Does Long-Distance Running Lead to Knee Arthritis?

The debate still continues in the medical community regarding the connection of running and knee arthritis. Read on to learn more about the results of recent studies if long-distance running can lead to knee arthritis.

To begin, these first two studies we will discuss have shown contradictory results. In the first, patients who participated in light exercise routines suffered less arthritis than their running counterparts. Another study looked at x-rays of runners and non-runners and detected no difference between the two groups as far as arthritis tendencies. 

This conclusion astounded many physicians, who usually recommend that patients with knee arthritis stop running.  As Dr. Torrance writes in his book, “Motion is lotion.” In contrast, a study involving rats showed that running for extended periods led to arthritis in the rodents.

Which study is correct? Does the distance run make an impact?

One investigation reviewed ultra-marathoners serum COMP markers (bio-markers of cartilage damage that increase when the cartilage deteriorates). As expected, blood samples taken from ultra-marathoners (people who run farther than 26.2 miles at a time) had more serum COMP markers the farther the runners traveled. This shows a relationship between distance run and cartilage damage.

A study bearing similar results looked at the bone breakdown markers of people who ran a 246-kilometer race. Two other studies (study 1 and study 2) seem to back up these results.

Given that cartilage and bone erosion happens during long-distance runs, the question remains: does arthritis follow or is bone marrow concentrate able to repair the affected cartilage and bone? Several studies involving marathon runners have not seen an increase in MRI or cartilage lesions in the knees. However, one study did indicate marathon runners have thinner cartilage on their knee MRIs.

We still need to discover if an increase in serum COMP markers (the cartilage breakdown markers) means that arthritis will ensue.  After all, we are living organisms that are capable of healing ourselves. To learn this, we would have to find evidence of long-term changes after a lengthy run or conclusive studies showing ultra-marathon runners having arthritis versus non-marathon runners. 

As far as long-term changes go, one well-conducted study found that a specific MRI indicator (T1rho) in the knee meniscus is altered post-marathon. This means that there is less GAG, a chemical that helps cartilage and the meniscus stay shock-absorbent. Another aspect of this study’s conclusion is that there is no improvement three months after a race.

When we’re looking at an increase in arthritis, a German study analyzed 20 former elite marathon runners and non-runners (the control group). All participants were of comparable age and BMI (body mass index). The result? Marathon runners had no more arthritis than the control group. Please note that this study might have a “selection bias” because marathoners with significant arthritis probably won’t reach elite status.

Therefore, this study could have unintentionally chosen runners with healthy knees or weight-bearing exercise could be good for our joints.

Based on the data above, long-distance running can be linked to a breakdown of knee cartilage and the meniscus. While this alone isn’t cause for alarm, there is at least one study showing that the meniscus may not repair itself.

 We have yet to see a definitive study that indicates an increase in arthritis in marathon or ultra-marathon runners, but if you are one, stay tuned to your knees and seek medical attention to avoid serious issues.  Our Regenexx Procedure Candidate Form is a great place to start understanding if regenerative orthopedic medicine is right for you.

About The Author
Ron Torrance II, DO FAOASM

Ron Torrance II, DO FAOASM

Ronald Torrance II, DO FAOASM, is a non-surgical orthopedic physician specializing in Sports Medicine at Regenexx® at New Regeneration Orthopedics.
Ron Torrance II, DO FAOASM

Ron Torrance II, DO FAOASM

Ronald Torrance II, DO FAOASM, is a non-surgical orthopedic physician specializing in Sports Medicine at Regenexx® at New Regeneration Orthopedics.

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