Running improves general health, but does it increase the risk of osteoarthritis?
As a marathon runner and a physical therapist working with patients who have undergone recent joint replacements to rid themselves of osteoarthritis pain, this is a question I debate often. With all of the mixed messages portrayed in the media and conflicting conclusions being drawn in scientific research, even the most well-informed doctors don’t seem to have a concrete answer.
Osteoarthritis (or degenerative arthritis) is caused by the breakdown and eventual loss of the cartilage of one or more joints. Cartilage is a protein substance that serves as a “cushion” between the bones of the joints. It is thought that exercise over many years, such as running and other high-impact sports, stresses the cartilage to a point that it no longer cushions your joints. Without the cushion, you are left with bones rubbing against each other, causing debilitating 
pain, swelling, limitations in motion, and ultimately a joint replacement. (Now, if that isn’t a good excuse to skip the gym, I don’t know what is.)
But what about all the benefits of running? Running improves body image and confidence, helps to maintain a healthy weight, fights bad cholesterol, improves coordination, reduces the risk of stroke, boosts the immune system and much more. Despite these benefits, however, the possible deleterious effects of running remain controversial. One study I read looked at MR imaging of the hip and knee in runners before and after completing a marathon. The results suggest that “the high impact forces in long-distance running are well tolerated and subsequently do not demonstrate changes on MR images.” Another study compared non-runners and runners who ran 12 to 24 miles/week for a median of 40 years to determine joint changes and cartilage wear and tear. Their results suggest “that a lifetime of long distance running at mileage levels comparable to those of recreational runners today is not associated with premature osteoarthritis in the joints of the lower extremities.” In fact, long-distance running might even have a protective effect against joint degeneration because it stimulates bone-growth and health.
Osteoarthritis is still prevalent in runners, however running itself is not classified as a “cause” of degenerative arthritis. If a runner acquires osteoarthritis, it is due to a combination of many risk factors including: older age (people under 40 rarely experience osteoarthritis), sex (women are more likely), bone deformities and previous injuries (some people are born with malformed joints or defective cartilage) and obesity (carrying more body weight places more stress on your weight-bearing joints, such as your knees).
Nevertheless, I certainly don’t recommend becoming a couch potato to avoid osteoarthritis. I recommend a healthy approach to running with adequate rest and recovery, proper nutrition, appropriate footwear to help absorb the impact of running, alternating high impact with low-impact cross-training days (such as the elliptical trainer or running on a more forgiving surface, such as turf) and using ice and anti-inflammatories if you pushed your workout a little too far to help combat joint swelling. All of these measures allow you to be active and experience the benefits of running, while protecting your joints.
Unfortunately avoiding degenerative changes in joints over many years is not always black and white – it’s the gray area in-between that might just send me running to the nearest surgeon for a hip replacement when I’m 50. Until then, I’ve still got a lot of marathons in me.
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