Is Running bad for the Knees and Hips?It is common to hear the statement that running can be harmful and damaging to your joints, especially the hips and knees. But is this really true? Let’s investigate!
For more information, click on one of the topics below:
Does Long-Distance Running cause Osteoarthritis?
Most studies have shown that hip and knee arthritis is not more common in recreational runners. A study in 2017 combined and analyzed the data of 17 previous studies, to compare the rates of hip and knee arthritis in recreational, competitive, and non-runners. The study found that:
Recreational runners had a lower rate of arthritis, 3.5%.
Competitive runners had a rate of 13.3%.
and non-runners/sedentary individuals had a rate of 10.2%.
Competitive runners were professional or elite athletes, or participated in international competitions. The results show that a long duration of elite level running, or a sedentary lifestyle, are both linked with higher rates of knee and/or hip arthritis. It is not possible to determine if the running caused these results, or if they were also impacted by other factors. However, this study shows that running at a recreational level does not increase the risk of hip and knee arthritis. (1)
Is running safe for older adults and elderly?
One study looked at the effect of running in individuals over 50 years old with knee arthritis. They found that running at the intensity and amount chosen by the participants was associated with improvements in knee pain, compared to non-runners. Their study also showed that running was not associated with worsening of structural joint changes found on x-ray. The study concluded that there may be a benefit from running for knee health in those with osteoarthritis. (6)
Finally, another review study found that low to moderate quality evidence points to a decreased rate of surgery for knee osteoarthritis among runners, compared to non-runners. At this time we cannot conclude that it was the running that reduced the chances of needing knee surgery, so more evidence is needed. But this is an interesting finding. (7)
The studies discussed point to a positive impact of running on the knee joints – it may be beneficial to reduce pain, improve the structure of the main weight bearing joints of the knee, and have a potential link with reduced surgeries for knee osteoarthritis.
But what about running for people who are overweight?
Is running harmful for your joints if you’re overweight?
Sometimes we may hear people saying that running may be especially harmful for your joints if you are overweight. However, a study done in 2016 found that at a participants chosen running speed, overweight runners adopted strategies to reduce stress on their joints. These strategies included:
Less Joint Range of Motion
Less Vertical Displacement
Shorter Step Length
The study concluded that overweight runners who participate in moderate to vigorous running are equally as safe and effective as the general population in following an appropriate running program. (8)
In addition, starting a running program can be associated with weight loss, and continuing running supports the continuation of a healthy weight. (5) Obesity is one of the risk factors for knee and hip arthritis (7), and even if you aren’t running to lose weight, exercise is an essential part of arthritis management (3).
Top 5 tips for new or returning runners
The take away message is that running is not to be discouraged for people with arthritis, and research has shown several benefits from running on hip and knee joint health, even in those with arthritis.
Tip #1 – Avoid increasing volume or intensity too quickly
Volume = how much you run (minutes or km).
Intensity = how hard/fast you run (pace or RPE).
You wouldn’t want to do both at the same time, for example: you wouldn’t want to run more distance overall in a week and also at a faster pace because that would be increasing both volume (distance increases) as well as intensity (harder to run faster).
Tip #2 – Try not to push your pace too soon
Similar to the tip above, pushing your pace too soon increases the intensity too much if not done progressively.
Tip #3 – Avoid changing what terrain you run on right away
If you start running with one type of terrain like track or treadmill for example, and then the next day you want to run the same distance but on a trail with increasing hills and challenging terrain, that would increase the intensity as well if not done progressively.
Tip #4 – Changing the type of shoes you wear
The time to think about changing things up is when you are trying to increase your running time or if you get a running injury. Changing the type of shoe you wear while in the middle of training can add intensity to your running if the heel to toe drop difference and stack height of the shoe are not consistent.
Tip #5 – Work on your lower body strength as well
For maximum benefits, work towards strengthening your lower body alongside running. It is recommended to complete a lower body strengthening program to keep your knees and hips stronger, which can reduce injuries in the lower limbs.
Our physiotherapists and kinesiologists at Westcoast SCI can be a valuable resource in assisting you to safely progress in your running program and provide an appropriate strengthening program!
Need help improving your running performance and preventing running injuries?
We offer an Individualized Running Program!
1) Alentorn-Geli, E., Samuelsson, K., Musahl, V., Green, C. L., Bhandari, M., & Karlsson, J. (2017). The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 47(6), 373-390.
2) Driban, J. B., Hootman, J. M., Sitler, M. R., Harris, K. P., & Cattano, N. M. (2017). Is
Participation in Certain Sports Associated With Knee Osteoarthritis? A Systematic Review. Journal of Athletic Training, 52(6), 497-506. doi:10.4085/1062-6050-50.2.08
3) Esculier, J., Krowchuk, N. M., Li, L. C., Taunton, J. E., & Hunt, M. A. (2018). What are the perceptions about running and knee joint health among the public and
healthcare practitioners in Canada? Plos One, 13(10). doi:10.1371/journal.pone.0204872
4) JOSPT perspectives for patients (2017). Running and Osteoarthritis: Does Recreational or Competitive Running Increase the Risk? Journal of Orthopaedic & Sports Physical Therapy, 47(6), 391-391. doi:10.2519/jospt.2017.0505
5) Kozlovskaia, M., Vlahovich, N., Rathbone, E., Manzanero, S., Keogh, J., & Hughes, D. C. (2018). A profile of health, lifestyle and training habits of 4720
Australian recreational runners—The case for promoting running for health benefits. Health Promotion Journal of Australia, 30(2), 172-179. doi:10.1002/hpja.30
6) Lo, G.H., Musa, S.M., Driban, J.B., Kriska, A.M., McAlindon, T.E., Souza, R.B.,
Petersen, N.J., Storti, K.L., Eaton, C.B., Hochberg, M.C., Jackson, R.D., Kwoh, C.K., Nevitt, M.C., & Suarez-Almazor, M.E. (2018). Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative. Clinical Rheumatology, 37, 2497–2504. doi: 10.1007/s10067-018-4121-3
7) Timmins, K.A., Leech, R.D., Batt, M.E., Edwards, K.L. (2017). Running and Knee Osteoarthritis: A Systematic Review and Meta-analysis. The American Journal
of Sports Medicine, 46(6), 1447-1457. doi: 10.1177/0363546516657531
8) Zdziarski, L. A., Chen, C., Horodyski, M., Vincent, K. R., & Vincent, H. K. (2016). Kinematic, Cardiopulmonary, and Metabolic Responses of Overweight
Runners While Running at Self-Selected and Standardized Speeds. PM & R,8(2), 152–160. doi: 10.1016/j.pmrj.2015.06.441