Running Safely With Knee Osteoarthritis

Many people mistakenly believe that running causes knee osteoarthritis — however, doctors now know this is not true. Researchers who compared long-term effects of walking, running and other strenuous forms of exercise found that running significantly decreased the risk of hip and knee replacement, while other forms of exercise increased it. Another long-term study of runners versus non-runners showed that the runners did not have a higher incidence of knee osteoarthritis than the non-runners.

While doctors are still trying to understand how running can improve knee arthritis directly, it is well understood that running can facilitate weight loss, which is known to significantly reduce stress on joints and improve OA symptoms.

Running can be a healthy way to manage symptoms of knee osteoarthritis, but there are a few considerations that should be made before you begin.

Take it Slowly, and Listen to your Body

Like with any new fitness program, it’s important to start slowly. D. Casey Kerrigan, MD, a pioneer of gait analysis research at Harvard University and owner of OESH Shoes, suggests working closely with your doctor and physical therapist, listening to your body and using pain as a signal to back off when you’re pushing too hard. “The goal is to run without knee pain. Build up to it,” says Dr. Kerrigan.

Advice can seem contradictory — on the one hand, you are advised not to run through knee pain, but on the other hand, how do you know when to stop, if some amount of knee pain is a part of your daily life? For people with knee OA, the pain can seem constant. Dr. Kerrigan recommends taking note of your baseline pain and paying close attention to your knees to be sure that pain isn’t increasing. If pain starts to get worse, stop running and rest for a day or two. Keep a journal so you can keep track of what you did last time and use it to guide your next workout. This is a great way to track progress, as well as keep up with any factors that might be causing you pain.

Distinguish Different Sources of Pain

Be sure to pay attention to any new pain — something other than OA could be exacerbating your existing pain. Other common types of knee pain that affect runners include patellofemoral pain syndrome, commonly referred to as “runner’s knee,” and chondromalacia patella, which is a condition often mistaken for patellofemoral OA.

Patellofemoral pain syndrome is characterized by pain in and around the kneecap. While there is no one cause, it is generally considered an overuse injury that can be brought on by poor alignment of the knee and/or hip. The best way to avoid patellofemoral pain syndrome is to start slowly with speed as well as distance, and to allow plenty of rest between runs.

Chondromalacia patella carries symptoms similar to those associated with OA. “Many people think it is the same thing as osteoarthritis, but the differences are important in how we approach it,” says Dr. Kerrigan. Chondromalacia, which most often affects women, is caused by softening of the cartilage under the kneecap, largely due to poor tracking of the patella in its groove. Treatment and pain management methods are similar to osteoarthritis, but can also include exercises to strengthen the inside thigh muscles, which can improve tracking.

Always consult a doctor for any new or concerning pain.

Pay Attention to Footwear and Choose Forgiving Surfaces

The most important component in managing OA knee pain while trying to run is footwear. Research shows that the best footwear for minimizing knee pain associated with OA is a flat-soled shoe. “When it comes to shoes,” says Dr. Kerrigan, “the flatter the better.”

But it’s not just the shoe you run in that affects your running. “You’re only wearing them for a short time when you’re running,” says Dr. Kerrigan. “It’s what you’re wearing the rest of the time that’s important. If you want to run, minimize total daily load on your knees by wearing shoes throughout the day that don’t increase loading.”

When possible, run on grass or small gravel. Another good option is asphalt, which absorbs more of the impact than the harsh and unforgiving surface of concrete.

Overall, Dr. Kerrigan has one simple piece of advice for people who have knee OA and want to run: “Go do it! Don’t listen to people who sit around and say, ‘you’re going to ruin your knees.’ You’re going to do the exact opposite! But it’s going to take a little bit of time to get there.”