Should I stop running if my knee hurts?

The most common site for pain in recreational runners [1] is the knee. For some, especially older runners, the pain can be a symptom of osteoarthritis. But does running worsen knee pain and osteoarthritis?


Ewa M Roos, Christian Barton, The Conversation September 1, 2020

A study from Canada [2] shows that many people – including health professionals – believe running might be harmful to knee joints, particularly in people with knee osteoarthritis. One in two people believes that the repetitive loading associated with running, especially frequent or long-distance running, will speed up the deterioration caused by knee osteoarthritis and shorten the time to having the knee surgically replaced with an artificial joint.

But are these fears about running supported by science? Recreational exercise does not seem to be harmful to knee cartilage.[3] In fact, exercise is important for cartilage health – the stimulus brings nutrients to the joints.[4] And people who exercise moderately are less likely to have knee osteoarthritis.[5] More specifically, recreational runners have far lower rates of knee osteoarthritis than non-runners.[6] So you could say that not running might be bad for your knees.

However, high-volume or high-intensity running is associated with higher rates of knee osteoarthritis compared with recreational running,[6] suggesting that there is probably a sweet spot which doesn’t involve being a couch potato or getting too competitive.

Exhausted runner
Don’t overdo it. Izf/Shutterstock
What if you already have knee pain or osteoarthritis?

It is not clear whether continuing to run with knee pain or osteoarthritis is bad for your knees, and many researchers around the world are exploring this question. But continuing to run, if you can, will help achieve the many health benefits of regular physical activity, including preventing at least 35 chronic diseases, such as heart disease, stroke, type 2 diabetes and depression.[7] In general, runners live three years longer than non-runners. And the benefits of running are independent of other things, such as age, sex, weight, alcohol and smoking.[8] In other words, if two people regularly smoked cigarettes or drank alcohol excessively, and one of them was a runner, the runner would still live longer than the non-runner.

Running is an activity that can be done outdoors in most parts of the world and requires minimal equipment. And health benefits can be achieved with as little as 50 minutes running a week.[9] During the pandemic, the fact that it can be done alone without the help of others further increases its attractiveness and ensures people can continue to participate to stay healthy.

Three tips for managing running-related knee pain

You can exercise safely by following simple rules.

  1. Reducing running volume or intensity (reduced speed, avoiding downhill) will reduce knee loads and can help reduce pain.[10]
  2. Seeking help and guidance for therapeutic exercise, such as strengthening the knee and hip muscles, from a physiotherapist or other qualified professional, can reduce knee pain related to running and other activities, including in people with knee osteoarthritis.[11]
  3. Carefully consider changing your running technique with guidance from a professional. Changing your running style to a forefoot strike instead of heel strike can reduce loads on the knees [12] and running-related knee pain.[13] However, it will increase loads on the ankle, posing risks to injure other joints and tissues.[12] Increasing running cadence (step rate) or changing the position of your trunk can also reduce loads on the knee and may help reduce pain.[14]
Ewa M Roos, Professor of Muscle and Joint Health, University of Southern Denmark
Christian Barton, Senior Post-Doctoral Research Fellow, MRFF Fellow, La Trobe University

Source The Conversation


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2. What are the perceptions about running and knee joint health among the public and healthcare practitioners in Canada? Esculier JF, Krowchuk NM, Li LC, Taunton JE, Hunt MA. PLoS One. 2018 Oct 1;13(10):e0204872. doi: 10.1371/journal.pone.0204872. Full text

3. Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials, Bricca A, Juhl CB, Steultjens M, Wirth W, Roos EM. Br J Sports Med. 2019 Aug;53(15):940-947. doi: 10.1136/bjsports-2017-098661. Epub 2018 Jun 22. Full text

4. High-bandwidth AFM-based rheology reveals that cartilage is most sensitive to high loading rates at early stages of impairment, Nia HT, Bozchalooi IS, Li Y, Han L, Hung HH, Frank E, Youcef-Toumi K, Ortiz C, Grodzinsky A. Biophys J. 2013 Apr 2;104(7):1529-37. doi: 10.1016/j.bpj.2013.02.048. Full text

5. Physical Activity Is Related with Cartilage Quality in Women with Knee Osteoarthritis, Munukka M, Waller B, Häkkinen A, Nieminen MT, Lammentausta E, Kujala UM, Paloneva J, Kautiainen H, Kiviranta I, Heinonen A. Med Sci Sports Exerc. 2017 Jul;49(7):1323-1330. doi: 10.1249/MSS.0000000000001238.

6. The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis, Alentorn-Geli E, Samuelsson K, Musahl V, Green CL, Bhandari M, Karlsson J. J Orthop Sports Phys Ther. 2017 Jun;47(6):373-390. doi: 10.2519/jospt.2017.7137. Epub 2017 May 13. Full text

7. Lack of exercise is a major cause of chronic diseases, Booth FW, Roberts CK, Laye MJ. Compr Physiol. 2012 Apr;2(2):1143-211. doi: 10.1002/cphy.c110025. Full text

8. Leisure-time running reduces all-cause and cardiovascular mortality risk, Lee DC, Pate RR, Lavie CJ, Sui X, Church TS, Blair SN. J Am Coll Cardiol. 2014 Aug 5;64(5):472-81. doi: 10.1016/j.jacc.2014.04.058. Erratum in: J Am Coll Cardiol. 2014 Oct 7;64(14):1537. Full text

9. Is running associated with a lower risk of all-cause, cardiovascular and cancer mortality, and is the more the better? A systematic review and meta-analysis, Pedisic Z, Shrestha N, Kovalchik S, Stamatakis E, Liangruenrom N, Grgic J, Titze S, Biddle SJ, Bauman AE, Oja P. Br J Sports Med. 2020 Aug;54(15):898-905. doi: 10.1136/bjsports-2018-100493. Epub 2019 Nov 4.

10. Is combining gait retraining or an exercise programme with education better than education alone in treating runners with patellofemoral pain? A randomised clinical trial, Esculier JF, Bouyer LJ, Dubois B, Fremont P, Moore L, McFadyen B, Roy JS. Br J Sports Med. 2018 May;52(10):659-666. doi: 10.1136/bjsports-2016-096988. Epub 2017 May 5.

11. Patellofemoral Pain, Willy RW, Hoglund LT, Barton CJ, Bolgla LA, Scalzitti DA, Logerstedt DS, Lynch AD, Snyder-Mackler L, McDonough CM. J Orthop Sports Phys Ther. 2019 Sep;49(9):CPG1-CPG95. doi: 10.2519/jospt.2019.0302. Full text

12. What are the Benefits and Risks Associated with Changing Foot Strike Pattern During Running? A Systematic Review and Meta-analysis of Injury, Running Economy, and Biomechanics, Anderson LM, Bonanno DR, Hart HF, Barton CJ. Sports Med. 2020 May;50(5):885-917. doi: 10.1007/s40279-019-01238-y.

13. The effects of gait retraining in runners with patellofemoral pain: A randomized trial, Roper JL, Harding EM, Doerfler D, Dexter JG, Kravitz L, Dufek JS, Mermier CM. Clin Biomech (Bristol, Avon). 2016 Jun;35:14-22. doi: 10.1016/j.clinbiomech.2016.03.010. Epub 2016 Apr 7.

14. Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion, Barton CJ, Bonanno DR, Carr J, Neal BS, Malliaras P, Franklyn-Miller A, Menz HB. Br J Sports Med. 2016 May;50(9):513-26. doi: 10.1136/bjsports-2015-095278. Epub 2016 Feb 16.

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