Running may protect the knee from osteoarthritis

I was just perusing the abstract book from the American College of Rheumatology annual meeting in Boston last week (all 3018 of them!) and found more than a few gems. We already know that pretty much all the previous studies have generally shown that the prevalence of osteoarthritis in former or older runners is no different to the rate that is found in the non-running populations with one recent study that I reviewed showing it decreased the risk for hip osteoarthritis. So it is probably pretty clear that generally running does not increase the risk for osteoarthritis. This is despite one lab based study on healthy runners putting out a press release that running shoes may increase the risk for osteoarthritis that went viral in the fan boy community and with two barefoot running websites even claiming that they actually do … when that was not what the research showed at all! (see my discussion on that here). This has led to a still persistent myth that running shoes do cause osteoarthritis.

This is the abstract from the ACR meeting that caught my eye:

Habitual Running Any Time in Life Is Not Detrimental and May be Protective of Symptomatic Knee Osteoarthritis: Data from the Osteoarthritis Initiative. Grace H. Lo, Jeffrey B. Driban, Andrea Kriska, Kristi Storti, Timothy E. McAlindon, Richard Souza, Charles B. Eaton, Nancy J. Petersen and Maria E. Suarez-Almazor
Background/Purpose: Controversy exists regarding whether habitual running is beneficial versus harmful to the knee. Chronic mechanical overloading could potentially physically damage structures within the knee. Alternatively, runners have a lower body mass index (BMI), protective of knee osteoarthritis (OA). Most existing studies evaluating running and knee osteoarthritis (OA) have focused on elite male athletes, not generalizable to most of the population. Therefore, we aimed to evaluate the relationship of habitual running with symptomatic knee OA in the Osteoarthritis Initiative (OAI), a cohort recruited from the community not based on elite running status. Methods: This is a cross-sectional study of OAI participants with knee x-ray readings, symptom assessments, and completed surveys on lifetime physical activity. At the 96-month visit, a modified version of the Lifetime Physical Activity Questionnaire(LPAQ) asked participants to identify the top 3 most frequently performed physical activities(20 times in life) from ages 12 – 18, 19 – 34, 35 – 49 and 50 years old. Those indicating running as an activity were defined as a runner in that time period. Running at any time in life included runners from all time periods. Posterior-Anterior semi-flexed knee radiographs were obtained at OAI 48-month visit and scored for Kellgren-Lawrence (KL) grade (0–4). Radiographic OA (ROA) was defined as KL  2. Frequent knee pain within a person required at least one knee have frequent knee pain at the OAI 48-month visit. Symptomatic radiographic OA (SOA) required that at least one knee had both ROA and frequent knee pain. Anyone with a total knee replacement was classified as having SOA. We performed logistic regression analyses where the predictor was running any time in life and running in the specific age ranges. The outcomes were ROA, frequent knee pain, and SOA; adjusted analyses included covariates age, sex and BMI.
Results: 2439 participants were included, 55% were female, mean age was 64.7(9.0)years and BMI was 28.5(4.9)kg/m2.28% ran at sometime in their lives; of those,49%,31%,15% and 5% identified running in 1,2,3,and 4 of the time periods respectively. From lowest to highest BMI tertile, 35%, 28%, and 24% were runners at any time in life. For outcomes of frequent knee pain and ROA, the results were similar to that of SOA.
Conclusion: Our findings suggest an exposure to non-elite running at any time in life is not associated with a higher odds of prevalent ROA, knee pain, and SOA. Those with the lowest BMI were most likely to identify running as a habitual activity. These findings were observed in a cohort recruited from the community not based on elite running status making these findings potentially more applicable to a broader population. Non-elite running at any time in life does not appear detrimental, and may be protective of SOA.

I have no more information than what is available in the above abstract, but the results are pretty clear:

  • non-elite running, regardless of age at which they ran, is NOT associated with an increased risk for knee osteoarthritis

and if you look at the data in the table:

  • the odds ratios suggest that the running may actually be somewhat protective for developing knee osteoarthritis.

This strengthens the evidence that running does not increase the risk for osteoarthritis and given that almost all runners wear running shoes is further evidence that running shoes do not cause osteoarthritis.

As always, I go where the evidence takes me until convinced otherwise…and this is good evidence.

POSTSCRIPT: Here is a press release put out by ACR on this study

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