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Running With Arthritis: You Can Keep Your Running Routine!

Strategies for Runners with Arthritis, What Does The Science Say?

Have you ever felt pain or stiffness in your ankle, knee, or hip joint and wondered if you should run through it or stop and have it looked at by a professional? 

Chances are that if you have pain in one or more of your joints that is continuous, you may have developed a form of arthritis.

If you have arthritis, it does not mean that you have to stop training; it just means that you may have to adjust your training.

There are several forms of arthritis, and contrary to popular opinion, people (and animals) of all ages and body types are susceptible to developing a form of arthritis. 

In fact, according to a longitudinal study1Murphy, L., Schwartz, T. A., Helmick, C. G., Renner, J. B., Tudor, G., Koch, G., Dragomir, A., Kalsbeek, W. D., Luta, G., & Jordan, J. M. (2008). Lifetime risk of symptomatic knee osteoarthritis. Arthritis & Rheumatism59(9), 1207–1213. https://doi.org/10.1002/art.24021 of over 3,000 people, arthritis has a high prevalence, with one in four people experiencing a form of arthritis in their lifetimes. Runners and nonrunners!

An elderly runner holds their knee.

Arthritis: How Does It Affect You As An Athlete?

No matter what your level of fitness, if running and exercise are part of your life you are an athlete! 

And as an athlete, you are probably used to running with and dealing with occasional aches, pains, soreness, stiffness, even injury.

For some of us, it is more than occasional, depending on your training plan.

Athletes with arthritis may have more frequent symptoms, and they may last longer than those without arthritis.

But is it OK to run if you have arthritis?

As we mentioned before, it does not mean that you have to stop training; it just means that you may have to adjust your training.

If you are starting out running, and have a history of osteoarthritis, you should start gradually, alternating between running and walking.  This allows the joints and supporting muscles, like the quads and hamstrings, to adjust to the new movement.

The effects of running should be positive, but running with arthritis means that you will need more recovery and perhaps increase your strength training to increase muscle mass to support those affected joints.

Increasing muscle mass, by the way, also increases resting metabolism and therefore reduces your risk of developing obesity, which in turn reduces your future risk of arthritis.

As you know, regular running has numerous whole-body benefits, even in times of soreness and times of stress!

A close up of a knee joint.

Knee Arthritis: Is It the End of Your Running?

The points about slow progression, strength training, and recovery are especially important for athletes who have arthritis in their knees

The knee joints are especially prone to cartilage damage and need tender loving care in the form of rest and muscular support to help adjust to running.2Running Safely With Knee Osteoarthritis | Arthritis Foundation. (n.d.). Www.arthritis.org. https://www.arthritis.org/health-wellness/healthy-living/physical-activity/other-activities/running-safely-with-knee-osteoarthritis

Over time, physical activity, in particular running, actually increases cartilage growth. A much better option than a knee replacement!

Don’t listen to those who may tell you to stop running if you have arthritis; just tell them that you’re growing with every run!3Chakravarty, E. F., Hubert, H. B., Lingala, V. B., Zatarain, E., & Fries, J. F. (2008). Long Distance Running and Knee Osteoarthritis. American Journal of Preventive Medicine35(2), 133–138. https://doi.org/10.1016/j.amepre.2008.03.032

Another technique to support your knee joints is to work them in different ways

If you are accustomed to running on concrete or asphalt, try running on different terrains to help cushion your runs.

Gravel, dirt, turf, cushioned track surfaces, these landing zones work different muscles in your feet and legs. 

How effective is an evidence-based exercise intervention in individuals with patellofemoral pain? Exercise intervention is key to eventually overcoming knee pain.4Lo, G. H., Musa, S. M., Driban, J. B., Kriska, A. M., McAlindon, T. E., Souza, R. B., Petersen, N. J., Storti, K. L., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Nevitt, M. C., & Suarez-Almazor, M. E. (2018). Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative. Clinical Rheumatology37(9), 2497–2504. https://doi.org/10.1007/s10067-018-4121-3

‌Also, adding hill work into your routine will strengthen the muscles around the knee joints, and the bonus is the increased cardiovascular work it takes to crush those hills!

Changing up your terrain will help strengthen the smaller, stabilizing muscles that support your joints. 

So, go ahead and treat your soft tissue to new and possibly welcoming surfaces! 

Another way to support the knee pain is to run in supportive shoes with cushioned soles.  Supportive running shoes are designed to absorb more force will help take the load off your knees.

If you are a barefoot runner or are running in a neutral running shoe, one with more stability may help your arthritis symptoms.

Your joint health will thank you!

There are also cutting-edge therapies in laboratories around the world, including injectables that help regenerate cartilage and others that may stop the breakdown.  These are not yet available for consumer use, but stay tuned!

A runner clutches their knee while on a run.

Does Running Make Arthritis Worse?

Does running cause knee osteoarthritis?

There are several studies that have shown running actually improves arthritis5Lo, G. H., Musa, S. M., Driban, J. B., Kriska, A. M., McAlindon, T. E., Souza, R. B., Petersen, N. J., Storti, K. L., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Nevitt, M. C., & Suarez-Almazor, M. E. (2018). Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative. Clinical Rheumatology37(9), 2497–2504. https://doi.org/10.1007/s10067-018-4121-3

Routine activity, such as recreational runners, has been shown to reduce total body inflammation and thus reduce the risk of arthritis. 

The anti-inflammatory benefits of regular exercise have the potential to reduce arthritis symptoms.  

The key to these benefits is that exercise needs to be a regular part of your daily life.

Ten Tips To Keep Running With Arthritis And Not Get Injured

Tips:

A personal trainer trains a client.

Different Types of Arthritis

There are several different types of arthritis that affect both young and older adults.  The most common types are:

  • Osteoarthritis (degenerative type),
  • Rheumatoid arthritis, psoriatic, ankylosing spondylitis (inflammatory types),
  • Infectious Arthritis,
  • Gouty Arthritis (Metabolic type)

The scope of this article will focus on Osteoarthritis (OA), the most common one and the one we think of as “wear and tear” on the joint.7Centers for Disease Control and Prevention. (2023, June 13). Osteoarthritis | CDC. Www.cdc.gov.

How Do I Know If I Have Arthritis?

There are four main symptoms of osteoarthritis, and you may experience one or all of them in one or more joints. 

The four main symptoms are:

  • Joint pain.
  • Swelling.
  • Stiffness.
  • Difficulty With Joint Mobility.

The main joints affected by arthritis in runners are the hips and knees. In OA, the spongy, impact-absorbing tissue called cartilage breaks down over time, and the bone underneath can become damaged. 

Risk factors for OA include:

  • Obesity (Body Mass Index / BMI >30.0).
  • Sedentary Lifestyle.
  • Age (OA risk increases with age).
  • Gender (women after age 50 more at risk than men).
  • Genetics.
  • Running Injuries or Overuse.
A picture showing common areas of arthritis.

The first bit of good news is that runners and athletes overall are at lower risk of developing OA simply due to their reduced body weight, or increase in lean body mass.

Obesity is the largest risk factor for OA due to chronically increased stress placed on the joints. 

The second good bit of news is that an active lifestyle also puts people at lower risk for OA. As a runner you most likely already have an active lifestyle, so you are at low risk for developing OA.

Diagnosing Arthritis

Arthritis can be best diagnosed by a healthcare specialist (think physiotherapist, orthopaedic practitioner, pain specialist, or physical therapist) with a combination of a good history, a physical exam, and a few X-rays.

Occasionally, some people will need more specialized tests such as ultrasounds, MRIs, or nerve testing, and sometimes blood tests to see if there are chemicals in the body causing damage to the joints.

The workup of osteoarthritis will also tell you about the severity of the joint inflammation, which helps guide your treatment.

A specialist will usually recommend a course of physical therapy to strengthen the tendons and ligaments through various forms of exercise to reduce arthritis pain and symptoms over time.

A doctor looks at a patient's knee.

Final Thoughts

Despite concerns about exacerbating symptoms, research suggests that regular running, when approached with caution and accompanied by appropriate adjustments in training and recovery, may actually alleviate arthritis symptoms and reduce the risk of joint deterioration.

While arthritis presents unique challenges for marathon runners, such as increased risk of injury and weight loss, implementing strategies like gradual progression, strength training, and terrain variation can help mitigate these risks.

It’s essential to listen to your body, seek professional advice, and prioritize recovery to ensure a sustainable running practice.

Related article: Is Running Bad for Your Knees?

References

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I am a native Texan, born to run, enjoy and live life outdoors. My medical career has allowed me to live in Philadelphia, Boston, San Antonio, Minneapolis, and now Columbus Ohio. I am trained as a general surgeon, have practiced acute care, trauma, burn, and general surgery. I've traveled and found running groups throughout Europe and Singapore. My favorite sports are whatever my kids are playing. I run to feel great! Favorite running companion is CrossFit, favorite hobbies are cooking and travel! Goal: Can't wait to run my first International Marathon!

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