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• Posted March 7, 2023

Does Running Bring on Arthritic Knees?

New research offers up some good news for diehard marathon runners: You don't necessarily have to give up running if you are experiencing hip or knee pain.

Contrary to widespread opinion, running marathons does not increase your risk for developing hip or knee osteoarthritis, the wear and tear form of the disease, a new study of seasoned Chicago marathoners showed.

"You don't develop knee or hip osteoarthritis simply because of how fast you run or how many miles you put on your body,"said study author Dr. Matthew James Hartwell, an orthopedic surgery sports medicine fellow at the University of the University of California, San Francisco.

So, what does increase a runner's risk for hip or knee arthritis?

Basically, the same things that up these risks in non-marathoners, Hartwell said. This includes advancing age, family history of hip or knee arthritis, and previous injuries or knee surgery, as well as higher body mass index (BMI), a measure of body fat based on height and weight.

For the study, more than 3,800 Chicago marathoners (mean age: nearly 44) answered questions about their running history, including number of marathons, number of years spent running, and average weekly mileage. They also answered questions about known risk factors for knee and hip arthritis.

Participants completed an average of 9.5 marathons, ran 27.9 miles per week, and had been running for around 15 years, the survey showed. Fully 36.4% of runners had knee or hip pain in the past year, and 7.3% received a diagnosis of hip and/or knee arthritis.

The bottom line? Running history wasn't linked to the development of knee or hip arthritis on its own, the study showed.

Most runners planned to run another marathon, even though 24.2% said their doctor told them to run less or stop running altogether.

Health care providers should rethink this blanket advice, Hartwell said.

"Telling someone to stop running for sake of joint health is not the answer,"he said. "Even with small aches and pain, you don't have to stop running."

If you have persistent pain in your hips or knees, talk to your doctor and see if you need an X-ray to check for signs of arthritis, Hartwell recommended.

The new research is scheduled for presentation Thursday at a meeting of the American Academy of Orthopaedic Surgeons (AAOS), in Las Vegas. Studies presented at medical meetings are considered preliminary until published in a peer-reviewed journal.

The findings reinforce the advice that Dr. Matthew Matava gives his patients who run. He is a professor of orthopedic surgery and physical therapy at Washington University School of Medicine in St. Louis and an AAOS spokesman.

"A long-held myth is that cumulative running mileage causes osteoarthritis of the knee and hip, [but] distance running doesn't cause osteoarthritis in an otherwise healthy person without prior joint injury or surgery,"said Matava, who was not involved with the study.

Running can make preexisting arthritis worse in folks who already have it to some degree, he noted.

Most causes of lower extremity joint pain in runners are due to overuse and follow the "rule of toos" -- too many miles, too little rest and too fast, Matava said.

"Treat the pain symptomatically with ice for no more than 20 minutes at a time and use Tylenol or an over-the-counter, anti-inflammatory medication for a short period of time,"he said.

It may also be time to invest in a new pair of running shoes.

"Each pair of running shoes can withstand 350 to 500 miles of running before their outsole [rubber sole] loses its cushioning effect,"Matava said.

If a runner experiences swelling, catching or locking in the joint or doesn't improve with conservative care, Matava said he or she should see an orthopedic sports medicine specialist to see what may be going on.

More information

The American Academy of Orthopaedic Surgeons provides more on knee osteoarthritis.

SOURCES: Matthew James Hartwell, MD, orthopedic surgery sports medicine fellow, University of California, San Francisco; Matthew Matava, MD, professor, orthopedic surgery, physical therapy, Washington University School of Medicine in St. Louis; presentation, American Academy of Orthopaedic Surgeons meeting, Las Vegas, March 9, 2023