Knees: Understanding Risks and Overcoming Injury
In any given year, it is estimated that approximately 1 out of every 4 active ultramarathon runners will suffer from knee pain or a knee-related injury (Hoffman, 2104). What most people don’t know is that running, more often and in further distances, has been found (in a number of studies) to prevent knee injuries (Satterthwaite, 1999; Wen, 1998; van Gent, 2007). How can we make sense of this paradox? An important paradigm in sports medicine reveals that exposing your joints and tendons to a sudden, heavier than usual load puts them at risk of injury. However, the better we prepare joints and tendons for the load through consistent training, the more injury-resistant they will become.
Running injuries to the knee may include (especially in older runners) arthritis (typically osteoarthritis), iliotibial (IT) band syndrome, patellofemoral pain (or pain from improper tracking of the knee cap), tendonitis of the quadriceps or patellar tendon at the front of the knee, meniscus tears (with or without a Baker’s cyst at the back of the knee) or more rarely, traumatic injuries to the medial, lateral collateral ligaments or anterior or posterior cruciate ligaments.
When considering this daunting list, it is important to keep in mind that running itself is not expected to cause these injuries, assuming proper training (including avoidance of increasing mileage or speed too quickly along with been consistently found to be more common in runners than non-runners. In fact, a recent systematic review (Gutsell, 2019) found that runners are not more at risk of knee arthritis and are to develop painful arthritis of the knee or knee pain than non-runners. Risk factors for arthritis of the knee include increasing age, obesity, previous knee injuries (specifically those that result in instability), previous surgery, joint asymmetry and with some physical labor (such as with frequent knee bending/squatting or heavy lifting) (Sharma, 2021; Persson, 2018). A recent study (Khan, 2021) demonstrated that although going on a run may lead to changes in the cartilage of the knee, the cartilage quickly recovers and adapts to regular running. In other words, at least for most people, running is not in and of itself harmful for the knees. In fact, it is likely better for the knees than being sedentary.
