age 50.

Approximately one in seven US adults has osteoarthritis. The annual direct medical cost of osteoarthritis is approximately 80 billion dollars in the United States.

Osteoarthritis is defined as a disorder involving movable joints characterized by cell stress and extracellular matrix degradation initiated by micro and macro injury that results in a maladaptive repair response including pro-inflammatory pathways of innate immunity. Osteoarthritis manifests first as abnormal joint tissue metabolism followed by anatomic and/or structural changes.

Symptoms of arthritis include joint deformity, joint stiffness, variable pain worsened by weight bearing and use of the affected limb, abnormal joint noises like clicking or grinding, joint buckling/giving way, and mechanical symptoms like the joint getting stuck in one position.

Treatments for osteoarthritis include exercise-based activity, physical therapy, weight loss, bracing, oral medications, injections, and other surgical interventions.

Across different sports, some studies have found an increased risk of osteoarthritis in adults. Looking at individual sports, soccer has a greater than average risk of athletes developing knee and ankle arthritis.  This is also related to the number of years played.    In distance runners, the relative risk of arthritis was lower than average, and in athletes who experienced an injury to the affected joint the risk of developing arthritis was higher than average.  In looking at a study regarding early onset arthritis in retired National Football League players, the study found that football players reported a high incidence of knee injury. Approximately 53% of NFL players reported knee injuries, 74% reported knee ligament or tendon injuries, and 14% reported knee anterior cruciate ligament injuries.

Returning to our initial question, what about running? Is it linked to osteoarthritis? Looking at a systematic review of 25 studies that reviewed running and its association with hip and knee arthritis, the study found that competitive runners have an increased risk of knee and hip arthritis compared to recreational runners and sedentary controls. However recreational runners had a much lower prevalence of hip and knee osteoarthritis compared to sedentary individuals. Another study that looked at elite athletes and hip arthritis found that significantly more elite runners had hip arthritis than did bobsledders or the non-running control group. 

Another study looked at 27 former competitive runners who ran 12 to 24 miles per week for an average of 40 years compared to 27 age-matched sedentary controls. The average age of both groups was 58 years old. No differences were found and joint alignment, pain, joint range of motion, or X-ray appearance of the hips, knees, and ankles.

Though some questions remain unanswered such as what the role of running surfaces, athletic footwear, running gai, and other forms of cross training as affecting arthritis development, it is this author's opinion that recreational running which encompasses most adult runners does not increase the risk of developing hip or knee arthritis. The caveat to this would be related to a history of previous joint injury or surgery as post-injury or surgical joint-related changes may Increase the risk of developing degenerative changes to that joint.

If you have a running-related injury, our sports medicine specialist is happy to see you and help you get back on track. 

Dr Westerdahl David Westerdahl MD FAAFP RMSK Sports Medicine Physician and owner Sports Health Northwest, Inc.

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