Somewhere between 25% and 50% of people have evidence of knee osteoarthritis on x-ray. However, only 13% of women and 10% of men have pain secondary to arthritis. 

This is an important point — just because there is osteoarthritis that shows up on x-ray does not mean that it causes pain. Of course, knee osteoarthritis can make the knee hurt! But many people have evidence of osteoarthritis and do not have pain from it.

Recently, I had a patient that recently began a weight loss program and started running to lose weight. Within a few days of beginning her workout routine, she started to have knee pain. After evaluation, she was found to have mild to moderate osteoarthritis.

She then asked ” should I continue to run, or is this making my osteoarthritis worse?”

While the answer is fairly clear, certain adjustments must be made to make sure that her pain does not return.

Many studies support the notion that running or other weight-bearing activities do not worse knee osteoarthritis. This recent study suggests that high-intensity jumping exercises improve muscle strength and cartilage in the knee, resulting in an actual improvement in osteoarthritis and a decrease in symptoms. An article in the New York Times further supports that running does not cause or worsen knee osteoarthritis.

Well, what about the people whose knee begin to hurt when they begin running?

This issue is probably best explained by the sudden increase in activity in a previously inactive individual. A significant increase in activity, particularly in an untrained individual, is a risk factor for pain.

In the case for my patient, the muscles in her legs were not trained and her bones and joints have not adapted to the stresses of running. It happened to be her knees that flared up, maybe because of osteoarthritis, but it could have been her ankles, shins, hips or back. The sudden stress of impact exercise can be too much if there is no gradual increase in exercise stress.

After talking to her further, she did reveal that she jogged a mile for the first time in 10 years in shoes that were about 2 years old. She bought new running shoes and gradually increased her running distances over a period of months. At follow up, she did not have knee pain, lost weight and overall felt much better.

Take Home Point

Intuitively, it seems that high-impact activities would worsen knee osteoarthritis. However, exercise increases muscle strength, improves bone density and also improves the health of cartilage in the joint under stress. The key is to gradually increase your amount of impact physical activity over a period of time. While a health professional or personal trainer can help you design a graduated program, it is best to listen to your body. If you hurt, back off. Slow your running pace or decrease your mileage. Let your body be your guide.

“No pain, no gain,” doesn’t necessarily apply here. While beginning a new workout program is exciting, be patient with your progress. Move too fast and you may set yourself back.

So, go live your life! Use pain as a guide to limit progress that is too abrupt.