Does running increase the risk of osteoarthritis?
It is often stated “today’s runners are tomorrow’s cyclists” but how much truth is in this phrase? Concern over damage to joints as a result of running does seem to be a common theme runners worry about. As an osteopath I am frequently asked questions such as “am I storing up joint problems for myself later in life?” or “am I going to get arthritis from this running linked injury”.
These are questions most runners will be able to relate to, in this article I will examine the evidence linking running with osteoarthritis and future disability.
What is osteoarthritis?
Osteoarthritis is a disorder of the joints caused by gradual loss of cartilage and resulting in of boney change to the joint and the formation of cysts and spurs at the margins of the joints. The term osteoarthritis is derived from the Greek words meaning bone, joint, and inflammation.
Osteoarthritis is generally divided into two types, primary related to age and genetics, though little else is known about what causes it and secondary, where there is an obvious cause such as surgery to the joint structures, abnormal joints at birth (congenital abnormalities), gout, rheumatoid arthritis, diabetes, and other hormone disorders.
We want to know does running increase the risk of developing primary osteoarthritis?
One of the more recent studies implicating running as a cause of osteoarthritis was by Cheng et al (2000). They found a significantly higher incidence of osteoarthritis in men who were involved in high levels of physical activity i.e. walking or running more than 20 miles a week.
It is often hypothesised that repetitive loading from an activity such as running might accelerate the development of osteoarthritis in weight bearing joints. Many researchers have conducted retrospective studies comparing prevalence of osteoarthritis in professional athletes compared to amateur runners. Following both groups up decades later to see how they have faired over the years with mixed conclusions.
In contrast Klunder (1980) et al. failed to identify any significant association between habitual running and premature degenerative change relating to osteoarthritis, as did Marti et al. when investigating running as being predictive of degenerative hip disease.
The issue with retrospective studies is researchers use varying criteria to evaluate the extent of osteoarthritis. Some look at X-ray, whilst others rely on patient self-reports and or case notes from other physicians. This perhaps goes some way to explaining the conflicting results.
Running protects against Osteoarthritis…
Despite their mixed results these retrospective studies are useful. When looking at the studies that rely purely on x-ray results endurance athletes frequently show evidence of boney change but do not always report pain or symptoms. It has been hypothesised that joints will remodel in response to the forces they are subjected to but that this level of remodelling will not predispose to osteoarthritis. This is particularly common in younger runners. The idea of structures adapting to function is a concept osteopaths agree with and an exciting theory that needs to be tested. Furthermore some papers go so far as to suggest this level of change may even help protect against osteoarthritis (Childs 2006).
Moderate Vs Strenuous running…
Another theme that has come out with these retrospective studies is that osteoarthritis may not be linked to mileage but rather to intensity. Studies on animals by Pap (1998) and, Kiviranta et al. (1988,1992) showed improved joint condition with thicker healthier cartilage as a result of moderate running. However there was evidence of osteoarthritis in animals subjected to “strenuous running”. Lapvetelainen (2001) also demonstrated that moderate physical activity does not predispose to osteoarthritis and may again have a protective benefit.
Whilst this is positive news for the running community the idea and principles cannot be assumed to be applicable to humans. The animals in theses studies will have different anatomy, biomechanics, and muscle strength from humans.
How to reduce your risk of osteoarthritis…
What can be said fairly definitively is that there is a direct link between body max index and osteoarthritis (Childs 2006) The greater the body mass index, often the greater the radiographic evidence of osteoarthritis in the joints.
The other issue that runners are able to influence themselves to reduce their risk of osteoarthritis is seeking treatment for injuries rather than running through them. Studies by Baker et al (2002) demonstrated that amending the biomechanical issues that cause injuries such as meniscal damage and joint laxity could reduce the likelihood of developing osteoarthritis.
Existing evidence on whether running causes osteoarthritis is insufficient to draw unequivocal conclusions. However, studies do seem to indicate that a moderate level of running does not increase the risk of osteoarthritis for runners with a healthy BMI. Also that moderate running may also have a protective effective on the joints.
Injury, abnormal biomechanics, or a high body mass index can accelerate the onset of osteoarthritis so it is important to get any injuries checked and treated, and to learn the proper training methods so that joint injury might be prevented.
Kiviranta I, Tammi m, Jurvelin j, Saamanen am, Helminen hj. Moderate running exercise augments glycosaminoglycans and thickness o articular cartilage in the knee joint of young beagle dogs. J orthop res 1988:6:188-195
Kiviranta I, Tammi m, Jurvelin j, Arokoski j, Saamanen am, Helminen hj. Articular cartilage thickness and glycosaminoglycan distribution in canine knee joint ater strenuous running exercises.clin orthop relat res October 1992:302-308
Pap G, Eberhardt R, Sturmer I, Macher a, Schwarzberg h, Roessner a, et al. development of osteoarthritis in the knee joints of wistar rats after strenuous running exercise in a running wheel by intracranial self –stimulation.pathol res pract.1998:194:41-47
Lapvetelainen t, Hyttinen m, Lindblom j,Langsio tk, Sironen r,Li sw, et al. more knee joint arthritis in mice after inactivation of one allele of type II procollagen gene but less OA after life long voluntary wheel running exercise. Osteoarthritis cartilage.2001 9:152-160
Klunder kb, Rud b, Hansen j, osteoarthritis of the hip and knee joint in retired football players. Acta orthop scand 1980, 51: 925-7
Childs T, Sinkov V, does long distance running cause osteoarthritis? Cymet TC, SinkovV.JohnsHopkinsSchool of Medicine, Owings Mills, MD21117-4713, USA
Cheng Y, MaceraCA, Davis DR, Ainsworth BE, Troped PJ,blair SN. Physical activity and self reported, physician-diagnosed osteoarthitis:is physical activity a risk factor. J clin epidemiol. 2000:53:315-322.
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