Is running bad for your knees?

People who aren’t runners like to say things to make themselves feel better about the fact that they don’t run.

At least, that’s what I’ve found.

I guess it’s like some kind of sour grapes thing. I think some of them are jealous that they aren’t athletic, so they gotta justify it to themselves somehow.

“Running ruins your knees, so it’s a good thing I don’t do that like some kind of sucker! And you know what else, I am actually SUPERIOR because I don’t run, I’m smarter than those idiots. Why don’t you go for a JOG you dummy and wreck your body while I sit on my arse and judge you without a lick of scientific evidence behind my obnoxious opinion?!”

Or something.

Reader Pankaj Vidhani writes:

Would love to read about your knowledge which you share...

What is the impact of running  on knees with proper form if we run too much all these years.?

Let’s get to it, my astute athletes.

So, there are a lot of myths about running and knees. I’m not entirely sure where they all started, probably a buncha sour grapesing like I was talking about.

The main myth I see is that running breaks down the cartilage in your knees and can cause inflammation that leads to arthritis. 

Well, it’s BS.

From a 2017 study by Dr. GH Lo¹, using a large sample size, results showed that: 

There is no increased risk of symptomatic knee osteoarthritis among self-selected runners compared with non-runners in a cohort recruited from the community. In those without osteoarthritis, running does not appear detrimental to the knees… Our findings support that a history of leisure running is not associated with increased odds of prevalent knee pain...  running does not appear detrimental from a knee health perspective.

Contrary to many other studies, this one didn’t focus solely on elite runners. Dr. Lo points out that this gives it a wider application for recreational runners, too. We aren’t training at a load even close to what the elites are, so results from studies that use only them as subjects can skew the results a bit for little ol’ you and me.

In addition, a smaller 2016 study from The European Journal of Applied Physiology² suggests that longterm running can actually help prevent arthritis in the knee by decreasing intra-articular pro-inflammatory cytokine and COMP (cartilage oligomeric matrix protein). These are two kinds of cells that increase inflammation.

This means that the cells that would “cause” this mythic arthritis are actually decreased when running.

The researchers are careful to note that more work needs to be done to understand this fully, but are confident in saying that the movement in running is effective at removing those cells, which do accumulate in activities like sitting.

Here’s how all this applies to you more specifically.

Mild to moderate running (24-32km/wk, 15-20mi/wk) can actually help maintain cartilage as you age.³

Many “knee” injuries aren’t really knee injuries in the way we think they are. They’re actually issues with the muscles, tendons, and ligaments surrounding your knee. I was a bit shocked when I learned that the knee actually has no muscles of its own!

I mean, it makes sense. I hadn’t thought of it before, though.

Anyway, these surrounding tissues (the quads cross over the knee and insert at the patella to facilitate extension, and the hamstrings cross at the back of the knee, inserting at the tibia to facilitate flexion) can experience an imbalance pretty easily in runners.

Physio Steve and I were chatting about this on a long drive this past weekend, and he said that what a lot of runners don’t realize is that the outside of their legs (IT band) can get a lot more work than the inside of their legs during training.

This imbalance can cause the knee to track differently during your stride, and that’s what can cause irritation.

My hubby, who’s an accomplished duathlete, later pointed out to me that this is where runner-cyclist hybrids have an advantage… while runners will typically cause stress to the outer tissue, cyclists use more of the inside muscles (pushing through a pedal stroke).

So, a person who trains for both running and cycling develops each of these equally, which helps to keep their knee tracking correctly (less chance of muscular imbalance).

If you’re not a cyclist as well, you can still develop these muscles with a good strength plan that focuses on the adductors and quadricep muscles of the upper leg.⁴

That said, here’s what my lazy-ass runners can do (no judgment, you are my people)…

As a runner, regularly stretching your IT band will help you keep that soft tissue flexible and less likely to pull on your kneecaps which is what screws up your tracking. And that’ll help you avoid knee pain and injury in the long run, among a lot of other common running issues.

I’d say IT band stretching is probably one of the most valuable recovery activities you can do as a runner. Warning sign that the IT band could be the culprit: lateral knee pain.⁵

So, we do have evidence that it’s entirely possible to keep your knees happy and healthy with a proper maintenance plan. This isn’t to say running knee injuries are a myth in and of themselves -- they can and do happen.

But, we’re seeing that arthritis isn’t one of them.

So, you can recite this whole email to that Judge-O Jerkface if you hear them talking smack about running wrecking your knees.

Got a question that needs answering? Reply and let me know. Put my studies to good use, will ya? I plan to eventually charge for question answering, so get ‘em in while the gettin’s good.

I take each one seriously, if you couldn’t tell.

L

References:

¹Lo, Grace H, et al. “Is There an Association Between a History of Running and Symptomatic Knee Osteoarthritis? A Cross-Sectional Study From the Osteoarthritis Initiative.” Arthritis Care & Research, U.S. National Library of Medicine, Feb. 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5179322/.

²Hyldahl, Robert D, et al. “Running Decreases Knee Intra-Articular Cytokine and Cartilage Oligomeric Matrix Concentrations: a Pilot Study.” European Journal of Applied Physiology, U.S. National Library of Medicine, Dec. 2016, https://www.ncbi.nlm.nih.gov/pubmed/27699484.

³Williams, PT. “Effects of Walking and Running on Osteoarthritis and Hip Replacement Risk.” Medicine and Science in Sports and Exercise, 45[7]: 1292-1297,  2013.

⁴Puleo, Joe. “Running Anatomy.” Human Kinetics, 57, 2019.

⁵Puleo, Joe. “Running Anatomy.” Human Kinetics, 153, 2019.