Is Running Bad for Your Joints?

Are the 30,000 runners who qualified for Boston in 2024 doomed to a future of knee and hip pain because of their chosen sport? The answer may surprise you.

In 2017, a systematic review set out to determine if there is a relationship between hip and knee Osteoarthritis (OA) and running recreationally or competitively1. They looked at all pertinent research to date at that time, performed in-depth statistical analysis, and shared some findings you’ll want to see. 

In short, they found recreational runners had the lowest incidence of OA among nonrunners and competitive runners. The stats are listed below.

The prevalence of hip and/or knee OA:

• Competitive Runners - 13.3%

• Controls (nonrunners) - 10.23%

• Recreational Runners - 3.5%

(Runners were deemed “Competitive” if “the authors specifically reported that the runners were professional, elite, or ex-elite athletes, or in any case in which runners represented their countries in international competitions”)

They also found that runners who had been running longer than 15 years had a higher prevalence of OA, but these runners were all deemed “competitive” as well. Those who had been running less than 15 years had less OA compared to nonrunners.

Over time, research has determined certain risk factors for OA including previous injury, heavy labor jobs, and obesity. It is not known how prevalent those factors were in the control groups or the running groups. It could be that individuals who choose to run don’t have those risk factors. However, if running recreationally did accelerate the onset of OA, we would expect the prevalence to be higher. In this study, it suggests that not only is it safe for the joints, but could actually be protective for the joints.

When it comes to the human body, we know that our tissues adapt to the loads we experience or don’t experience. Our muscles get stronger when they are loaded appropriately. They get weaker when unloaded. Bones do the same. More research recently suggests joint cartilage is no different. Our bodies are resilient. Running, in the right amounts, may keep joint cartilage healthy. 

Now, the absence of OA doesn’t mean the knees get off scotch-free with running. The load through the knee is 4.6 times higher with running vs walking. The load through the hip is 1.8 times higher, and 1.9 times higher in the achilles tendon. Of all running-related injuries, the knee has the greatest prevalence2. 

If an athlete is having knee pain with running we can work on addressing the load tolerance of the knee, especially when we identify the specific tissues involved. We can also perform a gait analysis and use gait retraining if needed to reduce the stress on the knee. We can also vary the type of running, for example, running uphill is less stressful on the knee than downhill. There are multiple variables to explore to help you run without knee pain.

In summary, running recreationally doesn’t lead to long-term guarantees of osteoarthritis, it may be protective of it. Running does increase the loads and forces our joints experience, especially the knee, but the body is resilient and adaptable and can be trained to tolerate those loads and forces so you can run, and run, and run. Looks like the Boston marathoners might be okay after all! 

Author: Dr. Annalee Scott, PT, DPT, CSCS

Sources: 

1. Alentorn-Geli E, Samuelsson K, Musahl V, Green CL, Bhandari M, Karlsson J. The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017 Jun;47(6):373-390. doi: 10.2519/jospt.2017.7137. Epub 2017 May 13. PMID: 28504066.

2. ​​Kakouris N, Yener N, Fong DTP. A systematic review of running-related musculoskeletal injuries in runners. J Sport Health Sci. 2021 Sep;10(5):513-522. doi: 10.1016/j.jshs.2021.04.001. Epub 2021 Apr 20. PMID: 33862272; PMCID: PMC8500811.

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