Myths and realities of running – Does running cause osteoarthritis?

You love running, but you’ve been told that the impact will “wear out your knees.” Osteoarthritis changes the tissues in a joint, particularly the cartilage that covers the ends of the bones. Does running cause these changes? Studies suggest there’s more to this concern than meets the eye.

Good news: Studies do not show a higher incidence of knee osteoarthritis among recreational runners. One review even found a lower prevalence of hip or knee osteoarthritis among recreational—that is, non-professional—runners.¹ Another review found no clear difference in knee osteoarthritis between runners and people who ran little or not at all. These findings do not prove that running prevents osteoarthritis.² Our guide explains how to start running gradually.

What Science Tells Us About Running and Osteoarthritis:

• A review links running to fewer knee replacement surgeries for osteoarthritis. This finding does not prove that running prevents surgery.³
• Cartilage exhibits minor changes after a run, such as changes in thickness. These changes are generally temporary. Whether running strengthens cartilage remains a hypothesis that requires further study.^{4, 5}
• A review found that elite runners have higher rates of osteoarthritis than recreational runners. The comparison with non-runners remains unclear. Previous injuries may contribute to these differences.¹
• The 2017 and 2023 reviews do not compare exactly the same groups. A lower prevalence of osteoarthritis in one group does not, on its own, demonstrate a protective effect of running.^{1, 2}

This article demystifies the link between running and osteoarthritis. To understand osteoarthritis in general, consult our article Is it really your osteoarthritis that's causing your pain?.

Does running cause knee osteoarthritis?

Recreational running is not a proven cause of knee osteoarthritis.³ Studies have yielded mixed results and do not establish a causal link.³ The 2017 review found a lower prevalence among recreational runners; the 2023 review found no clear increase among the runners studied.^{1, 2} Most of these studies examine participants’ habits. They do not randomly assign participants to run or not run, which limits conclusions about causation.³

The 2017 summary covers osteoarthritis of the knee and hip. The estimated prevalence rates are 3.5% among recreational runners, 13.3% among elite runners, and 10.2% among individuals in the non-running group. These rates describe the groups studied; they do not predict your personal risk.¹ One proposed explanation is that cartilage adapts to the repeated stresses of running. This adaptation remains a hypothesis, not a proven protection against osteoarthritis.⁵

A review of 43 articles examined cartilage using magnetic resonance imaging (MRI), a test that visualizes tissues using a magnetic field. After running, the images show small changes in the volume, thickness, or other characteristics of the cartilage. These immediate changes generally do not persist.⁴ The review found no new cartilage lesions—that is, damaged areas—attributable to running. However, the results regarding pre-existing lesions are inconsistent. Long-term data on repeated runs remain limited.⁴ The strengthening of cartilage through training therefore remains a possible explanation that needs to be verified.⁵

To see which structures bear the load with each step, check out our page on knee anatomy.

The group of elite runners includes professionals and participants in international competitions. The prevalence of knee or hip osteoarthritis among them is higher than among recreational runners. The comparison with the non-running group remains too uncertain to conclude that there is a difference. Repeated injuries, running volume, and intensity may contribute to these results.¹

A study estimated knee forces in 14 healthy adults during walking and running. Maximum force was higher during running, but each step duration was shorter and stride length was longer. For the same distance, the estimated load—calculated by summing the forces during each step—did not differ significantly between the two activities.⁶ This finding helps explain why peak force does not fully account for the total load. It does not indicate that the load is the same for all runners or that the risk of osteoarthritis is the same.⁶

The 2017 review describes its comparison group as sedentary and not engaged in running.¹ Sedentary behavior refers to periods of wakefulness spent sitting or lying down with very little movement.⁷ The 2023 review uses a different criterion: individuals in the comparison group run less than 8 km per week. They are therefore not necessarily sedentary. This review finds no clear difference in knee osteoarthritis, even among groups that run more. However, several of the included studies have limitations that reduce confidence in this comparison.²

A study of 2,637 people also compared those who had previously run with those who did not. Frequent knee pain was less common among the former, even after taking into account age, sex, weight relative to height, other activities, and previous injuries.⁸ However, the difference in osteoarthritis visible on X-rays was no longer clear after these adjustments. The same was true for osteoarthritis that combined these X-ray findings with frequent pain.⁸

These comparisons do not allow us to completely separate the effect of the race from that of other differences among participants.¹ Past injuries, training volume, and intensity can all play a role. Researchers therefore cannot attribute differences in osteoarthritis to just one of these factors.¹

Several studies have shown that knee pain is less common among runners.⁸ The 2023 review confirms this positive finding. However, the groups of runners and non-runners differ notably in terms of age and follow-up duration. Some people may also have stopped running because of pain. The result therefore does not demonstrate that running alone relieves pain that is already present.⁹

Where can I learn more about preventing running injuries?

The “Parle-moi de santé” podcast and our guides explain how to prevent running injuries. Physical therapist Alexis Gougeon interviews Blaise Dubois in the first episode. Our articles cover how to start running without getting injured, overuse injuries, what shoes to wear for running, and the best running technique.

Episode #1 discusses the prevention and treatment of running injuries.

You can watch the episode on YouTube.

Sources

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1. Alentorn-Geli E, Samuelsson K, Musahl V, Green CL, Bhandari M, Karlsson J. The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017;47(6):373-390. (Back to sections: 1, 2, 3, 4, 5, 6, 7, 8, 9)
2. Burfield M, Sayers M, Buhmann R. The association between running volume and the prevalence of knee osteoarthritis: A systematic review and meta-analysis. Phys Ther Sport. 2023;61:1-10. (Back to sections: 1, 2, 3, 4)
3. 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. (Back to sections: 1, 2, 3, 4)
4. Khan MCM, O'Donovan J, Charlton JM, Roy JS, Hunt MA, Esculier JF. The Influence of Running on Lower Limb Cartilage: A Systematic Review and Meta-analysis. Sports Med. 2022;52(1):55-74. (Back to sections: 1, 2, 3)
5. Miller RH. Joint Loading in Runners Does Not Initiate Knee Osteoarthritis. Exerc Sport Sci Rev. 2017;45(2):87-95. (Back to sections: 1, 2, 3)
6. Miller RH, Edwards WB, Brandon SC, Morton AM, Deluzio KJ. Why don’t most runners develop knee osteoarthritis? A case for per-unit-distance loads. Med Sci Sports Exerc. 2014;46(3):572-9. (Back to sections: 1, 2)
7. Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, Latimer-Cheung AE, et al. Sedentary Behavior Research Network (SBRN) — Terminology Consensus Project: Process and Outcomes. Int J Behav Nutr Phys Act. 2017;14(1):75. (Back to section: 1)
8. Lo GH, Driban JB, Kriska AM, McAlindon TE, Souza RB, Petersen NJ, et al. Is There an Association Between a History of Running and Symptomatic Knee Osteoarthritis? A Cross-Sectional Study From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken). 2017;69(2):183-191. (Back to sections: 1, 2, 3)
9. Dhillon J, Kraeutler MJ, Belk JW, Scillia AJ, McCarty EC, Ansah-Twum JK, et al. Effects of Running on the Development of Knee Osteoarthritis: An Updated Systematic Review at Short-Term Follow-up. Orthop J Sports Med. 2023;11(3):23259671231152900. (Back to section: 1)