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STOP Running with knee arthritis: OR should you?

So you are here. Are you a runner? Are you frustrated, confused, and tired of dealing with arthritic pain resulting in you NOT being able to run like you want? You’re afraid that the one activity you love doing most is exacerbating the problem and you don’t want to settle for that?

I am so glad you’re here. Let’s talk. Got 5 minutes to read the words below?

Running is a popular activity practiced worldwide. It is important to understand how running affects joint health to provide recommendations to runners. So this may go against information you have been told before. So go into this LEARN with an open mind and open consideration.

You’ve heard it before: Running is bad for your knees. Right? Right????? How did you or even the person who told you this arrive at this conclusion? Maybe you did because running seems to be making the problem worse and that’s fair. But pain is way more complex to generalize it to one specific thing. Have you tried not running for several weeks and then going back to it, only to find it worse than before? How can that even be?

Running causes a lot of wear and tear to the joints. So if arthritis is the wear and tear then you should stop performing movements that “wear and tear” the joint.


Arthritis is not as simple as the cartilage being worn off the bone resulting in less joint space and bone on bone contact. So it’s not a wear and tear issue. The wear and tear seen with running. Arthritis is more to do with biology, genetic markers, metabolism, overall health, and other factors. Yes mechanical loading can increase arthritic changes like misalignment, bow legged-ness, prior meniscus pathology, and fractures. But too many health care professionals counsel their patients to stop running to save their joints (because it’s the wear and tear) and most of the time, you need to do just the opposite. The research over the years has been unequivocal.

So how do you even know your running related pain is arthritis versus

1) Patellafemoral Pain

2) Tendonopathy

3) Meniscus Pathology

4) Stress Fracture

How do you even know you have arthritis? What does it present like?

The signs can vary significantly. With mild arthritis, many people will have an ache associated with load. The location of the ache or pain can be on the inner side of your knee, the outer side, or even in the back of the knee. In some people arthritis will produce swelling, or fluid around the knee. Some people with knee arthritis will have the feeling that the knee is unstable, or that the knee will not support them. Some people with that feeling will notice an improvement if they use a knee slave or some type of brace. A feeling of grinding or “crepitus” is also a common complaint. When the inflammation due to knee arthritis increases, you may have knee pain at night. That’s why you may reach for a pillow to put between your knees when you sleep. Morning stiffness of the knee, or stiffness if you have been sitting for a while is a common complaint if you have inflammation associated with your arthritis. Other indicators could be increased age or prior knee pathology or injury that depresses your cartilage health.

So what’s the takeway: Is running good or bad for arthritis?

So here is the good news. It’s good. As long as it’s managed.

“As of 2002 sufficient evidence had accumulated to show significant benefit of exercise over no exercise in patients with osteoarthritis, and further trials are unlikely to overturn this result. An approach combining exercises to increase strength, flexibility, and aerobic capacity is likely to be most effective in the management of lower limb osteoarthritis. The evidence is largely from trials in patients with knee osteoarthritis.”

The last twenty years we have known the benefit of loading your cartilage with intentional stress like through various forms of exercise. I’m not sure why the message is still so diluted and misinformed.

Runners have lower incidences when compared to their non-running peers. Yes, running is actually beneficial for arthritis. The cartilage in the knee actually likes the loading of the knee when you run.

When compared over the same distance, a runner and a walker actually put the same relative amount of force and load through the knee. As a runner you are taking a longer stride therefor taking over all less steps than a walker. So when someone says you can’t run but you can go for a walk; thats actually not good advice. It seems it would be but when you think about it in terms of total joint compression it makes sense.

So in regards to the fear of arthritis associated with running we really have three groups.

1) Those who DO NOT currently have arthritis but fear running will cause it.

-This group should consider resistance training to promote more capacity of the knee joint alongside their running program. They should be mindful of aches and pains that persist that may cause abnormal loading to the joint because of compensation or fear. They should always prioritize recovery and be mindful of total running volume.

2) Those with arthritis without cranky knees who fear they need to stop before it gets too bad.

-Remember arthritis is more than a mechanical wear and tear or loss of joint space issue. This group needs to track their symptoms and consider changing their running volume to avoid high miles in a short time period. They should add in a few extra rest days or replace a running day with more active mobility or resistance training.

3) Those with arthritis AND cranky knees who are limited who fear return to running is bad.

-If your arthritis is severe you may consider more alternative forms of exercise: balance training, resistance training, aerobic exercises like swimming or biking. These different forms of exercise help minimize the risk of developing age-related muscle loss (sarcopenia), heart disease, type 2 diabetes, and high blood pressure; all of which can negatively influence inflammation and arthritis. That’s not to say you should omit running completely but overtraining and overreaching can have the same effects of unloading the knee; if not worse. The important thing to remember is that you NEED load to the painful joint to create more resiliency and adaptation.

Five Considerations and (ONE MUST) for runners with arthritis.

  1. Runners with knee arthritis should consider shorter runs at higher frequencies. If you run 26 miles a week, run four 4-mile days and two- 5 miles days instead of three- 9ish mile days.
  2. The cartilage in a runner’s knee will usually respond favorably to the low impact, shorter duration repetitive forces.
  3. Slow down, avoid hills while you are going through a bout of discomfort.
  4. Build volume (distance) first… if tolerated, then add in speed and hills.
  5. Pain should be mild (3 or less), you should not be limping, and any residual pain should be gone within an hour or two of the end of your run.

You must find a health ally to help educate you and build overall more tolerance and capacity. Physical Therapy is a great asset to help keep your miles elevated and knees healthy. We can prescribe exercises to strengthen key muscles and regions involved with running and help you make logical-informed decisions about when to progress your miles or decrease your miles. It’s never black and white. It’s always… it depends…. or maybe… or i don’t know. But we collaborate with you to keep you moving!


1) Running is is associated with LESS knee AND hip osteoarthritis as well as decreased odds of needing a joint replacement.

2) Exercise is good and necessary for cartilage. Load your joints to keep them healthy in the same manner you brush your teeth to keep your teeth healthy.

3) Runners with knee arthritis MUST understand the importance of global load management. Can’t do too little and can’t do too much. Education helps find the sweet spot.

4) Look beyond running to resistance training, running mechanics, AND footwear to help overcome arthritis and address running limitations because of arthritis.

You need to put stress on your joints to maintain joint health. It’s kind of like a vaccine that inoculates your body to stress. You become more resistant to it. The benefits of exercise aren’t just reserved for runners, either. Any physical activity, whether it’s dancing, playing tennis or walking, is good for joint health to an extent. It also strengthens your heart and lungs and reinforces your bone density and muscle strength. Movement is medicine.




Dr. Bryan Keith

Myomuv PT

We help active adults and athletes return to the activities they love without pain, without taking time off, and feeling more confident and capable than ever before.