Recently, I took a course given by Jean-Francois ESCULIER | PT, PhD on Running and Osteoarthritis.

In a nutshell his recommendations concluded:

1. Recreational running is associated with less knee and hip osteoarthritis and reduces the odds of requiring a joint replacement.
2. Load your joints to keep them healthy – exercise is good for cartilage.
3. In runners with knee OA – focus on education regarding load management. Also consider resistance training, gait modifications and footwear.
4. Running is even possible after a joint replacement. 

If you conducted a random survey of the general population asking the question, “Is running bad for your joints?” the majority would say yes. There is a common belief that running will lead to osteoarthritis of the joints, particularly knee. Personally, I have been a moderate runner (10 kilometers) since my twenties, a few decades ago. However, I have changed my volume of running and added in more resistance training over the years.

Jean-Francios Esculier has looked at research studies that investigated if runners had more osteoarthritis compared to non-runners. Studies concluded recreational running is not bad for healthy joints. (25 studies-including 100,000 people). Evidence showed recreational runners had the least amount of osteoarthritis vs sedentary and Olympic class runners. Joints and in particular cartilage can adapt to running as long as the forces are added gradually. 

If you consider Wolff’s Law, developed by German surgeon and anatomist, Julius Wolff, in the 19th century – it states that “bones adapt to the mechanical stresses placed on them.” When a bone is stressed, it remodels to become stronger or vice versa if it is not stressed it becomes weaker. Thus, with the management of osteoporosis weight bearing exercises are advocated.  Jean-Francios, who in his own studies had access to MRI, found the cartilage in runners is thicker than that in non-runners. Thus, cartilage as well adapts to the forces placed upon it. 

There are other factors that lead to OA in the knee. The body adapts as long as the applied stress is not greater than its capacity to adapt. Cyclic compression or movement of the body is necessary to maintain cartilage health. If you look at a non-running population that starts running the GAG (glycosaminoglycan) content of cartilage increases. GAG is a key component of cartilage that helps it resist compressive forces by binding to water and lubricates the joints.

Is it safe to run with knee OA?

Here the research is limited to only a few studies.  One study looked at X-ray changes over time in the running verse non-running population. Non-runners had more arthritic changes over the same time span. Another study was more of a review of a self-reported questionnaire in which there was more improvement with knee pain in runners. A third study looked at an MRI before and after 30 minutes of treadmill running – if there was more knee swelling than before they overshot their upper limit. The recommendation was you shouldn’t push through pain, and you should allow more recovery time.

So, what do you tell runners with OA? Run more often for shorter distance and decrease load by running flat. Ideally there should be no increase in swelling, no increase in symptoms during running or return to pre-running symptoms in less than an hour, no increase in symptoms the next day, no limping.

If all works out: increase volume, then increase speed, and finally add hills. Resistance training and physiotherapy for sports injuries can increase strength, improve joint tolerance, and help runners maintain proper form. Move from low-impact to higher-impact exercises gradually. When running, use more supportive shoes or custom foot orthotics, and return to minimalist shoes gradually. Run softer or quieter to minimize joint impact.

Is Running Safe with a Prosthesis (joint replacement)?

Here the research is more sparce. In a very small study, the conclusion indicated complications were not worse than non-runners. The wear and tear on the prothesis was minimal, but other factors were not looked at such as loosening of the shaft of the prosthesis. However, the presenter is starting a long-term study of running with Total Knee Replacement.  Results will come in a few years. 

Stay tuned.