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I have knee arthritis, can I still run?

The short, simple answer is yes, but read on to find out how to make it successful.

When people say they have knee “arthritis”, they typically mean osteoarthritis (OA). This is commonly thought of as wear and tear on the joint cartilage, but is actually a chronic disease of the entire joint. This includes not only the cartilage but also the meniscus, ligaments, and muscles surrounding the joint. Age, obesity, and trauma caused by repetitive movements are risk factors but several studies have been able to show running is not a risk factor unlike many people believe. In fact, a recent systematic review published in March of 2023, which included data from 17 prior studies, 7194 runners and 6947 nonrunners, concluded “In the short term, running is not associated with worsening… (presence of knee pain)... or radiological signs of knee OA and may be protective against generalized knee pain.” (Dhillon, et al. 2023). Considering obesity is a risk factor, exercise reduces the incidence of obesity, and the strength gains in the leg muscles achieved with running, many people even advocate running as a prevention strategy for progression of knee OA. Now that is great news!

That being said, a common phrase we like to use around here is you need to train to run, not run to train. Set yourself up for success by being prepared to run and managing your symptoms. If your body isn’t strong enough to do your normal daily activities without pain, it isn’t strong enough to run either. Addressing your hips, quads, hamstrings and calves is recommended and physical therapy can help you with this. When you are ready to start running, you need to start slow and build up over time. Starting with 5 minutes of jogging or with a 2 min jog / 1 min walk ratio for 15 minutes total is very reasonable. Working with a run coach can be very helpful to establish a good training program and the good news is we have one here at Point Forward Physical Therapy! Giving yourself time to recover between runs of 1 or 2, possibly even 3 days is important. Also recognize muscle soreness from new activity is not the same as pain from your knee OA, so don’t let this scare you as you start your journey.

Having the right shoes is another key component in being prepared for running. You should not need to “break in” your shoes. They should be comfortable with walking and running immediately. Don’t be afraid to wear them for a good 15 minutes at the store before you make your purchase. A good supportive shoe is necessary. Minimalist shoes are not in your future if you want to be a successful runner with knee OA. You might need to experiment with different surfaces as there is no specific recommendation. Everyone’s symptoms respond differently, so what works for your friend may not work for you. Keep this in mind and try a few different options including treadmill running, pavement, grass or gravel, but usually running downhill needs to be avoided. Fortunately we are very lucky around here with so many options within the Green Circle Trail, so get to know your knees and figure out what is best. Finally, figure out the volume which is successful for you. That might mean you do really well with 2 miles per run with a maximum of 6 miles per week, or it could mean 20 minutes per run every other day works well to stay away from aggravating your symptoms. Get to know your knees! Cross training with biking or swimming is an option if you are looking for more cardiovascular fitness beyond what your knees will tolerate for running. 

The bottom line is you can be reassured as a runner your knee OA is not likely to get worse because of running and there are many successful runners out there who happen to have knee OA just like you. You are no more likely to get knee OA as a runner than anyone else and in fact it may even be preventative if it means less obesity and being more active. If you are strong enough, wear the right shoes, and manage your training well, you have excellent chances of reaching your goal of starting or continuing to run. We are here to help anywhere along your journey from preparation to execution.

Good luck and enjoy the run!

(Dhillon J, Kraeutler MJ, Belk JW, Scillia AJ, McCarty EC, Ansah-Twum JK, McCulloch PC. Effects of Running on the Development of Knee Osteoarthritis: An Updated Systematic Review at Short-Term Follow-up. Orthop J Sports Med. 2023 Mar 1;11(3):23259671231152900. doi: 10.1177/23259671231152900. PMID: 36875337; PMCID: PMC9983113.)

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