Does running ruin your knees?

One of the most common things I've heard from patients, friends, and family members over the years is the concern that running "wears our your knees".

I can see why people might think this. Doctors used to (& some still do) tell their patients that running "ruins knees" and causes "bone on bone" arthritis. At first thought it makes sense. Every time we take a step, it puts pressure and force through the knee joint. If we take thousands of steps per mile, and run many miles over the weeks/months/years, wouldn't it make sense that your knees wear out?

Research tells us a different story.

Let's do a quick anatomy review before we dive into what the research says.

The knee is made up of a few bones such as the femur (thigh bone), tibia (shin bone) and your patella (kneecap). The ends of each of these bones are covered in cartilage. Cartilage is important because it helps to reduce friction and provide smooth movement when we move.

Inside the knee joint, there is also your meniscus. Your meniscus helps to absorb shock/force, and evenly distribute it. There is also synovial (joint) fluid inside, to provide lubrication and nutrition.

On the outside of the knee joint, there are many ligaments, tendons, and muscles that help to produce movement and stability.

Okay, lets circle back to cartilage now. Cartilage is a living struture, meaning that it can adapt and change over time in response to loading. Just like your bones and muscles can become stronger and more resilient over time, your cartilage can as well.

How so?

Cartilage gets much of its nutrition through movement. The synovial fluid I mentioned above helps deliver nutrients to structures inside the knee that do not have a strong blood supply. As you recover from running and exercise, this process helps support cartilage health and adapt over time.

I like to compare it to forming a callous. First time you try something (e.g. pull-ups), you can only do so many before your hands hurts and the skin of your palm feels sensitive. Overtime, your skin thickens and forms a callous in the area, allowing you to do more exercise without the hand sensitivity. Similarly, overtime your knee will be able to handle more forces going through it.

What does the research show us?

Research has looked at different levels of running- recreational, novice, and high level runners- to see whether running increases the risk of "wear and tear" or knee arthritis.

Research has shown that cartilage in newer and novice runners adapts to the forces created by running. Building that "internal callous" to be able to handle more over time. When compared to sedentary individuals, they had lower rates of hip and knee arthritis. Some studies have even suggested that running is beneficial for long term health and protecive against developing arthritis.

Professional and high volume runners are at a slighly higher risk for overuse injuries, because they accumulate a much higher training volume over time. Even with this higher risk, it is not a straightforward relationship with running and developing knee arthrits.

What's more important when it comes to the development of knee arthritis are a few other factors such as:

• Prior injury

• Genetics

• Training errors

• Recovery

• Strength

• Body composition

Running is rarely the sole reason someone develops knee pain and arthritis. It is often due to other underlying factors that running may exacerbate.

So what should runners look at when they have knee pain?

Oftentimes, pain starts when the volume or load is too much for the joint to handle at once. When runners (or other athletes) come into the office, we ask them about their:

• Mileage- Have you increased mileage recently? Are you getting back into running and progressed too quickly? Have you started running more days/week, or running more than one time/day?

• Training- Hills? Surface type? Speedwork?

• Footwear

• Strength training- Do you do any? Have you decreased it recently?

• Recovery & lifestyle factors- Sleep, nutrition, and hydration all play a large role in how your body recovers from your last run.

• Prior injuries

Often times we aren't having the runner stop running completley (unless it's a stress fracture), but make changes based on some of the questions we discussed above.

If you've tried to make changes, but pain persists after a few weeks, this is when it is time to have a health care professional take a look at what's going on. We provide virtual consultations to see if we can help you out with your and injury and if we would be a good fit HERE.

In summary, running does not automatically ruin your knees. For most, running is protective for maintaining long term joint healh, as long as it is done in an appropriate manner. If your knees start hurting, most likely it is a sign that there is an imbalance in your training load vs. what your knees can happen at the moment.

Questions or comments? We are available by phone or email. You can reach out to us at 714-640-9937, or drnataliegrohmanndc@gmail.com .

References:

Alentorn-Geli, E., Samuelsson, K., Musahl, V., Green, C. L., Bhandari, M., & Karlsson, J. (2017). The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis. The Journal of orthopaedic and sports physical therapy, 47(6), 373–390. https://doi.org/10.2519/jospt.2017.7137

Dhillon, J., Kraeutler, M. J., Belk, J. W., Scillia, A. J., McCarty, E. C., Ansah-Twum, J. K., & McCulloch, P. C. (2023). Effects of Running on the Development of Knee Osteoarthritis: An Updated Systematic Review at Short-Term Follow-up. Orthopaedic journal of sports medicine, 11(3), 23259671231152900. https://doi.org/10.1177/23259671231152900