Running Safely With Knee Osteoarthritis

Updated by Linda Rath | April 17, 2022

Many people believe that running causes knee osteoarthritis (OA), but doctors now know this isn’t true. Researchers who compared long-term effects of running and other strenuous forms of exercise found that running significantly decreased the risk of hip and knee replacement, while some other forms of exercise increased it. Another long-term study showed that the incidence of hip and knee OA was three times higher in sedentary people than in recreational runners. Elite competitive runners, on the other hand, had more cases of hip and knee OA than people who didn’t exercise.

Listen to Your Body

As with any new fitness program, it’s important to start slowly. D. Casey Kerrigan, MD, a pioneer of gait analysis research at Harvard University and owner of OESH Shoes, suggests listening to your body and using pain as a signal to back off when you’re pushing too hard. “The goal is to run without knee pain. Build up to it,” she says.

The challenge for people with OA is learning to distinguish among different types of discomfort: the everyday ache they may normally feel, the soreness that can come from a good workout and pain from an actual injury. Dr. Kerrigan recommends taking note of your baseline pain, then paying close attention to be sure it isn’t increasing and you’re not mistaking normal muscle soreness for arthritis. As your muscles get stronger, running should make your knees feel better. If pain starts to get worse, stop running and rest for a day or two, but don’t use it as an excuse to stop moving entirely. Use a journal to track what you did last time and to guide your next workout. 

Different Sources of Pain

Lots of things other than arthritis can cause sore knees, including poor form, the wrong running shoes and uneven or hard surfaces, like unpaved trails or concrete. And then there are common running injuries, such as:

• Patellofemoral pain syndrome, commonly called “runner’s knee,” causes pain in and around the kneecap. It often results from misalignment of the kneecap or overtraining and is best treated with physical therapy and/or a few days’ rest.
• Chondromalacia patella causes symptoms similar to OA. It mainly affects women and is often due to poor tracking of the patella in its groove. Treatment and pain management methods are similar to OA, but can also include exercises to strengthen the inside thigh muscles, which can improve tracking.

Right Shoes at the Right Time

One of the most important parts of managing OA knee pain is what you wear on your feet. Although it’s convenient to buy shoes online, you might benefit from seeing a specialist at a running shoe store who can analyze your gait and make recommendations. Be sure to let them know you have knee OA; otherwise, you might get a shoe that’s great for knees without arthritis but that would aggravate yours.

It’s not just the shoe you run in that affects your knees. “You’re only wearing them for a short time when you’re running,” Dr. Kerrigan says. “It’s what you’re wearing the rest of the time that’s important. If you want to run, minimize total daily load on your knees by wearing shoes throughout the day that don’t increase loading.”

Overall, Dr. Kerrigan has one simple piece of advice for people who have knee OA and want to run: “Go do it! Don’t listen to people who sit around and say, ‘You’re going to ruin your knees.’ You’re going to do the exact opposite! But it’s going to take a little bit of time to get there.”