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Running does not increase pain or structural damage in people with knee osteoarthritis (OA)

As a physiotherapist in the field of sports & exercise medicine, I feel somewhat obsessive about keeping an eye on the latest research and use this knowledge in management of all clients. I feel that it is very important communication of this up to date research to our patients / clients is achieved in plain, easy to understand language. In this short review I would like to share the results of a recently published study1 of 1203 participants regarding their knee osteoarthritis(OA) and running habit. In this study, the mean age is 63.2 years old and mean body mass index (BMI) is 29.5. Of the 1203 participants 11.5% are runners.

Traditionally, health care providers have generally advised AGAINST running for people diagnosed with knee OA, of advancing age and overweight. This is based on the anecdotal impression that running at older age with a heavier body may make the knee OA worse. Over time, this concept has become a generally-accepted fact that people will self- discourage from this seemingly “high risk” exercise. Despite this, hospital surgical statistics tell us the rate of surgery for people requiring knee OA operations is soaring.

On the other hand, doctors understand that higher levels of moderate to vigorous aerobic physical activity (e.g. running or gardening) improve all-cause mortality and prevent cardiovascular diseases. Moreover, people at risk of cardiovascular diseases are likely to have OA. So what do we do?

The above dilemma has lead the researchers in this study1 to analyse a national database in the United States (where the lifestyle is similar to Australia) from 2004 to 2014. They discovered, surprisingly, that when compared to non-runners, participants who choose to run:

  1. Do not have worsening knee OA structural severity in their prospective x-ray results
  2. Do not have worsening knee pain
  3. Do experience improved knee pain

So what are the take home messages?

  1. Self-selected running need not be discouraged in people with knee OA, overweight or both. Although the symptoms & your level of fitness may impact on the intensity and duration of your session, you can work with your sports & exercise physiotherapist to progress this gradually.
  2. Pacing yourself systematically is the key for many people who were successful in achieving physical activity goals.
  3. Runners in this cohort actually had more improvement in knee pain. This may be explained by muscles strengthening effect occurs in regular running. The stronger the muscles, the less impact is transferred to the knee joints.
  4. How much is enough? As a rough indication, 92.7% of runners in this cohort run 5-12 months per year and the majority run > 4 times per month. So ideally you want to achieve 1-2 runs per week all year round with allowance of some holidays / festive breaks.

In the next review we will move from the knee to the spine and look at some latest research that studied running and the health of intervertebral discs.


Lo, G. H., Musa, S. M., Driban, J. B., Kriska, A. M., McAlindon, T. E., Souza, R. B., . . . Suarez-Almazor, M. E. (2018). Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative. Clin Rheumatol, 37(9), 2497-2504. doi:10.1007/s10067-018-4121-3

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