Does Running Cause Arthritis?

My 85-year-old Aunt Marian thinks it’s pretty cool that I’m a runner. The only problem is that she wants me to give it up. In her opinion, I’m doing fine now but trouble looms. A few years down the road, I’ll probably need a wheelchair. All that pounding and wear and tear; it can’t do the body any good, she thinks. Marian’s got her share of aches and pains, and loving auntie that she is, she doesn’t want me to end up in even worse shape.

I bet you’ve got an Aunt Marian in your life, too – a family member, or friend, or colleague who’s always worrying about the toll running is taking on your knees, hips, and back. You might even be worried yourself. We all know a few one-time runners forced to become swimmers, cyclists, or power-walkers. We wonder if the same fate awaits us?

The logic behind the wear-and-tear scenario can seem convincing. After all, your car eventually breaks down, even if it’s a Volvo. It’s the same for your toothbrush, and the foam in your shoes. You’ll need to replace them at some point. You understand that, and you’ve worked the expense into your budget. The chances are, however, that you’re not so keen on the idea of replacing body parts.

Fortunately, your body is different. It’s a biomechanical system, not a mechanical one, and those three little letters make all the difference. Your body is composed of living tissues that are constantly rebuilding themselves. Not only that, but living tissue actually grows stronger when it is used. Use is better than abuse, which includes both sedentary living and running when you’re injured, which is why you shouldn’t do either.

The strongest evidence that running won’t condemn you to a life of pain and arthritis comes from an ongoing study of the Fifty Plus Runners Association. The study was launched in 1984 when all the runners were at least 50, and it has been updated every five years or so. Many of the runners are now in their 60s, 70s, and beyond.

The newest update was published last September in Arthritis Research & Therapy, under the title "Aerobic exercise and its impact on musculoskeletal pain in older adults: a 14-year prospective, longitudinal study." It compared the runners, who averaged about 26 miles a week, to a matched set of controls, who averaged about two miles a week. The authors noted that many observers would predict a sad outcome for the ageing runners. "If running creates damage through accumulated trauma," they wrote, "then runners with about ten-fold the exposure to such trauma should have increased pain over time."

Yup, that’s it: the Aunt Marian argument in a nutshell. Only the argument appears to be unfounded, probably for some of the biomechanical reasons I’ve already mentioned. The study’s major conclusion was that the runners experienced "about 25 per cent less musculoskeletal pain" than the controls.

Dr Bonnie Bruce, the principal investigator, is a doctor of public health as well as a registered dietitian and a marathon runner. I called her to find out why she chose to measure a subjective feeling such as pain rather than a more objective, physical one such as joint-space narrowing. "Think about it," she says. "When you’re in pain, you can’t move about the way you’d like, you can’t work effectively, and you can’t enjoy a good social life. Pain is important, because it affects every aspect of our lives."

Before long, we’re discussing the widely held misperception that vigorous exercise, especially running, will inevitably lead to joint problems. Bruce thinks it comes from the way that running has so often been used as punishment. "It was what your PE teacher made you do when you weren’t behaving," she says. It would help immensely if medical investigators could explain why running and other vigorous exercise don’t lead to joint pain. Unfortunately, few doctors are willing to make this leap, and Bruce certainly isn’t one of them. She makes it clear that her research only uncovered pain trends – and not the pathways behind them. She does, however, list some possible explanations: endorphins, fewer muscular injuries, and the high pain threshold that runners might develop. An Arthritis Foundation paper called "Exercise and Your Arthritis" offers a more direct answer. "The stronger the muscles and tissues around your joints, the better they will be able to support and protect those joints," it says. "If you don’t exercise, your muscles become smaller and weaker."

It’s exciting to find a long-term study that supports the connection between running and good joint health, but I wonder how many other doctors and medical organisations are ready to take up the cause. To check up, I called Dr Patience White, the chief public health officer of the Arthritis Foundation. I told her about the Fifty Plus runners, and asked if she’s surprised by the results. "That study makes complete sense to me," she said. "People with pain in their joints imagine that runners must have even more pain, but we have lots of good data to show that running doesn’t cause arthritis."

She went on to say that obesity is a major culprit in the onset of arthritis, and that runners do themselves a lot of good simply by keeping the pounds off. Also: "Runners keep their muscles strong and well-balanced, which helps the joints."

Music to my ears. Of course, it will be a long time before we runners convince sceptical friends that we aren’t headed for a hellish destiny with pain and arthritis. But keep the faith; the tide is turning. The medical community is slowly coming to accept that running is good for your joints, as well as your heart, and the evidence is growing. This doesn’t give you license to pound out long runs while swallowing a handful of ibuprofen, but regular, moderate, pain-free running? Get out there and enjoy it, no matter what your auntie says.