Running and knee health

I messed my knee up a lot of years ago. And by I messed it up, I mean someone else did something stupid that messed it up but that’s beside the point. I was told I would never do a lot of things again and some of them I have completely gone along with. I did however, work to improve my strength and stability a lot. I also got my range of motion to a point where it is basically even with the other leg. As a result, I was allowed to run more than a decade after the original injury. I do wear a beefy, custom made brace to help with stability and alignment when I run but I run. I’ve done multiple sprint triathlons and did my first 10 km race this past fall. But my injured wrist (see any number of historical posts on the site to get the story) has thrown a wrench in my running.

The last surgery (in fall), the third one on my wrist (had three on my knee too), took it out of me and I haven’t run, except for the occasional sprint for the bus, since my 10 km race. For the past month or so, I’ve been noticing that my knee has been hurting more than it has in quite a while. I mean, it’s always been present but now it is calling attention to itself. So, as the only real change for my knee has been not running, and it is starting to hurt at pre-running shape levels, I can’t help but wonder if there is a connection.

The thing is, that it has been “common knowledge” for years that running is bad for your knees, which is why I wasn’t allowed to run for so long. I did switch from doing heel strike, which did seem to cause pain (and shin splints) to running on my forefoot. I don’t wear minimalist shoes but I do wear really low rise shoes to help get away from heel striking. But, running has seemed to help my knee, does that make sense?

Miller et al (2014) compared the maximum load through the knee for running and walking. Not surprisingly, the maximum load for running was significantly greater. However, because you actually strike the ground less when running, compared to walking, for the same distance (it takes less steps to run 1 km than to walk it), the load divided by the distance was the same for running and walking.

In an study designed to evaluate whether standing really is a better alternative to sitting Miller, Edwards, and Deluzio (2014) analyzed the total accumulated knee joint load and the total energy expended for standing, walking, and running for 30 minutes. Walking and running both used more energy than standing (300% and 1100% respectively) which raises questions regarding whether standing is actually healthier if you are trying to increase how much energy you burn in a day. But the surprising result was that walking and standing resulted in a similar accumulated load on the knee joints. Running for the same amount of time resulted in greater load (remember the study above talked about distance rather than time). I am currently writing this at a standing desk, which I love. But I definitely need to shift my weight around a lot to keep my knees happy. Perhaps this explains why.

Hansen, English, and Willick (2012) reviewed literature regarding risk of osteoarthritis in the hip or the knee caused by running. Based on the research they reviewed they found that people who run a low volume (me) have the same risk of developing osteoarthritis than nonrunners, and that the results are inconclusive for high volume runners. They do highlight though that treating injuries when they do happen is important to long term health. While, some people might question the need to point this out, many people have a habit of working through the pain thinking that it will go away. Lo et al (2016) also found that history of running was not associated with increased risk of symptoms of knee osteoarthritis. And, for those individuals who had osteoarthritis, running did not appear to escalate symptoms or damage.

On a different note, Luedke, Heiderscheit, Williams, and Rauh (2016) examined how step rate influenced shin injury and knee pain in high school runners. When I switched from heel strike to forefront my step rate increased and my own rate of knee pain and shin injury decreased, so I was intrigued to see what happened in the study. Not surprisingly to me, they found that rates of shin injury decreased with faster step rate. However, they found no difference in rates of knee pain.

Admittedly, this is the type of topic that I could go on looking into for a long time: there’s a lot of research due to the popularity of running and (probably) the ease of study relative to some other sports. But I’m going to stop there, for now anyway, and continue to count down the days (read weeks) until I can run again without risk of falling and destroying my wrist again, and I can tolerate the vibration, which is a lot more than one might expect.

Hansen, P., English, M., & Willick, S. Controversy: Does running cause osteoarthritis in the hip or knee? Physical Medicine and Rehabilitation, 4(5), S117-S121.

Lo, G., Driban, J., Kriska, A., McAlindon, T., Souza, R., Petersen, N., Storti, K., Eaton, C., Hochberg, M., Jackson, R., Kwoh, C., Nevitt, M., & Suarez-Almazor, M. (2016). History of running is not associated with higher risk of symptomatic knee osteoarthritis: A cross-sectional study from the osteoarthritis initiative. Arthritis Care & Research. 10.1002/acr.22939

Luedke, L., Heiderscheit, B., Williams, D. S. B., Rauh, M. (2016). Influence of step rate on shin injury and anterior knee pain in high school runners. Medicine & Science in Sports & Exercise, 48(7), 1244-1250.

Miller, R., Edwards, W. B., Brandon, S., Morton, A., & Deluzio, K. (2014). Why don’t most runners get knee osteoarthritis? A case for per-unit-distance. Medicine & Science in Sports & Exercise, 46(3), 572-579. DOI: 10.1249/MSS.0000000000000135

Miller, R., Edwards, W. B., Deluzio, K. (2014). Energy expended and knee joint load accumulated when walking, running, or standing for the same amount of time. Gait & Posture, 41(1), 326-328. DOI: 10.1016/j.gaitpost.2014.10.009