Should Runners Stop Running if They Have Risk Factors for Hip or Knee Osteoarthritis?

Chicago Marathon participants assisted orthopaedic researchers in further understanding the impact of long-distance running on bone and joint health, specifically knee and hip osteoarthritis (OA) in recreational runners. Results from the largest survey of marathon runners ever conducted showed no association between cumulative running history and the risk for OA.

Results of the study, Does Running Increase the Risk for Hip and Knee Arthritis? A Survey of 3,804 Chicago Marathon Runners, were presented at the 2023 annual meeting of the American Academy of Orthopaedic Surgeons.

“Despite growing knowledge that running and being active can be healthy for your joints, there is a continued dogma among the healthcare community that patients should stop running to avoid wearing out their cartilage,” said lead author Matthew J. Hartwell, MD.

“In fact, our survey showed that 1 in 4 people have received a recommendation by their physician to reduce their running volume, and for those with arthritis, nearly 50% of runners were told by their physicians to stop running altogether.”

Dr. Hartwell is currently an orthopaedic surgery sports medicine fellow at the University of California San Francisco. He and his colleagues conducted this prospective cohort study during his residency at Northwestern University Feinberg School of Medicine in Chicago.

30 Questions

The electronic survey was completed by 3804 participants registered for the 2019 and 2021 Chicago Marathons. The mean age of respondents was 43.9. Participants had run an average of 5 or fewer marathons, and they had been running for an average of 14.7 years.

The survey featured 30 questions, including queries about:

  • Demographic information: Age, sex, height, weight, country of origin, and occupation
  • Running history: Number of years running; average weekly mileage over the past year; average running pace during training runs; number of marathons completed, including ultra-marathons; and participation with cross training
  • Hip/knee health: Occurrence of hip or knee pain over the past year that prevented running, a history of hip or knee injuries that required a break in running, a family history of hip and/or knee OA, surgical procedures performed on the hip or knee. and receiving a hip or knee arthritis diagnosis

About 7% of respondents had hip and/or knee OA. Risk factors for OA included prior hip/knee injuries or surgery, advancing age, family history, and BMI, while cumulative number of years running, number of marathons completed, weekly mileage, and mean running pace were not significant risk factors for OA.

“Our multivariate analysis showed that the factors that increase a person’s risk for arthritis are the same for anyone with joint degeneration — whether or not they’re a runner,” Dr. Hartwell said.

Dedicated Athletes

The participants were also asked if a physician had ever advised them to stop or reduce their running, if they were still running at the time of questionnaire completion, and if they plan to run another marathon. The majority (94.2%) of runners planned to run another marathon despite 24.2% of all participants being told by a physician to do otherwise.

“Recreational runners are a dedicated group of people who use the sport for exercise, mental clarity, or to challenge themselves,” said Vehniah K. Tjong, MD, associate professor of orthopaedic surgery at Northwestern University.

“Our hope is these findings educate physicians, so they don’t instinctively advise against running and they work to meet patients on their level — because, as these data show, runners are likely to continue running despite medical advice.”

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