In order to keep running with knee arthritis we have to make sure we understand what osteoarthritis is, have appropriate single leg strength, and adequate balance to make sure our body is ready. It is possible to continue running despite knee osteoarthritis and it has actually been found that running may improve osteoarthritis symptoms. Various research has proven that self-selected running is not associated with increased joint space narrowing or progression of the disease. In order to reap the benefits of running, instead of increased arthritis pain, we have to make sure our joints are prepared to handle the stress.
“I have been having knee pain off and on for the past 2 years. I used to love running, especially trail running. I would run about 20 miles per week. My knee pain started getting more consistent after 1 mile, every time I tried to run. My doctor had mentioned arthritis which scared me. Now I am scared to run because I don’t want to be making my knee worse. I have resorted to lower impact exercise but I really miss running. What should I do?”
This is an extremely common scenario that I hear all the time. Chronic joint pain, mention of arthritis, and thus initiation of fear, especially of running. I’m here to tell you today that running with knee arthritis is actually okay. In fact:
“Among individuals over 50 years of age with knee [osteoarthritis], running was not associated with longitudinal worsening knee pain or radiographically defined structural progression.”
“Additionally, runners also had more improvement in knee pain compared to non-runners, suggesting that there may be a benefit to running from a knee health perspective in people who have knee OA.”Lo et al, 2018. Running Does Not Increase Symptoms or Structural Progression in People with Knee Osteoarthritis: Data from the Osteoarthritis Initiative
If running is so good for osteoarthritis, then why do people still have pain during it? This is the question I will solve for you today. When you are running with knee arthritis, you may not be able to get up and run out the door like you have been able to before. It will require a little more planning and preparation but you can still do it.
In order to avoid osteoarthritis pain, you have to make sure you understand your arthritis and what causes it. Many people still believe it is caused by “wear and tear” which leads to the idea we have to avoid movement if we want to keep it from getting worse. I want to clear that up for you.
Step number 2 is to make sure your single leg strength is appropriate. Many times if you have one leg that is stronger than the other or if you have more pain on one side or the other, there is likely some asymmetries in your strength. This can lead to altered running mechanics which can actually lead to more pain.
Lastly, balance is very important to make sure your body is able to stabilize itself. Running is essentially standing on one leg over and over again. If you struggle with balance, then ask your body to stabilize under pressure when running with knee arthritis, your muscles won’t be prepared and thus your joint will take a lot of the stress.
Let’s explore these a little more in depth:
1. UNDERSTAND WHAT OSTEOARTHRITIS IS
The more you know, the more confidence you will have.
Osteoarthritis (OA) is a chemical process and is not just a normal aging process. There has been extensive research on this but essentially, OA cartilage contains a specific type of cell that likes to cause problems compared to simply aging cartilage. This means there is some chemical process that happens with OA so it is not just because you are “getting old”- age does play a small part though.
In healthy joints, you do have cells that cause problems but the key is, you also have enough “worker” cells that can repair the breakdown. Thus, minimal to no pain is experienced.
If you were to get injured, most of the worker cells can get wiped out (think of like a hurricane or natural disaster) Then, your body works to slowly replenish the worker cells through healing. This is why time is very important in the healing process.
With osteoarthritis, you are slowly losing worker cells so the repair process inside of your joints becomes less and less efficient. Sometimes, the workers aren’t able to keep up with the cleaning and inflammation is allowed to stick around.
What triggers this gradual loss of workers?
Commonly multiple factors contribute to this loss. These factors also contribute to inflammation as well:
- Diet low in anti inflammatory foods
- Weight gain (excess fat tissue can increase the amount of inflammatory cells)
- Genetics
- History of joint injury and/or surgery (can increase inflammation in your body)
- Lack of exercise (inflammatory cells can accumulate when sedentary)
- Poor sleep (less time for recovery and repair)
- Smoking
- Overactivity (for example, too much running volume can increase inflammation)
Apart from the usual theory of “wear and tear”, there are actually lifestyle factors that can dramatically reduce inflammation in your body and help your worker cells become more efficient.
As it turns out, exercise can actually improve your cartilage strength. Find out more about that in this post.
But notice, that the last bullet point includes overactivity. Too much exercise can actually be detrimental, especially in the case of osteoarthritis. A sudden increase in running volume can make your joints more sensitive to pain.
For example, if you usually run 8 miles per week but suddenly increase to 20 miles per week because you have a race coming up or are trying to run longer- this could actually increase your pain. Gradual increases are KEY.
If you notice a sudden increase in pain, thinking back to some of these factors can help to determine potentially what caused it. Once you can identify factors that may be contributing to your pain, it can help to reduce further flare ups.
2. REBUILD AND MAINTAIN SINGLE LEG STRENGTH
Think about the act of running…
Running is essentially standing on one leg over and over again. It’s a single leg dominant activity. If you don’t have the appropriate single leg strength, your joints will have to absorb a larger majority of the force than they are prepared to. This overload can lead to more pain or further injury, especially at higher volumes and longer distances.
How do you know if you have adequate single leg strength for running? Let’s find out!
The first step is to make sure you can do a normal squat without pain, like in the video below.
I always test this by just having my patient stand up and down from a chair. If you are able to do that for at least 10 reps without pain, you can move on to step number two.
Step number two is then trying a modified single leg squat like in this video below.
Answer these questions as you attempt 5-10 repetitions on each side:
- Do you experience significant pain during any part of the squat?
- Is there is a significant difference side to side? (meaning does the right or left side feel much more difficult, weaker, and/or painful)
- Do you lose control when sitting down? (for example, plopping down in the chair)
If you answered yes to any of these questions, this is an exercise to practice. In order to be successful with running, especially with osteoarthritis, you have to master this movement.
The goal is to be able to do at least 5 squats symmetrically on each leg, with the front leg out straight and toe pointed upwards, without an increase in pain and without losing control at the bottom of the squat.
This is not the only way to test single leg strength but this can give you an idea. If this does feel difficult- there is still good news. Single leg strength can be improved upon.
You can modify this exercise specifically by using a higher surface (for example, using a cushion to raise the sitting surface or use a higher surface such as a bed). You can also use hand support from a kitchen counter or TRX suspension straps to help you gain more control as you build leg strength.
You can also modify how far your leg is out in front of you. The straighter the other leg is, the harder this will be. You can move the leg in front back closer to the leg that is working to make it easier as you work on building strength and regaining control.
Single leg strength should absolutely be a priority if you are working towards running with knee arthritis.
3. ADEQUATE BALANCE FOR RUNNING
Not only do you need single leg strength with running with knee arthritis- you also need higher level balance.
This goes beyond being able to stand on one leg, although that tends to be a good place to start.
When you are balancing on one leg, you are asking all of your leg muscles to work together to keep you upright. If there are some imbalances in your leg muscles, they don’t work together very well. This leads to delayed balance reactions. This can dramatically affect your running mechanics because in order for the force to be evenly distributed every time you put your foot on the ground, those muscles need to work together. If they don’t, you start to overload different parts of your joint. This then can lead to increased arthritis pain.
Find out more about balance here.
So how do you know if your balance is up to par? Try this testing progression below:
- First, try simply standing on one leg. You should be able to stand confidently on each foot for at least 10 seconds. You may be a little wobbly but should feel stable.
- Second, try standing on one leg and bending forward in a single leg deadlift like this video HERE. You should be able to do at least 5-10 repetitions on each side with confidence.
- Lastly, try this ultimate balance challenge. You are aiming for confidence in this position at least 3-5 successful repetition each side.
If you feel unstable or are not confident in any of these three positions, it may indicate you need more stability to ensure your joints are protected when running with knee arthritis. These tests can then be used as exercises to help practice.
There are also thousands of balance exercises you can do (here are my top 5 favorite balance exercises for arthritis). You can find a few to try and then test your balance again with these above tests.
The more you practice your balance, the better off it will be. The more stability you have, the less pain you will have when running with knee arthritis. I would aim to at least try 2-3 quick balance exercises a day until you can pass the above tests.
RECAP:
Arthritis can be tricky but there are ways you support your joints so they aren’t responsible for taking all of the stress, especially when running with knee arthritis.
It is possible once your joints are prepared and ready for it. These three tips above are a great place to start. Focusing on understanding how osteoarthritis impacts your joints, building adequate single leg strength and higher level balance are important things to focus on FIRST.
If you are running with knee arthritis and your joints are not prepared, you may experience more pain and pain may actually spread to other joints due to potential compensations.
You can listen to a discussion about running with arthritis with a fellow physical therapist in this video below:
Running with knee arthritis IS possible, we just have to give our bodies the care they need first.
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Alyssa Kuhn is a doctor of physical therapy and arthritis specialist with Keep the Adventure Alive in Sandy, UT. She has helped arthritis sufferers all over the state of Utah finally break free from their pain without surgery or more pills. She has lots of adventure of her own including hiking, biking, and skiing. Adventures don’t have to be extravagant. It is simply what makes you happy on the inside. That is worth keeping alive. She has found that there is a lack of positive and optimistic information out there about arthritis and Dr. Alyssa is on a mission to change that once and for all. Follow her on Youtube for more arthritis tips and tricks.
Disclaimer: This post is for informational purposes only. It should not be used to self-diagnose and it is not a substitute for a medical exam, cure, treatment, diagnosis, and prescription or recommendation. It does not create a doctor-patient relationship between Dr. Alyssa and you. You should not make any change in your health regimen or diet before first consulting a physician and obtaining a medical exam, diagnosis, and recommendation. Move Well Age Well, LLC and Dr. Alyssa Kuhn, PT, DPT are not liable or responsible for any advice, course of treatment, diagnosis or any conclusions drawn, services or product you obtain through this video or site. Try all exercises at your own risk.
