Can running damage my joints?
A Review of Recent Scientific Journal Articles
“April showers bring May flowers”, that is what they say. The month of May also brings the unofficial beginning of the running season in Ottawa. While this city has plenty of hardcore runners who brave the winter, as the weather gets nicer, a daily run along the Ottawa River or behind the parliament buildings becomes a reality. Ottawa is an amazing city for runners who love both road and trail running. I have been running 40-80 km per week regularly ever since my track and field days back in university. I have often been told by people (health care professionals, family members, and even patients) that running in this fashion will lead to wear and tear on my joints leading to an increased risk of low back pain, knee pain, and other conditions. This brings us to the question, does running cause joint damage? I will review a few recently published peer-reviewed articles to answer this questions.
Does Running Cause Osteoarthritis in the Knee?
This was a question that Leech and colleagues (2015) attempted to answer in a short editorial in the British Journal of Sports Medicine. While the editorial acknowledges that, at the time, there was not a great body of research to draw from to answer this question, the conclusion that they were able to make is that “recreational running is not a risk factor for knee osteoarthritis”. They point out that there is one study that suggests running may protect from knee OA and another that identifies a higher level of knee arthritis in elite, high-mileage runners. This article yields a less than satisfying answer, but it gives us a glimpse into the complex nature of the research being done and the increased suspicion in the field that running does not necessarily lead to damage of the joints of the knees.
In January of 2017, a study by Lo and colleagues was published in the journal Arthritis Care and Research which examined the association between a history of running and symptomatic OA of the knee. This study was a retrospective cross-sectional study (which is considered less valid than say, a randomized control trial). The authors concluded that there is no increased risk of symptomatic (painful) OA in the knee among runners.
WHAT ARE THE LOADING FACTORS INVOLVED WITH RUNNING AND KNEE CARTILAGE AS FAR AS OSTEOARTHRITIS (OA) IS CONCERNED?
Ross Miller (2017) begins his argument by pointing out that there is evidence that long-distance runners do not have a high risk of OA in the knee. While this news on its own is reassuring, he goes on to develop two well-developed educated guesses to explain this. The first hypothesis is that while peak forces inside the knee joint are high while running, the accumulated forces in the knee from running are not that different from walking. The second hypothesis is that running somehow conditions the intra-articular tissue of the joint, making it more resilient to the loads applied. He also explains that while high loading patterns are not associated with knee OA, unusual patterns are. A runner may have a more consistent and repeatable stride pattern and this may help to reduce the incidence of knee OA in runners.
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CAN JOINTS OTHER THAN THE KNEE BE DAMAGED BY RUNNING?
In the previously mentioned article, Miller points out that while peak forces in the ankle are much higher during running, the rate of OA in the ankle is much lower. As a practitioner, I can say that OA, especially one that would be called symptomatic, in the ankle is rare. Another very important region in the body is the back. In the last week, the journal Nature published a very exciting paper that actually shows an increased health of the intervertebral disc in runners. Belavý and colleagues (2017) did a prospective study on disc health, using MRI imaging, and running. Runners showed better intervertebral disc characteristics when studied. This may mean that running is good for low back health and may help (when applied correctly) in treating low back pain.
WHAT DOES THIS ALL MEAN?
I would say that all of this research is good news for people who enjoy running. The long-term outlook on people who run, as far as their joint health is concerned, is positive: there does not appear to be any increased risk of joint damage or osteoarthritis. Running seems to be associated with very good long-term outcomes. However, that optimism comes with some caution: runners may have a slightly higher risk of some types of injuries. If you are having any pain from running and need some help or even just a bit of reassurance, come and see one of our great Ottawa-area professionals at Inovo Medical.
By Dr. Ben Matheson, D.C. If you like our blog, check out our blog post archives here.
Lo, G. H., Driban, J. B., Kriska, A. M., McAlindon, T. E., Souza, R. B., Petersen, N. J., … & Kwoh, C. K. (2017). Is There an Association Between a History of Running and Symptomatic Knee Osteoarthritis? A Cross‐Sectional Study From the Osteoarthritis Initiative. Arthritis Care & Research, 2(69), 183-191.
Mathieu Bélanger, MD, CCFP, CPSO Recognized Specialist (Chronic Pain), is the founder and President of Inovo Medical. Dr. Bélanger began his academic career by earning an undergraduate degree in kinesiology (i.e., the science of body mechanics) before enrolling in medicine at the University of Montréal. He is particularly interested in pain related to sports injuries and musculo-skeletal disorders. This interest led him to travel extensively for various types of training on pain treatment given by leading experts. Since then, his objective has been to play an active role in the development and delivery of the most sophisticated and effective treatments for chronic pain.