By: Erin Williams, PT, DPT

Knee Osteoarthritis: To run or not to run?

We gravitate toward running because of many wonderful benefits. To name a few, running maintains heart, lung, muscle, tendon, and bone density health – and that’s just the body! Running also helps improve mood, reduces stress (boosting the immune system), and gives us a great connection to our community. 

What is Knee Osteoarthritis?

Concerns about joint health have historically created hesitation around running. People are often particularly concerned about their coveted knees and avoiding the creation or progression of osteoarthritis (OA). Osteoarthritis is the most common joint disease. Osteoarthritis is the progressive damage to the cushioning tissue (cartilage) at the end of our bones. OA can result in fluid buildup, abnormal bony growth, and loosening and atrophy of muscle and/or tendons. This may limit motion and cause pain. Most of us have heard someone express, “running is bad for your knees.” While this claim may be said out of concern, the trouble is that it is missing some truth. 

Emerging Evidence

Over the past few years, research and some large reviews of studies have begun to to present a much more promising picture about knee health. Just like our muscles, tendons, and ligaments benefit from exercise and strengthening, as do the cartilage structures of our joints. Our joints are meant to accept load.

“Lower dose” (>57 miles/week = higher dose/intensity training) running has promise to be protective against OA (2). In a meta-analysis review by Alentorn-Geli et al. researchers looked at 17 studies with a total of 114,829 people. They found only 3.5% of recreational runners had hip or knee arthritis, for both male and female runners. Individuals in the studies who were sedentary and did not run had a higher rate (10.2%) of hip or knee arthritis (1, 4).

Even in people over 50 years old who have positive imaging (very normal as we age) and symptoms of OA have shown benefits to health and knee pain from “self-selected” running (3). They were slower and the amount of time ran was lower, but there was no progression of OA damage on joint imaging and even better, there was often improved pain.

Run for Your Knees

Running does not have to be “bad for your knees.” In fact, if you are a recreational/ habitual runner, keep on running! However, pay attention to OA risk factors, both modifiable and non-modifiable. One of physical therapists’ favorite modifiable risk factors is targeting muscle weakness through strength training for the muscles (BUT also the ligaments and joint structures) around the knee, hip, and even the ankle.

If you are currently running or wanting to begin running and are concerned about your risk of OA, we recommend discussing this with a physical therapist, and possibly a running coach. This would entail investigating preventive strategies such as conditioning and cross-training, potential weight management, assessing running volume/ timing, and navigating any injury history.

For more information or to chat with a PT, schedule an appointment! Sapphire PT also offers free injury consults at Runner’s Edge on the 2nd and 4th Thursday of each month.


  1. Alentorn-Geli E, Samuelsson K, Musahl V, Green CL, Bhandari M, Karlsson J. The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017;47(6):373-390. doi:10.2519/jospt.2017.7137
  1. Gessel T, Harrast MA. Running Dose and Risk of Developing Lower-Extremity Osteoarthritis. Curr Sports Med Rep. 2019;18(6):201-209. doi:10.1249/JSR.0000000000000602
  1. Lo GH, Musa SM, Driban JB, et al. Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative. Clin Rheumatol. 2018;37(9):2497-2504. doi:10.1007/s10067-018-4121-3
  1. Running and Osteoarthritis: Does Recreational or Competitive Running Increase the Risk?. J Orthop Sports Phys Ther. 2017;47(6):391. doi:10.2519/jospt.2017.0505