Low Prevalence of Hip and Knee Arthritis in Active Marathon Runners
Seven pages on PainSci cite Ponzio 2018: 1. Is Running on Pavement Risky? 2. The Complete Guide to Patellofemoral Pain Syndrome 3. Guide to Repetitive Strain Injuries 4. 5 reasons running on pavement probably isn’t injurious 5. How do you slow down the progression of arthritis? 6. Running does not wreck knees (probably) 7. Exercise is anti-inflammatory medicine for injuries (Member Post)
PainSci notes on Ponzio 2018:
In this survey of 675 marathoners, there was no link between current arthritis symptoms and their running history, and they had a lower rate of arthritis than the general population. That is, no matter how much they ran, they had the same low rate of arthritis: about 9%, compared to 18% in non-runners.
This is good-news evidence that challenges the assumption that relentless “pounding” on the road is hard on joints, as many other studies have. But we’re still far from “proof.” For something closer, see Chakravarty — the best single study on this topic that I’m aware of to date.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
BACKGROUND: Existing evidence on whether marathon running contributes to hip and knee arthritis is inconclusive. Our aim was to describe hip and knee health in active marathon runners, including the prevalence of pain, arthritis, and arthroplasty, and associated risk factors.
METHODS: A hip and knee health survey was distributed internationally to marathon runners. Active marathoners who completed ≥5 marathons and were currently running a minimum of 10 miles per week were included (n = 675). Questions assessed pain, personal and family history of arthritis, surgical history, running volume, personal record time, and current running status. Multivariable analyses identified risk factors for pain and arthritis. Arthritis prevalence in U.S. marathoners was compared with National Center for Health Statistics prevalence estimates for a matched group of the U.S. population.
RESULTS: Marathoners (n = 675) with a mean age of 48 years (range, 18 to 79 years) ran a mean distance of 36 miles weekly (range, 10 to 150 miles weekly) over a mean time of 19 years (range, 3 to 60 years) and completed a mean of 76 marathons (range, 5 to 1,016 marathons). Hip or knee pain was reported by 47%, and arthritis was reported by 8.9% of marathoners. Arthritis prevalence was 8.8% for the subgroup of U.S. marathoners, significantly lower (p < 0.001) than the prevalence in the matched U.S. population (17.9%) and in subgroups stratified by age, sex, body mass index (BMI), and physical activity level (p < 0.001). Seven marathoners continued to run following hip or knee arthroplasty. Age and family and surgical history were independent risk factors for arthritis. There was no significant risk associated with running duration, intensity, mileage, or the number of marathons completed (p> 0.05).
CONCLUSIONS: Age, family history, and surgical history independently predicted an increased risk for hip and knee arthritis in active marathoners, although there was no correlation with running history. In our cohort, the arthritis rate of active marathoners was below that of the general U.S.
POPULATION: Longitudinal follow-up is needed to determine the effects of marathon running on developing future hip and knee arthritis.
LEVEL OF EVIDENCE: Prognostic Level III.
related content
- “High-Field Magnetic Resonance Imaging Assessment of Articular Cartilage Before and After Marathon Running: Does Long-Distance Running Lead to Cartilage Damage?,” Luke et al, American Journal of Sports Medicine, 2010.
- “Effects of running and walking on osteoarthritis and hip replacement risk,” Williams, Medicine & Science in Sports & Exercise, 2013.
- “The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis,” Alentorn-Geli et al, Journal of Orthopaedic & Sports Physical Therapy, 2017.
- “Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative,” Lo et al, Clin Rheumatol, 2018.
- “Long distance running and knee osteoarthritis. A prospective study,” Chakravarty et al, Am J Prev Med, 2008.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
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- Gabapentinoids and Risk of Hip Fracture. Leung 2024 JAMA Netw Open.
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