Running has one of the largest participation rates in the world of any physical activity. With events ranging from ultra-marathons to 5km park runs, there are plenty of events for people of all abilities to test themselves against the clock and have some fun. Unfortunately, there is a common misunderstanding in the exercise industry that people with knee osteoarthritis (OA) should look at minimising their involvement in high impact sports such as running. This is due to the thought of potential degenerative structural change of the knee joint and the possible progression of the disease. Throughout this article I will discuss what osteoarthritis is, its link to running and shed some light on the common question “can I run with my knee osteoarthritis”? through a recently published research publication.
What is OA?
Osteoarthritis (OA), also known as degenerative joint disease, is a condition which is categorised in simple terms as the breakdown of cartilage. Cartilage is found at the end of each bone and acts as a lubricant to help the joint move freely while also acting a cushion to help with the absorption of force. The breakdown of cartilage can be a result from inflammatory properties, acute musculoskeletal injuries, natural ageing or a combination of these factors. Below is an image comparing a healthy joint to one that has OA.
What do we know currently?
Research has shown, via the use of imaging, that running does not increase the incidence of OA in people over the age of 50 in 2 separate studies at the 2 year (1) and 5 year (2) follow up points. A recent study in 2018 looked at already established OA & running and found that running was not associated with worsening knee pain or radiographically defined progression of the condition (3). The authors did mention that it was the first study to their knowledge that had evaluated the effects of running in those who had established knee OA. Although more research needs to be conducted in this area to understand the long-term effects, this does shed some light on the continuation of running in established knee OA.
If you have been diagnosed with knee OA and want to continue or pick up running as a hobby then there are certain things you need to consider. The approach to tackling this should be individualised by working with a qualified Accredited Exercise Physiologist, Performance Coach, Physiotherapist or Osteopath, and that the information you receive will be different from the information someone else receives with knee OA. Some things to consider, but not limited to are:
- Associated comorbidities or other injuries that accompany your OA
- Your injury and running history to help plan appropriate running loads
- Movement & Strength assessment to highlight movement limitation and strength capacity
- Current activity, symptoms and pain levels
It is interesting to note that pain may not always be associated with radiographically evident OA with a study in 2008 showing people with radiographical OA that also reported with knee pain ranged from 15-81% (4) while another study in 1990 found that only 53% of people with knee pain had radiographical osteoarthritis (5). This highlights something important that people with established knee OA may not have any symptoms of pain, so be wary of basing treatment on imaging.
Your focal point
Undertaking a strength program should the focal point of your initial programming as research (6) has shown significant improvements in strength, function and reductions in pain within OA. With running itself being a high loading and impacting activity, your strength training program should look at adding in elements that resemble the dynamic nature of running. For example, high velocity resistance training (greater focus on the shortening phase) which then builds into a plyometric (jumping) phase has been shown to improve muscle power (7) while also improving landing mechanics and overall force absorption (8). These will be great additions to your program, however it must be noted that this is an advanced form of training and should only be performed by trained and experienced clients, under the guidance of a skilled coach.
What are some steps on building running into my program
Here are some pointers on how you can go about introducing running into your program.
- Getting a customised strength program that focuses on your movement and strength capacity that gradually incorporates some training elements discussed above
- Understanding how you are tolerating your strength training loads through a patient tracker and wellness sheet
- Initially performing low load bearing aerobic activities to help promote aerobic fitness and improve your tissue tolerance to repetitive activities and movements
- Slowly and gradually perform a customised walking program that then incorporates some high speed or interval walking periods of higher intensities
- Introduce running on grass to minimise loading and ground reaction force. This can be done via the introduction of a run/walk strategy that has shown to report less pain and fatigue in marathon runners (9).
- Gradually introduce periods of road running exposure, while always tracking patient tolerance through a patient tracker as above
Remember the above steps are examples of how to go about incorporating running into your program, but should always be individualised and under the guidance of a qualified Accredited Exercise Physiologist, Performance Coach, Physiotherapist or Osteopath.
While there is still more research needed to be done in relation to running protocols in already established knee OA, early indications are positive. As long as there is prior application of a thorough strength training program before the initiation of your running phase, you will give yourself the building blocks to progress safely. When seeing whether you are able to start a running protocol, consider all factors above, not relying on imaging and most importantly, see an expert to guide you.
From Accredited Exercise Physiologist & Performance Coach Adam Luther
- Lane, N., Bloch, D., Hubert, H., Jones, H., Simpson, U., & Fries, J (1990). Running, osteoarthritis, and bone density: initial 2-year longitudinal study. American Journal of Medicine
- Lane, N., & Michael, B., & Bjorkengren A. (1993). Running was not associated with increased progression or incidence of osteoarthritis of the knee or spine. American College of Physicians
- Lo, G., Musa, S., Driban, J., Kriska, A., McAlindon, T., Souza, R., Petersen, N., Storti, K., Eaton, C., Hochberg, M., Jackson, R., Kwoh, C., Nevitt, M., & Suarez-Almazor, M. (2018). Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative. Journal of Clinical Rheumatology
- Bedson, J., & Croft, P (2008). The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. Journal of BMC Musculoskeletal Disorders.
- Lethbridge, C., Scott-Jr, W., Reichle, R., Ettinger, W., Zonderman, , Costa, P., Plato, C., Tobin, J., & Hochberg, M. (1995). Association of radiographic features of osteoarthritis of the knee with knee pain: data from the Baltimore Longitudinal Study of Aging. Arthritis Care Res.
- Latham, N., & Lui, C. (2010). Strength training in older adults: the benefits for osteoarthritis. Journal of Clinical Geriatric Medicine.
- Fielding, R., LeBrasseur, N., Cuoco, A., Bean, J., Mizer, K., & Fiatarone, M. (2002). High velocity resistance training increases skeletal muscle peak power in older women. Journal of the American Geriatric Society.
- Davies, G., Riemann, B., & Manske, R. (2015). Current concepts of plyometric exercise. International Journal of Sports Physical Therapy.
- Hottenrott, K., Ludgya, S., Schulze, S., Gronwald, T., & Jager, F. 2016 Does a run/walk strategy decrease cardiac stress during a marathon in non-elite runners. Journal of Science and Medicine in Sport.