ASSOCIATION BETWEEN RUNNING VOLUME AND KNEE OSTEOARTHRITIS IN ADULT RUNNERS: A NARRATIVE REVIEW

Abstract

Knee osteoarthritis is one of the leading causes of functional disability in adults and older individuals and has traditionally been associated with progressive mechanical wear of the joint. However, current understanding recognizes the disease as a multifactorial process that affects not only the cartilage, but the entire joint unit, including subchondral bone, synovium, menisci, and ligaments. In this context, running remains surrounded by controversy, especially due to the belief that high training volumes could accelerate joint degeneration. Recent literature, however, suggests that this association is not consistently supported. Recreational runners show a prevalence of osteoarthritis similar to or even lower than that observed in non-runners, and even among marathon runners there is no robust evidence that cumulative running exposure alone determines a higher risk of joint disease. In addition, changes observed in cartilage after running appear to be predominantly transient, suggesting an adaptive response to mechanical stimulus rather than irreversible damage. In individuals with established osteoarthritis, self-selected running also does not appear to worsen symptoms or accelerate structural progression of the disease. The discussion of the findings indicates that running volume alone is a weak predictor of knee osteoarthritis, whereas factors such as age, elevated body mass index, family history, previous injuries, and joint surgeries exert a more relevant influence on the risk of degeneration. Thus, current evidence suggests that the impact of running on knee health depends less on mileage itself and more on the interaction between mechanical load and preexisting joint vulnerability.