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Health & Exercise Forum

Long Distance Running May Not Accelerate Knee Joint Arthritis

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Jul 11, 2016

Dr. Mackarey's Health & Exercise ForumIt is the time of year when many runners will ramp up their training for the Steamtown Marathon to be held in October. As you increase your mileage in preparation for the marathon you probably have noticed some difficulty walking down the steps for your morning coffee the next morning. The stiffness in your joints, coupled with severe muscle soreness, makes you walk like an arthritic octogenarian. In spite of stiff hip, knee and ankle joints you should feel good about your accomplishment. I am sure that your well-meaning wife, parents, friends, and coworkers, (especially those who don’t like to run) are telling you how foolish you are to run 26.2 miles. They will say that you are ruining your knees and it is time to grow up. Many will say that you will regret this someday when you can’t even walk without pain.

Up until recently, your well-intended family and friends had reason to be concerned. Many previous studies indirectly supported their point of view. A British study found that almost 50% of former elite soccer players had crippling, bone-on-bone knee arthritis by middle-age. Similar findings were reported for elite weight lifters and retired NFL football players. However, the good news for runners is that they may be different. The lean, light-weight runner, who trots like a deer, light on his feet, in perfect alignment, and with good form, may not be doing so much damage to his knee joints after all.

Therefore, I hope to add to some level of comfort as you prepare for a 26.2 mile journey by sharing wonderful news based on recent research about runners and knee arthritis. You may not have done as much damage to your joints as previously theorized. Last year an article in Skeletal Radiology received significant attention for disproving “current wisdom” about running and knee arthritis. Researchers from Austria used MRI imaging to examine the knees of participants before the 1997 Vienna Marathon. Ten years later, runners received an MRI before the 2007 race. Scans of those participating in both races were compared for changes. The results were very surprising. No major changes regarding new internal damage to the knee joints of the runners in both marathons were discovered.

A 2008 Stanford University study supported the findings in the Austrian study. In 1984, Stanford researchers followed runners who began running in their 50’s and 60’s and continued to run for 20 years and compared them to the same age group of non runners. While 7% of the runners began the study with creaking and crackling associated with mild arthritis under the knee caps, none of the non runners had such findings. However, 20 years later, only 20% of the runners had advanced arthritic changes compared with 32% of the control group. Furthermore, only 2% of the runners had knee arthritis requiring surgery when compared to 10% for the control group.

Therefore, current wisdom suggests that running may not cause advanced and progressive knee arthritis. Moreover, running may actually offer protection by grooving the surfaces through motion and creating demands on the cartilage in the joint to rebuild, repair and protect. Keep in mind that the joint requires optimum conditions to benefit from the stresses associated with running. Some suggestions purported are:

Top Ten Suggestions for Running with Healthy Joints

  • Keep Leg Muscles Strong – strengthen the hip, knee and ankle muscles to lessen stress on joints
  • Maintain Leg Range of Motion – do mild flexibility exercises after a warm up
  • Maintain Body Weight – running on a large frame or with extra weight can lead to increased joint stress
  • Run in Alignment – ask an elite runner or running coach how you might improve your stride and alignment. It will give you running longevity.
  • Eat Well – proper nutrition will not only maintain your body weight but also maintain healthy bones and joints
  • Change Shoes – every 250-300 miles for the best support and shock absorption and be sure to wear the right shoe for you
  • Change Routine – cross training is essential: swim, bike, elliptical, walk and hike

Remember, not every workout has to be pounding and demanding

  • Do Not Run With Pain – listen to your body! All good runners perform with some discomfort to be successful. However, if you have hip, knee or ankle pain when running that doesn’t go away while running, STOP. Do not run through pain that does not lessen during the run.
  • Take Time Off – running intensely, 7 days a week for an extended period of time will eventually lead to problems
  • Run for Life Mindset – is the attitude that will keep you safe. If you think about how important it is to be running for fitness and fun for the rest of your life, not just for 3-5 years, then you will be more likely to make intelligent decisions about when, where and how often to run.Visit your doctor regularly and listen to your body.    


NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” in the Scranton Times-Tribune.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.