President George W. Bush – the nation’s First Runner – recently underwent a clinical and MRI examination of his knees, which have been bothering him enough the past few months to severely curtail his running. (He is reported to have substituted pool running and an elliptical trainer to keep in shape.)

Fortunately for the president, his MRI scan proved negative for a suspected meniscal (cartilage) tear in his left knee. Unfortunately, the pictures and exam indicate some "post-traumatic degenerative changes in the medial compartment of the right knee" and "previously identified mild diffuse degenerative changes" in his left knee. In other words, he has degenerative joint disease, or osteoarthritis – what most of us refer to simply as "arthritis." [Note: the area referred to here is the tibiofemoral joint – between the thigh and shin bones – not the patellofemoral joint discussed last month.]

Just as unfortunate was the characterization of this injury, offered by the president’s spokesperson, as "normal wear and tear associated with an active 57-year old." This quote once again demonstrates that the misconception that running inevitably leads to early-onset of joint arthritis, particularly of the knees and hips, is still with us.

As first discussed here more than a decade ago [http://www.syracusechargers.org/therapy/chapt18.htm] there is little scientific evidence that this is the case; in fact, since that earlier article appeared, more evidence has appeared to contradict this common fallacy. Here are a few examples:

• University of California investigators undertook a 5-year study (1984-89) comparing the development of OA of the hands, lumbar spine and knees in 35 runners and 38 non-runners. The results showed that running did not accelerate the development of radiographic or clinical OA of the knees, but with aging, 13% of all subjects developed OA of the hands and 12% of all subjects developed OA of the knees. [Journal of Rheumatology, 1993 Mar;20(3):461-8]
• A later study by some of the same investigators [J Rheumatol. 1998 Feb;25(2):334-41] compared hip and knee OA in two similar groups. Again, they concluded that there were no differences between runners and non-runners in the radiographic (x-ray and CT scan) evidence of hip OA or the progression of knee OA after a 9-year controlled study period.
• A six-year study comparing 410 runners to 289 non-runners for musculoskeletal pain and disability showed slightly less of the first and much less of the second in runners. The authors concluded that vigorous running activity over many years is not associated with an increase in musculoskeletal pain with age, and there may be a moderate decrease in pain, particularly in women. Vigorous physical activity is associated with greatly decreased levels of disability and with decreased mortality rates.
• An earlier study [JAMA. 1986 Mar 7;255(9):1152-4] comparing pain and swelling, as well as radiologic changes in the hips, knees, ankles, and feet of 17 male runners and 18 male non-runners showed no differences between the two groups. The authors concluded that long-duration, high-mileage running need not be associated with premature degenerative joint disease in the lower extremities.

A computer search of the medline database (key words: running and arthritis) will produce many more studies that concur with those listed above. To be fair, it should be noted that there are a few studies that suggest increased incidence of OA in runners, but in all of these cases the runners studied were highly competitive, high-mileage athletes who engaged in high-intensity training, so there may be a cautionary message here regarding these factors.

For the "average" runner, however, the evidence still provides a measure of relief that we are not setting ourselves up for an inevitable joint replacement. It also provides us with more ammunition in the constant battle against those who persist in perpetuating the myth that running and arthritis go hand in hand.

Gabe Yankowitz, PT