We’ve invited readers to send in topic suggestions for this column, and we received this question from David: “Is it possible to run or jog when one has a chronic and painful condition of the knee, like arthritis?”
To begin, there are many causes for “arthritis.” I’m using quotation marks since the patient has to be satisfied that the diagnosis of arthritis is correct in the first place. Arthritis of the knee should definitely be confirmed before any alterations of activity or lifestyle are made.
Alexander Redl / Unsplash
Osteoarthritis is usually secondary to some other cause that has caused the wear and tear of the joint. It could have been from previous trauma or injury, such as a fracture that disturbed the smooth cartilage of the femur, tibia or kneecap. A previous injury to one of the ligaments or to the cartilage in or around the knee can lead to instability and altered mechanics, resulting in premature wear. Arthritis can eventually be seen on an X-ray of the joint, but sometimes other imaging is needed to view early-stage cases. Arthritis produces symptoms of pain, swelling, redness and stiffness of the affected joint.
The Canadian Arthritis Society states that one in five Canadians over the age of 15 have arthritis. By 2031, it is projected to be one in four. Sixty percent of arthritis sufferers are female. Among all cases of disability in Canada, arthritis ranks first for women and third for men. The American Arthritis Society reports that more than 10 million Americans suffer from knee osteoarthritis, making it the most common form of arthritis in the United States.
Let’s assume that David has had his knee arthritis confirmed and now wants to know whether he should maintain the same level of intensity in his running as before. Or, should he cut back and quit running completely?
There are very few, and mostly anecdotal, reports that link running to the development of osteoarthritis. One report from Finland concluded that “life-long running” in male lab mice was associated with increased arthritis in the knee.1,2Other well-conducted, properly controlled studies have indicated that exercise is not inherently harmful to joints.
A report from Palo Alto, California determined that running activity over many years is not associated with an increase in joint or muscle pain, in spite of increasing age. The report suggested there might even be a decrease in joint and muscle pain in those who maintain an active running schedule. It also noted that vigorous physical activity was associated with decreased levels of disability with age and decreased mortality rates.3,4 Another California study looked at 498 long distance runners and compared them with 365 controls (non-runners) and concluded that “musculoskeletal disability” (osteoarthritis) appeared to develop with age at a lower rate in runners than in the non-runner group.5You can conclude from these studies that running does not lead to osteoarthritis—in fact, it may delay the onset of osteoarthritis and let you live longer!
Once you have osteoarthritis, does running make it progress more rapidly? Overuse or excessive use of a “mal-aligned” joint will lead to premature and worsening of symptoms of osteoarthritis. That is why the time-honoured advice given to patients by their doctors (such as losing weight, using a cane and resting the affected leg) still applies. However, this is usually applicable only to “end stage” osteoarthritis, which is so disabling that the only alternative is surgery. That is not what we are discussing in reference to David’s question.
In a long term study on the effects of weight loss on obese patients, researchers found that losing one pound of body weight results in a four-pound reduction in knee joint load for each step.6A study from Stanford followed two groups of people with osteoarthritis (runners and non-runners) and analyzed the progression of their arthritis over a five-year period with various tests, including x-rays. They concluded that running was not associated with more rapid progression or increased incidence of osteoarthritis of the knee or the spine.7
Treatment of an arthritic joint should follow the course of the patient’s symptoms. Use medications and other treatment advice as advocated by your physician. Strict rest and inactivity are no longer recommended. In fact, most treatment plans for arthritis include exercise as an important element, along with walking and running. Joint impact loads during running are less of a concern, whereas flexibility as a shock absorber is more important. This refers to the maintenance of appropriate muscular support of the limb through muscle strengthening.
At the annual meeting of the American College of Sports Medicine in Seattle, Dr. Kristin Baker presented her results of an investigation concerning exercise and osteoarthritis. She concluded that exercise routines designed to boost muscle strength can significantly reduce pain and clinical symptoms in patients with knee osteoarthritis. Her data showed that 38% of patients saw a reduction in their pain with exercises, compared to only 4% of the controls (who did not do the exercises). The investigators noted a 95% improvement in muscle strength in the affected quadriceps muscle.
So, in response to David: yes, you can run with a sore knee, but don’t overdo it. Pay attention to how the joint feels and let pain be your guide. If the pain increases, cut back. Be sure your muscles are strong and flexible, too.
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Dr. Richard Beauchamp is an orthopedic surgeon based in Vancouver. He is the medical director of the Shriner’s Gait Lab at Sunny Hill Health Centre and a clinical professor in the Department of Orthopedics at the University of British Columbia. He is an avid runner and walker who has completed seven marathons.