Degenerative changes in the knee—commonly referred to as cartilage wear or osteoarthritis (OA)—are among the most frequent orthopedic issues, particularly in individuals over 50. Despite its prevalence, many patients struggle to understand this condition, what activities are safe, and, most importantly, how to manage it. The term "wear and tear" can sound alarming, suggesting a purely mechanical issue that requires surgical intervention. Fortunately, this is not entirely accurate.
Physiotherapists Daniel Markowitz and Assaf Etzioni shed light on the causes, treatments, and the common question: does running increase the risk of osteoarthritis?
What is Osteoarthritis (OA)?
Osteoarthritis is a chronic joint condition, among the most common worldwide. It involves localized inflammation and structural changes in the cartilage and the underlying bone. While the hip and knee are most frequently affected, OA can occur in other joints, albeit less commonly. The primary symptoms include pain, stiffness, swelling, and reduced range of motion over time, often impacting daily functioning and overall quality of life.
OA is typically diagnosed through a combination of X-rays and clinical evaluations. However, it’s important to note that X-rays do not always correlate with pain levels. For example, some individuals may have significant cartilage wear visible on X-rays but experience little to no discomfort, while others may have mild wear and severe pain. Therefore, clinical assessments focusing on the patient’s functional challenges and daily limitations are crucial for personalized treatment recommendations.
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A review of MRI scans of individuals over 40 without knee pain found that up to 43% showed degenerative changes—highlighting that imaging alone cannot predict pain.
How is Osteoarthritis Treated?
Standard treatments for OA often include anti-inflammatory medications, steroid injections, or joint replacement surgery. However, Markowitz and Etzioni advocate for conservative treatments as the first line of defense before considering invasive procedures.
According to the World Health Organization, risk factors for OA include obesity, inactivity, genetics, diabetes, prior joint injuries or surgeries, age, and gender. Women, particularly those over 50, are two to three times more likely to develop OA than men. While some risk factors, such as genetics and age, are beyond control, others, like excess weight, can be managed.
Losing weight can significantly reduce joint inflammation and stress, as adipose tissue secretes inflammatory mediators that exacerbate conditions like OA. Alongside dietary changes, engaging in regular physical activity—particularly low-impact aerobic exercises—can help maintain joint health.
Movement is key
Joints thrive on movement, and regular activity nourishes cartilage. However, the type and intensity of movement depend on the current state of the joint. If the pain is severe, low-impact exercises like bending and straightening the knee without bearing weight or walking with Nordic poles (proven to reduce OA-related pain) may be beneficial. Strengthening surrounding muscles is equally important, as they absorb and distribute the load on the joints.
A 2021 review concluded that running does not increase the risk of OA. On the contrary, running promotes nutrient flow to cartilage, protecting it and even reducing the likelihood of knee replacement surgeries.
Markowitz and Etzioni emphasize that giving up on sports you love, simply because someone suggests it might harm you, is unnecessary. If you experience pain, consult a professional specializing in OA to help manage your activity levels temporarily. Once the pain subsides, they can guide you on safely resuming activities like running.
The message is clear: don’t abandon movement. Staying active and informed is your best defense against the progression of OA and a step toward maintaining a better quality of life.