Knee osteoarthritis sport and exercise

Most studies looking at the relationship between sport, exercise and the risk of developing knee OA have identified clear links between knee injury related to sport and exercise, and OA development.  Fewer have just looked at the increased risk from sport and exercise participation and development of knee OA.  Overall there is no clear increased risk although there is good evidence of increased risk in high impact and high load sports, particularly at elite level. There is insufficient evidence to demonstrate a clear increased risk of knee OA from typical military sports and exercise participation.  There is good evidence that exercise is protective for progression of knee OA (see below under ‘prognosis’).

Running and regular performance of sports are not associated with knee OA progression.  A systematic review looking at factors associated with knee OA progression found strong evidence that varus alignment, serum hyaluronic acid and Heberden’s nodes were associated with knee OA progression, and strong evidence that sex, former knee injury, quadriceps strength, smoking, running and regular performance of sports were not associated with knee OA progression (Bastick et al., 2015).

Soccer, elite long-distance running, weight lifting and wrestling have an increased prevalence of knee OA. A systematic review of case-control and cohort studies looking at radiographic and clinical knee OA, total knee replacement and self-diagnosis of knee osteoarthritis found an overall OR of 0.9 for knee OA in sport participants. There was significantly higher knee OA associated with soccer (OR 3.5), elite-level long-distance running (OR 3.3), competitive weight-lifting (OR 6.9) and wrestling (OR 3.8).   Elite-sport (soccer or orienteering) and nonelite-sport (soccer or American football) participants without a history of knee injury had a greater prevalence of knee OA than non-exposed participants (Driban et al., 2015).

There is inconclusive evidence for a possible association between high-volume running and the development of OA. Low- and moderate volume runners appear to have no more risk of developing OA than non-runners. The existing literature is inconclusive about a possible association between high-volume running and the development of OA.  Early literature on minimalist and barefoot running has primarily focused on biomechanics and has not yet focused on cartilage health (Hansen et al., 2012).

There is an increase in radiographic evidence of osteoarthritis in endurance sports athletes.  Overall, the evidence in relation to long-distance running and knee OA is inconclusive.  There is good evidence that there is an increase in arthritis associated with history of injury or atypical environments in animal studies, and human studies show an increase in radiographic evidence of OA in endurance sports athletes but no related increase in symptoms reported. It appears that [non-elite] long-distance running does not increase the risk of knee OA for healthy people who have no other contra-indications for this type of physical activity.  Long-distance running may have a protective effect against joint degeneration (Cymet and Sinkov, 2006).

BASTICK, A. N., BELO, J. N., RUNHAAR, J. & BIERMA-ZEINSTRA, S. M. 2015. What Are the Prognostic Factors for Radiographic Progression of Knee Osteoarthritis? A Meta-analysis. Clin Orthop Relat Res.

CYMET, T. C. & SINKOV, V. 2006. Does long-distance running cause osteoarthritis? J Am Osteopath Assoc, 106, 342-5.

DRIBAN, J. B., HOOTMAN, J. M., SITLER, M. R., HARRIS, K. & CATTANO, N. M. 2015. Is Participation in Certain Sports Associated With Knee Osteoarthritis? A Systematic Review. J Athl Train.

HANSEN, P., ENGLISH, M. & WILLICK, S. E. 2012. Does running cause osteoarthritis in the hip or knee? PM R, 4, S117-21.