One More Time: Running Isn’t a Death Sentence for Your Knees

I think I’ve been in the forefront of voices trying to spread the message that no, running isn’t inherently bad for your knees, and in fact can even help strengthen them.

Just search this blog. Here I am back in 2010:

Keep Running Past the Age of 40 and Your Knees Will Fall Apart! True or False?

The answer, incidentally, was a resounding “false.”

In October of last year, an article in the Washington Post highlighted more good news for runners. Studies are increasingly showing that not just running, but its extreme form, distance running, is actually beneficial for your knees:

… distance running does not wreck most runners’ knees and, instead, fortifies them, leaving joints sturdier and less damaged than if someone had never taken up the sport.

A recent 2019 study is cited, where the researchers rounded up 82 middle-aged first-time racers who had signed up for the 2017 London Marathon. Few had done much if any running. None had knee pain.

By conventional wisdom, this group should have been prime for lots of damaged knees. They were middle-aged, didn’t have a history of running, and were training for a 26.2 mile grueling endurance race!

But what the researchers observed: most of the pre-training knee scans showed signs that the runners did have signs of joint injuries setting up, such as cartilage tears and bone-marrow lesions. But two weeks after their first marathon, most of the lesions had shrunk, and so had much of the areas of bad cartilage.

Still, there were signs of fresh (though slight) damage in the bones and cartilage around their kneecaps. That was understandably concerning. So new scans were taken later, six months after the race and:

Many of the lesions and tears that had begun shrinking during training were smaller and the fresh damage seen around some kneecaps had largely dissipated, with few remaining signs of lesions and tears.

But the more important, more broadly relevant message in this article (after all, not all of you are runners or want to be) comes from Jean-Francois Esculier, a clinical professor of physical therapy at the University of British Columbia in Kelowna. This is one of the BIG messages in my book (emphasis below is mine):

“For a long time, we thought that cartilage could not adapt” to running or other activities, he said, because it lacks blood supply and nerves. “But in fact, cartilage does adapt,” he said, “by becoming stronger and more tolerant to compression.”

Yes, yes, yes. Knee cartilage is not an inert material, like the rubber on your car tires, fated to eventually wear out. But the difficulty we face in recovering, with bad knees, is dialing back our level of activity enough so that we don’t continue to do further damage to our weak knees.

I’m happy that these messages are gaining wider acceptance. But the battle is not yet won, for as the article noted:

An online survey conducted by Esculier and his colleagues, its results published this year in the Orthopaedic Journal of Sports Medicine, found more than half of the 2,514 respondents believed distance running damages knees.

So don’t be surprised if your doctor isn’t on the side of the enlightened yet. But opinion in the orthopedic doctor/therapist community is finally swinging around. And that’s a very, very good thing for people with knee pain.

A Success Story to Start the New Year!

Why not start 2023 with a story of someone overcoming knee pain? Hoisted from comments and lightly edited (with emphasis mine): 

Your book "Saving My Knees" was an inspiration. It gave me hope that I could overcome the limitations of osteoarthritis (Stage 3 according to an orthopedist who interpreted my MRI results). Three years ago, I couldn't walk the length of my house without pain so bad that it even interrupted my sleep at night.

After reading your book, I decided to chuck the orthopedist and the NSAID he recommended, and embark on a program of my own design after reading everything I could about osteoarthritis.

I soon learned that inflammation played a major role in both the pain that people with osteoarthritis endured and the progression of the disease. In addition to daily walks and yoga, I adopted an anti-inflammatory diet consisting mostly of plant-based whole foods. Currently, I eat seven to ten fruit and vegetable servings per day as well as legumes, whole-grains, and soy. I also lost 20 lbs. of excess weight, which I'm sure has contributed much to my improvement.

This morning I walked [four miles in an hour] with no pain. Most days I walk 6,000 to 9,000 steps daily during my walks and about another 1,200 to 1,500 steps as I do my daily chores at home. Not bad for a man in his seventies!

I love reading stories like this.

First of all, note that this person's knee pain was hardly mild: "stage 3 according to an orthopedist" (I suspect that refers to the extent of deterioration in his cartilage, where stage 4 is bone on bone) and "I couldn't walk the length of my house without pain so bad that it even interrupted my sleep at night."

Can you imagine that? Just walking from one end of your house to the other, and then having intense knee pain at night as a result? I'm sure some of you can, but this is definitely at the more extreme end of the knee pain spectrum.

After that, he did a few smart things, maybe the smartest being this: "I also lost 20 lbs. of excess weight ..."

I'm not sure how much an anti-inflammatory diet contributes to alleviating knee pain -- it didn't seem to make a huge difference for me, but my dietary changes weren't really radical -- but I've read so many medical studies about how being overweight contributes to knee pain that I'm quite confident that shedding pounds will make some kind of difference, if you're patient.

I also sense a kindred spirit in these words: "I decided to chuck the orthopedist and the NSAID he recommended and embark on a program of my own design" ... which is exactly what I did. Again, I'm not trying to denigrate doctors, and some are very, very good, and they are important to help diagnose what might be plaguing you. But ultimately, a lot of healing chronic knee pain will depend on you and your individual efforts and plan to heal.

But of course he healed, you may have thought after reading the first few paragraphs -- he was probably in his twenties or thirties, at an age when healing is still possible ... nope! He was in his seventies!

In some ways, it may be easier to heal in your seventies instead of your twenties or thirties. Why?

When you are young, that illusion of immortality, of being unbreakable (at least in a permanent way), is still very much with you. And that can be a dangerous illusion. It will cause you to pronounce yourself prematurely healed; you will tend to think that all healing must be on a two- to four-week (or at most a four- to six-week) timeline.

When you are older (in your forties, fifties, sixties, or beyond), you have two advantages: (1) the knowledge that good health shouldn't be taken for granted, that it can be a fragile and easily lost thing if one is reckless or ignores the body's warning signals (2) patience.

Yes, healing takes longer in someone older, but that older person is more likely to possess the wisdom and patience to be able to handle that fact.

There you are: a success story to start 2023.

How are you all doing out there? This year, my posting will probably become less frequent, as book sales have kind of tapered off, and that has led to a corresponding dip in traffic to this blog. But I'll still be here, at least occasionally.

Best wishes, and to all, good knee health in 2023!