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Osteoarthritis and Running

Osteoarthritis and Running

Does running accelerate the developing of osteoarthritis?

There are so many misconceptions about running and how bad it can be for your joints. You may have heard many friends and family members comment on this and they may have even tried to convince you to stop running and go swimming instead. Here is what the scientific research tells us so far:

Osteoarthritis (OA) is a musculoskeletal condition that involves degeneration of the joints and impact during weightbearing exercise such as running and may contribute to joint loads. There is very little evidence however, that running causes OA in the knees or hips. One study reported in 1985 by Sohn and Micheli compared incidence of hip and knee pain and surgery over 25 years in 504 former cross-country runners. Only 0.8% of the runners needed surgery for OA in this time and the researchers concluded that moderate running (25.4 miles/week on average) was not associated with increased incidence of OA.

In another smaller study of 35 older runners and 38 controls with a mean age of 63 years, researchers looked at progression of OA over 5 years in the hands, lumbar spine and knees (Lane et al. 1993) . They used questionnaires and x-rays as measurement tools. In a span of 5 years, both groups had some participants who developed OA- but found that running did not increase the rate of OA in the knees. They reported that the 12% risk of developing knee OA in their group could be attributed to aging and not to running. In 2008, a group of researchers reported results from a longitudinal study in which 45 long distance runners and 53 non-runners were followed for 21 years. Assessment of their knee X-Rays, revealed that runners did not have a higher risk of developing OA than the non-running control group. They did note however, that the subjects with worse OA on x-ray also had higher BMI (Body Mass Index) and some early arthritic change in their knees at the outset of the study.

Is it better for your joints to walk than to run?

It is a common belief that it must be better to walk than to run to protect your joints. In a recent study comparing the effects of running and walking on the development of OA and hip replacement risk, the incidence of hip OA was 2.6% in the running group, compared with 4.7% in the walking group (Williams et al 2013). The percentage of walkers who eventually required a hip replacement was 0.7%, while in the running group, it was lower at 0.3%. Although the incidence is small, the authors suggest the chance of runners developing OA of the hip is less than walkers.

In the same study, Williams and colleagues reinforced that running actually helped keep middle-age weight gain down. As excess weight may correlate with increased risk of developing OA, running may reduce the risks of OA. The relationship between bodyweight and knee OA has been well-established in scientific studies, so running for fitness and keeping your weight under control is much less likely to wear out your knees than being inactive and carrying excess weight. 

How much is too much running?

Recent studies have shown that we should be doing 30 minutes of moderate exercise daily to prevent cardiovascular disease and diabetes. But with running, researchers still have not established the exact dosage of runners that has optimal health effects. Hansen and colleagues’ review of the evidence to date reported that the current literature is inconclusive about the possible relationship about running volume and development of OA but suggested that physiotherapists can help runners by correcting gait abnormalities, treating injuries appropriately and encouraging them to keep the BMI down.

We still do not know how much is “too much” for our joints. However, we do know that with age, we expect degenerative changes to occur in the joints whether we run or not. Osteoarthritis is just as common as getting grey hair. The important thing is that we keep the joints as happy and healthy as possible.

What is the best way to start running?

If you are not a runner and would like to start running, walking would be a good way to start and then work your way up to short running intervals and then longer intervals as you improve your fitness and allow time for your body to adapt.

Therefore, running in general is not bad for the joints. It does not seem to increase our risk of developing OA in the hips and knees. But the way you run, the way you train and how fast you change your running frequency and distance may play a role in future injuries of the joints.

But that’s another story. Watch this space for more running gems....

Are you just starting to run?

Do you have pain during or after running?

Would you like a running assessment?

Our sports physiotherapists can provide you with a thorough assessment to assess your 'run-readiness' and help you build or re-build your running routine.


Cymet and Sinkov 2006. Does Long Distance running cause OA. The Journal of the American Osteopathic Association, June 2006, Vol. 106, 342-345.

Hansen et al 2012. Does Running cause osteoarthritis in the hip or knee?. Physical Medicine and Rehabilitation. 4 (5) 117-121.

Lane et al. 1993. The Risk of OA with Running and Ageing. Year Longitudinal Study. Journal of Rheumatology (20) 461-468

Sohn et al. 1985. The Effect of Running on pathogenesis of OA in hips and knees. Clin Orthop Res (9) 106-109

Williams 2013. Effects of Running and Walking on OA and Hip Replacement Risk. MedSci Sports Exerc. 45 (7) 1292-1297

Heels are not always good for the sole

Heels are not always good for the sole

As physio's we often see a link between high heels and pain, but so many people are attached to their heels and these fashion items have been worn for many centuries. Did you know that men used to wear high heels? According to historians, way before the famous high heel was part of the female wardrobe, they were used by soldiers in the 16th century to give them stability in stirrups while riding on a horse so they could shoot their bows while standing up. High heeled shoes have evolved over the centuries with Christian Dior making them popular after World War II and today they are a part of most women’s wardrobe. But apart from being a fashion statement, what do heels do for you?

The HIGH behind the high heels

A recent study by Morris and colleagues studied female gait patterns in flat and high heeled shoes. They found when females wore heels, their perception of attractiveness was increased. They started to walk in a more feminine way with greater pelvic rotation and increased lateral pelvic tilt. Smith in 1999 reported that wearing high heels indicated status for women. No wonder researchers also found that the number of pairs of high heeled shoes owned by study participants was a minimum of 4 and maximum of 25. These may be the good reasons to own a few pairs! How many pairs of heels do you own?

The DOWNSIDE of wearing high heels

Wearing this type of footwear does have its ups, however long term they do take a toll on the body. Several studies have shown that long term high heel use impacts on the whole lower body, from the lower back all the way down to the feet.

High heels and lower back pain

Researchers  have reported that in a survey they conducted with 200 females who had been wearing high heels regularly for 1 year, 58% of them were complaining of low back pain (Lee et al 2001). This is not surprising considering standing and walking in heels has been shown to result in changes in the curvature of the lower back and increased levels of activity in the back muscles, both potentially amplifying loads on the joints of the lower back and fatigue in the back muscles.

High heels and hip pain

When wearing heels, weight is transferred forward towards the forefeet. This forward shift of the bodyweight at the feet means that the trunk and head need to shift relatively backwards to balance the body weight. This changes where the weight is transmitted through the hip and potentially places larger loads particularly through the front of the hip. The increased in rotation and tilting of the pelvis that occur while walking in heels can also place adverse loads across the hips joints and tendons. Even when sitting, high heels push the knees up higher than normal which can result in higher compressive loads across the hip joint. All of these factors may explain why wearing high heels often aggravates hip pain.

High heels and knee pain

The knee joint is also affected with increased compressive forces around the patellofemoral joint (kneecap) (Kerrigan et al 1998) and the inner compartment of the knee joint with forces increased by 23% (Kerrigan et al 1998, Stephanyshyn et al. 2000, Simonsen et al 2012). Landing on those heels while walking also means your quadriceps have to work harder as the foot tends to accelerate more quickly to its impact with the ground (Stefanyshyn et al 2000). Too much activity of your quadriceps can contribute to the higher compressive forces around the knee. Some researchers suggest that the wearing of high heels may make females more vulnerable to developing knee osteoarthritis (Kerrigan et al 1998, Simonsen et al 2012).

High heels and calf & ankle pain

The forward shift in bodyweight can lead to unstable postures (Lee et al 2001) and an increased rate of falls and ankle sprains. In the lower leg, calf muscles shorten while the Achilles tendon, the tendon at the back of the heel, stiffens up resulting in decreased active range of motion of the ankle (Csapo et al 2010). This can explain why regular heel users have discomfort when walking in flats.

High heels and forefoot pain

The biggest impact however occurs at the forefoot. Wearing high heels creates a doubling of pressure under the balls of the feet compared to walking barefoot (McBride et all 1991, Speknijder et al 2005). Bunions and callouses under the feet have also been associated with wearing narrow and shorter shoes (Menz 2005).

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Physiotherapy recommendations around high heels

From a health perspective, high heels are not the greatest footwear. As physiotherapists, we commonly see lower back, hip, knee and foot problems aggravated with the use of heels.

Our recommendations for wearing high heels:

  1. Avoid or minimise use of high heels
  2. Save those heels for special occasions rather than wearing them on a daily basis
  3. Don’t walk to/from work in heels – change into sports/walking shoes
  4. Keep the heels to < 2 cm heel height (Ko et al 2009)
  5. When sitting, if you can slip those heels off and place your feet flat on the ground, do so.
  6. Take some ballet flats with you when going out so you can easily slip them on to dance

So, here’s your excuse to go out and buy some new shoes ladies!

Do your body a favour and choose the flats or the lower heels.

Do you experience pain when wearing heels?

Our physiotherapists can assist you with your pain and get you standing more comfortably again.


Csapo et al (2010)On Muscle Tendon and High Heels. Journal of Experimental Biology, 213,2582-2588

Kerrigan, Todd, O Riley (1998)Knee Osteoarthritis and high-heeled Shoes. Lancet, 351:1399-1401

Ko et al (2009) Relationship Between Plantar Pressure and Soft Tissue Strain Under Metatarsal Heads with Different Heel Heights . Foot and Ankle International , 3,11

Lee, Jeong,Freivalds (2001) Biomechanical Effects of wearing High Heeled Shoes. International Journal of Industrial Ergonomics, 28,321-326

McBride et al (1991) First Metatarsophalangeal Joint Reaction Forces during High- Heel Gait. Foot and Ankle International

Menz, Morris (2005) Foot Characteristics and Foot Problems in Older People. Gerontology, 51(5): 346-351

Simonsen et al (2012)Walking on High Heels Changes Muscle Activity and the Dynamics of Human Walking Significantly. Journal of Applied Biomechanics,28,20-28

Smith (1999) High Heels and Evolution. Psychology, Evolution and Gender ,1.3,245-277

Speksnijder et al (2005) The Higher the heel, the igher the forefoot –pressure in ten healthy women. The Foot,15, 17-21

Stefanyshyn et al( 2000)The Influence of High Heeled Shoes on Kinematics, Kinetics and Muscle EMG of Normal Female Gait. Journal of Applied Biomechanics, 16, 309-319

Thompson, Coughlin (1994) The High Price of High- Fashion Footwear, The Journal of Bone and Joint Surgery 76A,1586-1593