Contrary to what many believe, runners suffer no more from knee injuries and knee arthritis than the general population. In fact, runners may have fewer knee problems. A 2017 report in Arthritis Care & Research investigated the question, looking at more than 2,600 adults. The researchers found that the runners had 24 percent less knee osteoarthritis than the nonrunners.
There’s a reason the runner’s knee is so resilient: We were born to run. The knee joint has literally evolved to assist simple forward and backward tracking of the lower leg. We walk and we run. No problem. (But beware knee-torquing sports like skiing, tennis, and basketball.) Runners also have healthy knees because we build muscle around the joint and carry little excess weight on the rest of our frame.
Of course this doesn’t stop runners from worrying about the knees more than any other part of the leg. Every runner experiences some knee pain at one time or another. And we know too many who have quit running due to knee pain. This fills us with fear and trepidation.
The knee isn’t soft tissue that can heal itself in a matter of days. It’s a complex joint where major bones, muscle groups, and support structures come together. And, no doubt about it, the knee absorbs substantial shock and strain when we run. Occasionally some part of the knee gives out.
I count myself among the knee-injured runners. In 2010 I had meniscus repair surgery at the left knee. The injury occurred when I ran a half marathon despite several prior days of distinct pain at the knee. Stupid, I know. I was past sixty when I had the surgery, and worried that my running days might be near their end.
Not even close. Four months after surgery and appropriate recovery and training, I completed the 2010 Athens Classic Marathon. That was the one that celebrated the 2,500th anniversary of Pheidippides’s run from Marathon to Athens. My left knee felt good as new.
It has carried me through five straight Boston Marathons since Athens, and every other run and race I’ve chosen to enter. When you treat the body well, it has amazing recuperative powers.
Don’t overstride: Overstriding is the most common form mistake made by runners. A long stride is necessary for sprinters, but the wrong approach for distance runners. You know you’re overstriding when your front foot strikes the ground ahead of a plumb line dropped straight down from the knee.
This does two bad things. First, it increases the shock forces that flash up your leg to your knee and hips. Second, it puts the knee in a bad position to use its surrounding muscles and other support structures.
Instead aim for a comfortably short stride, more of a shuffle than a pogo-stick bounding effort. With this stride you’ll land under your knee (not in front of it) in the perfect position to use your powerful knee muscles.
Try different shoes: Some runners have resolved their knee issues by switching to minimalist (barefoot-like) running shoes, and/or severely shortening their stride to land on the forefeet instead of the heels. In fact, a 2017 study in the Journal of Science and Medicine in Sport recommended that a combination of both—minimalist shoes and a shorter stride—is one of the best ways to recover from knee injury. Other studies have reached similar conclusions.
However, this isn’t a universal solution for all injuries. Other research indicates that the minimalist approach carries its own risks. It may increase the chances of calf, Achilles, ankle, and foot injuries. I recommend that you try minimalist shoes only after you have exhausted all other nonsurgical therapies, and primarily to fight knee injuries.
Avoid hills: Uphill and downhill running both make the knee muscles do double the work of flatland running. Avoid them if you have knee pain. Stick to flat roads or a running track, often the best place to renew running after an injury.
Many runners with achy knees find relief on trails and grass, which are, after all, softer than asphalt roads. Since these surfaces are uneven, they demand a shorter, nimbler stride—a good thing on its own. Boston Marathon legend Bill Rodgers stays off the roads as much as he can these days. “I’ve enjoyed running on grass ever since high school,” he says. “Now that I’m in my late sixties, I definitely think it helps.”
Strength train: Research consistently shows that strength training can promote healthier knees that are less likely to develop an injury. Concentrate on the quadriceps and hip abductors. There are many simple routines, using equipment or only your own body weight, to strengthen these two muscle groups. Stronger muscles help the bones track straight and true through the joint without excessive wobble or instability.