The Truth About Running and Your Knees

Source: AOL.ca

Posted: 10/16/08 12:36PM

Filed Under: Health

Running as a form of exercise continues to grow in popularity. The number of runners entering half marathons, marathons and ultramarathons is at an all-time high as people discover the physical and mental rewards of the long-distance workout. And yet, the sport continues to be dogged by the idea that running will destroy one's knees.

In an effort to get a conclusive answer to this oft-debated question of whether there is a relationship between running and knee problems (or hips or joints in general) in the average healthy person, we asked five experts (sport medicine physicians, coaches and runners) for their opinions.

1. Dr. Reed Ferber Ph.D., CAT(C), ATC Assistant Professor, Faculties of Kinesiology and Nursing, Director: Running Injury Clinic at the University of Calgary.

Q: Is there a correlation between running and knee problems in the average, healthy person who is using the right shoes and implementing a proper training plan?

Dr. Ferber: There is actually an inverse relationship meaning people who participate in a regular running program have fewer knee problems compared to those who are less active. However, this statistic does not hold up for people who have sustained traumatic knee injuries in the past such as high school football, basketball, and soccer injuries to the knees. These people have a higher prevalence of chronic injuries and osteoarthritis later in life even if they run on a regular basis.

Q: What is Runner's Knee then? ie. Do aches and pain in knees and joints not necessarily mean damage?

Dr. Ferber: Runner's knee is pain behind the knee cap (technically called Patellofemoral Pain Syndrome - PFPS). Aches and pain do not necessarily mean damage but could certainly indicate that if proper precautions are not taken an injury could occur. Precautions include a good assessment by a trained therapist, reducing mileage to allow tissue to heal, and making sure that you are running in the proper shoe.

Q: Why do so many people think running is going to wreck their knees?

Dr. Ferber: I'm not sure why but perhaps it’s because the incidence of osteoarthritis is so high.... people are paranoid about being disabled later in life.

Q: Is running harder on women?

Dr. Ferber: Running is definitely not harder on women. Women are, however, twice as likely to sustain certain injuries such as PFPS, iliotibial band syndrome (ITBS - pain on the outside of the knee), and stress fractures. In contrast, men are twice as likely to sustain hamstring injuries, meniscal (cartilage) injuries in the knee, and Achilles tendonitis.

Q: Are there best practices for running ie. ways to minimize any adverse effects? If so, could you name a few?

Dr. Ferber: The best practices involve a good workout schedule that includes cross-training. Cross-training is swimming, biking, running, and weight training. If the sole focus is on running (or any one activity for that matter) then the chances for injury increase. Most running injuries are because of training errors and can be avoided.

Our research also shows that most running injuries (92% in fact from a study of 364 runners) involve hip muscle weakness. These hip muscles are the key stabilizers of the leg when running and weakness can lead to atypical mechanics. We have also shown that by incorporating these exercises click here to read the study and get the exercises into a rehab program and increasing the strength of these muscles 89% of runners are pain-free within 4-6 weeks.

2. Kevin Smith, a NCCP-Certified running coach with over 10 years experience coaching runners and president of Marathon Dynamics, a coaching and training company in Toronto. Smith has been a runner for 27 years.

Q: Does running have a long term degenerative effect on the knees (or any of the joints/connective tissues/muscles etc.?

Smith: In short, NO. That’s an old wives' tale—usually just an excuse that people who don't want to run, or who find it hard when they do, come up with and latch onto to give themselves permission to not do it or quit!

Every month or two there are new study results released, which show that not only does running NOT cause long term joint degeneration, but that it actually reduces/decelerates the rate/onset of conditions such as arthritis and osteoarthritis.

And these studies trumpet the benefits of weight-bearing exercise (not exclusively running, but in the studies I'm referring to, specifically running) to counter osteoporosis, loss of lean muscle mass, and countless other health/biomechanical problems (along with the indisputable cardiovascular and pulmonary health benefits), and dispelling the widespread myth that running + knees = injury.

Q: What is Runner's Knee then?

Smith: I'm not saying that running doesn't often involve knee pain and even injury (Runner's Knee!), but 90% of the time the cause is found in the type, volume, intensity, duration of the training someone is attempting, and/or in the equipment they're using, and/or is due to a "latent structural imbalance/misalignment" that was lurking in the background, waiting to spring, which the intensity of running just brings forth. Once the issue is addressed and corrected (ie. by rehabilitation and longer term strengthening/balance), then more than 95% of the running population can enjoy decades of fairly pain free running—and benefit from improved long term aerobic fitness and skeletal-muscular health.

Q: Is running becoming more popular?

Smith: Distance running is growing at an enormously fast rate and race participation is at an all-time high, with many races (local and international) now filling up weeks or months in advance. And most long-time runners don’t run as a means to weight control or health benefits, but we do it first and foremost because we love the feeling of running!

3. Dr. Laura Cruz is the co-owner of Pivot Sport Medicine and Orthopaedics, a patient-centred, multi-disciplinary rehabilitation clinic in Toronto.

Q: Does running damage the knees? (or hips or joints in general).

Dr. Cruz: Running does not necessarily damage joints, but someone who has a specific issue could experience adverse effects to running. Overall, there is no direct correlation to running and knee problems for the average, healthy person. Running is a great way to maintain cardio fitness, but like any sport/activity can cause injuries, which can be avoided with proper training and preparation.

Q: Will regular running over a lifetime wreak havoc on the body?

Dr. Cruz: The benefits of running (being fit) are greater than the risk of wreaking "havoc." Running does not wreak havoc at all!! It may feel like it if runners push to extremes or do races that they are ill-prepared for.

Q: Do you recommend running as main form of exercise?

Dr. Cruz: I frequently recommend running as a form of cardio fitness—with a regular stretching and strengthening program. I rarely recommend any one form of exercise alone since fitness consists of cardio, flexibility and strength.

Q: Is running harder on women?

Dr. Cruz: Running is not harder on woman, but women may experience injuries or running-related pains at lower running volumes than men, e.g. knee pain and hip pain, which is related to the female body (wider hips than knees).

Q: Are there best practices for running, for example ways to minimize any adverse effects?

Dr. Cruz: Absolutely!! Careful and conservative progressed training with stretching and strengthening. Proper shoes, nutrition, sleep, choice of routes, rest days—all things readily accessible online or in running magazines—can help reduce the risk of injury.

4. Dr. Michael Clarfield is the director of The Sports Medicine Specialists clinic in Toronto as well as an associate professor at the University of Toronto and was the head team physician for the Toronto Maple Leafs from 1989-2005. He is the company physician for the National Ballet of Canada and the team physician for the Canadian National Tennis Team.

Q: Is there a correlation between running and knee problems in the average, healthy person who is using the right shoes and implementing a proper training plan?

Dr. Clarfield: There is no evidence of that and in fact there is evidence to the contrary that running leads to degeneration of the knee. But saying that, runners do get knee pain. And they can get injuries, but those will not cause long term problems.

Q: What is Runner;s Knee then?

Dr. Clarfield: Runner's Knee can mean various problems, which is why if you have pain you should see a physician. Different things can cause pain in runners and they need to be diagnosed properly.

Q: Why do so many people think it's going to wreck their knees?

Dr. Clarfield: The people who often say that are not runners and don't want to run. You never hear that coming from runners. But, if you have problems and are prone to chronic injury, running can irritate it. In a person with good knees, running won't lead to problems.

Q: Are there best practices for running ie. ways to minimize any adverse effects?

Dr. Clarfield: 1. You need proper shoes for your body type And, 2. if you are a new runner you should increase slowly and methodically, which will mitigate the chances of injury. Runners do get injured, that's why I'm in business. Listen to your body.

Q: Running is high impact, does all the pounding (particularly when running on sidewalks) take any toll on the body as a whole?

Dr. Clarfield: I don't think surface makes a big difference. I think your body adapts to what you are doing and where you are doing it. Yes, a treadmill has a softer touch and is more forgiving, but I'm not saying you shouldn't run on asphalt or pavement.

5. Brad Hudson is the founder of and coach at the Performance Training Group, a team of elite runners as well as the co-author of a new book, *Run Faster From the 5K to the Marathon*. He has been running for 33 years.

Q: Is there a correlation between running and knee problems (or hips or joints in general) in the average, healthy person who is using the right shoes and implementing a proper training plan?

Hudson: No.

I think a lot of people do things counter-productive to their knees such as stretching before a run, which I'm very much against. The only thing they should do before a run is lightly stretch the quads. And they should run in good shoes on softer types of surfaces such as dirt roads, tracks or on good grass, which are better than asphalt or cement. They must strengthen and adapt and not overdo it. As long as you smart with training you shouldn't have knees problems.

Running, in fact, should help strengthen the bones and the whole skeletal system will get stronger. That doesn't man go out and run six miles the first time. You need to get out there three or four a week, which is a moderate amount. A treadmill will also lessen the impact.

Q How long have you been running?
Hudson: Since I was 9 years old, so for 33 years.

Q How are your knees?

Hudson: My knees are fine. I had a bike accident so I have some other problems I've been coaching for five years. I see a lot of people with planter fascititis and that comes from arches not being supported or if they are a little overweight and there is more pressure on their feet. I also see some people with runner's knee, which is inflammation on the upper knee.

Q Why do you like running? Hudson: It's much more intense than walking and revs up the metabolism and strengthens the heart and strengthens the muscles. Also, you get a euphoric feeling and I think that is what keeps people doing it, the endorphins.