Is running really bad for your knees?
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Run long enough and you’ll eventually hear “Running is bad for your knees.” But is it true?
Sure, runners may have more knee injuries than someone sitting on the couch, but does that really mean running is bad for our knees? We talked to Brad Kuske, DO, MultiCare sports medicine physician to get some answers and advice so you can avoid knee pain and injury to begin with.
First of all, we have to know: Is running actually bad for your knees?
This is a bit of a loaded question. The short answer is “No, not necessarily.” When people speak of running being bad for your knees, most are referring to the long-term risk of developing osteoarthritis (OA). This risk may be increased in some individuals regardless of the miles they run.
We know there is some genetic predisposition to developing OA with running, but we currently don't have a way of testing for this. The risk may be increased in those who run high volume, high intensity and longer duration.
Still, the health benefits gained from running in regard to general and cardiovascular health far outweigh the risks of injury to the knees.
What are the most common knee injuries you see in runners?
1. Patellofemoral pain syndrome (aka "runner's knee") is by far the most common cause of knee pain in runners and is caused by improper tracking of the patella (kneecap) within the notch at the end of the femur (thigh bone) due to multiple mechanical factors.
2. Iliotibial (IT) band syndrome is another very common issue with runners where the strip of connective/tendon tissue along the outside part of the thigh becomes tightened and causes friction with activity, resulting in pain.
What causes these injuries?
1. Too much, too soon is the most common cause for knee pain or injury in runners. People will gain motivation from their friends, their doctors, a TV show, you name it, and they will go out and try to implement a running program that their bodies are not ready for.
I see this all the time in the "bucket-list" marathoner; a person who has always wanted to run a marathon, but has no guidance in how to prepare for the race.
2. Poor running mechanics is another very common cause of injury. A lack of hip/core strength to maintain good posture as the body fatigues after running longer distances can put you at risk for injury. These can be corrected with appropriate strengthening programs.
3. Wearing the wrong shoes is a simple cause of injury. Couple that with the other causes and you have a perfect storm. Get fitted at a running shoe store and return the shoe if it doesn’t feel right. Most specialty running stores have a lenient return policy.
Are women more prone to knee injury?
Unfortunately, anyone can be susceptible to running injuries, but according to injury data, women are approximately 50 percent more likely to have running-related knee injuries or knee pain (patellofemoral pain syndrome and IT band syndrome) than their male counterparts.
What’s more concerning is that women are also more prone to non-contact ligamentous injuries (specifically the anterior cruciate ligament, ACL), which predisposes a runner to earlier onset osteoarthritis with distance running following surgical repair.
How can knee injuries be avoided?
1. Assure that you have proper fit and support in the running shoes you wear. Go to a running store and have them perform a shoe fit with running gait analysis. Be sure to change your running shoes every 300–400 miles (depending on your running stride and wear pattern).
2. Start low, and go slow. This is to directly counter the "too much, too soon" causative relationship discussed above. Gradually work your way up by 10 percent (either duration or intensity) each week.
3. Stretch out after exercise. Use a foam roller, rolling pin style roller or lacrosse ball to work out any tight spots in the quadriceps, hamstrings or IT bands.
4. Maintain adequate hydration and electrolyte balance. The words of my cross country coach echo in my mind: "Drink until your pee is clear!"
5. Work to improve running mechanics. Have a formal running gait analysis done and/or work with a running coach to improve technique.
Is there an easy way to tell the difference between pain and injury — when to keep going, cut back or stop?
As you run more, you build up tolerance to the delayed onset muscle soreness (DOMS) which is the usual feeling of "soreness" a day or two after exercise. Your body undergoes a process called "systematic adaptation to training" where overall pain associated with exercise decreases as you build muscular strength and endurance.
The best way to know if you are doing "too much, too soon" is to listen to your body. If you feel like your pain is stacking in a manner where it is becoming more difficult to run, consider cutting back or being evaluated by a physician.
Clearly the red flags of chest pain, lightheadedness/fainting or significant muscle tightness following exercise should trigger a prompt visit with a health care provider, urgent care or emergency room.
The take-home point is that the health benefits of running still far outweigh the risks of injury or long-term problems with your knees. Listen to your body and when in doubt, get checked out. Keep running!
Thank you, Dr. Kuske! Now you’re equipped with the knowledge to avoid the injury bench.
In my experience, seeing a sports medicine specialist at the first sign of imbalance is key to staying healthy. I even book a preventive appointment before a big training block and ask for three to five strength exercises I should incorporate into my training so I get out ahead of any potential pitfalls.
Brad Kuske, DO, is a board-certified pediatrician with additional training in pediatric sports medicine. Comfortable treating children and adults, he focuses on treating the young athlete. He also enjoys providing health care for the “young at heart.” Outside of work, Dr. Kuske relishes time with his family. Together they play soccer, hike, cycle, cook, travel and root for the Seahawks, Mariners and Sounders.
About The Author
Sarah Robinson is a runner, mom, brand storyteller and writer living and training in Tacoma. She has been running and racing for over 20 years and was a 2016 Olympic Trials qualifier in the marathon with a PR of 2:42:36. She has raced and won Sound to Narrows once, and remembers it as one of the toughest (and most fun) courses she’s raced.More stories by this author