Does Running Cause Osteoarthritis in the Hip or Knee? (2022)

Table of Contents
Abstract Introduction Section snippets In Vitro Studies on Articular Cartilage Degradation In Vivo Animal Studies Barefoot (or Minimalist Footwear) Running Limitations of the Existing Literature Conclusion References (49) PM R Prev Med Am J Med Am J Prev Med J Clin Epidemiol Clin Geriatr Med Physiol Behav Bone Lancet Running and osteoarthritis Reduction in incident stroke risk with vigorous physical activity: Evidence from 7.7-year follow-up of the national runners' health study Stroke Lower prevalence of hypertension, hypercholesterolemia, and diabetes in marathoners Med Sci Sports Exerc Running injuriesA review of the epidemiological literature Sports Med Incidents and determinants of lower extremity running injuries: A systematic review Br J Sports Med Running and osteoarthritis Clin Sports Med Direct measurement of local pressures in the cadaveric human hip joint during simulated level walking Ann Rheum Dis Survival of articular cartilage after controlled impact J Joint Bone Surg Articular cartilage: Biomechanics A second study of tensile fatigue properties of human cartilage Ann Rheum Dis Mechanical disruption of human patellar cartilage by repetitive loading in vitro Clin Orthop Relat Res Joint changes after overuse and peak overloading of rabbit knees in vivo Acta Orthop Scand Effects of mechanical loading on the tissues of rabbit knee J Orthop Res Analysis of acute mechanical stress in an animal model of post-traumatic osteoarthritis J Biomech Eng Moderate running exercise augments glycosaminoglycans and thickness of articular cartilage in the knee joint of young beagle dogs J Orthop Res Cited by (23) Recommended articles (6) Videos
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Volume 4, Issue 5, Supplement,

May 2012

, Pages S117-S121

Abstract

Running is an excellent activity to promote general health and well-being. However, running injuries are common, and concern is sometimes raised that running might lead to osteoarthritis in weight-bearing joints. This article reviews the relevant in vitro and in vivo literature that looks at possible associations between running and the development of osteoarthritis. Also reviewed is the limited literature on running barefoot and with minimalist footwear. Low- and moderate-volume runners appear to have no more risk of developing osteoarthritis than nonrunners. The existing literature is inconclusive about a possible association between high-volume running and the development of osteoarthritis. The early literature on running barefoot and running with minimalist footwear has primarily focused on biomechanics but has not yet focused on any effect on cartilage health. Experienced and beginner runners should be encouraged to allow the body adequate time to adapt to changes in gait biomechanics caused by changing footwear, which can be done by slowly increasing running mileage in the new footwear. Clinicians can improve the health of runners by encouraging appropriate treatment of musculoskeletal injuries, encouraging maintenance of an optimal body mass index, and correcting gait abnormalities caused by deficits in flexibility, strength, or motor control along the kinetic chain.

Introduction

Running has a low participation cost and can be performed almost anywhere, which makes it an ideal activity to combat the negative effects of physical inactivity and obesity [1]. The well-known benefits of running include improved cardiovascular fitness, strength, and endurance [2]. Running also decreases the risk of stroke [3], decreases the risk of developing hypertension [4], improves bone density [5], has a positive effect on mood [6], and improves cognition [7]. However, running is not without risk. The annual incidence of incurring a running injury has been reported as high as 59% by Van Mechelen [8] and 79% by Van Gent et al [9]. Overload injuries that affect muscles, tendons, ligaments, and bones are common. The effect of running with knee osteoarthritis has been extensively studied, and, more recently, barefoot running has been suggested as a strategy to reduce the risk of acquiring running injuries. This article reviews the existing literature that examined the association of running and osteoarthritis. First, we review pertinent in vitro studies on cartilage breakdown. Second, we provide a limited review of in vivo animal studies that have explored the relationship between running and osteoarthritis. Third, we present a broader discussion of the in vitro human epidemiology literature, divided into a review of studies that support and refute an association between running and osteoarthritis. We then include a brief discussion about running barefoot and running with minimalist footwear.

Section snippets

In Vitro Studies on Articular Cartilage Degradation

Multiple intrinsic and extrinsic factors affect a joint's ability to withstand destructive forces. Intrinsic factors include the thickness of the articular cartilage, the composition of the articular cartilage, the strength of the bone adjacent to the joint, periarticular ligament strength, muscle strength, neuromuscular control of the joint, and the body's ability to repair damage to the joint. Extrinsic factors include nutrition; training technique; and the magnitude, direction, duration, and

In Vivo Animal Studies

A complete review of in vivo animal studies that investigated running and osteoarthritis is beyond the scope of this article. Some caution must be exercised with in vivo animal studies, because changes to articular cartilage may be interpreted as either osteoarthritic changes or normal tissue adaptation. Several of the more salient in vivo animal studies are presented here. Results of 2 studies by Kiviranta et al [19, 20] suggest that low- and moderate-volume running increases articular

Barefoot (or Minimalist Footwear) Running

Barefoot running and minimalist running shoes, which feature much less cushioning and support than traditional running shoes, have received considerable media attention in recent years. Lieberman et al [46] compared foot-strike patterns of persons in the United States and Kenya who were either habitually barefoot or shod. They found that the habitually barefoot individuals tended to run with a forefoot or mid-foot strike pattern. Habitually shod individuals tended to run with a rear-foot strike

(Video) DOES RUNNING CAUSE KNEE & HIP ARTHRITIS?!

Limitations of the Existing Literature

The existing literature regarding running and osteoarthritis has several limitations. First, the majority of studies focused primarily on the hips and knee. Limited information exists regarding the effect of running on the development of osteoarthritis at the ankle or the lumbar spine. Comprehensive studies that control for common variables such as type of running surface, type of footwear, foot-strike and gait pattern, presence of biomechanical deficits, and cross-training are difficult to

Conclusion

The existing literature fails to support an association or causal relationship between low- and moderate-distance running and osteoarthritis. Increasing age, previous joint injury, and greater body mass index have consistently been associated with an increased risk of developing osteoarthritis. Inconclusive evidence exists regarding high-volume running and the development of osteoarthritis. Further research is needed to clarify the relationship between high-volume running and the development of

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    (Video) Does Running Cause Knee Osteoarthritis? Episode 28

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  • Cited by (23)

    • Knee injuries in runners

      2019, Clinical Care of the Runner: Assessment, Biomechanical Principles, and Injury Management

      Knee injuries are likely most commonly seen in runners. Patellofemoral pain syndrome, iliotibial band syndrome, and patellar tendinopathy are three very commonly encountered conditions that make up the majority of knee-related running injuries. In addition to accurately diagnosing the injury, a careful assessment of the runner's biomechanics along the kinetic chain is key to resolving the problem and preventing future injuries. The vast majority of treatment for running-related knee injuries revolves around appropriate rehabilitation.

    • Is physical activity, practiced as recommended for health benefit, a risk factor for osteoarthritis?

      2016, Annals of Physical and Rehabilitation Medicine

      The existing literature supports that older runners are generally healthier than their non-running counterparts. Evidence is inconclusive regarding the association of high-volume running and the development of OA [60]. Consistently, when considering the general population, in the absence of significant joint injury, risk of knee/hip OA is not increased with daily general PA or recreational sport activity, with moderate level of practice [10].

      In this critical narrative review, we examine the role of physical activity (PA), recreational and elite sports in the development of knee/hip osteoarthritis (OA), taking into account the role of injury in this relationship. The process of article selection was unsystematic. Articles were selected on the basis of the authors’ expertise, self-knowledge, and reflective practice. In the general adult population, self-reported diagnosis of knee/hip OA was not associated with low, moderate or high levels of PA. For studies using radiographic knee/hip OA as a primary outcome, the incidence of asymptomatic radiographic OA was higher for subjects with the highest quartile of usual PA than the least active subjects. The risk of incident radiographic knee/hip OA features was increased for subjects with a history of regular sports participation (for osteophyte formation but not joint space narrowing). This risk depended on the type of sport (team and power sports but not endurance and running), and certain conditions (high level of practice) were closely related to the risk of injury. The prevalence of radiographic OA was significantly higher, especially the presence of osteophytes, in former elite athletes than controls. The risk of OA was higher with participation in mixed sports, especially soccer or power sports, than endurance sport. However, the prevalence of clinical OA between former elite athletes and controls was similar, with less hip/knee disability in former athletes. Moderate daily recreational or sport activities, whatever the type of sport, are not a consistent risk factor for clinical or radiographic knee/hip OA. Risk of injury in different sports may be the key factor to understanding the risk of OA related to sport.

    • Evaluation and Management of Hip and Pelvis Injuries

      2016, Physical Medicine and Rehabilitation Clinics of North America

      The articular cartilage of the femoral head and acetabulum can be prone to breakdown, causing arthrosis. However, no study has clearly defined an association between hip arthrosis and running.88–90 In fact, a reduced incidence of osteoarthrosis and hip replacement has been found with long-term recreational running,91 corresponding to a lower rate of disability progression among runners.92,93

    • Joint contact forces when minimizing the external knee adduction moment by gait modification: A computer simulation study

      2015, Knee

      Gait modification is often used to reduce the external knee adduction moment (KAM) in human walking, but the relationship between KAM reduction and changes in medial knee joint contact force (JCF) is not well established. Our purpose was to examine the limiting case of KAM-based gait modification: reducing the KAM as much as possible, and the resulting effects on JCF.

      We used musculoskeletal modeling to perform three optimal control simulations: normal walking, a modified gait that reduced the KAM as much as theoretically possible (Min(KAM) simulation), and a second modified gait that minimized the KAM plus the metabolic cost of transport (Min(KAM+CoT) simulation).

      The two modified gaits both reduced the peak KAM from normal walking (−82% for Min(KAM) simulation, −74% for Min(KAM+CoT) simulation) by increasing trunk lean, toe-out, and step width, and reducing knee flexion. Even though the Min(KAM+CoT) simulation had the larger KAM, it had a greater reduction in peak medial JCF (−27%) than the Min(KAM) simulation (−15%) because it reduced the KAM using less knee muscle activity. These results were qualitatively robust to a sensitivity analysis of the knee joint model, but the magnitude of changes varied by an order of magnitude.

      The results suggest that (i) gait modification can benefit from considering whole-body motion rather than single adjustments, (ii) accurate interpretation of KAM effects on medial JCF requires consideration of muscle forces, and (iii) subject-specific knee models are needed to accurately determine the magnitude of KAM reduction effects on JCF.

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    • Knee osteoarthritis: Clinical connections to articular cartilage structure and function

      2015, Physical Therapy in Sport

      Most notably is aging, with a higher prevalence of OA in the elderly population (Buckwalter & Martin, 2004; Buckwalter, Martin, & Mankin, 2000; Ghosh & Smith, 2002; Zhai et al., 2006). Body mass index (BMI) and sex appear to be contributors, and other factors such as dietary intake have been implicated (Amin et al., 2008; Beavers, Serra, Beavers, Cooke, & Willoughby, 2010; Berenbaum, Eymard, & Houard, 2013; Griffin, Huebner, Kraus, Yan, & Guilak, 2012; Hansen, English, & Willick, 2012; Lohmander, Ostenberg, Englund, & Roos, 2004; de Luis, Izaola, Garcia Alonso, Aller, Cabezas, & de la Fuente, 2012; Muraki et al., 2013; Nguyen, Zhang, Zhu, Niu, Zhang, & Felson, 2011; O'Conor, Griffin, Liedtke, & Guilak, 2013; Shen et al., 2013). Hereditary factors also contribute to the problem.

      Articular cartilage is a unique biphasic material that supports a lifetime of compressive and shear forces across joints. When articular cartilage deteriorates, whether due to injury, wear and tear or normal aging, osteoarthritis and resultant pain can ensue. Understanding the basic science of the structure and biomechanics of articular cartilage can help clinicians guide their patients to appropriate activity and loading choices. The purpose of this article is to examine how articular cartilage structure and mechanics, may interact with risk factors to contribute to OA and how this interaction provides guidelines for intervention choices This paper will review the microstructure of articular cartilage, its mechanical properties and link this information to clinical decision making.

    • The epidemiology of osteoarthritis

      2014, Best Practice and Research: Clinical Rheumatology

      A recent review by Hansen et al. [43] failed to find evidence to support an association or causal relationship between low- and moderate-distance running and hip and knee OA in general population studies defined as incident radiographic or symptomatic OA. The review also produced inconclusive evidence regarding high-volume running and OA development [43] suggesting that, in the absence of joint injury, the risk of OA development due to running and exercise is minimal. Limited information exists regarding the effect of running and the development of OA at the ankle and the lumbar spine.

      Osteoarthritis (OA) is a leading cause of disability and its incidence is rising due to increasing obesity and an ageing population. Risk factors can be divided into person-level factors, such as age, sex, obesity, genetics, race/ethnicity and diet, and joint-level factors including injury, malalignment and abnormal loading of the joints. The interaction of these risk factors is complex and provides a challenge to the managing physician. The purpose of this review is to illustrate how each of these factors interact together to instigate incident OA as well as to outline the need for ongoing epidemiologic studies for the future prevention of both incident and progressive OA. It is only by understanding the impact of this disease and the modifiable risk factors that we will be able to truly target public health prevention interventions appropriately.

    View all citing articles on Scopus

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      Gait analysis was performed on 104 asymptomatic and 140 individuals with moderate knee OA. Each subject group was divided into three body mass categories based on body mass index (BMI): healthy weight (BMI<25), overweight (25≤BMI≤30), and obese (BMI>30). Three-dimensional knee joint angles and net external knee joint moments were calculated and waveform principal component analysis (PCA) was applied to extract major patterns of variability from each. PC scores for major patterns were compared between groups using a two-factor ANOVA.

      Significant BMI main effects were found in the pattern of the knee adduction moment, the knee flexion moment, and the knee rotation moment during gait. Two interaction effects between moderate OA disease presence and BMI were also found that described different changes in the knee flexion moment and the knee flexion angle with increased BMI with and without knee OA.

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      This study used magnetic resonance imaging (MRI) to evaluate in vivo preoperative changes in the length of the patellar tendon (LPT) in patients undergoing total knee arthroplasty (TKA). We sought to answer two questions: first, does the LPT change with flexion? Second, does the LPT show a gender-specific pattern?

      Eighty-five knees in 76 consecutive osteoarthritic patients were evaluated. The age range was 56–90years (mean 70). The study included 62 females and 14 males. MRI was performed at full extension and at 30°, 60°, 90°, and full flexion.

      There were significantly different patterns between genders (p<0.001). The main shortenings occurred earlier, at 30°, in females and later, at 60°, in males. In females, LPT values in full extension were significantly longer than those measured at other flexion angles. In male subjects, significant differences in LPT values were found between full extension versus 90° (p<0.001) and full flexion (p<0.001), and between 60° versus 90°(p=0.030) and full flexion (p=0.030).

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    Copyright © 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

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