Does Running Really Cause Knee Osteoarthritis?

 In Running

It is hard to argue that the benefits of running aren’t worth the risk or hardship that might be associated with running.

Yet so often as a physiotherapist I hear people tell me that they choose not to run because they do not want to get injured or develop osteoarthritis of their knees. So they ‘shy away’ from running fearful of the possible damage it may cause all founded on the belief that running will ‘wear their knees out’.


As a physiotherapist the ‘rationaliser’ people espouse to not run based on the fear of developing worn out knees has long bothered me. My response to hearing this excuse has typically been based around why the running avoidant individual should consider the many life enhancing benefits of running; the time efficiency, the fitness, the weight loss, the leg strength, and the reduced chance of dying from cardiovascular disease (see Running Reduces Your Chance of Dying).  In addition to these pro-running arguments I have harboured a belief and theory that running instead of wearing out people’s knees may actually prevent knee osteoarthritis and result in healthier knees.

My belief that running may help people’s knees has been formed over 8 years of treating runners and delivering in excess of 25,000 physiotherapy consultations in that time. I have observed that those people who stay ‘in shape’ by running (or other exercise means) tend to go onto have better physical health through their life span. Meanwhile those who are ‘out of shape’ and carrying few (or more) extra kilograms of bodyweight are not exercising (or running) often present suffering from joint related pains such as knee, hip, and lower back pain. So I coached runners that they need not be fearful of deleterious effects of running on their knees based on this observation and from my knowledge the little quality or reliable research which has looked at the association of running and the development of knee OA.


However I was thrilled to discover that in March 2014 a research paper was published in the American College of Rheumatology Journal which revealed that runners do not have a high risk of developing OA when compared with non-runners. It was further revealed that running may even help prevent the onset of knee osteoarthritis.

Researchers analysed data from more than 2,600 subjects who provided information about the three most common forms of exercise that they had performed through -out their lives. The average age of the volunteer subjects was 64 years. The time periods of the subject’s lives that were assessed were between the ages of 12-18 years, 19-34 years, 35-49 years, and 50 years and beyond. Among the subjects 56 per cent were female and 29 per cent reported being runners at some stage through-out their lives.

At study baseline participants were assessed for symptoms of knee OA and underwent x-rays. Knee x-rays were then taken 2 years later and were assessed fir signs of knee OA.  In addition participants were also assessed for clinical signs of knee pain.


The study’s key findings were:

  1. Runners who engaged in regular running experienced knee pain less often than non –runners. This finding was irrespective of what period of their lives they ran. Of participants who ran at any point in their lives 22.8% experienced symptomatic (or painful) knee OA compared with 29.8% of non- runners.

  2. Regular running even at a non-elite level does not increase the risk of knee osteoarthritis among the general population. In fact running may even protect against the development of knee OA.

  3. There is no reason to restrict participation in habitual running at any stage of life as running does not appear to be harmful to the knee joint.

  4. People with a lower BMI (body mass index) were more likely to engage in regular running.

It should be noted that the study did not address the question of whether or not running is harmful to people who have pre-existing knee osteoarthritis.

So next time you consider not running on the basis of not wanting to ‘wear out’ your knees-reconsider your thinking. Get out there and JUST DO IT!

Brad Beer (APAM)

Physiotherapist, Author, Founder POGO, Runner


  1. Habitual Running Any Time in Life Is Not Detrimental and May be Protective of Symptomatic Knee Osteoarthritis: Data from the Osteoarthritis Initiative. Grace H. Lo, Jeffrey B. Driban, Andrea Kriska, Kristi Storti, Timothy E. McAlindon, Richard Souza, Charles B. Eaton, Nancy J. Petersen and Maria E. Suarez-Almazor. The American College of Rheumatology Annual Meeting. Paper 2895, Boston.

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