This past month I enjoyed a coffee with a local colleague. We caught up on recent personal and professional news. I noted I was in the final stages of training for a half marathon.

She looked at me quizzically. It was the type of look that said, “come on you know better than to do that.“

I knew what she was going to say but I wanted her to say it anyways.

“Don’t you treat a lot of people with knee and hip arthritis.”

I saw this is an opportunity to advance my colleagues understanding of the numerous benefits of running on joints! Here are some of my favorite bullet points:

• Wear and tear is a misconception. Joints/cartilage adapt to stress. The saying should be updated to wear and repair.

• A systematic review in 2016 looked at the association of running and the development of hip or knee osteoarthritis found recreational runners had a lower occurrence of osteoarthritis compared to sedentary and competitive runner counterparts.

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• A 2018 study, followed a group at individuals who were over 50 years old with diagnosed knee osteoarthritis. They found running was able to improve their knee pain and did not contribute to any progression of the arthritis on x-rays.

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• What about marathons? A group of researcher’s performed MRI’s on 44 runners four months pre, immediately before and after then six months post marathon. They found cartilage and bone improvements in the subject’s knees during 4 months of training! Although immediately following the marathon there was worsening of the cartilage to the knee cap, this was reversed at the 6 month follow up.

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When we parted ways, I do not think she endorsed my running habit, but maybe I started to lay the foundation for a new perspective!

The modern physical therapist not only has a responsibility to help people get out of pain to move better, but we also have a role in providing health and wellness education and promotion strategies.

One of my favorite groups of people to work with are former runners. This is a group who have been dogmatically told that running is bad for their joints. Thus, most of them stop running when told this by healthcare providers. Through a foundation of strength and conditioning, facilitating optimal biomechanics, and teaching appropriate training behaviors, we can facilitate the return to running process.

A key tenet to our approach is movement is medicine. What better way to promote health than to empower runners to run! Informed with what we know about running’s effect on knees combined with the beneficial effects of exercises on joints, running can be a safe, simple and cheap way to receive quality exercise and to live longer!

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As always, I'd love to hear your thoughts and please share this with any friends or family members who enjoy running!

p.s. This article was originally written for my monthly newsletter. In reviewing it to post as a blog, I thought I should provide the cons of running on joints as well.

Here they are:

• After a single run, cartilage thickness decreases and levels of serum protiens associated with cartilage breakdown increase

  • These return to baseline 24 hours and up to 30 minutes later, respectively

  • Runners have higher baseline of cartilage thickness then sedentary peers

  • Running/exercise inhibits pro-inflammatory protiens and enzymes

• A 2014 study MRI’d 10 healthy runner’s knees pre and 6 months following marathon training. They found no change in cartilage at the knee cap, tibia and medial femur (3 of the 4 surfaces of the knee joint. They did not a loss of cartlage at the lateral femoral condyle but it was not clinically relevant

• The Marathon researcher’s noted above did find after the marathon the cartilage of the knee cap worsened according to the radiograph report yet the subjects were asymptomatic AND by the 6 month study the changes reversed to baseline.

• A 2023 systematic review of running’s effect on osteoarthritis looked at 17 studies and over 14 thousand participants. It found runners with knee OA had better pain and function reports compared to their sedentary peers as well as no worsening of OA on radiologic studies.

Conclusion. Running is highly effective and safe. We still do not know the ideal dosage to promote healthy joint changes nor those that would yield negative joint changes… my experience tells me it is individualistic. Running and movement are dose related. As long as the loads we put on the body are progressed slowly and gradually, the body will adapt.

If you are stuck or still have more questions, I’m happy to chat!