Does Running Ruin Your Knees?
Most of the group of guys that I tend to golf with know that I run quite a bit and occasionally, some comments are made. Last week, one of them got a very serious tone (which is a rare thing with the guys I golf with). With all sincerity, he cautioned me, “You should be careful. Of all the guys that I hung around with when I was younger, the guys who used to run are now the ones having knee and hip problems. You know running ruins your knees, right?”
“Hang on a minute there Skippy…” is what was on the fast track from my brain to my vocal cords, but I managed to come out with a more polite response. “Well, the research doesn’t actually back up that statement, in fact some of it says the opposite.”
My buddy didn’t really care to hear about clinical research studies and the conversation quickly died out since after all, we were golfing and conversations never last long when the beer cart pulls up.
Hopefully, you are reading this because you are interested, so lets take a closer look at the studies:
Studies Linking Running with Arthritis:
Marti et al  compared hip x-rays in 27 elite runners, 9 bobsledders, and 23 sedentary people. The runners had the highest evidence of arthritis in the hips. Age, mileage, and running pace were independent predictors of hip arthritis. For example, running more than 65 miles per week was associated with significantly more degenerative changes on the x-rays. Faster running pace was an even stronger predictor of degenerative changes than running mileage.
Cheng et al  surveyed 17,000 clinic patients over a 25 year span looked at the relationship of self-reported physical activity and physician-diagnosed osteoarthritis. They found increased physical activity was associated with increased arthritis, including running more than 20 miles per week in men younger than 50 years. However, no association was found with physical activity levels and osteoarthritis in women or in men older than 50 years.
Studies Reporting No Link Between Running and Arthritis
There are far more studies in this category. I will only outline a few but trust me, if I discussed all of the articles that refute running being associated with arthritis, none of you would continue to read this – with or without a beer cart distracting you.
Sohn et al  looked at 504 collegiate cross-country runners vs. 287 collegiate swimmers. They surveyed them between 2 and 55 years after graduation and found severe hip or knee pain in 2% of the runners compared with a 2.4% of the swimmers. They found no differences in pain between the high mileage and low mileage runners.
Kohatsu et al  took a history and did physical examinations and x-rays of 46 people with severe knee arthritis and compared the results with 46 age matched controls. They found twice as many runners in the control group than in the arthritis group, suggesting that running may actually have a protective effect against developing osteoarthritis.
Cymet et al  was a review study, done solely on long-distance running. They found it does not increase the risk of osteoarthritis of the knees and hips for healthy people and “that this activity might even have a protective effect”. They went on to tout the other benefits of running by citing other research findings: “Running has been shown to decrease the risk of cardiovascular disease,diabetes mellitus, and depression. This kind of physical activity has also been shown to help with weight control, to improve bone density, and to decrease mortality. ”
Bosomworth  – This study reviewed all previous studies done up until January 2009. They found that:
- “The best evidence suggests that exercise, at least at moderate levels, does not accelerate development of knee osteoarthritis. Running seems to be particularly safe.“
- “marathon running does not seem to induce changes in joints or increase the risk of osteoarthritis in most studies.”
- “There is evidence for reduction in lower-extremity disability and all-cause disability in self-selected runners compared with controls.”
- “There is some evidence for prolongation of lifespan in self-selected runners.”
In the most recent review of all the literature, Henson et al  concluded, “The existing literature fails to support an association or causal relationship between low- and moderate-distance running and osteoarthritis…Inconclusive evidence exists regarding high-volume running and the development of osteoarthritis.” They go on to say, “The existing literature supports the assertion that older runners are generally healthier than their nonrunning counterparts.”
When you consider that running has been shown to reduce the risk of stroke [Williams 2009], marathoners reduce the risk of hypertension, diabetes and high cholesterol [Williams 2009], improve moods [Schneider 2009], increase bone density [Wilks 2009] and just generally decrease disability and mortality [Chakravarty 2008], it becomes hard to argue that “running is bad for you”
Here’s the caveat: These studies are all looking at associations. Maybe, just maybe, people who run their whole lives are living different lives than those who don’t run. Maybe those who don’t run also don’t eat as well, maybe they also smoke, maybe they are more obese (which has a huge association with knee and hip arthritis.) This reminds me of a study that recently came out that said men who skip breakfast have a 27% higher chance of a heart attack during a 16 year study. Well, maybe those men who skip breakfast are just generally less healthy. Are those the guys who will eat less healthy food as well? Are they the guys who don’t get up early and exercise? Are they the guys who skip breakfast because they were up later at night? There are a lot of variables.
What we can say, is we are pretty sure that in general, running does not “ruin” your knees. As usual – proper running form (via Running Reform) with careful, and thoughtful training including gradual increases in mileage and pace are recommended.