Everything You Need to Know About Running With Knee Arthritis
Here’s how to modify your routine to sidestep pain associated with arthritis.
Let’s start with a not-so-fun fact: An estimated 46 percent of adults will develop osteoarthritis of the knee at some point. It is, by far, the most common type of diagnosed arthritis, according to the Arthritis Foundation.
The good news is that running doesn’t cause osteoarthritis, and in many cases, you can — with some adjustments — continue to run.
Still, if you’re diagnosed with knee arthritis and want to continue lacing up and pounding the pavement for years to come, you may need to make some adjustments to take care of your joints.
Here, two experts give us the must-know intel on running with arthritis, including the different types of knee arthritis, tips for modifying your run routine to sidestep pain, and specific strength exercises that can help to mitigate your symptoms.
What is arthritis and how might it affect runners?
Knee osteoarthritis describes wear and tear of the cartilage surrounding the knee joint; cartilage is tissue that protects bones at the joint, Andy Fata-Chan, P.T, New York-based physical therapist, fitness coach, and founder of Moment Physical Therapy & Performance, tells Runner’s World.
When cartilage degrades, you may feel pain, stiffness, and swelling. Other common symptoms include warmth and clicking at the knee, as well as the sensation that the joint is going to give out.
A subtype of osteoarthritis is post-traumatic arthritis, which develops when the cartilage begins to degrade after trauma to the knee. Sutton explains that things like an ACL tear or other severe ligament injury can cause post-traumatic arthritis.
Then, there’s rheumatoid arthritis, an autoimmune disease which causes systemic inflammation that leads to arthritis. Lyme disease can also cause an immune system reaction that leads to arthritis, Sutton says.
While no one wants to develop osteoarthritis, the condition may be especially difficult for runners whose knees play a critical role in stabilising the body while running and bending the legs with every stride.
Because runners rely on their knees to move forward with power, it was long assumed that running could contribute to overuse, which might then lead to arthritis. But running doesn’t cause arthritis, Dr Karen M. Sutton, sports medicine surgeon at Hospital for Special Surgery in Stamford, Connecticut, tells Runner’s World.
Research backs this up: A 2017 study published in Arthritis Care and Research involving 2,637 people found that runners had no increased risk of symptomatic knee osteoarthritis compared to non-runners. Likewise, a 2023 study presented at the annual meeting of the American Academy of Orthopaedic Surgeons, which included 3,804 Chicago Marathon runners, reached a similar conclusion: There’s no association between a person’s running history and their arthritis risk.
As Fata-Chan puts it: “Running is not bad for the body.” In fact, some research suggests it may even help guard against generalised knee pain, in addition to providing a bunch of other stellar benefits.
How can you keep running with knee arthritis?
Here’s the tricky thing about knee arthritis: Some don’t have symptoms, while others are consistently sidelined from discomfort. If arthritis is getting in the way of your run, it’s important to figure out how to adjust your running program. “I’m a huge fan of letting pain be your guide,” Sutton says.
To do that, see if you can find a safe starting point, Fata-Chan says. Basically, find a level of running that doesn’t trigger your symptoms. For example, a 45-minute workout may cause your knees to ache, while a 30-minute run doesn’t trigger pain. “In that case, you’d stack more 30-minute runs,” he explains.
Another option is to dial back the intensity of the 45-minute run with a slower pace, and see if that makes a difference.
From there, slowly increase your total running volume by no more than 10 percent each week (the typical recommendation for any runner!). Also, incorporate a cut-back week every four weeks where you decrease your volume by about 50 percent before slowly building back up, Fata-Chan says. “There have got to be periods where you dial things back,” he explains. “If you just keep adding more and more stress, it’s only a matter of time before something breaks down.”
In cases of moderate to severe arthritis, Sutton encourages people to incorporate low-impact cross-training, like cycling and swimming, if they just can’t give up running. Also, for arthritis of any severity, tools such as physical therapy, joint mobility, and strength work (including the four moves below) can help too, Sutton says.
If you suspect you’re dealing with knee arthritis and you’re not sure how to manage it on your own, a doctor or physical therapist is your best bet. They may recommend prescription anti-inflammatory medications, cortisone injections, gel injections, and platelet-rich plasma therapy, Sutton says.
Also, don’t hesitate to get a second opinion if the first medical professional you see discourages you from lacing up. “There are a lot more physical therapists, physicians, and surgeons that are reading the research that are more open-minded, that will encourage you to continue to be physically active and help you find strategies to work around things that potentially are provocative [to your knee arthritis],” Fata-Chan says.
Beyond that, tweaking your lifestyle to be a little bit healthier — getting better sleep, cleaning up your diet, or reducing stress — can help improve arthritis symptoms by reducing systemic inflammation throughout the body, Fata-Chan explains.
Strength Exercises to Help Knee Arthritis
Building stronger quads and glutes — key muscles that play a big role in running — can help manage knee arthritis symptoms by supporting good mechanics and preventing the knee from taking on undue stress.
How to use this list: For the goblet squat, lateral step down, and forward tap to skater squat, aim to do as many reps in the given rep range as needed so that you’re left with 2 reps in reserve (meaning, you stop when you feel like you could only manage to eke out 2 more reps with good form). Once you reach a point where you have 4 reps in reserve, increase the difficulty of the exercise, either by holding more weight or relying on one of the progressions mentioned below.
You can do all of these moves as part of a strength-training workout, in which case you’d aim for 3 sets of each. Alternatively, you can do the lateral step down, split squat isometric, and forward tap to skater as part of a dynamic warm-up, in which case you’d do one set of each, according to Fata-Chan.
1. Tempo Goblet Squat
Why it works: Squats build strength in the quads so that those muscles can be strong enough to withstand the forces of running and ultimately reduce stress on the knee. Also, the slow tempo decreases knee stress while still providing a good strength training stimulus, Fata-Chan explains.
How to do it:
- Stand tall with feet hip-width apart. Hold a kettlebell or dumbbell at shoulder level.
- Bend knees and, over the course of 3 to 5 seconds, send hips down and back to descend into a squat.
- Drive through feet to stand up at a normal tempo.
- Repeat. Do 8-15 reps.
Trainer tip: Modify your range of motion as needed to make it comfortable for you and your knees. For example, instead of squatting all the way down, tap your butt to a bench.
2. Lateral Step Down
Why it works: With this lateral move, you work both the quad and glute medius (side butt muscle), Fata-Chan says. The stronger these muscles are, the less force your knee will take on as you run. This move also challenges your single-leg stability, another crucial component of knee health.
How to do it:
- Stand on an elevated surface (like a bench or step) with one leg and let the other dangle off to the side or hold at hip height.
- Bend hips and standing knee to slowly lower until dangling foot touches ground.
- Reverse motion to return to the start position.
- Do 8-15 reps, then switch sides and repeat.
Trainer tip: Decrease the height of the bench to make it easier, or increase it to amp up the challenge.
3. Split Squat Isometric Hold
Why it works: According to Fata-Chan, long isometric holds can help alleviate pain in the muscles and joints. This exercise develops stability and strength in a position that mimics your knee positioning during a portion of your running stride.
How to do it:
- Get into a staggered stance with one leg forward and the other behind.
- Slowly lower back knee toward the ground to sink down into lunge position, keeping torso upright, both knees bending about 90 degrees.
- Pause when back knee is hovering slightly above the ground. Make sure front knee tracks over toes.
- Hold for 30-60 seconds.
Trainer tip: Add weights or elevate the front leg to increase the challenge on the back leg, or lean forward to increase the challenge on the front leg.
4. Forward Tap to Skater Squat
Why it works: These two positions strengthen your quads during the forward tap and the glutes in the skater squat. This also dynamically challenges your body to maintain single-leg stability in different positions, which benefits running performance.
How to do it:
- Stand with one heel elevated on a small platform, step, or sturdy object, the other leg lifted.
- Bend grounded knee, pushing hips back. Slowly tap the opposite heel in front of body.
- Stand up from forward tap.
- Bring elevated leg to back, bending both knees to about 90 degrees to complete a skater squat by lowering into a lunge-like position, with back knee hovering off the floor.
- Drive through grounded leg to stand up.
- Do 8-15 reps.
- Then switch sides.
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