As a physical therapist, I get asked this all the time: Does running cause knee pain, wear and tear, and osteoarthritis?
During our first appointment together, my client told me that his doctor said he should never run again.
His doctor looked at him and said: “You’re too old to be running as much as you are, it’s just too much impact. Just start biking instead...”
He was so scared and frustrated. For so long, running had been his favorite way to exercise and to take care of himself, physically and mentally.
His son was a runner too, so they often went on runs together around Charleston, like the Cooper River Bridge Run, but he had recently started experiencing knee pain.
A lot of people unfortunately believe that running and impact is bad for our knees and that it leads to "wear and tear," pain, and arthritis. A lot of people, like my client, are told that they should just stop running for good.
In this blog, I'll answer these two common questions:
Is running bad for my knees?
Does running lead to more wear and tear and osteoarthritis later on in life?
and in part 2, I'll tell you:
What really matters when it comes to knee pain and running
How to decrease AND prevent knee pain as a runner
Let's get started!
Is running bad for my knees?
There’s a lot of myths about knee pain, impact, and "wear and tear."
Like with my client: this guy had been running about 10 miles a week for over 10 years.
10. YEARS!
You may be thinking - no wonder he has pain.
“Well I guess all that wear and tear finally caught up to him! All those miles!”
Here’s actually where my brain went, as a physical therapist who works with runners all the time:
“Wow, he’s been able to do this for so long. I bet his body and his knees are really strong and really prepared for that load and volume.”
That's because, if you do it RIGHT (and follow these guidelines I'm about to give you), then you can keep running forever, without worrying about pain.
What upsets me about what his doctor said is that he’s telling this man who has spent 10 YEARS running that his body isn’t capable of handling the demands of running
He didn't say, "Take some time off running then gradually build back up," he went straight to: "You should be done with running forever."
Make it make sense. It doesn't to me.
The problem is: most people think that running is bad for our knees, and that running leads to more “wear and tear” and osteoarthritis (OA) later on in life.
However, the research suggests differently. Just to give you a few examples:
This systematic review published in 2023 found that there were actually more cases of knee pain in the non runner group, and there were no differences between the groups in terms of OA or cartilage thickness.
There’s a study published in 1998 that studied runners over the course of 9 years to see if the runners vs. non-runners developed more knee and hip arthritis. There were no significant differences between the presence or progression of OA between groups. They were VERY similar.
This study published in 2017 found that out of non-runners, recreational runners, and competitive runners (meaning that they were either professional athletes or represented their country in international competitions), the recreational runners had the least amount of arthritis.
So here’s how I’m interpreting this:
1. Let's say that both groups developed the same amount of osteoarthritis. Now, think about the runner group - people that CHOSE to run for exercise. I wonder how much healthier and happier they were overall. What are the health benefits of running versus the potential (and apparently unlikely) risks? What are the risks of physical INactivity?
2. Also, the “risk” of osteoarthritis might not even be a risk. If there’s no differences between groups, does that just mean that arthritis is inevitable? Is it just a normal part of aging? Is it just like wrinkles on the inside?
3. There’s also a lot of research suggesting that what shows on imaging and MRIs doesn’t actually predict or correlate with our pain. A study published in 2018 looked at over 5397 knees (that’s a lot of knees!) and found that osteoarthritis was present in up to 43% of those knees WITHOUT ANY SYMPTOMS.
Sounds like OA isn’t always correlated with pain anyway, huh?
4. With the study in 2017, recreational runners had the lowest amount of OA compared to non-runners AND competitive runners. Could it be that it's actually all about dosage and load management???
(Hint: yes)
Which brings me to FAQ #2:
Is running going to lead to "wear and tear" and pain later on in life?
Running doesn't inherently lead to arthritis or pain down the road (see research above). You're not going to "pay for it later." PLUS, arthritis doesn't correlate well with pain.
I repeat, running is NOT going to inevitably lead to pain later on in life.
In my opinion, you're way more likely to "pay for it later" if you're NOT physically active. There are way more health risks with the lack of physical activity.
So to recap, running and impact is not bad for your knees, and it’s not going to inevitably lead to pain or problems later on in life.
That client I mentioned before just ran a 10k with his son and hasn't had knee pain in months.
So this is your permission, from a physical therapist, to keep running.
In part 2 of this blog, I'll tell you:
What really matters when it comes to knee pain and running
How to decrease AND prevent knee pain as a runner
At Made 2 Move, we help runners get back to doing what they love without worrying about pain or injuries. Our physical therapists work with all levels of runners: from competitive athletes to weekend warriors to grandparents who just want to keep up with their grandkids!
In a world where most doctors will tell you to stop running, we'll help you get back to running safely and confidently.
At Made 2 Move Physical Therapy in Charleston, we'll help you stay active, pain-free, and healthy. Don’t let a sedentary lifestyle hold you back. Contact us today to schedule your consultation and take the first step towards a more active, healthier you.
I’ve always been afraid of running too much because of the impact on my knees, but this is making me rethink things. Good snake game have responsive controls that allow players to maneuver the snake smoothly around the play area.