Research Review: Running and its Relationship with Osteoarthritis

Heat 1 of the Womens 100m Semi-Final

We often believe that the more activity we do, the more osteoarthritis (OA) we will develop leading to more pain. So I had to find out if this is what researchers have published.

What I found was very interesting and it turns out that there are publications stating the exact opposite of what we believe. Many studies have found that movements may lead to arthritis, we know this. But many studies have found that there is no direct relationship of activities such as running and the development of osteoarthritis!!!

Here is a list of articles published by researchers studying pain:

“Running significantly reduced OA and hip replacement risk due to, in part, running’s association with lower BMI, whereas other exercise increased OA and hip replacement risk.”  Published by Williams PT in 2013

“Running is possible with mild forms of OA if proper joint mechanics, neuromuscular control, and technique are present” Published by Siverling S in 2012

“Limited evidence was found linking biomechanical measures of knee joint loading and observed short-term deformation of knee articular cartilage volume following running. Further enhancement of knee muscle modelling and analysis of stress distribution across cartilage are needed if we are to fully understand the contribution of biomechanical factors to knee joint loading and the pathogenesis of knee osteoarthritis (OA).” Published by Boocock M in 2012

“Previous research did not show a significant association between intense physical activity and knee OA in the general population” Published by Zeller L. in 2008

“Long-distance running among healthy older individuals was not associated with accelerated radiographic OA. These data raise the possibility that severe OA may not be more common among runners” Published by Charkravarty EF in 2008

“Osteoarthritis of the knee joint is rare in former elite marathon runners. The risk of osteoarthritis of the hip joint seems to be higher than in control subjects who do not engage in much sport.” Published by Schmitt H in 2006

“The presence of radiographic hip OA and the progression of radiographic knee OA was similar for older runners and nonrunners. Lumbar spine BMD remained higher in runners, but changes in lumbar BMD were similar for runners and nonrunners over a 9 year period.” Published by Lane NE in 1998

“We did not find an increased prevalence of OA among our runners, now in their seventh decade. These observations support the suggestion that running need not be associated with predisposition to OA of the lower extremities.” Published by Panush RS in 1995

“In summary, running did not accelerate the development of radiographic or clinical OA of the knees, but with aging, 13% of all subjects developed OA of the hands and 12% of all subjects developed OA of the knees.” Published by Lane NE in 1993

So if you are a runner and are experiencing pain, there are solutions.

1. Understand that pain can occur for many reasons and by understanding pain, you may be able to take charge of it. Go here to understand the most up to date definition of pain that I know and here to read about stories and metaphors to help explain pain in more detail.

2. After reading the  pages listed above, check out this page here to understand that arthritis and pain may not be connected.

3. Now what? You now understand that pain can occur for many reasons and that your pain may not be related to arthritis or a tear. Confusing isn’t it?

Don’t worry, pain is a complicated process that researchers do not fully understand it. What is known is that movements and exercises help to decrease pain through various mechanisms including changing how our brain protects us.

4. Research studies have found that there is no best form of exercise. This means that you should move, but grade your movement to prevent protective mechanisms from your brain. If you keep forcing into pain, you may experience more pain.  It is also important to vary your movement exercises to stimulate the brain and move to in ways that are enjoyable.

Try Yoga, Feldenkrais movements, Pilates, and etc. Find what works for you and your body.

I can’t give you a list of the best exercises that I think would help unless you attend an evaluation. Everyone is unique and what works for one person will not help someone else.

5. Go to a health care practitioner who understands how assess your body using modern pain science to promote movement through exercise and manual therapy.

You must give yourself a chance to improve. You can do it!

For starters, here are a few articles that may help give you some options:

1. “Incline walking: An offloading option for patients with knee OA” by By Henry Wang, PhD, Mason Haggerty, MS, Clark Dickin, PhD, and Jennifer Popps, PhD

2. “Phys Ed: Can Running Actually Help Your Knees?” By

3. ” Five Strategies to Help Your Pain.” By Marianne Kane

4. Runners World published an article here:

If you are a clinician, there is a shift in orthopedics, which involves the blending of orthopedics and neurophysiology. I think that the best website to discuss and learn about these topics is You can also check out the list of blogs and clinicians here to learn more.



Boocock M, McNair P, Cicuttini F, Stuart A, Sinclair T. The short-term effects of running on the deformation of knee articular cartilage and its relationship to biomechanical loads at the knee. Osteoarthritis Cartilage. 2009 Jul;17(7):883-90. doi: 10.1016/j.joca.2008.12.010. Epub 2009 Jan 18. PubMed PMID: 19246217.

Chakravarty EF, Hubert HB, Lingala VB, Zatarain E, Fries JF. Long distance running and knee osteoarthritis. A prospective study. Am J Prev Med. 2008 Aug;35(2):133-8. doi: 10.1016/j.amepre.2008.03.032. Epub 2008 Jun 12. PubMed PMID: 18550323; PubMed Central PMCID: PMC2556152. Free full text

Lane NE, Oehlert JW, Bloch DA, Fries JF. The relationship of running to osteoarthritis of the knee and hip and bone mineral density of the lumbar spine: a 9 year longitudinal study. J Rheumatol. 1998 Feb;25(2):334-41. PubMed PMID: 9489830.

Lane NE, Michel B, Bjorkengren A, Oehlert J, Shi H, Bloch DA, Fries JF. The risk of osteoarthritis with running and aging: a 5-year longitudinal study. J Rheumatol. 1993 Mar;20(3):461-8. PubMed PMID: 8478853.

Panush RS, Hanson CS, Caldwell JR, Longley S, Stork J, Thoburn R. Is Running Associated with Osteoarthritis? An Eight-Year Follow-up Study. J Clin Rheumatol. 1995 Feb;1(1):35-9. PubMed PMID: 19077939.

Schmitt H, Rohs C, Schneider S, Clarius M. [Is competitive running associated with osteoarthritis of the hip or the knee?]. Orthopade. 2006 Oct;35(10):1087-92. German. PubMed PMID: 16932832.

Siverling S, O’Sullivan E, Garofalo M, Moley P. Hip osteoarthritis and the active patient: will I run again? Curr Rev Musculoskelet Med. 2012 Mar;5(1):24-31. doi: 10.1007/s12178-011-9102-y. PubMed PMID: 22231957; PubMed Central PMCID: PMC3535123. Free full text

Williams PT. Effects of running and walking on osteoarthritis and hip replacement risk. Med Sci Sports Exerc. 2013 Jul;45(7):1292-7. doi: 10.1249/MSS.0b013e3182885f26. PubMed PMID: 23377837; PubMed Central PMCID: PMC3756679.

Zeller L, Sukenik S. [The association between sports activity and knee osteoarthritis]. Harefuah. 2008 Apr;147(4):315-9, 374. Review. Hebrew. PubMed PMID: 18686813.

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