The Myth

Busting the myth that running is inherently bad for you knees

Busting the myth that running is inherently bad for your knees

This needs to stop!  What you may ask?  The scare tactics!  Scare tactics don’t help patients. Actually, scare tactics harm them. One of the more common scare tactics we find is the scare tactic, stop running cause it’s bad for your knees.  We hear medical providers like orthopedic surgeons, physiatrists, sports medicine physicians, primary care physicians, physical therapists, chiropractors, athletic trainers and strength coaches using tactics like:

  • “Stop running, you’ll trash your knees.”
  • “If you want a knee replacement, continue to run.”
  • “Running is bad for your knees.”
  • “Do you want osteoarthritis of the knees, then continue to run.”
  • “If you continue to run, then your doctor won’t be able to help you and you’ll need surgery.”
  • “Do you want to walk when your 60 or 70?  Then stop running.”

Fear & Scare Tactics

Scare tactics create fear. Fear creates mental and sometimes physical fragility. That perceived fragility creates anxiety and/or depression which can lead to things like increased pain, stress, social withdrawal, activity withdrawal, dysfunction and inactivity. These are all bad things. Last time I checked, there’s also an obesity epidemic in this country so taking away what could be a very beneficial activity for the athlete can have huge ramifications on their physical and mental health.

The Science

Very applicable! The overwhelming scientific odds are a decades long bias against running that's been propagated for way too long! Let's science the sh*t out of that bias and break that stereotype!

Very applicable! The overwhelming odds are a decades long bias against running that’s been propagated for way too long! Let’s science the sh*t out of that bias and break that stereotype!

Do you want to know the truth? The scientific body of evidence ACTUALLY SUPPORTS THE OPPOSITE CONCLUSION! In English, this means continue to run if you can. See below for a quick review of the research:

  1. Marathon runners did not show increased evidence of radiographic damage on pre-marathon vs. post race MRI (1)
  2. Healthy runners did not show increased evidence of radiographic damage on MRI pre-marathon vs. post race vs. months later (3)
  3. Running a marathon did not substantially alter MRI findings. Abnormal findings were found in both marathoners and in active, non-runner control subjects (4)
  4. Cartilage volume (amount) changed on MRI based on volume of running and load; however, those changes were mostly asymptomatic resulting in the conclusion that cartilage adapts well to the forces of running (6)
  5. Cartilage shows deformation (changes) with running but has the ability to adapt and rebound quickly allowing for rapid recovery (8)
  6. The presence of meniscal tears in runners is no higher than sedentary people (9)
  7. Runners have the same amount of degenerative changes as the non athletic population (9)
  8. Overall, knee osteoarthritis risk was the same for sports participants and  non participants (10)
  9. Peak unit loads to the knees are similar in walking vs. running (11)
  10. X-ray evidence in healthy older runners vs. controls did not show accelerated signs of osteoarthritis (12)
  11. X-ray evidence of progressed hip and knee osteoarthritis was not accelerated in runners vs. non runner controls (13)
  12. Running did not increase the risk for hip and knee osteoarthritis in athletes with no other risk factors and in fact running may have a protective effect (14)
  13. The forces on the knee during marathon running are generally well tolerated at the hip and knee (15)
  14. Seasoned and well trained runners have adaptations to the stresses of running that do not increase the risk for knee osteoarthritis on pre and post running MRI (16)
  15. Competitive recreational runners that started in their 20’s or 30’s and tracked over time when compared to non runner controls had no significant differences in joint alignment, range of motion, pain reports, cartilage thickness, grade of degeneration or bone spurs (18)
  16. Runners showed increased bone mineral density (19)
  17. Runners had no difference in knee joint space, joint stability, or symptomatic knee arthritis (19)
  18. There is no association between moderate long distance running and the risk of osteoarthritis (20)
  19. Evidence suggests that neither heavy mileage nor the number of years running are contributory to the future development of osteoarthritis of the hips and knees (20)

Risk Factors For Knee Injury

Is running a completely harmless activity for your knees? The answer is no. There are certain demographics of patients and athletes out there that may not be the best candidates for running.  Those candidates typically have the following characteristics:

  1. High training volumes (2)
  2. Past high grade or previous knee injury (3, 17, 21)
  3. Elite level runners (5)
  4. Past or current history of medial knee pain since the medial joint typically sustains higher loads (7)
  5. Overweight or obese (12, 17)
  6. Past knee injury with insufficient rehabilitation
  7. Structural misalignment of the knee (16, 21)
  8. Heavy physical demand level jobs (17)
  9. History of activities requiring prolonged or frequent kneeling and squatting (17)
  10. Past knee surgery (21)
  11. Ligamentous laxity (loose ligaments) (21)
Genu Valgum ("Knock Knee") and Genu Varum ("Bowlegged") are both risk factors for knee pain

Genu Valgum (“Knock Knee”) and Genu Varum (“Bowlegged”) are both risk factors for knee pain as are other structural deformities.

Other Risk Factors

It would be absurd of me and you for that matter to assume that runners never suffer an injury. It’s also unwise to assume the only issues are with the knee. In fact, estimates say 20-79% of runners suffer an injury at some point (22, 23, 26). There is an estimate that 90% of all marathoners suffer an injury at some point in their careers (25).  It’s important to understand the general risk factors for running injuries, so here goes:

  1. The cause of most running injuries in general is exceeding mileage limits (training errors) that we were designed to tolerate (22, 23)
  2. Previous month’s mileage significantly correlates to reporting an injury (23)
  3. Previous injury (anywhere) is the best predictor of future injury in life, in sports and in running
  4. Novice runner’s are more likely to get injured than seasoned runners (22, 24)
  5. Running to compete
  6. Excessive weekly distance > 35-40 miles (22, 25, 26)

There appears to be a point where excessive running or training causes diminishing returns. As you look on the graph below, you’ll notice that at the top of the bell curve is maximum performance. This is the point where the runner is not over trained or under trained. Too much or too little stimulus (“training”) will impact performance and increase injury risk. This point is highly variable! Different athletes and different runners have points where they perform the best and avoid injury or likewise where their performance tanks and risk for injury increases. 

Too much training to the right or left of your "ideal" point leads to poor performance and increases injury risk

Too much training to the right or left of your “ideal” point leads to poor performance and increases injury risk

This is where we come in. We can help runners identify the point of maximum performance as well as create resiliency/adaptability. What this means is simply, we can keep you from over training, poor performance, increased injury risk while increasing your body’s “emergency fund” to manage the forces associated with training.  

The Good News

Here’s the good news though. Running does not increase the risk for long term “damage” to your knee as much as other activities. Running in moderate doses can actually have a protective effect. So please, if running is a quality of life thing for you, continue to run just moderate the dose (frequency, intensity, duration, distance, etc.). Also, consider a comprehensive evaluation in our office with a physical exam, orthopedic exam, neurological exam, functional movement exam, gait analysis, nutritional analysis, implementation of therapeutic exercises & strategies for peak performance.  Call 708-532-2346 or email drdinopappas@gmail.com for more info. “Why Put Off Feeling Good?”

References

  1. http://www.ncbi.nlm.nih.gov/pubmed/16528558
  2. http://www.ncbi.nlm.nih.gov/pubmed/16368218
  3. http://www.ncbi.nlm.nih.gov/pubmed/11310202
  4. http://www.ncbi.nlm.nih.gov/pubmed/18463868
  5. http://www.ncbi.nlm.nih.gov/pubmed/26900507
  6. http://www.ncbi.nlm.nih.gov/pubmed/16436539
  7. http://www.ncbi.nlm.nih.gov/pubmed/22729505
  8. http://www.ncbi.nlm.nih.gov/pubmed/18287595
  9. http://www.ncbi.nlm.nih.gov/pubmed/1950873
  10. http://www.ncbi.nlm.nih.gov/pubmed/25574790
  11. http://www.ncbi.nlm.nih.gov/pubmed/24042311
  12. http://www.ncbi.nlm.nih.gov/pubmed/18550323
  13. http://www.ncbi.nlm.nih.gov/pubmed/9489830
  14. http://www.ncbi.nlm.nih.gov/pubmed/16790540
  15. http://www.ncbi.nlm.nih.gov/pubmed/14754724
  16. http://www.ncbi.nlm.nih.gov/pubmed/15918131
  17. http://www.ncbi.nlm.nih.gov/pubmed/7718008
  18. http://www.ncbi.nlm.nih.gov/pubmed/2403186
  19. http://www.ncbi.nlm.nih.gov/pubmed/3945033
  20. https://www.ncbi.nlm.nih.gov/pubmed/4028541
  21. http://www.ncbi.nlm.nih.gov/pubmed/6883024
  22. http://www.ncbi.nlm.nih.gov/pubmed/1439399
  23. https://www.ncbi.nlm.nih.gov/pubmed/3578639
  24. https://www.ncbi.nlm.nih.gov/pubmed/259519174
  25. http://4.https://www.ncbi.nlm.nih.gov/pubmed/?term=fredericson+M%2C+Anuruddh+M.+Epidemiology+and+etiology+of+marathon+running+injuries
  26. http://1.http://bjsm.bmj.com/content/41/8/469.full.pdf

*** About The Author ***

Dr. Pappas is a chiropractic physician, certified athletic trainer and certified strength and conditioning specialist. Dr.

Dr. Dino Pappas

               Dr. Dino Pappas

Pappas blends the best of physical medicine with the best of integrated medicine to help patients and athletes of all shapes and sizes. He utilizes tools such as joint manipulation, soft tissue work (IASTM, Graston, myofascial release, neural mobilization and joint mobilization), biomedical acupuncture, functional movement based assessment, the McKenzie Method, strength training and conditioning, kinesiology taping, customized nutrition and specialty laboratory testing (blood, saliva, urine, and stool) when needed. Dr. Pappas’ clinical focus is sports medicine, conservative orthopedics, rehabilitation and integrated medicine. He is extremely passionate on empowering patients towards their goals. His sports medicine interests are endurance athletes, overhead athletes (pitchers, throwers, volleyball players and tennis players), contact sports athletes (football, rugby, lacrosse, field hockey, soccer and basketball) and Crossfit athletes. He has worked with athletes at all levels from professional to amateur. He reads and interprets the medical literature daily to stay abreast of cutting edge advances in his field. The doctor is currently a sports medicine volunteer for Andrew High School in Tinley Park, IL. He is an avid runner and aspiring triathlete having completed 5 marathons, 6 half marathons and numerous 5 and 10k races. The doctor is also active in the local, suburban Chicago running scene. He has goals of qualifying and competing in the Boston and New York Marathons, the Ironman in Kona, Hawaii, and climbing Mt. Kiliminjaro in Kenya, Africa. He recently completed the Pikes Peak Ascent half marathon to the 14,115 ft summit of Pikes Peak in Colorado. One day he hopes to serve his country as a team chiropractor for the United States Olympic teams and serve as a team chiropractor for one of the professional teams in Chicago. His mantra is “Why Put Off Feeling Good?” He can be reached by email at drdinopappas@gmail.com or at 708-532-2346. ***

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