Many people avoid running because they think it’ll wreck their knees.
Is running as detrimental as they believe, or can it actually benefit knee health?
Get an evidence-based answer in this article.
Many people think “pounding the pavement” gradually wears away the cartilage in your knees.
They believe this leads to a condition called osteoarthritis (or “wear and tear” arthritis), where your bones don’t glide over each other as easily as they once did, causing stiffness and pain in your knees.
Research shows this assumption is probably wrong.
For instance, in a study published in the American Journal of Preventive Medicine, researchers followed long-distance runners and non-runners for 18 years. Using a series of x-rays taken throughout the study, the researchers found no connection between running and osteoarthritis in the knees.
In fact, the results showed that non-runners were more likely to develop knee arthritis (32%) compared to runners (20%).
Similarly, a meta-analysis of 25 studies published in The Journal of Orthopaedic and Sports Physical Therapy found that recreational runners are less likely than competitive runners and sedentary folks to develop osteoarthritis.
In other words, moderate running seems to have fewer long-term repercussions than running a lot or not at all.
Other studies suggest running enhances knee health.
In a study published in the journal PeerJ, scientists analyzed the movement mechanics of 22 people. Through their analysis, the scientists found that running is likely more damaging for your knee cartilage than walking.
It’s worth noting that this study also didn’t actually analyze the effects on running on knee cartilage over time—it only estimated what effect running would have based on biomechanical patterns.
What’s more, they also found that running appears to strengthen the bone and cartilage in your knees, potentially making it a net positive.
In another study, researchers at University College London scanned the knees of 71 people gearing up to train for their first marathon. The scans showed that, despite having little running experience, the first-time marathoners showed signs of early-stage knee arthritis.
Post-race scans of the marathoners’ knees revealed that their knee joints and cartilage had notably improved from the start of the trial. However, some runners began showing signs of a different type of cartilage damage.
To explore whether the running had caused this new damage, the researchers performed a follow-up study, in which they scanned the runners’ knees again 6 months post-race. In the intervening time, the runners had continued to run, though not as much as they had leading up to and during the marathon.
The scans showed that the marathoners’ knees were significantly better than they had been in the weeks following the race, leading the authors to conclude that running may help reduce osteoarthritis risk over the long term.
A review of 43 studies published in Sports Medicine provides further evident running benefits knee cartilage.
In this study, researchers found that cartilage warps immediately after running, but rebounds soon after. Moreover, it appears to adapt to repeated running by becoming stronger, thicker, and more resilient to compression.
In other words, running seems to affect cartilage in much the same way weight training affects muscle tissue: temporarily weakening and “damaging” it, but in a way that makes it stronger and healthier over time.
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While running likely isn’t harmful to your knee health in the long term, it can result in knee injuries, particularly for beginners.
Here‘s how to identify and treat the most common running injuries.
Iliotibial Band Syndrome (ITBS) is a common running injury caused by excessive friction of the iliotibial band (a thick band of connective tissue running from the hip to the knee) against the outer part of the knee joint.
Runners typically experience a sharp, burning pain or tightness on the outside of the knee that worsens with running or descending stairs or slopes.
To manage ITBS, it can help to take non-steroidal antiinflammatory drugs (NSAIDs) and apply ice to the affected area. This doesn’t actually help the affected tissue heal, but it does make the pain more manageable in the short term. To truly heal the injury, you need to stop running until your knee feels better (typically at least 1-to-2 weeks, but possibly several months). When you return to running, start with short, slow runs and gradually increase your distance and pace.
Commonly known as “runner’s knee,” patellofemoral pain syndrome presents as pain in or around the kneecap.
Runners with this syndrome may experience sore knees during running, squatting, climbing stairs, or after sitting for prolonged periods.
To manage this condition, rest, apply ice to the knee, take anti-inflammatory medication, and strengthen the muscles around the knee with leg exercises. And again—stop running until the pain goes away, and gradually reintroduce it.
Patellar tendonitis, or “jumper’s knee,” presents as pain in the tendon connecting the kneecap to the shinbone.
It’s common among runners and people who play sports involving jumping.
People with patellar tendonitis typically feel pain just below the kneecap. This discomfort often becomes worse if you run, jump, or climb stairs.
Treatment for patellar tendonitis involves rest, icing, compressing, and elevating the affected area, taking NSAIDs, and strengthening the quads.
Bursitis in the knee is inflammation of the small fluid-filled sacs (bursae) that cushion the knee joint, leading to pain and swelling around the knee.
In runners, bursitis is usually due to overuse (doing too much, too soon). Treatment typically involves rest, ice application, and NSAIDs. In more severe cases, a healthcare professional might drain the bursa or prescribe physical therapy, but this generally isn’t necessary in the case of overuse injuries related to bursitis.
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The two best ways to reduce your risk of knee injuries from running are:
- Follow a good running program: The single best way to avoid running injuries is to gradually increase your mileage and intensity while incorporating periodic rest days and “deload” weeks. The vast majority of running injuries are caused by doing too much, too soon, and not giving the body sufficient time to repair the wear and tear that accumulates after each workout. Such a program can help avoid overloading the knee joint, and stop your knee from hurting after running.
- Lose weight: Carrying excess weight increases knee impact during running and increases inflammation in the body, which can further exacerbate joint pain. Maintaining a healthy weight reduces this strain.
And here are two more techniques that might reduce your risk of knee injuries, but aren’t well supported scientifically:
- Improve your running form: Scientists still debate what “good” running form means, but most agree it’s a skill that can be improved over time with practice. That said, most research shows the best way to improve your running form is to simply run more and let your body figure out the rest. Trying to deliberately change your running technique with cues and other strategies backfires more often than not, making you slower and less efficient.
A few changes that may occur as you get better at running are that you’ll keep a more upright posture, you’ll shorten your stride, and begin to land on your midfoot or fore-foot instead of your heel. (Though again, this won’t look or feel the same for everyone).
- Choose the right running shoes: Wearing comfortable running shoes can reduce your risk of injury, but what’s comfortable for others may be very different for you. While it’s probably a good idea to run in the most minimal shoes you can, ultimately what matters most is that they’re comfortable during runs.
+ Scientific References
- Esculier, Jean-Francois, et al. “Do the General Public and Health Care Professionals Think That Running Is Bad for the Knees? A Cross-Sectional International Multilanguage Online Survey.” Orthopaedic Journal of Sports Medicine, vol. 10, no. 9, 1 Sept. 2022, p. 232596712211241, https://doi.org/10.1177/23259671221124141.
- Chakravarty, Eliza F., et al. “Long Distance Running and Knee Osteoarthritis.” American Journal of Preventive Medicine, vol. 35, no. 2, Aug. 2008, pp. 133–138, https://doi.org/10.1016/j.amepre.2008.03.032. Accessed 3 Jan. 2020.
- Alentorn-Geli, Eduard, et al. “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, vol. 47, no. 6, 2017, pp. 373–390, www.ncbi.nlm.nih.gov/pubmed/28504066, https://doi.org/10.2519/jospt.2017.7137.
- Miller, Ross H., and Rebecca L. Krupenevich. “Medial Knee Cartilage Is Unlikely to Withstand a Lifetime of Running without Positive Adaptation: A Theoretical Biomechanical Model of Failure Phenomena.” PeerJ, vol. 8, 5 Aug. 2020, p. e9676, https://doi.org/10.7717/peerj.9676. Accessed 15 Oct. 2020.
- Horga, Laura Maria, et al. “Can Marathon Running Improve Knee Damage of Middle-Aged Adults? A Prospective Cohort Study.” BMJ Open Sport & Exercise Medicine, vol. 5, no. 1, 1 Oct. 2019, p. e000586, bmjopensem.bmj.com/content/5/1/e000586.full, https://doi.org/10.1136/bmjsem-2019-000586. Accessed 2 Apr. 2020.
- Horga, Laura Maria, et al. “Is the Immediate Effect of Marathon Running on Novice Runners’ Knee Joints Sustained within 6 Months after the Run? A Follow-up 3.0 T MRI Study.” Skeletal Radiology, 17 Feb. 2020, https://doi.org/10.1007/s00256-020-03391-2. Accessed 22 Mar. 2020.
- Khan, Michaela C. M., et al. “The Influence of Running on Lower Limb Cartilage: A Systematic Review and Meta-Analysis.” Sports Medicine, 3 Sept. 2021, https://doi.org/10.1007/s40279-021-01533-7.
- Hadeed, Andrew, and David C. Tapscott. “Iliotibial Band Friction Syndrome.” PubMed, StatPearls Publishing, 2020, www.ncbi.nlm.nih.gov/books/NBK542185/.
- Petersen, Wolf, et al. “Patellofemoral Pain Syndrome.” Knee Surgery, Sports Traumatology, Arthroscopy, vol. 22, no. 10, 13 Nov. 2013, pp. 2264–2274, https://doi.org/10.1007/s00167-013-2759-6.
- Reinking, Mark F. “CURRENT CONCEPTS in the TREATMENT of PATELLAR TENDINOPATHY.” International Journal of Sports Physical Therapy, vol. 11, no. 6, 2016, pp. 854–866, www.ncbi.nlm.nih.gov/pmc/articles/PMC5095939/.
- Williams, Christopher H, and Britni T Sternard. “Bursitis.” Nih.gov, StatPearls Publishing, 14 Feb. 2019, www.ncbi.nlm.nih.gov/books/NBK513340/.
- Chen, Lianzhi, et al. “Pathogenesis and Clinical Management of Obesity-Related Knee Osteoarthritis: Impact of Mechanical Loading.” Journal of Orthopaedic Translation, vol. 24, May 2020, pp. 66–75, https://doi.org/10.1016/j.jot.2020.05.001.
- Loeser, Richard F. “Molecular Mechanisms of Cartilage Destruction: Mechanics, Inflammatory Mediators, and Aging Collide.” Arthritis & Rheumatism, vol. 54, no. 5, 2006, pp. 1357–1360, https://doi.org/10.1002/art.21813. Accessed 30 Mar. 2020.
- Halvorsen, Kjartan, et al. “Acute Effects of Reducing Vertical Displacement and Step Frequency on Running Economy.” Journal of Strength and Conditioning Research, vol. 26, no. 8, Aug. 2012, pp. 2065–2070, https://doi.org/10.1519/jsc.0b013e318239f87f. Accessed 12 Mar. 2020.