“You’ll hurt your knees if you run.”
This old yarn has been spun for decades…but is it true??
Conventional thinking has long believed that “running is bad for your knees,” largely based on anecdotal observation and blanket assumptions. Yes, runners are injured a lot (much of it self inflicted through poor training choices, not the inherent act of running). But does high prevalence of overall injury equate to chronic “bad knees”?
A meta-analysis (aka, really big study looking at a bunch of other papers) from 2017 by Alentorn-Geli, et al, examined several studies encompassing over 100,000 runners of all levels and control groups of non-runners to see if any association existed between running and arthritis.
Bottom line up front: Amateur runners (non-professionals) experience LOWER rates of hip and knee OA compared to runners who compete for money or people who don’t run at all. Among the amateur runners, the OA rate was 3.5% whereas more than 10% of the non-runners experienced OA, as did more than 13% of the professionals. (Also of note was that running for less than 15 years was associated with lower OA rates).
Based on these findings from a large set of data, running actually could be good GOOD for your joints, when done below the professional level. This makes physiological sense when viewed through the lens of Wolff’s Law, which states that bone will remodel in response to the forces or demands placed upon it. If you expose bone to repeated stressors of running it will grow stronger along the lines of forces applied. But we also know that with any stressor applied to the body, any excess force beyond the body’s ability to adapt can lead to undesirable changes, such as injury or chronic strain.
A subsequent 2018 study by Ponzio et al (thus not included in the 2017 meta analysis) on marathon runners of all levels found that age, family history and surgical history were predictive of hip or knee OA, but there was also NO significant risk associated with running duration, intensity, mileage, or the number of marathons completed. Additionally United States marathon runners in this sample experienced significantly lower OA rates (8.8%) as compared to the US average (17.9%).
Do runners get hip and knee OA? Yes, of course. But so do people who don’t run at all…and those people seem to get MORE OA than amateur runners by a notable margin.
Take home point: ALL types of people develop knee problems through the normal course of aging. Some happen to be runners, some don’t run. While intense training levels from the professional level seem to be related with increased OA signs, if we are to infer any causation from evidence, it would be that modest amounts of running could be protective against OA. Regardless, it would seem there’s enough evidence to cast significant doubt on the old suspicion that “running is bad for your knees.”
Let me tell you about our patient Ashley…
Ashley came to see me just weeks after starting an exercise program. Having turned 30 the previous August, she felt a sense of urgency in her life. Single and childless, the proverbial biological clock loomed in her consciousness. Professionally, life was great in her teaching job. But she knew she needed to make changes to her lifestyle.
Having been a casual smoker for years, the first step was to give up smoking and began exercising. Pizza and donuts also gave way to smoothies and salads. So firm was her commitment to change that she began this transformation in December, before the traditional “New Year’s Resolution” crowd. She found a welcoming home at the local Orange Theory and hired a personal trainer. She started craving the endorphin rush of the HIIT training and seeing the progress in her physique.
But one day in January she felt an unwelcome twinge beneath her knee. A trip to the doctor confirmed it was a stress fracture, and she was “sentenced” to at least six weeks of limited weight bearing on her injured leg and an even longer time in a knee brace. Over the next several weeks, she was diligently committed to the plan, as an active participant in manual therapy to control pain and swelling, while incorporating strength and mobility training to recover the function she had lost in the weeks of wearing a brace and guarding against pain.
But more important than recovering her function was recovering her confidence. Before each session on the treadmill, she required gentle reassurance of what she had already accomplished with ease in prior sessions. With each successful progression, her confidence and trust in her leg grew more robust. Thanks to quick healing, she was soon ready to return to Orange Theory. We had several talks about communicating with the coaches to find alternatives for jumping and running, which eased many of her concerns.
Then before her first class back, I received a text from her sitting in the parking lot..”I’m scared :(“ And who in her situation wouldn’t be? If anything, I was proud of her for recognizing her fear and pausing before entering a situation where she didn’t feel comfortable. Fortunately, she only needed a couple reminders of the physical and mental strategies that had worked for her in the clinic. Within minutes, she made a successful return to class and was back on course to living the new life she had envisioned for herself.
What can we learn from Ashley? Rehab is not just the physical. Strengthening the body is important, but callousing the mind is vital. Ashley regained her healthy lifestyle by confronting her fears and gaining strength through the daily victories she experienced both inside and outside of the clinic.
If you need help reclaiming the active lifestyle that pain and injury have robbed from you, please reach out to Ventana Physiotherapy for a 30 minute Discovery Visit to discuss how we can best serve you.
Dr. Allan Phillips
Owner, Ventana Physiotherapy
The Happiest Place on Earth. Or so they say. Who knew that having a full day of fun could be so much work? One of the oft unspoken aspects of any Disney Park experience is the physical fatigue from 10 or more hours of play. You’ll spend a lot of time on your feet, walk long distances…and sometimes do it for close to a week! With this in mind, one way to maximize your enjoyment of your Parks experiences is to arrive your best physical condition possible. You don’t need to be in marathon shape (and it wouldn’t be a complete form of preparation, because the physical demands are different), but you don’t want your body to hold you back.
Think of it this way: At Disney, time is money and money is time. If you need to take lengthy breaks, you are paying for time doing nothing! Yes breaks are essential to maximize the quality of your experience but there’s a balance between just right and too much. Now, I’m going by the assumption that you are going to Disney to DO stuff as there are far better destinations for relaxed idleness. My PERSONAL preference is to cover lots of ground, but yours might not be. And that’s fine. The main point is that your physical readiness should be sufficient to support YOUR desired activity level!
Footwear – Quality athletic shoes that fit are paramount. You could walk up to ten miles in a day. Socks are also overlooked and are not something to skimp on. Your regular socks that do the job for routine walking at home might not withstand the heat and moisture of long days, especially in Florida. In the military, sock changes are built into our road march routine. You can have the strongest lungs and legs in the world, but the pain of an open blister can turn your day into complete misery. Also consider investing in Bodyglide, which is a sports lubricant without any residue (I have no affiliation with them, but have used it for close to twenty years).
Walking – You don’t need to walk ten miles a day to prepare but you do need to be ready for walking a lot. Other things to consider..stair climbing is also helpful because there are some attractions involving stairs (Swiss Family Robinson, Sleeping Beauty Castle, Main Street Train Station), though generally the parks are flat. Additionally, sometimes the challenge isn’t only from the walking but also from being on your feet for so long during the day. If you’re used to sitting for 8-10 hours per day, spend time building yourself up to where you can comfortably spend prolonged periods on your feet.
Carrying Stuff – You may find yourself carrying a bag or even little people! Prepare accordingly but don’t go crazy and put yourself at risk for injury. Some things to consider: will you be carrying a double strapped backpack? Or something like a purse that hangs on one shoulder. If you are carrying kids will you be carrying them on your back, on your shoulder or in front? How much do the kids weigh?
Stroller? This is a simple one. Get out the baby jogger and start pushing those sleds, especially if you choose to load up the stroller with your supplies for the day or if you choose to rent a stroller from the Parks that is heavier than what you’re accustomed to at home! If you’re at Disneyland, you know you’ll face a small climb back to the center of the park if you visit Winnie the Pooh.
Food – I’m hardly a diet guru but I would offer some pragmatic advice. Be a little extra “good” before going if you’re worried about over-indulging. But don’t be so restrictive that the Disney influx of sugar sends your gut into a frenzy. Bottom line, give yourself months in advance of quality eating, but enough small indulgences sprinkled in to help develop the gut adaptability for the wide variety of tastes you may encounter in the Parks!
Intra-trip recovery – a restorative massage is always a good option if staying at one of the Disney resorts offering spa services. However, there are some free options available as well. Getting in the pool and kicking your legs around can help encourage quality circulation and facilitate the recovery process. Your resort gym may also have self-massage tools such as foam rollers. Better yet, invest in your own and bring it with you!
Exercise – For most of us, the fitness routine is not the main priority during a Disney visit. That said, if staying at a resort onsite, the exercise options are serviceable. Some will offer morning yoga or other group classes on certain days (though it could mean forgoing Magic Morning Hours). The fitness centers are generally decently equipped, at least enough to accomplish something (which is better than nothing!). Another way to go into a trip is to schedule a hard block of training immediately beforehand so you can use the vacation as a time to “recover” from your normal activities at home. The trip won’t be complete recovery, but it will serve as a break from the normal routine.
Like many things, it all comes down to thinking ahead and preparation. I have simply provided some options and suggestions here, but other strategies may work for you. The main point is to recognize the key areas and have a plan for your trip...just as you have a plan on how you are going to navigate the Parks!
Allan Phillips, PT, DPT is owner of Ventana Physiotherapy