Recreational running is also fine – there’s evidence that people who run a moderate amount have a lower risk of knee osteoarthritis than people who don’t run. If you already have mild arthritis in your knee, instinctively I’d suggest lower-impact activities. However, the one study that included this scenario found that people with early knee osteoarthritis (confirmed on X-rays) who chose to run regularly, when compared over four years to patients who did not run, did not show any increased progression in their osteoarthritis. In fact, the runners experienced less knee pain.
…or too much of the wrong exercise
The current movement towards doing lots of squats and lunges with heavy weights is not good for knees. Interestingly, I’m starting to see injuries in really young people – in their mid 20s and early 30s – who’ve lost a lot of cartilage from under their kneecaps through following very high-impact, high-repetition exercise programmes such as Hyrox and CrossFit. Similarly, there’s evidence that competitive runners have an increased risk of knee osteoarthritis compared to recreational runners.
The question as to what constitutes “recreational running” versus “competitive running” is actually difficult to answer, as it varies between studies. However, there is a link between longer distance and an increased risk of knee osteoarthritis, so a three-mile run in the park would definitely be preferable to a marathon.
Neglecting muscle strength
Muscles are important for absorbing some of the load. If they are strong, they can take some of the weight off the joint and help protect it from damage. It is the quads – the large muscle group at the front of the thigh – that are particularly important here. There are longitudinal studies that show people with knee osteoarthritis have measurably weaker quads, even before the osteoarthritis is visible on an X-ray. (This suggests that muscle weakness is not a consequence of joint damage, but a potentially modifiable risk factor that precedes it.)
Muscle strength certainly improves pain and function – not just the strength of the quads, but also the hamstrings, calf muscles, glutes and hip abductors. General strength exercises are all going to be good for this – using moderate weights or repetitions of low weights. Just don’t do 50 weighted squats in a row! It’s about moderation and finding a sensible balance.
Not being injury aware
With any injury, there’s the immediate damage, and then the long-term joint instability and inflammation, and a significantly raised risk of osteoarthritis. Look into your sport – whatever sport you are doing – and learn about its most common injury risks and how to reduce them. Personally, I love skiing, which is a very common cause of knee, especially ACL, injuries. There’s very good evidence from a successful research programme and public awareness campaign in Vermont that understanding how to reduce your risk of knee injury when skiing can make a very big difference. “Knee-friendly skiing” includes position, technique, the way you fall and your boot bindings.
