Is running bad for knees?

Is running bad for your knees?

Running is a hugely popular, easily accessible healthy physical activity (especially post COVID-19). Running also provides a range of physical and mental health benefits including reduced risk of mortality (that’s dying) as well as substantially reducing the risks of experiencing the harms associated with a range of chronic health conditions. Think heart disease, diabetes, high blood pressure, high cholesterol, depression, anxiety… So, yeah, there are some good things about running. Running can also assist people to maintain their body weight within a healthy weight range.

Despite this, for many years there has been an idea about running often misguidedly promoted by health professionals and others that suggests running is bad for knees (or causes osteoarthritis). Many people have been advised to reduce or stop running in order to protect their knees yet there is no evidence to support this advice for the average (uninjured) person.

There is a serious amount and depth of research* that demonstrates recreational running in distances up to marathon (42.2km) has a protective effect against the development of knee osteoarthritis (OA). Runners should understand that there are other risk factors more likely to increase the risk of OA including higher body mass (be very careful with running if you are above or below the healthy weight range), previous knee injury, previous knee surgery and heavy occupational workloads rather than running per se. So, if your BMI (Body Mass Index) is between 18.5 and 24.9 (healthy weight range) you can safely “approach a running programme”.

Here is a free BMI calculator on the Heart Foundation’s website 

All you need to calculate your BMI on the above site is your height, weight and gender. Some people do this just to check whether they are within the healthy weight range.

You can also approach a running programme if your BMI is outside the weight range specified however special advice from a Physiotherapist probably changes from being recommended to becoming essential.

Let’s talk about “approaching a running programme”. 

Management and progression of running loads, incorporating strength training, programming adequate recovery (including sleep) and running technique improvement are important to consider to minimise the risk of injury. Couch to 5km should take a minimum of 4 months (for someone who hasn’t run extensively with other sporting participation) when performed safely and comprehensively. We see the programmes in the papers, don’t worry, but we also see the consequences. Couch to half marathon (21.1km) would take a dedicated athlete around 12 months to prepare for if in the healthy weight range. Marathon takes a while longer. We know how long it takes muscles, tendons, joints, bones, lungs and hearts to adapt. You cannot beat nature.

Cross-training with appropriately guided strengthening, Pilates, protected weight bearing activities and remedial therapies such as joint mobilization, massage, dry needling and myotherapy can assist recovery and reduce injury risk.

Pain and injury are likely to develop when the body is pushed beyond its capacity such as when training loads are too heavy (just commenced hill training?) or not increased incrementally. 

As Physiotherapists we see people who have followed the advice of the personal trainers you may have seen on TV and “pushed hard”. Bodies safely adapt relatively slowly to new loads (and often break down when limits are tested or exceeded). Our advice to many people who are commencing running after significant time (more than three months) away from sport is to build resilience slowly and sustainably. Consider building your walks from 20 to 60 minutes duration over a 1 month time frame. Consider attempting to build bike riding in a similar fashion. See how your body feels (and changes). Cross your training up. Walk, ride, try free 7-minute workouts (there are apps everywhere for this) or get advice about strength or other conditioning possibilities from your movement expert (a Physiotherapist at Form and Practice).

Sub-optimal gait biomechanics are often a telltale indicator of both injury risk or existing injury. Have you noticed how many people you see running who look like they are really struggling (versus the absolute rhythm and control you may notice in a practiced and well trained runner)? This is where seeking guidance from a physiotherapist can be invaluable. It may be as simple as planning training loads, looking at key muscle groups to strengthen or assessing foot and lower limb biomechanics during walking and running.

If your goal is to run there is a safe way to approach it. The physiotherapists at Form and Practice work regularly with runners of all age ranges and abilities to help them achieve their goals, recover from or ideally prevent injuries. Book an appointment…

*The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis

Alentorn-Geli, Samuelsson, Musahl, Green, Bhandari and Karlsson 2017