Use it or lose it - run for knee health

August 18, 2009 8:03 AM

Running is actually good for your knees,if you haven't suffered knee injuries in the past. [D]espite entrenched mythology to the contrary, runners don’t seem prone to degenerating knees. An important 2008 study, this one from Stanford University, followed middle-aged, longtime distance runners (not necessarily marathoners) for nearly 20 years, beginning in 1984, when most were in their 50s or 60s. At that time, 6.7 percent of the runners had creaky, mildly arthritic knees, while none of an age-matched control group did. After 20 years, however, the runners’ knees were healthier; only 20 percent showed arthritic changes, versus 32 percent of the control group’s knees. Barely 2 percent of the runners’ knees were severely arthritic, while almost 10 percent of the control group’s were.
posted by caddis (81 comments total)

Me knees hurt after I run. They do not hurt the rest of the time. In your face, research data!
posted by smackfu at 8:04 AM on August 18 [5 favorites has favorites]

I hate running. I love using an elliptical machine. Changed my life!
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 8:08 AM on August 18

The control group consisted of 50 to 60 year olds and NONE of them had bad knees? And these runners are now 70-80 years old?
posted by DU at 8:08 AM on August 18

Woo-hoo! I choose to blindly believe this single study because it's what I want to hear! Whee!

Hey, you. Get offa my cloud.
posted by somanyamys at 8:10 AM on August 18

Runners ruin their health -- their knees, breathing in pollution, running in sweltering heat. Most of the people I know who had their knees replaced were joggers. Walking is still the best exercise in the world -- especially when you have someone by your side...
posted by Alexandra Kitty at 8:11 AM on August 18 [1 favorite has favorites]

The control group consisted of 50 to 60 year olds and NONE of them had bad knees? And these runners are now 70-80 years old?
posted by DU at 11:08 AM on August 18 [+] [!]

That's not exactly what the article says:

Most subjects showed little initial radiographic OA (6.7% of runners and 0 controls); however, by the end of the study runners did not have more prevalent OA (20 vs 32%, p =0.25) nor more cases of severe OA (2.2% vs 9.4%, p=0.21) than did controls. Regression models found higher initial BMI, initial radiographic damage, and greater time from initial radiograph to be associated with worse radiographic OA at the final assessment; no significant associations were seen with gender, education, previous knee injury, or mean exercise time.
posted by Comrade_robot at 8:11 AM on August 18

Could you elaborate, East Manitoba? I've been looking for a cardio exercise that I can stick to and haven't been successful. Sorry if this is going into AskMeFi territory.
posted by blucevalo at 8:13 AM on August 18

An epileptical machine, eh?
posted by Mister_A at 8:17 AM on August 18 [1 favorite has favorites]

And my knees hurt when I don't get exercise. Seriously, it's weird.

blucevalo, get a bike or join the Y and swim. Although the bike is probably a better bet at this point, it takes a while to build up the strength to swim aerobically for 20-30 min. Or you could do a brisk walk! Bring some brandy with you to pass the time.
posted by Mister_A at 8:19 AM on August 18

Trying not to derail, elliptical machines are fantastic. It's like slogging up-hill at a straight incline for an hour with perfectly designed no-impact shoes. An hour in "fat-burn" (or "weight loss") mode can easily burn 600 calories. Most elliptical machines have a reading stand in front, so you can multitask fairly easily (some of my big-law-firm-type friends are billing hours while working out!). So break out your ipod and this week's Economist and give it a go.
posted by jock@law at 8:19 AM on August 18

What about the runners' shins, hips and ankles? What about runners' backs? I'd imagine there's some wear and tear going on....there.

Sorry for the rhyme.
posted by glaucon at 8:20 AM on August 18

My thing about elliptical machines is that Rocky wouldn't use 'em. ROCKY TRAINING IS THE GREATEST TRAINING, YO!
posted by Mister_A at 8:22 AM on August 18

Walking SEX is still the best exercise in the world -- especially when you have someone by your side...
posted by Burhanistan at 8:22 AM on August 18

I fucked my left knee up by running for years with my toes pointed outwards. I 'd sprained my left ankle repeatedly until it got less flexible, and I was running and walking with my left foot pointed outwards, for years, without noticing it. My cousin had the exact same problem and also ended up with fucked knees. If you run a lot, it's worth making sure that your feet are aligned properly.
posted by creasy boy at 8:23 AM on August 18 [1 favorite has favorites]

Most of the people I know who had their knees replaced were joggers.

Sincere or hilarious parody of anecdotal, logically fallacious reasoning?
posted by DU at 8:23 AM on August 18

When you point out logical fallacies, do you utmost to not be a turd about it, eh?
posted by Burhanistan at 8:25 AM on August 18 [2 favorites has favorites]

Comrade_robot points out some important things - the differences between the groups were not statistically significant. We can't make assertions about one group having better outcomes than the other based on these data. There appears to be a trend in favor of the runners in terms of OA symptoms, but this can only be confirmed with a larger study. It's an interesting hypothesis-generating study, though.
posted by Mister_A at 8:27 AM on August 18

"do your..." And when you chide people, do yo utmost to type n stuff.
posted by Burhanistan at 8:27 AM on August 18

I just started running last week, for the first time since junior high school. Couch To 5K. I don't care about my knees. I care about my ass. Will running break my ass? Because it frankly could use some breaking. It's outta control.
posted by padraigin at 8:29 AM on August 18 [7 favorites has favorites]

I wonder if we will see this paper misrepresented on the Today show tomorrow morning.
posted by Mister_A at 8:29 AM on August 18 [2 favorites has favorites]

I don't suppose a study of this caliber could make a simple selection error, to wit: the reason longtime runners aren't prone to bad knees is because people prone to bad knees don't become longtime runners?
posted by George_Spiggott at 8:29 AM on August 18 [6 favorites has favorites]

I hate running. I love using an elliptical machine. Changed my life!

That's funny. Elliptical machines hurt my knees. I have no problems running. Go figure.
posted by Thorzdad at 8:31 AM on August 18

I'm sincerely not sure if it's a parody or not. Considering that that comment starts off by affirming without comment what this post is denying, it seems like it must be a parody. But then it ends apparently sincerely. So I don't get it.
posted by DU at 8:31 AM on August 18

I have tried elliptical machines so. many. times, and I just can't get the motion. I must be defective.

But my joints (knees, hips and back) ache when I don't exercise enough (and that includes running). I have no choice but to be active anymore. It's awesome.
posted by somanyamys at 8:31 AM on August 18

Most of the people I know who had their knees replaced were joggers.

Sincere or hilarious parody of anecdotal, logically fallacious reasoning?

How exactly is that an example of affirming the consequent?
posted by creasy boy at 8:32 AM on August 18

man, I need to know what the hell DOES lead to bad knees, because i'm 29 and my left knee is a horror show. I can't sit in a cramped car seat for more than a half an hour without suffering terrible pain. same at my desk. I need to routinely stretch the fucker out.

I suspect it's because I had the terrible habit of sitting on my left foot for years before this pain started. but then, I'm no doctor.
posted by shmegegge at 8:35 AM on August 18

I recently took up running (OK, since I'm a lard ass, mostly walking and panting heavily after running a short distance, lather, rinse, repeat) because I'm diabetic, need to lose weight, and need exercise in general. I am very happy to read this because my mother had her second knee replaced recently. She assured me it's because of an accident from the 1980s, but I'm paranoid. This allays some of my fears.
posted by crataegus at 8:36 AM on August 18

I love it when people who don't run tell me that my body should be falling apart. Tell it to my 16% body fat and fucking awesome body density, suckers!
posted by peep at 8:37 AM on August 18

George, the study was looking for signs of degeneration of the joint over a 10-year period, and found no increase in the runner group. The interesting thing was that the runners showed more signs of OA at baseline.

Now, it could still be possible that some other factor is at work here, but the fact that the runners' knees were no better (and showed a trend toward being worse) than the non-runners' at baseline suggests that the runners aren't self-selecting based on knee health. Of course, a larger study is needed to confirm and expand on these results.
posted by Mister_A at 8:38 AM on August 18

Ellipticals make my toes fall asleep. And barefoot running still makes my calves hurt. But I do both of them anyway - no pain, no gain?
posted by elsietheeel at 8:49 AM on August 18

This is certainly in keeping with my clinical views. Runners as a whole simply need very little in the way of medical intervention and from an orthopedic standpoint, someone with 20 extra pound (or 100 as is more common) is going to suffer far more from arthritis or other musculoskeletal issues.

Arthritis is a lot less common than deconditioning injuries like tendonitis as well. So exercise. If running is your thing, stop worrying about your knees.
posted by docpops at 8:49 AM on August 18 [3 favorites has favorites]

For people have trouble with an elliptical trainer: Have you tried pronating more? It helps me a lot. Since I started doing that I haven't had knee trouble.

My aim is to burn fat. I burn an alleged 600-700kcal in 45 minutes 6 days a week, after work. I just use manual mode, usually with medium settings. I prefer the machines with the hand levers. I ignore the heartrate monitors which never seem to work.

Apparently the calorie count includes the energy you would be using just by lying down (which for me would be around 70kcal), and some sources say it is exaggerating further, although the manufacturer denies this. But anyway, it is still a shitload of calories and I am burning fat successfully.

I need to take frequent breaks when running otherwise I just feel destroyed. With the elliptical I can just keep going and actually enjoy whatever it is I am watching or listening to.
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 8:51 AM on August 18 [1 favorite has favorites]

I totally killed my knees and my hamstrings when I first started jogging - then I got orthotics and a good-quality pair of running shoes (from a running store that let me "test drive" the shoes for two weeks), and I've never turned back.
_{Always buy your shoes from a running specialty store that looks at your gait when you walk, lets you test drive the shoes and offers a reasonable return policy - the Running Room where I purchased my shoes let me take them home, run with them (indoors on a treadmill) for 2 weeks and allowed me to replace them for another pair}

I also warm up a bit with some squats (knees always behind the toes) before a run, which seems to help loads.

Swimming is probably the best exercise for your joints, since there is minimal impact, but running is so convenient and can be done anywhere and is a helluva lot cheaper than any kind of machine.

But ultimately you gotta do what is best and most enjoyable for you, whether it be walking, running, swimming, biking, elliptical machines, stairmasters, rowing machines, hiking, basketball, soccer, hockey, football, lacrosse, yoga, aerobics, whatever.

You can get injured doing anything, really.
posted by bitteroldman at 8:52 AM on August 18 [2 favorites has favorites]

The trick to healthy knees is to say "Hi" to them from time to time. Go ahead, try it.
posted by yeti at 8:53 AM on August 18 [4 favorites has favorites]

I fuck up my knees everytime I run. Of course, I don't run properly. I always land on my heels instead of the balls of my feet. Whenever I try to run on the balls of my feet I end up doing it too fast and have to slow down as soon as I get in stride lest I hit someone or something by accident.
posted by enamon at 8:54 AM on August 18

shmegegge, that sounds like patella femoral syndrome
posted by batou_ at 8:59 AM on August 18

I've been running for years and except when I fall on one, I've no problems with my knees. My ankles though, ouch.
posted by octothorpe at 9:02 AM on August 18

Elliptical machines nicely and evenly exercise your muscles and provide a low-impact cardio workout. however, when it comes to burning as many calories as possible as quickly as possible, nothing beats the treadmill or the stairmaster. The elliptical is for when I'm injured.

The thing about regular marathon runners is that they are much more likely to replace their running shoes often and make sure to wear good, comfortable walking shoes when they're not running. In short, because the demands of running force you to pay attention to your joint health, you're going to end up healthier than the regular people with 5-year-old sneakers and clunky shoes from Payless.
posted by deanc at 9:04 AM on August 18

The fact remains that long-term runners are a self-selecting group. So you have a lot to account for before generalizing too broadly from these results. For example, the children of athletic parents are far more likely to be athletic themselves. Would a child whose parent developed a degenerative knee problem be more or less likely to become a longtime runner? Predisposition can manifest in a lot of ways, not just early signs -- which themselves could include discomfort not obviously indicating a predisposition but nevertheless dissuasive in early years -- but also in family medical history and upbringing.
posted by George_Spiggott at 9:11 AM on August 18 [1 favorite has favorites]

But ultimately you gotta do what is best and most enjoyable for you, whether it be walking, running, swimming, biking, elliptical machines, stairmasters, rowing machines, hiking, basketball, soccer, hockey, football, lacrosse, yoga, aerobics, whatever.

Agreed. I tried running. A few years ago I got to the point where I could (slowly) run 3-4 miles at a time. But every. second. sucked. I never enjoyed it. I barely even enjoyed the accomplishment of meeting milestones. I felt slow, plodding, and heavy (although I'm not overweight).

This may just be excuse-making, but I've decided that at a curvy 5'1" with proportionally short legs, my body type is just not ideal for running.

Then this year I got a bike, and I have never enjoyed exercising more than I have in taking up cycling. There's a childish FUN that I don't find with anything else. And I can exercise with my (5'10" beanpole) husband, which I could never do running. Until a personal crisis upended our training plans, we were going to ride a century (100m ride) this year, and we may still try. In July I logged 550 miles. I can go fast, and have steadily improved my speed to the point where I can average 15mph on my commute if there's not a heavy headwind. Next year I hope to upgrade my hybrid commuter to a speedy road bike.

I am jealous of the people that make running a lifetime habit, sometimes, but not when I fly past them on my bike.
posted by misskaz at 9:12 AM on August 18 [1 favorite has favorites]

The thing about regular marathon runners is that they are much more likely to replace their running shoes often and make sure to wear good, comfortable walking shoes when they're not running. In short, because the demands of running force you to pay attention to your joint health, you're going to end up healthier than the regular people with 5-year-old sneakers and clunky shoes from Payless.

I bet there's a lot of truth to that. The couple of serious distance runners I know have multiple pairs of shoes, in fact--when I go to their houses, there's a pile of running shoes by the door. I guess they kind of overlap them so when it's time to retire one pair, there's another pair already broken in and a new pair ready to go. They're not out running in the same shoes they wear to go to the store or mow the lawn.
posted by padraigin at 9:15 AM on August 18

Running on its own is boring. I can only run away from something or after something. So, soccer.

Throwing in an extra flight of stairs helps my knees. For instance, instead of walking up one flight of stairs to the cafeteria, I walk up two, then down one flight. It takes maybe a minute and adds two flights of stairs, one up and one down.
posted by kirkaracha at 9:16 AM on August 18

I run a lot and I usually have two pair of shoes - my "good" shoes and my old shoes that I use when I think they might get wet.
posted by Mister_A at 9:16 AM on August 18

chicken ↔ egg
posted by rahnefan at 9:18 AM on August 18

This is good news for the MetaFilter running group! Join today, and cry yourself to sleep at night when thawed beats your sixteen-mile month with a hardly-believable 700mi!
posted by Plutor at 9:20 AM on August 18

700/30 = 23.333 mi/d.

Now that will hurt your knees and everything else.
posted by Mister_A at 9:22 AM on August 18

I don't trust running stores to sell me running shoes and tell me I have to buy more and more and more after X miles.

I only wear my running shoes running. Going to the store? That's what Croc's are for, amirite?
posted by yeti at 9:26 AM on August 18

bitteroldman: Always buy your shoes from a running specialty store that looks at your gait when you walk, lets you test drive the shoes and offers a reasonable return policy...

This needs to be shouted from the rooftops, not whispered in small tags. :)

I think I created a runnerplus account ages ago, but never really got around to updating it. I should see about that. Not that my measly mileage would ever impress anyone.
posted by somanyamys at 9:29 AM on August 18

An important 2008 study, this one from Stanford University, followed middle-aged, longtime distance runners (not necessarily marathoners) for nearly 20 years, beginning in 1984, when most were in their 50s or 60s.

The problem here is that they've already weeded people out that quit running because it damaged their knees. The conclusion of this study should be something like "Runners that make it their 50s or 60s without damaging their knees are not prone to degenerating knees for the remaining part of their running careers."
posted by ignignokt at 9:35 AM on August 18 [3 favorites has favorites]

"George, the study was looking for signs of degeneration of the joint over a 10-year period, and found no increase in the runner group. The interesting thing was that the runners showed more signs of OA at baseline. "

Mister_A they chose people who were running in their 50s. The people who ran for 10 years in their 30s and then blew out a knee or developed OA at that time may have stopped. IE: people who were at risk of developing running induced OA may have already stopped running by the time they are 50-60 years old because of OA. I'm not saying this is the case. Just that as presented there looks like a good possibility of self selection in the study. The study authors recognize the possibility of self selection inherent in their study: "

It must be recognized that this study is subject to possible selection bias as the runners were all healthy individuals who continued running at least into the 6th decade of life, most of whom had been running for nearly a decade prior to study entry.

"
posted by Mitheral at 9:36 AM on August 18

Also, what George_Spiggott said.
posted by ignignokt at 9:37 AM on August 18

Psychologically-induced pain syndromes and emotional repression.

Repetitive strain injuries, TMS and unacceptable emotions.
posted by Zambrano at 9:41 AM on August 18

Maybe we should run in sandals.
posted by Camofrog at 9:49 AM on August 18

It seems to me that marathon runners are by definition physically suited for running. They are the runners who seem to be effortlessly gliding down the road. Perhaps their efficient style is the reason they suffer fewer injuries while running. Perhaps if a person does not have the correct physiology for running they are not candidates for that particular exercise. By the way, I had 1/3 of my cartilage removed three months ago. If I knew then what my knee would feel like now, I would have had explored other options before so readily agreeing to surgery.
posted by digsrus at 9:50 AM on August 18

Running was the reason I always loathed exercise. Discovering exercise that didn't involve running (and the horrible pounding on my knees that resulted) was the reason I began to enjoy exercise again.

As such, I am innately opposed to any research that does not villify running. Next!
posted by Theta States at 9:53 AM on August 18

Metafilter: If it DOESN'T hurt, you're doing it WRONG.
posted by blue_beetle at 9:56 AM on August 18

As a 34-year-old former national-class distance runner now running marathons seriously (training 90+ miles a week) I've had the opportunity to make some observations about running in the 17 years I've been doing it.

I'm not so sure about the good shoes and orthotics argument making a difference across the board. I'm of the mind that a lot of people aren't really built to run in their current physical condition, but I'd also argue that lifestyle and 20+ years of not running is largely the cause, rather than any specific body type. Knees, in particular, are about the muscles surrounding them rather than the joint itself. If your quads are weak, your knees track incorrectly. This isn't a knee problem, but rather a conditioning problem.

I tend to get injured when I've had a layoff or transitioning from another activity. Over the years I've fixed a lot of joint injuries by simply running through them and having the faith that the pain I'm feeling is largely related to a weakness that will be fixed by the strength gained through the running. Obviously you can't run through everything, but you can certainly fix imbalances by doing it. Knee pain, I believe, is one of these things.

Humans are really well adapted to running - show me a child under 10 that's a really horrible runner. I'll bet you can't find many. We get conditioned to running poorly by not running as we get older.

I agree that orthotics can make a difference for someone not used to running or with someone with a specific biomechanical condition, but I believe orthotics are way over-diagnosed and are a crutch that get depended on and eventually get conditioned to, such that the individual needs them - their gait has adapted to that (unnatural) stimulus.

I'm just not convinced that most of the running injuries we see amongst recreational and competitive runners alike aren't lifesyle related. I'm one of the lucky ones that can run 100 mile weeks in paper-thin racing flats and not suffer a hint of damage - but then again, my 15-year old self wouldn't have been able to do it. I'd say there's a mix of genetics and conditioning, but I'd also say that conditioning has a far greater effect than genetics.
posted by jimmythefish at 10:01 AM on August 18 [5 favorites has favorites]

I used to have terrible knees. I was one of those people who didn't go to the movies because I couldn't stretch my legs out; plane trips were sheer torture. I went to doctors and had MRIs. An orthopedic surgeon told me to my face that I "just had bad knees." No diagnosis, just live with it.

I started running and promptly got a stress fracture. I sat on my ass for another two years.

Then I started running again, this time in proper shoes and on a proper schedule (yes, it's that important to stick to three days per week in C25k).

A year and a half later, I've lost 65 pounds from my peak weight. I've run many 5ks, a few 10ks, a half-marathon, and a full marathon. I'm training for my second and third marathons and I hope to run at least two more halves this winter. And my knees don't hurt a bit. I am totally cured.

Is it because I lost a dramatic amount of weight or because I'm getting so much exercise? I don't really care. I love running and I plan to keep it up for the rest of my life. I can enjoy seeing a movie in a regular theater, I can travel without pain, and hell, I enjoy being able to wear fun clothes again too. My quality of life is immeasurably better.
posted by liet at 10:07 AM on August 18 [3 favorites has favorites]

Oh, I acknowledge that such may be the case, but the study is still interesting in that it showed no difference in OA symptoms between the two matched groups over the 10 year duration. If running contributes to OA, as has been suggested in the past, then one might expect to see OA changes over the course of the 10-year study at a somewhat increased rate compared with the matched controls. The reason that an older age cohort was selected, I assume, is that these people will start to show signs of OA at this age regardless of physical activity, allowing better detection of differences in the rate of OA symptoms between groups. Not perfect, but not bad. As I said, this is a hypothesis-generating study. The possible explanations I can see for the observations are:

1. The runner group has super-knees that are resistant to OA, or better form, or better shoes, or some protective factor.
2. Running is no worse for your knees than not running.
3. BMI has a greater effect on OA than running.
4. Sampling error prevents us from knowing anything about running and OA based on these data.

I think #2 and #3 are the most interesting to test next. #4 takes care of itself with a larger sample. Pathology reports can help us address #1, perhaps...

#3 is interesting, though. Neither group had exceptional BMI-the runner group was statistically significantly lower than the non- but, neither were out of the normal range. Could this 1-point difference in BMI mask the deleterious effects of running on the knee? Maybe.

The next study here will be tricky. A larger sample would hopefully match the BMI a little more closely between groups, so we can focus on #2–but how best to account for the possibility of self-selection of the running group via resistance to OA? I mean, we don't have any proposed mechanism to account for #1 but that doesn't mean we can discount it. The problem is that we're looking for chronic changes, things that take years to show up. You can't really take non-runners and randomize them and then expect them to run or not run, based on the randomization, for a decade or two, then compare... There may be surrogate markers of inflammation that are detectable non-invasively though. This is a tricky problem!
posted by Mister_A at 10:11 AM on August 18

I'm going to have to second JimmyTheFish here.

When I started running I was a pudgy desk jockey who got tired of getting winded on a single flight of stairs. I started running in some Vans I had laying around and other than straining muscles within my foot, I was doing okay. Only when everybody and their mom started yelling at me to get some running shoes, and I listened, did I start developing knee issues.

Hell, I think it was an article on Metafilter that highlighted some long distance running mexican tribe and their habits (or lack there of) did I think to ignore everybody's advice. Only then did my knee problems go away. I run in indoor soccer shoes, and from the first day I started doing it I have had little to no knee issues.
posted by The Power Nap at 10:25 AM on August 18

I run regularly, although only 16-24 miles per week. At age 48, I've had one knee injury that was attributed to running, although I can't pinpoint exactly what did it. What I've learned in speaking with other runners and with orthopedic surgeons, is that the two big problems are "postage stamping" of meniscus (constant pounding of joint punching little perforations in the meniscus until there's a tear) and good old arthritis.

One friend had his meniscus repaired, and as he was about to be put under the anesthesiologist commented, "Runner, huh? I see more middle-aged guys like you in here for the same operations over and over and over. You'll be in for a knee replacement eventually." He wanted to tell the knock-out doc to fuck off, but he fell asleep and never saw him again...
posted by VicNebulous at 10:27 AM on August 18

"Runner, huh? "

Many with knee issues don't bother getting them fixed. Runners, however need to do so to continue running. I had several operations between marathons and could use another but since I only run 2 miles at a time now, I can do without further surgery.
posted by Obscure Reference at 10:46 AM on August 18

A year and a half later, I've lost 65 pounds from my peak weight. I've run many 5ks, a few 10ks, a half-marathon, and a full marathon. I'm training for my second and third marathons and I hope to run at least two more halves this winter. And my knees don't hurt a bit. I am totally cured.


I see you are not superstitious either.
posted by notreally at 10:47 AM on August 18

I was addressing mitheral at the start of my previous comment.
posted by Mister_A at 10:55 AM on August 18

3. BMI has a greater effect on OA than running.
posted by Mister_A at 1:11 PM on August 18 [+] [!]

This is already rather well known, isn't it? Obesity is one of the leading indicators for OA. (So is previous knee injury.)

For example: Results: In 1983 to 1985, 468 subjects (33%) had radiographic knee osteoarthritis. For men, the risk of knee osteoarthritis was increased in those in the heaviest quintile of weight at examination 1 compared with those in the lightest three quintiles (age-adjusted relative risk, 1.51; 95% confidence interval [CI], 1.14 to 1.98); risk was not increased for those in the second heaviest quintile (relative risk, 1.0). The association between weight and knee osteoarthritis was stronger in women than in men; for women in the most overweight quintile at examination 1, relative risk was 2.07 (95% CI, 1.67 to 2.55), and for those in the second heaviest group, relative risk was 1.44 (95% CI, 1.11 to 1.86). This link between obesity and subsequent osteoarthritis persisted after controlling for serum uric acid level and physical activity level, and was strongest for persons with severest radiographic disease. Obesity at examination 1 was associated with the risk of developing both symptomatic and asymptomatic osteoarthritis.

Obesity and Knee Osteoarthritis
The Framingham Study
David T. Felson, MD, MPH; Jennifer J. Anderson, PhD; Allan Naimark, MD; Alexander M. Walker, MD, DrPH; and Robert F. Meenan, MD, MPH
posted by Comrade_robot at 11:04 AM on August 18

I ran through an entire brutally cold winter outside with decent shoes and loved it, but then I developed some serious knee pain, similar to shmegegge's, and stopped.

I tried various gym machines, including ellipticals, but never liked them. They made me feel like veal in a pair of Nikes.

Now I ride my bike all over Toronto (and Mississauga, and Oakville) and I feel like a wild animal being hunted for sport. Much better.
posted by maudlin at 11:14 AM on August 18

"Runner, huh? I see more middle-aged guys like you in here for the same operations over and over and over. You'll be in for a knee replacement eventually."

Well, this I can see. From an evolutionary standpoint, after about age 40 everything's a bonus. If you were this old 100,000 years ago you were a wizard.
posted by jimmythefish at 11:26 AM on August 18 [5 favorites has favorites]

Just running alone, especially when you say take it up well into adulthood after not exercising for years, may not strengthen the muscles supporting the knee and could lead to problems. I think any running program should be coupled with a general strengthening and conditioning program to protect your knees, ankles, back etc. The NYT article comes with a short video showing some good exercises to strengthen the muscles supporting the knee. To protect your back you want a strong core and of course run upright.
posted by caddis at 11:36 AM on August 18

If you were this old 100,000 years ago you were a wizard.

I am Evangeline the Highlighted.

I really wanted to run. Really, really. I had tried it very briefly several years ago, but it was too hard on my feet. So a couple of years ago, I decided to give it a go with a trainer to help me stay motivated and in good form. I went to a fancy store where they videotaped me running on a treadmill and recommended shoes.

I lasted for about 2 months before my right knee started hurting so bad I had to quit. And my feet - ugh. Still, I wish I could do it.

I love it when people who don't run tell me that my body should be falling apart. Tell it to my 16% body fat and fucking awesome body density, suckers!

I don't really know what 16% body fat looks like, but every hardcore marathon runner I know looks like a famine victim. But you go on with your bad self.
posted by Evangeline at 11:36 AM on August 18

What's not well known or clear, Comrade_robot, is whether the small but significant difference in BMI between the two groups (something like 22 vs 23), with both groups still in the "normal" range, can mask hypothetical deleterious effects of running in this group of patients. Personally, I don't think so, but that's why you do the experiment.
posted by Mister_A at 11:53 AM on August 18

I always hated running when I was younger but took up a gentle program a couple of years ago. 2 or 3 miles, every other day shakes out all the muscle kinks and eliminates my back pain. I lost 30 pounds. I've had having problems with my left knee but I think I'm getting over it by turning my toes outward a bit more and doing proper, deep squats to build up my quads.
posted by bonobothegreat at 12:14 PM on August 18

you know, this has gotten me thinking:

don't a lot of people run, who aren't what we'd normally classify as "runners?" I mean, don't pretty much all fitness buffs do some kind of running for their cardio routine? I know some people do elipticals, or bikes, or stair masters, but usually more treadmill stuff, right?

is this something that affects a lot of fitness buffs who might not be competitive or amateur distance runners?
posted by shmegegge at 12:22 PM on August 18

Now I ride my bike all over Toronto (and Mississauga, and Oakville) and I feel like a wild animal being hunted for sport. Much better

I used to cycle the credit river valley trail riding in and climbing out and riding in and climbing out almost every day I could. Specifically to make my knees hurt.

Now I live in England and would like to go on a cycle holiday somewhere flat to give my knees a break.
posted by srboisvert at 12:31 PM on August 18

I have been somewhat brutal to my body over the years. Doing some very high impact activities that have, over the last 30 years, worn out some parts. My knees, and ankles (and feet) particularly. Everything people do know that is supposed to be a curative - bare foot training, core training, HIT training, I did all that BY DEFAULT for decades. And you know I think all these claims of efficacy are exaggerated at best. I'm constantly nursing one injury or another that people who just do Yoga don't have.

People kept trying to tell me that running was "good" for my knees. So I would keep at it. Only about 15-20 miles per week. And inevitably after four or five months a knee would go out and I'd have to lay off for a month or two. I got fed up with the constant damage and I can't stand the shit anymore. Though I think it was the combination of Thai boxing and running. Constantly kicking pads AND running I don't think the two are sustainable for most people over 35.

Now that I've reduced impact in my training I feel 100% better. I jog/walk stairs for 22 minutes 2-3 times per week. Do a cross-fit style mostly body weight work out 2-3 times per week. And only do boxing/kickboxing 2-3 times per week. With lots of shadow boxing an jump rope. No running. I'm not falling for it again, study or no.
posted by tkchrist at 12:46 PM on August 18

The human body is pretty amazing at adapting to the stresses placed on it. As someone who does not enjoy running and gets most of my cardio commuting on a bicycle, it makes me happy that all those friendly people I pass along the canal aren't doing permanent damage to their knees. Movement is medicine, after all.

Now if only the heavy squat could get off the hook for destroying knees.
posted by Barry B. Palindromer at 1:08 PM on August 18

A few months ago I bought a pair of Nike Frees. They are--hands down--the most comfortable shoe I've ever owned, and I wear them as much as possible.

These shoes have little to no support for your ankles, so it simulates running barefoot, though of course with a rubber sole for protection against the road, glass, etc. The human foot is a product of millions of years of evolution, and there is an arch in it for a reason--it holds up the weight of the entire body. And humans were meant to run.

What modern shoes do is protect the foot and take away the shock to the arch. A good idea, but this weakens the rest of the leg, including the knees. My knees used to hurt from time to time, but now that I'm wearing these Frees, the knee problems are gone. I recommend them to everyone.
posted by zardoz at 4:03 PM on August 18

I'm one of the lucky ones that can run 100 mile weeks in paper-thin racing flats and not suffer a hint of damage

Ah, this was me until about 8-10 weeks ago (minus 50 miles, natch). Then I did something to my foot. :(

No I'm struggling to get to five kms, my foot is hurting from about 3/4 way through, I've dropped a coupla hundred on a podiatrist with no end in sight. What used to be an enjoyable, liberating, unthinking pleasure has become a source of anxiety, thought and a small amount of pain, interpersed by doubts as to whether I'll ever get another 20km run again.

'Ware the lure of flats people! Padding is not the ultimate evil.
posted by smoke at 4:52 PM on August 18

shmegegge, that sounds like patella femoral syndrome
posted by batou_ at 5:59 PM on August 18 [+] [!]

I second this as I have been diagnosed with chrondromalacia / patella femoral syndrome and my symptoms were exactly the same. Sitting with bent knees for long periods is unbearable, and when my knees are "acting up" it can be excruciating to go from a full squatting position to standing, and even going up stairs can be painful.

It's basically an inflammation under the knee cap. It's also called "runner's knee" which i find hilarious as I have never ever been a runner. I do cycle however, and if you have your seat too low, it can really aggravate this condition. I have also been advised not to run or do lots of jumping.

It was explained to me that me kneecaps were tracking wrong as the muscles holding them in place were imbalanced. So now I have a bunch of specific exercises that target those muscles so they will bring my kneecaps into alignment and theoretically reduce the pain.

http://en.wikipedia.org/wiki/Runner%27s_knee

I think some people's bodies are made for running and some, like mine, are absolutely not.
posted by smartypantz at 12:06 AM on August 19

"The human foot is a product of millions of years of evolution, and there is an arch in it for a reason--it holds up the weight of the entire body"

So is the appendix. The vast majority of that millions of years our ancestors were walking on all fours. You can see it in our back that the human skeleton is a far from optimal design for a creature walking upright.
posted by Mitheral at 7:58 AM on August 19

The appendix holds up the weight of the entire body? I knew it was there for a reason!
posted by infinitywaltz at 8:29 AM on August 19

I started running at 43, being totally out of shape, with a then-girlfriend who was a big runner. At first, my knees hurt a lot and I was worried that I was damaging them. But as jimmythefish said, it's about the muscles (tendons? ligaments?) around the knees, not the joints themselves. Running built them up, and I can run 8-10 miles w/out knee pain now.

Here's what works for me:

1) DON'T run every day, not even short jogs. Alternate runs with leg weights, yoga or both.
2) Start with very short runs and build up very gradually.
3) Don't be shy to stop and walk when it hurts. Pick it up again when you can.
4) Run on trails or anything other than pavement, if possible. This helps with boredom, too.
5) Stretch, not before you run, but after about a half mile.
6) Don't worry about speed, at all. Just find the pace your body likes.
7) Good protective shoes, changed frequently. Nike Pegasus ($75, highly padded) work for me. Nike Frees when I don't run build up my foot strength and seem to help.
posted by msalt at 9:58 AM on August 19