Running is not only safer for the knees than walking but actually has a protective role when it comes to knee arthritis, according to a study

First published in Mint newspaper on 24th Feb 2014

Mark Wolley at the 6th (2015) edition of La Ultra - The High at 215 km of 333 km race. His knees are just fine even though he's had fractures because of non-running related injuries in both legs.

At the outset I need to say: I am crazy about running and have been running for 30 years. I like it and recommend that everyone should pick up running as well.

For the longest time I have been hearing how bad running is for the knees and how it leads to arthritis of the knee. These kinds of statements come from sedentary doctors and non-runners. It’s disappointing because there is no scientific evidence to support them. Maybe the intention of these doctors is correct, but this kind of information only adds to the growing sedentary epidemic.

Why can’t non-runners, both medics and the general population, understand that “not running” is far more harmful for the knees than running? S. Bakhtiar Choudhary, sports medicine doctor and director, Hyderabad Spine Clinics, Hyderabad, says, “Many people suffer from osteoarthritis of the knees due to lack of running, contrary to what people believe.”

In a 2013 study conducted at the Panjab University in Chandigarh, published in the Journal of Exercise Science And Physiotherapy, knee X-rays of 30 sportspersons were compared with those of 30 non-sportspersons, all aged above 50. Sportspersons were people who had played at the inter-varsity or national levels in different sports for over a decade and were still recreationally active.

Knee-joint degeneration, which can be seen on the X-rays, happens to be the major cause of disability among the Indian population. This has led to the booming business of knee replacement surgeries. But Gagandeep Kaur Saini and Narinder Kaur Multani of Punjabi University, Patiala, the authors of the study, found that sportspersons had “less worsened” structural knee changes, better knee joint range of motion, muscle strength, physical activity levels and a better quality of life than non-sportspersons.

Though the study does not talk about running in isolation, it does make a case for the fact that sporting activities are good for your knees.

A study, Effects of Running And Walking on Osteoarthritis And Hip Replacement Risk, done over seven years on over 74,000 runners, showed that if there was no knee arthritis to start with, the risk of hip and knee osteoarthritis was significantly reduced among runners, even marathoners, as compared to people who only walked. The study was published in the 2013 issue of Medicine And Science in Sports And Exercise.

These findings can possibly be explained by another study, Why Don’t Most Runners Get Knee Osteoarthritis?, which looked at the amount of force that went through the knee joint among runners and walkers. Even though there is greater pounding while running, it requires much fewer strides than walking the same distance. The study was published in the 2013 issue of Medicine And Science in Sports And Exercise.

This study highlights that contrary to conventional wisdom, running is not only safer for the knees than walking but actually has a protective role when it comes to knee arthritis.

Why? The answer is “optimal loading”—a balanced and incremental rehabilitation programme where early activity, instead of rest, encourages early recovery. A 2009 study, Mechanotherapy: How Physical Therapists’ Prescription of Exercise Promotes Tissue Repair, states that even when there is an injury, the injured part needs to be put under “optimal load” while strength training for optimal recovery at the earliest. The study was published in the British Journal of Sports Medicine.

The human body is designed to adapt to incremental changes in load. Osteoarthritis is set off by poor muscle imbalances leading to poor biomechanics, which leads to incorrect movements being repeated over years, which first lead to micro-injuries. So the concept used in injury management is applicable in the case of arthritis as well, especially in preventing it.

It goes without saying that loading needs to be graded, i.e. along with strength training, running distance and speed should be increased gradually. If done too quickly, it is a recipe for disaster. What goes against an activity like walking is that it is difficult to increase the load over time. It’s like staying in nursery forever. It might not be harming the knees, but it’s not even doing preventive favours after a while. Walkers need to gradually keep increasing their speed (and finally, run) and add strength training to their programme.

The Panjab University study, besides showing that being sporty is good for the knees, also highlights that arthritis of the knee is not inevitable as you age. To age gracefully, you need to stay physically active throughout. Apart from this evidence, given my 30 years of experience in running, from very competitive to very leisurely, being a sports medicine physician, and being part of a team that is creating La Ultra—The High (an arduous run of 111km, 222km, and 333km in the Leh-Ladakh region), I am of the opinion that running, whether on hard or soft surfaces, is not bad for the knees.

Poor running form, I may add, can at times be harmful for the knees, ankles, hips and back. For example, most of us have tightened/shortened hamstring and iliopsoas muscles as a result of sitting around in chairs all the time. When these muscles, which are prime movers when you run, can’t perform their task with efficiency, the knee joint is put under unnecessary stress. These imbalances are what lead to poor running form, which in turn leads to injuries. It’s more a question of “when”, not “if”, the injuries would occur.

To become a better runner and stay injury-free, it’s important to correct muscular imbalances first by sticking to a regular programme of strengthening and conditioning exercises. If muscular imbalances are corrected, running form almost falls into place. Trying to correct your running form without addressing muscular imbalances will only worsen the situation.

Click here to read about a 70+ yr old lady who walks 6-8 kms every day. Almost three decades ago, she was diagnosed with severe knee osteo-arthritis. She was advised total knee replacement for both knees. 

Click here to read a story about a young man who injured his knee (Menisci tear) weeks before he was to join his dream job, Indian Army. Surgery would have disqualified him. How he got back to passing the running exam in a very good time with having the knee surgery.

Enough of other people's stories. Click here to have a plan to get started with moving.