Experts weigh in: is running bad for your knees?

We all seem to have the impression that running is bad for our knees, right? I remember before I started training for my first ultra, I was terrified about hurting my knees. I had heard so many stories of people whose running careers stopped almost as soon as they started due to knee pain. It seemed like you either were made to be a runner, or you weren’t. Sure enough, just a couple months into training as I ramped up my mileage, I was ground to a halt by my knees. My doctor told me if I didn’t stop then I wouldn’t be able to walk by the time I hit 30 (ahem, I’m 34 now and walking just fine). After doctor shopping a bit, I finally found one that diagnosed me with patellofemoral syndrome (described below). Basically, I was feeling knee pain because of muscle imbalances that were not allowing the kneecap to track properly. Running wasn’t bad for my knees – my lazy ass was.

I’ve since had a fundamental belief that too many people get discouraged by running because of this myth about the knees… but in order to back up my claim, I thought I would turn to the experts to get the real answer!  Thanks to my friends at the Bowskill Clinic in London, as well as their trusted medical colleagues, we’ve got answers to some of the key questions runners have about their knees. This post will focus on:

• helping us understand the bigger picture of how running affects our knees;
• providing us with a simple test we can use to gauge how injury-prone we might be; and
• detailing the different types of injuries, conditions or running technique that might cause knee pain.

In the next post, we will explore what to do if you already have knee pain, and some stretches and exercises that might help runners’ knees! The information in these two posts have been researched and written wholly by them, specifically for you (us!), which is pretty awesome.  Only minor edits (and a few cheeky comments) by me.

So, experts, help us out here: is running bad for our knees?

Understanding the full picture

Running is a dynamic and repetitive activity that relies on us being able to accept up to six times our body weight on each foot strike. The repetitive and relatively high amount of impact involved mean that if we do have particular structural issues, we may experience problems more quickly than we would with more varied activities. However, according to the team at the Bowskill Clinic, there is nothing inherently bad about running. Some people are just at higher risk of injury than others depending on a number of different factors. The key is understanding the risk factors for running, knowing which ones you might be exposed to, and to what degree.

“Most running injuries are not traumatic in nature [unless you fall or trip]”, says Dr Jonathan Rees, Consultant in Rheumatology and Sports and Exercise Medicine. “Instead, most running injuries occur as a result of too much load being placed on a part of the body in a repetitive manner. In this respect, an injury occurs when load is repeatedly greater than the body’s resilience to that load.”

Dr Rees tells us that the key to preventing a knee injury – and indeed any running injury – is to understand your own individual ‘intrinsic’ factors and ‘extrinsic’ factors, and how these make you more or less injury prone.

Intrinsic factors are things that are unique to us as individuals, such as age, genetic, previous injury history, and our biomechanics. Extrinsic factors are the things that are done to our body, such as running load, footwear, running surface, intensity of training, nutrition and rest.  While we are stuck with the intrinsic factors, we are better able to control and change the extrinsic ones. (To learn more about these factors from Dr Rees, check out this article published in ‘Football Medic & Scientist’ Issue 15 Winter 2015/2016 here).

What factors may contribute to a higher risk of knee injury in some runners?

So we know that a runner’s risk of injury depends on a host of different factors – but how do figure out how these apply uniquely to us? The Bowskill Clinic has tried to simplify this down to an easy test of just five questions, which you can use to score yourself on a scale of 1-10.

0 is absolutely perfect – 10 is absolutely awful!

The closer your cumulative score is to 50, the higher your relative risk is of injury. It does not mean you can’t run, only that the odds are stacked less in your favour.

1. Biomechanics

‘Biomechanics’ refer to the way in which your body is put together and the manner in which you move. Do your knees heavily drop in when you run? Do your feet either overly pronate or supinate? (See here for an explanation and video examples of each) Have a peek at the soles of your shoes – is there an uneven pattern of wear?  If you look like Mo Farah when you run then you’re a zero – more Forest Gump then closer to a 10.

0          1          2          3          4          5          6          7          8          9          10

2. Physiological load

Physiological load means how much stress your body is currently under. If you are in bed by 10pm every night, don’t bother with alcohol or coffee, eat a healthy diet, live a stress-free life, are happy at work and happy at home, you are closer to a 0 (and, apparently, complete life fulfillment – please give the rest of us advice!) . If your life is rather a more turbulent mess of late nights, takeaways, long stressful hours of work, and a caffeine or wine drip, you’re closer to a 10.

0          1          2          3          4          5          6          7          8          9          10

3. Training programme

This category has to do with how structured or unstructured your training programme might be (or, cough, whether you have a training programme at all). To score a zero here you need to be well organized, follow a periodised programme to manage load, understand heart rate or lactate thresholds, and be acutely aware of what every run or rest day is aimed at achieving (if this is you, I’m guessing you’re actually a triathlete in disguise, rather than an ultrarunner).  On the other hand, if, say, you’ve recently ramped up your running after a long period of inactivity in the hopes of cranking out a half marathon on just a few weeks of training, you are much closer to the other end of the scale.

0          1          2          3          4          5          6          7          8          9          10

4. Previous history of injury

If you have managed to stay properly injury free from your pelvis down to your toes, you’re a zero (and, in my humble opinion, a hero…as in a fictional superhero). If you’ve had two hips replaced, an ACL repair from an old skiing injury and also a dodgy ankle you seem to keep rolling, put yourself closer to a 10!

0          1          2          3          4          5          6          7          8          9          10

5. Mobility

If you have never touched your toes and would be pleased to reach your knees, congrats, you are a 10! If you are the most mobile person in your yoga class and can basically contort yourself into all kinds of pretzel shapes, you are also a hypermobile 10. To get a zero, you work regularly on stretching the areas where you are tight and probably use things like foam rollers and stretching tools. Regular massage or soft tissue work is also essential if you are going to get a zero here.

0          1          2          3          4          5          6          7          8          9          10

0-17                Good to go and relatively low risk

18-36             Can go in both directions – time to review some of your decisions

37-50             Time to get some expert advice and make some changes

Patella tendinitis: The patellar tendon is a short but very wide tendon that runs from your patella (kneecap) to the top of your tibia. Its job is to absorb the loading forces on the knee via the large quadriceps muscles. This can inure the long strands of the tendons. This is often a result from a forward drawn posture with an anterior rotated pelvis, weak hamstrings and/or quad dominance. Look out for a stiff feeling and eventually a sharp pain below your knee cap. Worse when going downstairs or downhill.

Referred pain: Pain can also be felt in the knee as the result of ‘referred’ pain (pain coming from an issue elsewhere). Pain may be referred to the knee area as a result of a degenerate hip joint, a stiff or mobile sacroiliac joint (the sacroiliac joint connects the sacrum – triangular bone at the bottom of the spine – with the pelvis on each side of the lower spine), or other areas.

Can my running style affect my knee pain?

Jayesh Thakrar, Musculoskeletal Podiatrist at the Bowskill Clinic explains, “the mechanism or process that leads to a running knee injury can in many cases be related back to how the knee moves and loads during the gait cycle. Since this is determined by how you run and your biomechanics, the simple answer is yes.”

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