When someone asks whether running is bad for your knees, they are usually worried that running will “wear their knees out”, or they are getting aches and pains in their knees when they run, or they’ve been told they have arthritis in their knees, and they don’t want to make it worse. Let's take a look at all of these concerns.
Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.
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In this article:
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Defining knee “wear-and-tear”
When people talk about knees wearing out, they usually picture the cartilage being damaged – the medical term is knee osteoarthritis.
While osteoarthritis (OA) does cause thinning of the cartilage, it actually involves multiple knee joint structures including the bone, ligaments, and surrounding muscles. So, when we want to know whether running is bad for your knees, we have to look at how it impacts all of these things.
Does running cause knee osteoarthritis?
Runners have reason to feel relieved.
A systematic review of the available body of research by Dhillon et al. found no clear link between running and increased risk of knee OA. Interestingly, runners often report fewer knee injury symptoms than non-runners.
Another review by Voinier et al. confirmed that moderate running doesn't lead to structural knee deterioration and can be safely recommended, even for those at risk of arthritis.
Can running improve knee health?
Surprisingly, yes. 🥳
Horga et al. found that novice marathon runners showed improvements in their subchondral bone (the bone beneath the cartilage) after running a marathon, indicating possible joint-strengthening effects.
Research by Coburn et al. noted minor decreases in cartilage thickness immediately after running. However, these effects were temporary, with the cartilage recovering within hours.
Zhang et al. reported increased cartilage thickness and volume in long-term runners (2 to 7 years’ running experience), suggesting positive long-term adaptations rather than degradation despite the initial reaction after a run.
💡 Simply put – yes, we can see that the knee cartilage takes a bit of strain during a run. However, it recovers within a few hours and the net effect is stronger, thicker cartilage.
But of course there are also risks 🫣
While running as such isn’t bad for your knees, how you train and run might actually lead to knee injuries. The two most prominent reasons why running might hurt your knees are:
1. You’re not allowing enough recovery time between runs
Our body tissues take strain when we exercise, and it require a period of time afterwards to repair and recover. The more intense the run and training over time, the more recovery time is needed.
In Coburn’s study, where they reported that the cartilage recovered within a few hours, the run wasn’t very hard, so the recovery cycle only lasted a few hours.
But in the study by Horga et al. they scanned runners’ knees two weeks after completing their first marathon – so, after four months of training plus a hard race. They could still see signs that several structures around the knee (hamstring tendons, IT band, bursas, kneecap cartilage) have not fully recovered yet, despite the runners not reporting any knee pain.
If you have a habit of training before your body has had enough time to recover from the previous session, you risk getting overuse injuries like patellar tendonitis, IT band syndrome, and patellofemoral pain syndrome (runner’s knee).
👉 These are all injuries from which you can recover with the correct treatment, so “running wears out your knees” does not apply here.
📖 Here’s a quick guide to help runners figure out what might be causing their painful knee.
2. You’re ramping your training up too quickly
As mentioned above, our bodies go through a cycle of breakdown and repair in response to exercise, and this is how we grow stronger over time. If you ramp up your training too quickly, your tissues don’t have enough time to strengthen properly, which then often lands you with an overuse injury.
This is why following a sensible training plan and adapting it when you feel you need more recovery is so important.
If you’re a new runner or just getting back to running after a long break, following a run-walk plan can be a brilliant way of building the strength your body needs for continuous running.
If you’re looking for a sensible training plan, I can recommend the Exakt app. I've helped design the Strength and mobility as well as the Running plans. The plans adapt to your training level, so it’s suitable for absolute beginners as well as experienced runners who have been strength training regularly.
🎉Discount Code: MARYKE
Running with existing knee arthritis
Moderate running can still be beneficial if you already have arthritis. Dhillon et al. reported that, in people who had been diagnosed with knee OA, runners were less likely to need total knee replacement surgery than non-runners.
In our experience, you usually do have to adapt your running to suit your knees if you have OA. Here are some things our patients have found useful:
Running on softer surfaces
Investing time in proper strength training — the stronger your muscles are, the better they can support your joints and reduce the strain on your knees
Choosing supportive but cushioned shoes (Hokas work well)
However, some find that transitioning to more minimalistic shoes is better — if you're thinking of switching, please just do it very slowly to avoid injuries like Achilles tendonitis
Shortening their stride so they don’t plant their heel out far in front of their bodies (reducing overstride)
Increasing recovery time between runs – switching some runs out for cycling works really well
Reducing mileage to what their knees feel comfortable with
Some find running up hills but walking down hills better
Doing all their runs as run-walk sessions
Losing weight if they are obese or overweight.
Injured? How we can help
Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.