Runners, Listen to Your Knees

Two orthopedic surgeons consider whether running is bad for the bones and joints.

By + More

When I wrote about the myths and truths about running, I got a lot of blowback over the notion that running won't ruin your bones and joints. It turns out that plenty of people blame running for just that, so I decided to investigate the idea further. I talked to two orthopedic surgeons who happen to practice in the same neck of the woods. For fun, I found one nonrunner (Michael Klassen, of Monterey Peninsula Orthopedic & Sports Medicine Institute in Monterey, Calif., who'd rather ski or golf) and one who does run, for fitness (Peter Gerbino, of Monterey Joint Replacement and Sports Medicine). Here's what they had to say:

A recently published study found runners don't get osteoarthritis any more often than nonrunners. True?

More or less, Gerbino thinks. "All of the well-done studies show that, for someone who is healthy, has normal joints, no underlying injuries or disease—and isn't bowlegged—running will not cause osteoarthritis." (Even if you're a marathoner.) The catch, he says, is that if you have ever had a knee injury—say a tear to the meniscus or a ruptured anterior cruciate ligament (ACL)—you are at higher risk of arthritis in that knee. That risk exists whether or not you run, Gerbino says, but running may wear out the cartilage and bring on osteoarthritis faster. Klassen isn't so sure that running can't turn a good knee bad. "I think there is evidence that patients who run do get osteoarthritis," he says. "Walking and ambulatory activities don't cause arthritis; pounding on the pavement does." That's especially true if you're heavier. He says he sees many surgical patients—in for arthroscopy and knee replacement—with a history of running. That said, just because you run does not mean you'll need a knee replacement.

What about other injuries?

Klassen says that running, especially running up and down hills, can hurt the tendons in the knees. Gerbino notes that, as with arthritis, running hasn't been shown to cause degenerative disk disease in the spine, but that it can make an existing problem worse, especially if you're heavy. Both agree that common overuse injuries of the tendons and connective tissues, such as iliotibial band syndrome or plantar fasciitis, are common for runners, but they say that most of those can be treated pretty easily by backing off at the first sign of pain and taking a more extended break if the problem persists. (Stretching and anti-inflammatories may also help in some cases. check with a doctor.) Is mileage the big factor in running injuries?

Gerbino believes that more than the number of miles run, it's the Type A personality that brings runners into his office, he says. "The pathological term is compulsion," he says; a nicer way to put it is "healthy obsession." Runners who don't listen to their bodies are more likely to be injured whether their weekly mileage is 30 or 90, he says. Klassen says you're not likely to be injured if you run three or four miles a week but that running more than 10 miles in a week (serious amateur runners can average seven times that) puts you at risk for overuse injuries like tendinitis. So, at the end of the day, what do you tell your patients about running?

"I don't discourage them from running, but I do discourage them from running marathons," says Klassen. Running is great for cardiovascular fitness and weight control but, like everything else, is best done in moderation, he adds. Gerbino says if your anatomy and injury history allow it and you don't become dangerously obsessive, running is great. If you're starting off, he advises having a checkup to make sure your heart and lungs are in good shape, beginning with walking rather than running, and increasing the distance or time that you run by no more than 10 percent a week. Any other advice for runners on preventing injuries?

Klassen advises cross-training; mix in weights and other aerobic activities to cut down on the repetitive pounding of running. And, he says, try to run on a more forgiving surface—like a track—than on concrete or asphalt. Join a running club and take a class or two if your technique is faulty. Both men agree on the need for good shoes. "Buy the best pair of running shoes you can afford," says Gerbino, by which he doesn't necessarily mean the most expensive on the shelf but ones that fit your feet and gait. (Many running stores now offer video analysis to match a shoe to the imperfections of your stride). What I learned: Both doctors convinced me of the need for moderation; I've experienced my own collection of (relatively mild) running injuries when I've been hewing strictly to an ambitious training plan without listening to my body's twinges and creaks and resting when they get too loud. And running isn't a gospel that's to be preached to everyone. If you come from a long line of knee replacement recipients, or your anatomy or injury history predisposes you to musculoskeletal problems, it's probably not the exercise for you.

For more: I wrote recently about how to start up a running routine if you're a newbie to the sport and about injuries commonly seen in female athletes.