Ever since I can remember I have heard mixed messages about running and what it does for our knees. I can recall a coach yelling at me as a youngster for running on the cement when there was perfectly good grass less than a metre away.
Had I been a fool, or did it not really matter?
What are your beliefs?
This has been a debate brewing in the health industry & society for years. Running has been blamed for countless people in pain but we also know running has helped a lot of people reduce their pain levels. So, is running good or bad for us?
Is running good or bad for us?
Firstly we should work out if there is any merit behind this statement – Do runners have higher prevalence of pain in their knees?
Unfortunately, this information is very difficult to find. However, there are some conclusions that can be drawn from the current research.
Knee pain is a common complaint for all members of society. Knee pain can occur from acute injuries usually with a mechanism of injury (eg. Tripped over and jarred knee) – where muscles, ligaments or other structures have been torn, stretched etc. Knee pain can also happen over time with no mechanism of injury and the major culprit is osteoarthritis.
A large systematic review determined the risk factors associated with an increase in osteoarthritis in elderly populations (over the age of 50).
This review included 85 studies & found some interesting results. These factors all contributed to increased levels of osteoarthritis in knees
- Increased BMI (overweight),
- increased age,
- previous knee injury,
- female gender,
- intensive physical activity history (competitive sport),
- reduced bone mineral density and
- certain occupational activities (lots of kneeling, squatting) (1)
If people who have an intensive physical activity history are more prone to osteoarthritis maybe there is some warrant behind the argument that running can increase knee pain and osteoarthritis.
Do runners have more osteoarthritis than non runners?
NO THEY DONT!
There are countless studies that have now been performed which show that running doesn’t cause osteoarthritis. A study looked at elderly runners and healthy non runners and did 20 year follow up with x-rays to determine any potential changes. The results concluded that running does not accelerate osteoarthritis. (2)
Another systematic review determined that runners have a lower prevalence of knee OA (3.5%) compared to sedentary individuals (10.2%). (3) This study also concluded similar results to the one previously with elite international runners having slightly higher levels of osteoarthritis compared to sedentary (13%).
So, in conclusion the right dosage of running will reduce your chances of developing osteoarthritis and prevent further osteoarthritic changes in people who already have osteoarthritis. Finding the right balance can be tricky- but it’s important to note that the study above only included participants in the running category if they ran at least 5 marathons and running a minimum of 16km weekly. That’s a decent amount!! The bigger concern is not doing too much but actually doing too little! Fear of causing injury or further joint degeneration is not warranted and shouldn’t be a reason for you stopping running!
Does running surface matter?
Yes and no.
Running surfaces haven’t been linked to any changes in the prevalence of knee injuries. However, we know that with a stiffer surface (concrete) we actually run with less leg stiffness to help. This is done by our bodies feedback from previous strides on similar surfaces. Our bodies adapt!
We also know that different surfaces change the time of contact (foot on ground), average deceleration rate and forces etc. This is why if you are suffering with pain whilst running then changing the surface can have a positive impact. But for the general public there is no increased risk in injury by running on a stiffer surface vs a softer surface. (5)
Benefits of running!
Surprise surprise, turns out there are many benefits to running 🙂
- Improved cardiovascular health (Running, even 5 to 10 min/day and at slow speeds <6 miles/h, is associated with markedly reduced risks of death from all causes and cardiovascular disease)
- Mental health benefits (ever heard of “runners high”?)
- Lose and maintain weight (we know this is important for preventing pain)
- Strengthens other areas of the body (did you really think it was just the knees getting stronger ?)
- Reduces risk of cancer
- Improves cognitive performance (helps reduce age related decline)
- Live longer (on average runners live for 3 years longer than non-runners)
- It’s cheap (doesn’t cost anything to get started)
- Better bone density (running increases bone density compared to tasks like cycling)
- Different types of running – sprinting, jogging, long distance, bush trails, etc. (all will give your body a different advantage compared to the people sitting on the couch!)
What other injuries are associated with running?
So, turns out knee pain is the most common complaint for runners but that doesn’t stop other injuries occurring. (4)
Achilles tendinopathy is also a common injury that can occur from running.
There is some good news for running here as well with studies showing that running can cause protective changes to tendons. Before you argue well it might cause degeneration in your back – you are wrong. Just like the response in your knees – running and loading through our back will only make it stronger in the long run! (excuse the pun)
Running and pain!
Just to be clear, I am not recommending that you go out there and “run your pain away”. As with most exercise – injuries do occur and how we manage them really has a massive impact on our future well-being.
So what can we do to prevent pain when running?
- Monitor training loads (make changes where appropriate)
- Look at footwear/gait pattern (make changes where appropriate)
- Strength training!!
- Stretching post run and doing good warm up prior
- Good Nutrition
- Good Sleep hygiene
- Include other forms of exercise (deloading – cycling/swimming etc.)
If you experience pain with running or, after reading this, would like to get started with your own running program, then please contact us for an appointment. Make a positive change in your life!
Jamie Wotherspoon, Physio