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.