As a keen recreational runner I get a lot of well intended questions or advice on my hobby. A common one is that 'running is bad for the knees' or that I will 'wear out my cartilage'. But is this true?
Often this question relates to osteoarthritis, a chronic disease involving the gradual loss of the cartilage that covers and protects the ends of the bones where they meet at a joint. Without this protection, the bone ends rub against each other, causing irritation and inflammation. While some runners do get 'bad knees' (or hips) the evidence indicates the opposite for most.
As always, we advise that if you are considering changing your diet, exercise or lifestyle practices, please discuss plans with your primary medical practitioner before making any changes. Links to relevant knee injury (meniscus and ACL) resources and studies are provided at the bottom of page.
If we take a mechanistic approach, imagining that we are cars with engine parts, the myth of running being bad for the knees is easy to understand. The parts get used and degrade, we have no way of changing the parts. But this is not how the body works, not only does running not 'wear out' the cartilage, what we use makes us stronger.
What is actually happening in most cases is that the body is wearing out due to a lack of exercise, weak musculature and often being overweight. Exercise (properly conducted) and recovery builds us up, it does not break us down. The evidence shows that non-runners have greater incidence of osteo-arthiritis (10.2%) than recreational runners (3.5%).
So what is happening? We do not wear out, we rust out.
Athletes or people who have put substantial strain on their legs, say military personel operating under heavy loads, have higher incidences of knee problems. The research indicates that this does not to apply to the general population.
Some argue that ultimatley the issue is moot, running equals injury. But this makes a case not to run, not to exercise. The issue is to exercise at an appropriate level, to respect the body. To take sufficient time, to have sufficient patience, to build up the body. This is often frustrating, to rein back the horses compared to our younger selves, but is essential. And, if necessary, to seek immediate treatment when a pain takes hold, rather than trying to battle through it.
How to Support Jopint Health and Avoid Injury
Exercise supports joint health. But how to start exercise safely? Firstly, if you have existing joint problems, speak to you doctor for advise on suitable exercsie regimens tailored to your situation.
If you are returning to running - perhaps after many years of inactivity - you might discover that yoi are generally weak or perhaps that your physcial, biomechanical, health is compromised. Muscle groups that should be in good condition are weak and do not support exercise, causing problems with the joints. For those that return to exercise and, after a few weeks have a problem, this is not likely due to an acute injury from the running itself although sometimes it can be. What is more likely is that long term weaknesses, from month or perhaps years of neglect, are being exposed.
Run (or exercise) in keeping with your current level of fitness.
Warm up with dynamic (movement) exercises; stretch only after the session.
Do not increase running volume or intensity too quickly.
Learn to understand the difference between sore muscles or a potentially more serious acute pain. Never try to push through pain.
Run on soft surfaces when you have the opportunity, for example, a soft trail.
Allow the body to rest and recover, especially after a hard workout session.
Strength training is a great way to complement your running, to promote joint and muscle health and to support higher intensity levels of running.
Listen to your body. It is ok to take additional rest or recovery days if you are tired. Consistency in the long-term is the best way to make progress.
Putting self-care into practice and taking the first steps is not easy. When it comes to health it is worthwhile to use the pillars of health as a basic checklist before delving deeper into evaluating and setting actual goals. This is where our consults and programmes support our clients’ own unique journeys to health.
Stay Healthy,
Alastair
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Related Resources and Studies
British Journal of Sports Medicine:
Studies
Dhillon J, Kraeutler MJ, Belk JW, Scillia AJ, McCarty EC, Ansah-Twum JK, McCulloch PC. Effects of Running on the Development of Knee Osteoarthritis: An Updated Systematic Review at Short-Term Follow-up. Orthop J Sports Med. 2023 Mar 1;11(3):23259671231152900. doi: 10.1177/23259671231152900. PMID: 36875337; PMCID: PMC9983113.
Glaviano NR, Kim S. Lower extremity muscle volume in females with patellofemoral pain and its relationships to hip and knee torque: A cross-sectional study. Phys Ther Sport. 2023 Sep;63:50-57. doi: 10.1016/j.ptsp.2023.07.003. Epub 2023 Jul 23. PMID: 37506654.
Hartwell MJ, Tanenbaum JE, Chiampas G, Terry MA, Tjong VK. Does Running Increase the Risk of Hip and Knee Arthritis? A Survey of 3804 Marathon Runners. Sports Health. 2023 Aug 9:19417381231190876. doi: 10.1177/19417381231190876. Epub ahead of print. PMID: 37555313.
Miller RH, Krupenevich RL. Medial knee cartilage is unlikely to withstand a lifetime of running without positive adaptation: a theoretical biomechanical model of failure phenomena. PeerJ. 2020 Aug 5;8:e9676. doi: 10.7717/peerj.9676. PMID: 32844066; PMCID: PMC7414768.
Fu S, Thompson CL, Ali A, Wang W, Chapple JP, Mitchison HM, Beales PL, Wann AKT, Knight MM. Mechanical loading inhibits cartilage inflammatory signalling via an HDAC6 and IFT-dependent mechanism regulating primary cilia elongation. Osteoarthritis Cartilage. 2019 Jul;27(7):1064-1074. doi: 10.1016/j.joca.2019.03.003. Epub 2019 Mar 25. PMID: 30922983; PMCID: PMC6593179.
Lo GH, Driban JB, Kriska AM, McAlindon TE, Souza RB, Petersen NJ, Storti KL, Eaton CB, Hochberg MC, Jackson RD, Kent Kwoh C, Nevitt MC, Suarez-Almazor ME. Is There an Association Between a History of Running and Symptomatic Knee Osteoarthritis? A Cross-Sectional Study From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken). 2017 Feb;69(2):183-191. doi: 10.1002/acr.22939. PMID: 27333572; PMCID: PMC5179322.
Alentorn-Geli E, Samuelsson K, Musahl V, Green CL, Bhandari M, Karlsson J. The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017 Jun;47(6):373-390. doi: 10.2519/jospt.2017.7137. Epub 2017 May 13. PMID: 28504066.