RUNNING WILL NOT RUIN YOUR KNEES
The longstanding assumption is that the repetitive pounding of the legs during running will damage the joint over time. The foot striking the ground continuously must lead to degeneration of the knee joint and onset of osteoarthritis, right? But researchers actually studied the impact of running on the knees, that is not what they found. On the contrary, research has actually suggested running to be beneficial and necessary for long-term healthy joints.
When you look at research on runners, including long-term studies following life-long distance runners you don’t find a significant increase in arthritis at the knee. Likewise, when you look at populations with knee arthritis you will not find a significant previous history of running. The greatest risk factors for osteoarthritis are age, weight, history of trauma to the knee, history of diabetes or cardiovascular disease (Heidari, 2011). One way running may be protective of the joint is by improving efficiency of your circulatory system, improving delivery of oxygen and nutrients to the joint and surrounding areas.
Coburn and colleagues performed a meta-analysis in effort to determine those at risk for osteoarthritis at both the knee and hip. They found that MRI findings show a decrease in cartilage volume immediately following a run (-3-4%), but within 48-hours these changes revert to pre-run levels. This suggests that runners will likely not suffer long term wear and tear.
Wolff’s Law: “The body responds to the load placed upon it.” In other words, if you load the knee joint gradually and appropriately over time, the structure of the joint will become stronger and adapted. In fact exercise appears to stimulate cartilage to repair minor damage. It could be that the impact of the body weight when the foot hits the ground increases production in certain proteins that enable the cartilage to become stronger and more resilient. This is similar to the way that exercise, particularly weight-bearing exercise like running, yields an increase in bone density and muscle mass.
Nancy Lane, director of the UC Davis Center for Healthy Aging, does call attention to the understanding that some cartilage loss occurs annually after a certain age, beginning around age 40. However, barring other risk factors present, you have every reason to believe that your joints will remain healthy with moderate volumes and paces of running as you age. Lane also supports continuing to run into your 50s, 60s, 70s and onward without running any significant risk to joint health. As an added bonus, those who maintain a routine of jogging into these decades of life are more likely to engage in other physical activities including swimming, strength training, yoga, and recreational sport. These individuals tend to sustain a greater quality of life, longevity and health-span as they age.
Caveat — risk factors for osteoarthritis are relevant. If you have suffered a previous knee injury you may be at increased risk to onset of arthritis. Ligamentous injury at the knee (ie. ACL, MCL, PCL, LCL) or meniscus tears, whether treated surgically or conservatively, can affect the stability of the knee joint and increase loading at the bony end-plates and articular cartilage. Excessive weight is another risk factor for onset of osteoarthritis, as this increases the loading at the knee joint especially with running. The midstance phase of gait with running can sustain up to 3 times body weight, so being an extra 35-pounds overweight can transmit more than 100 pounds of additional force on the lower limb. However, these ground reaction forces can be mitigated and more evenly distributed throughout the lower limb with proper running mechanics and muscle strength.
Key Points: Running will not destroy your knees. It is not a significant risk factor for arthritic changes at the knee joint, and may actually be protective. If you experience knee pain with running, consider the following: running form and mechanics, overall training stress and load management. Schedule a virtual gait analysis and consult with me today.
Heidari B. (2011). Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian journal of internal medicine, 2(2), 205–212.
Coburn, S. L., Crossley, K. M., Kemp, J. L., Warden, S. J., West, T. J., Bruder, A. M., Mentiplay, B. F., & Culvenor, A. G. (2023). Is running good or bad for your knees? A systematic review and meta-analysis of cartilage morphology and composition changes in the tibiofemoral and patellofemoral joints. Osteoarthritis and cartilage, 31(2), 144–157. https://doi.org/10.1016/j.joca.2022.09.013
Yu, L., Mei, Q., Xiang, L., Liu, W., Mohamad, N. I., István, B., Fernandez, J., & Gu, Y. (2021). Principal Component Analysis of the Running Ground Reaction Forces With Different Speeds. Frontiers in bioengineering and biotechnology, 9, 629809. https://doi.org/10.3389/fbioe.2021.629809
Chakravarty, E. F., Hubert, H. B., Lingala, V. B., Zatarain, E., & Fries, J. F. (2008). Long distance running and knee osteoarthritis. A prospective study. American journal of preventive medicine, 35(2), 133–138. https://doi.org/10.1016/j.amepre.2008.03.032
Nancy E. Lane, Daniel A. Bloch, Peter D. Wood, James F. Fries. Aging, long-distance running, and the development of musculoskeletal disability: A controlled study, The American Journal of Medicine, Volume 82, Issue 4, 1987, Pages 772-780.
