Does Running Cause Knee Osteoarthritis? A Systematic Review Says Otherwise
For years, runners have been told that “running will ruin your knees.” But a growing body of evidence — including a recent systematic review published in the Orthopaedic Journal of Sports Medicine (Dhillon et al., 2023) — challenges that long-held belief.
This comprehensive review examined 17 studies involving more than 14,000 participants (7,194 runners and 6,947 non-runners) to determine whether running contributes to or protects against knee osteoarthritis (OA). The results were striking: in the short term, running is not associated with worsening joint health and may even be protective against knee pain and disability.
The Study at a Glance
Researchers from Rocky Vista University and Houston Methodist Hospital analyzed clinical, imaging, and patient-reported data from thousands of adults across multiple cohorts. The goal was to determine whether habitual running increases the risk of developing knee OA or accelerates its progression.
Across studies that used X-rays, MRI, and validated outcome measures (like the Knee Injury and Osteoarthritis Outcome Score), runners showed no greater prevalence of radiographic OA or cartilage damage than non-runners.
In fact, non-runners were significantly more likely to report knee pain (41% vs. 28%) and had a higher risk of knee replacement due to OA progression (4.6% vs. 2.6%).
Key Findings
Running does not accelerate cartilage wear.
Multiple MRI-based studies found no difference in cartilage thickness or degeneration between runners and non-runners (e.g., Mosher et al., 2010; Mühlbauer et al., 2000).Less knee pain among runners.
Non-runners reported significantly higher rates of knee pain across several cohorts (Lo et al., 2017; Kujala et al., 1999).Lower risk of knee replacement.
Runners had nearly half the risk of progressing to total knee replacement compared to non-runners (Lo et al., 2017; Manninen et al., 2001).Possible protective mechanisms.
Running appears to strengthen periarticular muscle, maintain cartilage integrity through cyclical loading, and reduce systemic inflammation and BMI — all of which protect against OA (Bosomworth, 2009; Heidari, 2011).“Dose matters.”
The review highlights a dose–response relationship: moderate, consistent running is beneficial, while extreme overload or total inactivity may both contribute to degeneration.As summarized by the authors:
“In the short term, running is not associated with worsening PROs or radiological signs of knee OA and may be protective against generalized knee pain.”
Why This Matters
For runners and clinicians alike, these findings redefine how we think about joint longevity.
Rather than being a destructive activity, running seems to build joint capacity when appropriately progressed — aligning with Zero Point One Physical Therapy’s perspective that pain and degeneration often stem from capacity deficits, not damage itself.
This reinforces a broader message: Movement is medicine.
Consistent, load-bearing exercise like running supports cartilage health through nutrient diffusion, muscle stabilization, and improved metabolic function.
What About High-Mileage or Competitive Runners?
Even among long-term or competitive runners, studies found no increase in radiographic OA prevalence compared to non-runners (Kujala et al., 1994; Chakravarty et al., 2008).
In contrast, former elite soccer players and weightlifters showed higher OA rates due to impact trauma and torsional stress, not cumulative running load.
As one study noted, “runners typically have a lower BMI and better baseline joint health — both factors that protect against OA.”
The caveat: the benefits assume gradual, progressive loading and absence of repetitive high-impact injuries. Runners with poor strength foundations, abrupt training spikes, or existing biomechanical issues remain at risk.
Practical Takeaways
Running doesn’t damage healthy knees. For most adults, moderate running is safe and beneficial.
Consistency beats intensity. Sporadic, high-volume efforts pose more risk than regular, progressive training.
Strength training protects your knees. Building quadriceps, hamstrings, and hip stability improves load tolerance and running economy.
Manage recovery and mobility. Rest, sleep, and joint mobility sustain cartilage adaptation.
If you have knee OA, you can still run — with guidance. Studies like Lo et al. (2018) found that running did not worsen symptoms in people already diagnosed with knee OA.
Zero Point One Perspective
At Zero Point One Physical Therapy, we see the knee as part of a larger system — one that thrives under appropriate load.
Running, when paired with progressive strength training, enhances capacity, reinforces tissue tolerance, and helps sustain lifelong movement.
This aligns with our 3-Step Process:
Understand the Problem (Clarity & Relief) – Identify load tolerance and capacity gaps.
Rebuild the Foundation (Function & Resilience) – Restore strength and joint control.
Raise the Ceiling (Performance & Longevity) – Build capacity through running, lifting, and conditioning.
FAQ: Running and Knee Osteoarthritis
1. Does running cause knee osteoarthritis?
No — current evidence shows that recreational running does not cause knee osteoarthritis (OA). In fact, a 2023 systematic review published in the Orthopaedic Journal of Sports Medicine found that runners had less knee pain and no greater joint degeneration than non-runners. Moderate, consistent running may actually help protect joint health by improving muscle strength and joint load tolerance.
2. Is running safe if I already have knee osteoarthritis?
Yes, for many people it can be — when done progressively and under guidance. Research from Lo et al., 2018 (PMID: 29633031) found that people with diagnosed knee OA who continued running did not experience faster disease progression or increased pain. At Zero Point One Physical Therapy in NYC, we often help runners with OA rebuild strength, improve movement quality, and return to running safely.
3. Can running help prevent knee arthritis?
Yes. Studies suggest that running may lower the risk of developing knee OA compared to a sedentary lifestyle. Regular running helps maintain a healthy body weight, enhances cartilage metabolism through cyclical loading, and strengthens the muscles that stabilize the knee — all key factors in joint longevity.
4. How much running is considered safe for joint health?
Most studies reviewed show that moderate weekly mileage (10–25 miles per week) is not harmful to the knees. The key is progressive training — gradually increasing mileage, maintaining strength, and allowing adequate recovery. Problems usually arise when training load exceeds tissue capacity, not from running itself.
5. What type of running is best for knee health?
Running on softer or mixed terrain (like tracks, trails, or treadmills) can reduce repetitive impact. Maintaining good running form, strength training, and proper footwear also helps distribute load evenly across the joints. Incorporating strength training for the hips, quads, and calves improves knee stability and resilience.
6. Why do some runners still develop knee pain or arthritis?
Knee pain can result from training errors, poor strength balance, or sudden spikes in running volume, not necessarily from running itself. People who skip strength work, lack recovery, or have previous knee injuries are more susceptible. Addressing these capacity gaps through targeted strength and mobility work reduces risk.
7. What does Zero Point One Physical Therapy recommend for runners concerned about OA?
At Zero Point One Physical Therapy, we use an evidence-informed, progressive approach that blends physical therapy and performance training. Our team helps runners:
Identify load tolerance and movement inefficiencies
Rebuild foundational strength and joint control
Gradually return to higher training loads safely
We believe that pain, performance, and longevity all depend on capacity — not just diagnosis.
8. Where can I learn more about running, strength, and longevity?
You can explore our related educational resources here:
Why Strength Training Makes You a Better Runner — Especially When You’re Tired
Strength Training Is Injury Protection: A Foundation for Longevity and Movement Health
Strength Training Is the Missing Link for NYC Runners
Works Cited
Dhillon J, Kraeutler MJ, et al. Effects of Running on the Development of Knee Osteoarthritis: An Updated Systematic Review. Orthop J Sports Med. 2023;11(3):23259671231152900.
Timmins KA, et al. Am J Sports Med. 2017;45(6):1447–1457.
Lo GH, et al. Clin Rheumatol. 2018;37(9):2497–2504.
Bosomworth NJ. Can Fam Physician. 2009;55(9):871–878.
Heidari B. Caspian J Intern Med. 2011;2(2):205–212.