Running and Knee Pain: Debunking the Myths with Science

Prairie Doc Perspective Week of August 10th, 2025
Running and Knee Pain: Debunking the Myths with Science
By Matt Dewald, PT, DPT


You’ve likely heard -- maybe even from a medical professional -- that “running is bad for your knees.” But robust scientific evidence, including X-rays, MRIs, population surveys and long-term data, tells a different story: recreational running doesn’t increase the risk of hip or knee osteoarthritis (OA). In fact, it may reduce it.


Debunking the Arthritis Myth
Despite popular belief, running isn’t a cause of OA. A 2017 meta-analysis in the Journal of Sports and Orthopaedic Physical Therapy found lower OA rates among recreational runners compared to sedentary individuals. More recently, Hartwell et al. (2024) surveyed 3,804 marathon runners and found no increased OA rates, even among those with decades of high-mileage training. Impressively, 94% reported no diagnosis of hip or knee OA, and many with more years and higher mileage reported less joint pain overall.


The Osteoarthritis Initiative, a longitudinal study of nearly 4,800 individuals over eight years, adds further support. Runners showed no structural progression or narrowing in joint imaging, even among those with pre-existing OA. Interestingly, runners who continued to run were more likely to experience resolution of knee pain than those who didn’t.


The Role of Metabolism in Joint Degeneration
OA is increasingly understood as a metabolic condition rather than a wear-and-tear issue. Risk factors like obesity, high blood pressure, elevated cholesterol and insulin resistance, which are components of metabolic syndrome, can accelerate cartilage breakdown and raise the likelihood of requiring total knee arthroplasty (TKA).


A large Norwegian cohort study (HUNT data) linked to the Arthroplasty Register found those with metabolic syndrome were significantly more likely to undergo TKA, even when adjusting for lifestyle factors. Similarly, a 2025 case-control study found that 68% of OA patients who had TKA met criteria for metabolic syndrome -- nearly double the rate of those who avoided surgery.


Why Running Helps
Recreational running addresses key metabolic stressors that contribute to OA. It reduces body fat and inflammation by lowering levels of harmful adipokines, which are hormones released by fat cells that promote cartilage damage. Running also boosts insulin sensitivity and helps regulate blood sugar, reducing the low-grade inflammation associated with metabolic syndrome.


From a mechanical perspective, running supports joint integrity. Cartilage thrives on cyclical loading, and running supplies the ideal stimulus to help it stay nourished. Maintaining a healthy weight is also crucial; every extra pound of body weight adds roughly four pounds of compressive force to the knee with each step. Strengthening muscles and building bone density through running improves joint stability, reducing the risk of deterioration.


Smart Training = Injury Prevention
Running injuries are more often linked to training mistakes than to running itself. Sudden mileage increases, lack of strength support or ignoring warning signs are common culprits.
To minimize risk:

• Progress gradually. Avoid large changes in running.
• Incorporate strength training, especially for the glutes, quads, hamstrings and core.
• Tune into your body. Soreness is normal, but sharp or persistent pain warrants rest or adjustment.

Bottom Line
Far from being a joint hazard, running can be a powerful protector, especially for those managing metabolic risk factors. It strengthens supportive structures, counters inflammation and may delay or prevent OA and even TKA. With thoughtful training, running can help preserve joint health for decades to come.


Matt Dewald is a physical therapist who holds a position as an associate professor in the University of South Dakota’s Department of Physical Therapy. He also serves as director of the Sanford Health and USD Sports Physical Therapy Residency, where he treats runners. His research focuses on running injuries, and he serves as education chair of the Running Special Interest Group within the American Academy of Sports Physical Therapy. A dedicated runner himself, Matt starts most mornings on the move outdoors. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.