Is distance running bad for your hips and knees? New research says not, finding no link between arthritis and how far, and for how long, you have run

A study of marathon runners finds no links between their running history and osteoarthritis, instead citing age, high BMI and family history as risk factors
The findings undermine older studies linking distance running to knee and hip damage. Researchers say doctors should re-examine their guidelines against running

Wellness

Lily Canter

Published: 6:15pm, 18 Sep 2023

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A study of nearly 4,000 marathon runners has provided compelling evidence to dispel the myth that long-distance running damages the knees and hips.

The research, published in the Journal of Sports Medicine, suggests there is no link between the prevalence of osteoarthritis in runners and their running-related history – including the number of marathons completed, cumulative years of running, average weekly mileage, and average running pace.

“For those who have been closely following the science around this, the new findings are not surprising at all,” says Alexa Duckworth-Briggs, a certified running coach at UK-based running coach service We Run.

“The narrative that running, particularly long-distance running, is harmful to the knees and hips has been largely based on outdated or anecdotal evidence. Existing data have consistently failed to establish a causal link between running and arthritis.”

Marathon runners in Mong Kok, Hong Kong, this year. Running, including running marathons, does not cause knee and hip injuries, research shows. Photo: Dickson Lee

The research findings showed the most significant risk factors for developing hip or knee arthritis were age, a high body mass index (BMI), previous injury or surgery, and family history.

Researchers discovered a low level of self-reported hip and/or knee arthritis among recreational marathon runners, and found no “dose-response” relationship between running history and arthritis risk. In other words, the level of arthritis risk did not rise with the level of running.

The study found that rather than running, the most significant risk factors for developing knee or hip arthritis are age, a high BMI, previous injury or surgery, and family history. Photo: Shutterstock

“These results stand in contrast to long-established dogma suggesting that running increases the risk of developing hip or knee arthritis,” says study author Matthew Hartwell, of the Department of Orthopaedic Surgery at Northwestern University in Illinois, in the United States.

The results were drawn from a survey of non-elite runners aged 18 to 83, of whom 52 per cent were men. Participants had been running for a mean of 14.7 years and ran an average of 28 miles (45km) a week.

Runners had completed at least nine marathons on average.

It’s essential to emphasise that running is not inherently ‘bad’ for your knees

Seth Forman, head of education and training at US-based mobile gym equipment maker Kayezen

The study represented a wide spectrum of long-distance runners, from beginners to veteran marathon runners. While the majority were beginners who had run less than five marathons, some had run more than 100.

Most of the studies to date that looked at running and its potential link with arthritis were on small groups, usually focused on elite and high-volume marathon runners, the researchers noted.

This limited the findings’ applicability to patients most often encountered in the healthcare setting.

A woman with running-induced knee pain. In contrast to older studies, the new research tested non-elite runners, who are more often encountered in a healthcare setting. Photo: Shutterstock

This research underscores the idea that running, when approached mindfully and progressively, can be a safe and beneficial activity for joint health, says athletics coach Seth Forman, head of education and training at US-based mobile gym equipment maker Kayezen.

“It’s essential to emphasise that running is not inherently ‘bad’ for your knees; rather, it can be a valuable tool for maintaining overall fitness and joint function,” he adds.

Despite clear evidence that running provides health benefits, and a wealth of studies suggesting running does not hasten joint degeneration, many doctors advise their patients – with or without arthritis – to reduce their running or eliminate it from their routine altogether, according to the study authors.

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They urge healthcare providers to re-examine existing guidelines, and to use their findings “to inform discussions with patients about the risks and benefits of running”.

The research adds to a growing body of evidence that the number of years someone has been running, their weekly mileage and number of completed marathons does not have a direct relationship with pain and arthritis.

A previous study of marathon runners who had completed a mean of 76 marathons found the number of marathons completed was not a significant risk factor for hip or knee arthritis.

Runners in the 25th Standard Chartered Hong Kong Marathon. The recent research surveyed 4,000 non-elite runners of varying levels. Photo: Dickson Lee

A review and analysis of previous studies of running and knee osteoarthritis published in the American Journal of Sports Medicine found a history of running actually had a protective effect, with a more than 50 per cent lower risk of having to undergo knee surgery related to osteoarthritis.

“Collectively, these studies, combined with results from the current study, suggest that running to some degree may likely be beneficial for joint health,” say Hartwell and his colleagues.

Kevin Huffman, an osteopath and fitness coach in Tampa, in the US state of Florida, says the study is good news for people wanting to maintain an active lifestyle.

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“It emphasises that factors like maintaining a healthy weight, managing previous injuries, and being aware of family medical history are the main determinants of arthritis risk,” he says.

“This study encourages individuals to embrace the physical and mental benefits of long-distance running without worrying excessively about its impact on their joint health.”

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