This is one of my favorites. Probably because I run and I know for a fact that my 50 year old knees have definitely taken some hits in the past! This is a frequent question. The fact is that recreational running has become more popular in recent years and many are doing it later in life and want to continue to do it. Does running lead to increased rates of cartilage deterioration in the hips and knees? If I'm still running at 50, am I looking at a joint replacement or 2 or 4 in the next 5, 10, how many years later?
First, let's go over some quick definitions. "Cartilage deterioration" is another way of saying "osteoarthritis" which is the process of wear and tear of the articular cartilage (surface cartilage) in all joints. All humans undergo this process to varying degrees over time. Sorry folks. Our joints, just like our other parts, do not last forever. For more on osteoarthritis and what it means, you can go here
For years it was assumed that "pounding the pavement" must not be good for your weight bearing joints and over time there must be increased joint damage compared to non-runners. Sounds logical but is it true?
Here is some of the data:
1) "Is Running Associated with Increased Osteoarthritis? An Eight Year Follow-up Study". From the Journal of Clinical Rheumatology 1995 by RS Panush et al. They followed eighteen non-runners and seventeen runners over eight years with serial joint examinations and xrays. "We did not find an increased prevalence of OA (osteoarthritis) among our runners now in their seventh decade. These observations support the suggestion that running need not be associated with predisposition to OA of the lower extremities"
2) From JAMA (Journal of the American Medical Association 1986;255 p1147-51 Fries et al) a study of 41 long distance runners aged 50-72. These were compared with 41 non-runners to examine associations of repetitive long-term physical impact with osteoarthritis.....They also used both repeat physical exam and xray.
"There were no differences between groups in joint space narrowing, crepitation, joint stability or symptomatic osteoarthritis"
3) This is an interesting study out of Germany from the journal 'Orthopade' 2006 by H Schmidt et al. They looked at 20 former elite marathon runners 20 years after their careers were over! Their conclusions: "Osteoarthritis of the knee joint is rare in former marathon runners. The risk of osteoarthritis of the hip joint seems to be higher than in control subjects who do not engage in much sport"
4)" Long distance running and knee osteoarthritis. A prospective study" This one is from the American Journal of Preventive Medicine, 2008 by EF Chakravarty et al.. Forty-five long distance runners and 53 controls were followed from 1984 through 2002. Conclusion: "Long-distance running among healthy older individuals was not associated with accelerated radiographic OA"
5) And finally some science out of the American Journal of Sports Medicine 2006 by Markus A. Kessler MD et al. "Volume Changes in the Menisci and Articular Cartilage of Runners" investigated changes in knee cartilage after running. Their conclusion:"...cartilage is able to adapt well to the loads caused by running"
Bottom line is that evidence strongly suggests running does not lead to increased knee cartilage damage. There is some evidence it may affect the hip over time but this is not conclusive as the data on the hip is generally mixed. In my practice if I do see someone with xray evidence of hip osteoarthritis I generally suggest that other exercises such as cycling or swimming might be easier on the joint long term.
For more on the sports medicine of running, you can go here
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