Trying not to run myself into a knee replacement
February 18, 2012 11:51 AM   Subscribe

New runner...with 41-year-old knees. I am doing a decent amount of running for the first time ever, and have been pleased with how much my endurance has improved pretty quickly. BUT, I have a couple of questions: 1) does running surface matter a whole bunch; and 2) how to best prevent knee injury. (More below)

I wrapped up the Couch to 5k thing over the past summer, running almost exclusively on an indoor track surface. It was super, and I had no trouble with joint pain or really anything else (still don't LOVE to run, but the's lessening). Now that it's much cooler here in Texas I've been trying to run outdoors more, but the running on pavement just seems to cut my endurance in half. Am I being a big baby about this, or is it really that much harder?

And, I've had a bit of knee pain recently. Nothing major, but being 41 and all, and coming from a long line of people with crap knees, I'd like to head off a knee injury if at all possible. I found this thread with some good links for some strength exercises, and this one with some general advice, but wonder if anyone has any other suggestions.

Other relevant details: I'm female, generally healthy, average weight/BMI (5' 9" and 150-160 pounds), and I have a <1 year old pair of shoes I got from a good running shop. According to the clerk I have a normal gait and don't do anything too weird.

Thanks, running mefites!
posted by pantarei70 to Health & Fitness (24 answers total) 16 users marked this as a favorite
It is harder but I will let someone more expert quantify the "hardness". What I do know for me at least is that I can tell the difference between structured environments like the track and treadmill versus running "in the wild". For me the treadmill keeps me at a consistent pace but in the wild I know I am not staying constant. I know all too well that is very easy to get excited and go out faster than expected and consequently get worn out sooner. Plus running in the wild you have to deal with elevation changes, uneven surfaces as well as a lot more lateral changes unlike a track or treadmill.
posted by mmascolino at 11:59 AM on February 18, 2012

Pavement is terrible. Seriously. Asphalt is marginally better (if you ever wondered why so many joggers are in the street, that's why) but if you can find a dirt trail somewhere that will be noticeably easier on your joints.
posted by restless_nomad at 12:00 PM on February 18, 2012 [3 favorites]

Yes, running on pavement is very different from running on a track surface. Tracks are made of a material that is distinctly more... springy than paving, and consequently much more forgiving on the joints. I'm only 27 and I noted discomfort when I switched from indoor to outdoor running, for exactly the same reason. Other than changing surfaces, there's not a lot you can do - although different shoes may help somewhat, they're not going to eliminate the issue altogether. You can drop your target distance/speed and not feel embarrassed, dial it back to a point where you're no longer feeling discomfort, and then work up to where you want to be again.
posted by fearnothing at 12:06 PM on February 18, 2012 [2 favorites]

I have a <1 year old pair of shoes I got from a good running shop

I've heard that you want to measure the lifespan of your shoes in miles, not time, with 500 miles being about as long as you'd expect a pair of running shoes to continue to provide good shock absorbtion and support. Some people replace them after 300 miles. Depending on how much you run, that can be a matter of months, and the shoes can still look new.
posted by Balonious Assault at 12:43 PM on February 18, 2012 [3 favorites]

My feet an legs can feel the difference between concrete and asphalt in about three seconds. There is *definitely* a major difference. When I"m rested and "on", I can run 10+ on asphalt without really thinking about it; even my best days on concrete have me saying "fuck this" at mile 5.

Regarding the shoes, depending on how you run, they might be ready for replacement. Have you counted up the miles on those shoes?
posted by notsnot at 1:02 PM on February 18, 2012

Re: shoes

When I was working out semi-seriously (6-7 hours/week) I was about your weight, mostly running on pavement, and replaced my shoes 3-4 times a year. Otherwise the knee pain crept up on me.
posted by purpleclover at 1:03 PM on February 18, 2012 [2 favorites]

Plus running in the wild you have to deal with elevation changes, uneven surfaces as well as a lot more lateral changes unlike a track or treadmill.

This, to me, is totally true but also a point in favor of getting off the track. More subtle (or not subtle) changes in the running surface means less directly repetitive joint stress and more work for stabilizing muscles, especially in your feet and core. This is good.

The key, though, is not switching from 100% track to 100% sidewalk. Can you find dirt paths, trails, outdoor gravel tracks (high schools often have these around the football fields), or the like and mix it up?
posted by Ignatius J. Reilly at 1:08 PM on February 18, 2012 [2 favorites]

The NYT recently had an article on this very question, and recent studies seem to indicate both types of surface can be damaging. If you are used to one type of surface, it is important to change over to another type of surface slowly, to allow your body time to adapt.
posted by just_ducky at 1:11 PM on February 18, 2012

Nthing the above.
posted by luckynerd at 1:18 PM on February 18, 2012

Another vote for trails - as said above, hills, rocks, and hairpin turns are all features. Also, I find myself less prone to injury when mixing in some lifting. Don't know if it's empirically true, but it's logical that making a concentrated effort to strengthen the muscles around your knees will help protect them when you run.
posted by orangejenny at 1:39 PM on February 18, 2012

I do notice a difference in surface, but admittedly I continue to run on concrete because that's what's available at the nice park nearby. However, I find that paying attention to my form lessens knee pain for me. I'm no expert in form, but I've taken some tips from this NY Times article.
posted by Terriniski at 2:25 PM on February 18, 2012

Put on your running shoes and run around the room a couple of times. If you are like most people then you run in such a way that your heels strike the ground before your toes do. Each time your heel hits the ground the force is transmitted up your leg. There are no elements to give in this chain save for any cushioning in the heel of your shoe and any give in the surface you are running on. If the ground is hard and the heel cushioning is minimal then the size of the shock wave travelling up your leg will be greater. The further you go, the harder the surfaces you run on and the more worn your shoes - so the greater the chances of the shock waves injuring your knees.

Now take off your shoes and repeat the same exercise. This time you will probably convert to landing on your forefoot - like when you were a kid running along a beach. If you do this then the flexing of your feet and of your leg will help to absorb the shock. Over a few months you can train yourself to run this way with shoes on. You will be putting more strain on your ankles than you did before - and your calf muscles will also have to get stronger. However if you can perfect this technique you will be putting less strain on your knees (you can also buy cheaper running shoes and keep them for longer since your running comfort will not be affected by worn down heels).

Here is a page showing the comparative biomechanics. You can also read various threads on barefoot running on AskMe or elsewhere.
posted by rongorongo at 3:32 PM on February 18, 2012 [3 favorites]

Please, OP, take the barefoot running kool-aid with the giant pinch of salt its largely theoretical claims deserve. Barefoot is great for some people who are biomechanically suited, but terrible for others. Some aspects of barefoot running (high cadence; small, frequent steps; slight tilt forward from the waist etc) are worthwhile regardless of your footwear. But it is most definitely not a panacea, and you will find very few physiotherapists or podiatrists indeed who would recommend it, especially for a beginner. Barefoot running may avoid knee problem, but that can be because you're simply "outsourcing" that shock onto your feet and calves instead.

To answer your question: Yes, pavement is much much harder on your knees than track, though if you were running on a circular track that can bring its own problems anyway. The good news is, after a period of time your ligaments and tendons will slowly get used to the load and it will not bother your body as much.

But you will need to slowly add in those outdoor runs, rather than diving into them full bore. Also, though it is hard, asphalt is actually much better in terms of impact.

Regarding general avoidance of knee pain, it's good that you're considering strength exercises. Stretching after a run may be helpful for you, and depending on your type of pain a foam roller may help. Google ITB and see if it sounds like your twinges; there's a lot you can do if it is. Good luck! :)
posted by smoke at 3:41 PM on February 18, 2012 [1 favorite]

Yeah... just another vote for trails, especially trails with hills. On flat hard surfaces like roads, I find the continuous pounding at the same points on my body really bangs me up. The same distance on trails, maybe moving a little slower but covering a variety of different terrain, totally different feeling when I'm done.

Anyway, I've averaged 40+ miles / week for the last few years (reasonably uninjured) and I'm totally not sold on the whole barefoot thing. I know guys who do it and love it, so who knows, but I really dig shoes like MT110, which while minimal, still provide a fair degree of protection and traction. Bigger, more built up shoes tend to compress, so you're gonna wanna replace them fairly often. Like every 6 months, maybe?

My philosophy is something like: run farther, slower to stay out of trouble. And do lots of hills. Explore your neighborhood!

At the end of the day, though, no one really knows anything about running. Don't be afraid to experiment, see what works. And cross training is awesome too -- lifting, rock climbing, swimming, biking, whatever... all those things will make you a better runner.
posted by ph00dz at 4:37 PM on February 18, 2012

I played moderately serious ultimate frisbee in college (with a lot of former track and xc runners) and everyone said that strength training was the way to prevent injuries. This makes a lot of sense: if your muscles are strong they can stop your joints from moving the wrong way and coordination often follows from strength. Learn to squat properly and you can benefit from it even without weight; also strengthen your core so you can run with better posture.
posted by martinX's bellbottoms at 5:07 PM on February 18, 2012

You're at the point as a runner where your endurance has increased more than the ability of your joints (and bones, muscles, tendons, ligaments, etc., etc.) to deal with the constant pounding of running. The 6-month point is the point at which many new runners get injured in some way, because their heart and lungs are finally letting them run the distance they want to, but the rest of their bodies aren't ready to handle it.

Just keep that in mind as you increase your distance and/or start to throw in some faster efforts: Just because you can handle it aerobically doesn't mean your joints can handle it.

In addition to that, some general suggestions if/when your knees do start to give you some trouble:

- Do some of your mileage (1/2?) on softer surfaces (not pavement/asphalt)
- Don't have one of your runs during the week be much longer than the others
-Strength exercises 2-3 times a week; focus on your quads but also hips/glutes/core
-Don't be afraid to cut back a bit if you're experiencing pain
-Replace your shoes every 300-500 miles; I like to rotate two pairs, which helps me see when one needs replacing--if I have one pair with 400 miles and one pair with 100 and I start having pain when or after wearing the 400-mile shoes, I know it's time to replace them.
posted by matcha action at 5:14 PM on February 18, 2012 [1 favorite]

Nthing martinX. As a former runner with shredded knees ( I only ran for a few years before completely destroying my already not great knees-need a total knee replacement in one knee, bone graft in the other), my orthopedist and PT both say that the most important thing anyone who runs should do is strength training to build up the muscles that support the knees.
Squats and lunges usually are most recommended, but there are workout routines out there specifically for knee strength if you google.
If your knees are already starting to hurt, you need to take this seriously. I went from running to not being able to walk at all within a matter of a few months. Luckily modern technology has brought me back to almost where I was before, but still have some pain, I'm much weaker overall, and running is definitely out of the question (I tried barefoot running briefly and it started messing with my ankles and my knees still ached, so I stopped)
posted by newpotato at 5:27 PM on February 18, 2012 [1 favorite]

I had knee issues near the end of my Couch to 5k, which I blame on running on the edge of a road that had a fairly steep pitch for drainage. Running on trails for a bit (after a few weeks of rest and ice) seemed to help a lot, and I've had no issues since.
posted by schoolgirl report at 5:59 PM on February 18, 2012 [1 favorite]

> Barefoot running may avoid knee problem, but that can be because you're simply "outsourcing" that shock onto your feet and calves instead.

That's exactly the idea, distributing the load. I am 42, 282 pounds and very active, so my knees are already kinda shot.

What I have found very useful is exercising body intelligence first, I got good results with Contact Improvisation, fun and relaxing, the goal is to become aware of the body working as a system, and use this awareness to start moving in ways that put less stress on the knees.

Knowing how to forefoot strike is VERY important, not a panacea but done at the right moment puts a huge load off the knees. Barefoot radicalism is not necessary, just try some minimally-cushioned sneakers (I like Chuck Taylors) for normal everyday walking, now and then experiment gently with forefoot striking, it`s A LOT EASIER when going uphill, very very gradual, see how your body responds.

Also stretching and loosening up the pelvic region, the goal is to think of the body as a system of shock absorbers, foot-knee-pelvis rather than just bending the knee and everything else rigid. For this, I had excellent results with Aikido.

tl;dr learning to use your body better rather than band-aiding the problem putting a cushion under the heel. Takes longer but is VERY rewarding.
posted by Tom-B at 6:18 PM on February 18, 2012

I've had knee problems for half my life (seriously, since I was in my early teens) and had written off running as something I'd never be able to do regularly. Just walking insignificant distances could cause the soreness to flare up, and I am only 110 lbs and in my 20's. Then I was inspired to give it another try. I am still very much a beginner at running, but here's my take for what it's worth.

I did a lot of reading on bum knees and running before starting. Googled for knee-strengthening exercises, then searched Youtube for videos showing proper form for squats and lunges. I wobbled all over the place trying just a few reps without weights, and understood then how weak my stabilizing muscles were, and how much extra force was being left to the tendons and cartilage to handle. I read about running mechanics and form, and realized that I was heel striking like crazy. I did it even in my bare feet, because that's how I'd thought running should look. The overstriding caused by my heel striking meant that much of the force of impact was being shot back up into my knees and hips, making running both painful and terribly inefficient.

Since I started alternating running with the strengthening exercises, and changed to a midfoot/forefoot strike, my knee has been feeling much, MUCH better. I am still doing almost all of my running on a treadmill, because the surface is way more forgiving than pavement. When my knee is stronger, I will start doing some shorter runs outside and see how that feels. So my humble advice to you would be to concentrate on strengthening your knees and sticking to softer surfaces until your knees are pain-free again. Better to prevent damage than try to repair it afterward. Knees are very unforgiving.
posted by keep it under cover at 8:08 PM on February 18, 2012

I recommend Superfeet insoles, and swimming on your off days, for about the same amount of time as you'd run.
posted by alphanerd at 8:25 PM on February 18, 2012

Also n-thing walking/running on natural trails, a dancer friend taught me that it's an excellent exercise for body intelligence, just walk barefoot VERY SLOWLY on all kinds of natural terrain while paying close attention to what your whole body is doing and feeling, you'll notice that there are things you do that make your knees more relaxed. Apparently unconnected things, once a stiff injured shoulder was making my opposite hip hurt while walking, stretching and relaxing the shoulder made the hip pain go away instantly.
posted by Tom-B at 3:34 AM on February 19, 2012

Thanks for all the good advice here.

I will definitely start keeping better track of my distance -- I don't really have any idea how long I run at this point ('til tired...repeat). I have a new pedometer and will try one of the run tracking apps, for the sake of my knees and shoes.

And I will definitely try some trails and track surfaces, and some of the exercises.
posted by pantarei70 at 6:42 AM on February 19, 2012

I've got a friend who's an evolutionary biologist with a strong interest in biomechanics. He's also a marathon runner and his research is on the biomechanics of running. He's got a blog you might find useful for running related questions:
posted by Quizicalcoatl at 6:57 AM on February 19, 2012

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