Have you ever been told that running causes knee arthritis? It is true that many runners can experience knee injuries but the biggest fear most runners have is developing osteoarthritis (OA), or damage/loss of knee cartilage. You may have heard before that OA is a “wear and tear” condition, meaning the joint cartilage gets worn down over time with use. Interestingly, researchers have debunked this myth and propose that “wear and tear” may be the mechanism that helps keep our cartilage healthy, not damage it.[1,2] The function of cartilage is to take weight through the joint during movement. When pressure is applied, fluid is pushed out, and when released, it sucks fluid back in. This is critical – this flushing of fluid brings nutrients to the cartilage and stimulates healing.[1]
As mentioned in this month’s Deep Dive, stability for the knee is largely influenced by the hip and ankle, and the strength of the quad and glute muscles. Aside from this, there are many factors that contribute to OA development, such as increased BMI, dehydration, knee joint injury/accident, poor diet, and decreased physical activity.[1] While confounding variables has made the link between running and OA unclear in the past, recent high-quality studies and analyses have shed light on the topic. Overall, runners who engaged in regular running experienced knee pain less often than non-runners.[3] A meta-analysis showed > 50% reduction in knee surgery related to OA in runners, suggesting that running can actually be protective for the knee.[2] Additionally, if you actively have OA, running at a comfortable and self-selected speed is associated with improved knee health and less pain. Even further, radiographs (x-rays) performed on the knee did not show progression of the condition from running, meaning there was no evidence of worsened physical damage.[4]
What To Do
The main takeaway here is that running should not be avoided purely because you have been told you have osteoarthritis. In fact, running may be the activity that improves your condition. That being said, OA can be painful. Don’t try to “run through the pain”, and rather only move at the speed which is comfortable. Talk to a physical therapist or a medical provider if are curious what intensity of running is correct for you. Some ways to improve your tolerance to self-selected running pace/intensity is to stay hydrated and properly warm-up before exercise. Synovial fluid is a lubricating fluid that exists in the knee and other joints in the body which provides a cushioning effect and nutrition to the joint. When dehydrated, joint pain is more likely to develop due to loss of synovial fluid protection.[5] Dehydration can act like a “glue” for different tissues (skin, muscles, nerves, connective tissue), preventing them from sliding/gliding properly while you move.[6] Hydration improves blood circulation and deliverance of nutrients to muscles/tissue for healing. It is important to take in a bare minimum of 2-3 liters of water/day to allow for proper healing of your body from activity.[6] As for warm-ups, the increase in body heat from warm-up stimulates the secretion of synovial fluid into the joint, which helps keep joints lubricated and move smoothly.[1] An example could be a light walk or jog before you start running. For more ideas to treat knee pain, try some of the exercises from this month's Knee Trifecta.
References
Wells T. Arthritis is not a wear-and-tear problem. The Body Mechanic. https://thebodymechanic.com/active-release-technique-blog/arthritis-is-not-a-wear-and-tear-problem/
Timmins KA, Leech RD, Batt ME, Edwards KL. Running and Knee Osteoarthritis: A Systematic Review and Meta-analysis. Am J Sports Med. 2017;45(6):1447-1457. doi:10.1177/0363546516657531
Lo GH, Driban JB, Kriska AM, et al. Habitual running any time in life is not detrimental and may be protective of symptomatic knee osteoarthritis. Arthritis Rheum. Published online 2014.
Lo GH, Musa SM, Driban JB, et al. Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative. Clin Rheumatol. 2018;37(9):2497-2504. doi:10.1007/s10067-018-4121-3
Dehydration and Joint Pain: How Your Hydration is Affecting Joint Health. Orthopedic Associates: Orthopedic Surgery and Sports Medicine. Published June 12, 2020. https://orthopedicassociates.org/dehydration-and-joint-pain-how-your-hydration-is-affecting-joint-health/
Starrett K, Murphy TJ. Ready to Run: Unlocking Your Potential to Run Naturally. Victory Belt Publishing; 2014.
Healthy Is Wellness, LLC (“Healthy Is Wellness”) is not a health care provider, and does not provide professional medical advice, diagnosis, and/or treatment. THE INFORMATION PROVIDED BY HEALTHY IS WELLNESS IS FOR INFORMATIONAL PURPOSES ONLY.
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