Started running: did I permanently wreck my knees?
July 27, 2022 12:11 PM   Subscribe

Ok, so my completely sedentary 30-something ass decided to start running but did not read the instruction manual, as I literally thought "just run, bro!" was basically all I had to do. I am wondering if I permanently hurt my knees, or if at what point I need to see a doctor or physical therapist.

So in a rush to "get in shape" I started a None-2-5k style program two weeks ago that consisted of VERY light and slow 20 minute run-walk (1 minute run, 2 minutes walk) every other day.  And it felt really good!  But I made the following mistakes:

- Was using shitty 60 dollar discount cross trainers with zero support.  I told myself that I'd get fitted for expensive new running shoes if I can actually stick with it for a month; I was not thinking about "injury from wrong shoes" as an outcome because frankly I've never experienced something like knee pain before in my life.

- Made the big mistake of running two days in a row, something that I now understand to be a big no no when starting out.  Instead of Monday/Wednesday/Friday I did this on Friday/Sunday/Monday - deciding on Monday to basically start my MWF schedule.  I also upped my running time that day to 1.5 minutes because fuck it, I think I have the stamina to do it.  I now understand this to be a grave error and will never again underestimate the importance of recovery time.

So basically the next morning my knees felt like they had been blasted with a shotgun.  They were then in dull pain the rest of last week. They are much better this week, but still fairly achey.  I've been doing quad/hamstring/IT band stretches as well as some light body weight exercises like leg lifts and half-squats for the past 7 days, and waiting to wake up with no aching, but it's not happening yet.  I can walk around just fine, go up and down stairs, etc, but as long as there is any pain at all I'm REALLY nervous about starting up running again.

I understand that you are not physical therapists but perhaps some folks have experience with starting up with running late in life and encountering some setbacks.  My questions are:

1) How do I know the difference between "you HURT yourself by running in bad shoes with no recovery time" vs. "your knees are adjusting to #RuningLife because you previously spent 90% of your time sitting/laying around, and this high impact exercise is shocking and new to your legs"

2) Can I *only* run again when there is an undetectable amount of pain/aching?  Or is it normal to run through a small amount of knee pain if it is, in fact, natural "growing pains" from new exercise and it eventually goes away?  Let's say pain is at about a 3/10 compared to a 5/10 last week. How do I know when I'm ready to run again?

2) If "no pain" is the only appropriate option to start running again, then at what point do I go to a sports medicine doctor or PT and say, "ok my knees might be fucked up because they've been hurting for X amount of weeks after some VERY light runs?"  How many days/weeks of knee pain should one experience before it needs to be looked at by a professional?  

Keep in mind I'm not trying to go distance running here, this was two 13-minute miles of intermittent walking/running - pretty light fare, I think! I'm not overweight or anything.  I have some new running shoes that feel like pillows. And my only goal right now is to be able to run a mile without stopping, preferably in 10 minutes, and eventually work my way up to doing 6 or 8 miles per week. I'm just kind of shocked by how much of a strain this all put on my body, and am seeking advice on how to proceed and still meet my (what I *think* are pretty reasonable) running goals!
posted by windbox to Health & Fitness (25 answers total) 1 user marked this as a favorite
Hey so a physical therapist will be able to talk you through almost all of these questions and can tell you how to distinguish between good pain/bad pain. Generally with some chronic ankle stuff i have, dull aches are okay on days whe I've run as long as they are gone the next morning. If you are getting a sharp pinching sensation anywhere that's worth going to PT for. I would look into Couch to 5k programs or other interval training programs similar to this one in order to follow start up guidance. Link here. There are many audio mixes available that will. but also if you're in the Us and have insurance a pt visit will cost between $35-60 and without insurance $120 and may save you months more PT and PT payments if you nip this in the bud early.
posted by edbles at 12:17 PM on July 27, 2022

Also not a physical therapist and you should talk to a pro. That said, one rule of thumb I know is that if running a little makes you feel better — you’re sore starting out, but after a hundred yards or so you’ve loosened up and it doesn’t hurt anymore — you’re probably okay. If running makes it feel worse, you should stop and rest and definitely talk to a professional.
posted by LizardBreath at 12:27 PM on July 27, 2022 [9 favorites]

The difference between "I hurt myself and need to get fixed" and "I am just sore" isn't the clearest of lines but there are some things you can notice. Is the pain accompanied by a limitation of motion? Is the pain the same in both knees or is one noticeably worse? You also said the pain is reducing, another sign that you probably just overdid it.

I'm guessing you might have experienced Delayed Onset Muscle Soreness (DOMS) though. If you were sedentary and then shot up to a lot of running, your muscles might have revolted. I had that happen once, I went from being mildly in shape to trying a really hard core muscles class and it took like a week for my obliques to not ache, like really painful. But it goes away.

If you run/jog, you are going to feel pain/soreness at times, its just how it goes. Instead of PT, you might want to splurge for a trainer, someone who can watch your gait and suggest improvements and workout routines.
posted by RajahKing at 12:34 PM on July 27, 2022 [2 favorites]

Not a direct answer to your questions, but it sounds like you have learned a few lessons the hard way and I thought I'd help you with another potential issue: The surface you run on makes a HUGE difference in how much impact your joints have to take. Running on concrete sidewalks is basically the worst surface for your joints. Running on asphalt (so in the street if that is safe for you) is a little better. If you live in a place that has dirt trails, like in a park, that is far easier on your knees than any paved surface. If you have access to a treadmill, that might also help you ease into a high-impact routine.

Your muscles will strengthen quickly with exercise, but your tendons and ligaments take a much much much longer time to adjust (as you have found). Maybe think about your knee joints as needing to work up to running the same as your cardiovascular system. Start in easy mode on a treadmill or dirt path if you can, then after awhile see how pavement feels. If you're running on sidewalks, your joints might feel like you skipped right to week 8 of your Couch-to-5K program even if you're only running for a minute at a time!

A lot of running stores host an occasional "Ask a PT" night. If you have some running shops in your area, see if you can attend one and get some answers to your basic questions for free!
posted by adiabat at 12:40 PM on July 27, 2022 [3 favorites]

Hello, I have been sedentary for 10 years and started seeing a physical therapist around 4-6 months ago in order to treat and get back to regular physical exercise without hurting myself.

All of your questions and your experiences, you need to hightail it to a physical therapist if possible, but no, pain in any form should not be tolerated and it is a sign that it needs to get checked out. In reality your body has a lot of biomechanics that need to be analyzed and to make sure to identify where you have joint and muscle weakness. I stopped running because I started having knee pain, and after a few weeks of examining my gait, posture, and doing strength diagnoses, it was determined that I have hyper-extended knees, which has resulted in a cascade of effects that my left thigh muscles are much weaker than my right due to postural imbalance. I have plantar fasciitis and been wearing custom insoles since I was 9, for reference, and already was wearing very expensive running shoes. I had my feet analyzed at Fleet Feet on a machine and then had shoes recommended to me.

But in general, running is a really high intensity exercise, and there are other ways to pursue fitness that doesn't wreak such havoc on your joints. I am still essentially doing physical rehab to get my body back up to speed to be able to jog, but my physical therapist has suggested I look into low impact exercise like swimming instead, just because of this work.
posted by yueliang at 12:42 PM on July 27, 2022 [4 favorites]

Take a while off to recover, and when you start back again, please run much slower than that when you are on the run part. Like, I'm lightly jogging to catch a bus that I could walk to, but am jogging to look like I'm trying not to hold everyone up. Like, I want to get in line before my sibling who happens to be walking.
posted by advicepig at 12:52 PM on July 27, 2022

I did this exact same thing in my 30s. Get thee to a physical therapist! They will show you how to run in a healthy way and ease yourself into things. And they will teach you the difference between injury pain and just sore muscles from exertion pain. I hurt my knees sooooo many times until I started doing things the right way. Now in my 40s, I run 3 times a week, wear good sneakers, and always ALWAYS stretch beforehand with specific PT exercises. I also wear knee bands around my right knee to give it some extra support.
posted by silverstatue at 12:59 PM on July 27, 2022

I'll say this: I've never been a good runner, so a few years ago I decided to do Couch-to-5K, just to get the ability. I quit about three days in because I was in knee and ankle pain, I'm assuming because I got whatever cheapish shoe seemed most average when my feet and walking style are actually idiosyncratic. If I take it up again, I'll bite the bullet and spend $150 or whatever on shoes from a running store who can actually fit me to the right shoe.
posted by rhizome at 1:01 PM on July 27, 2022

Nthing to see a physio, but also - I'd suggest you stop doing the half squats, they may not be helping matters. Better to rest, at least until someone who knows what they're doing tells you what will help and what will make things worse.

And ease off on the beating yourself up - you're being super-harsh on yourself. Plenty of people would do what you did and not end up in pain, it wasn't that stupid. Also: Welcome to running! Everyone gets to see the physio at some point if they become a runner. Not because running's bad for you - it's absolutely a net gain, but you just need to take care of those joints and things while you're doing it, and sometimes unexpected stuff happens that needs a little attention. It's like having a good mechanic on call when you own a car. Worst thing you can do is hate on yourself every time things get tricky, or you're going to end up hating running and won't stick with it.

Learning to forgive yourself your running failings is part of the whole picture. Good job on getting started!
posted by penguin pie at 1:12 PM on July 27, 2022

If you are interested in anecdata on mid-30s knees meeting new high-impact exercise: I don't run unless I'm catching a bus but a few years ago I started a circuit type workout involving a substantial portion of high-impact moves (example: lunge to a one-legged jump, weighted jump squats). My knees definitely took a while to get comfortable. For maybe 6 months my knees would be stiff, sore (not stabbing pain, just sore), and generally tired for a day after the workouts, but eventually that faded to just tired. And importantly once I got moving there was no stiffness or pain, and no foot/ankle pain ever.
posted by esoterrica at 1:22 PM on July 27, 2022

Tendons and ligaments which surround muscle and bone take longer to strengthen than muscle itself. So even if you're already getting into shape muscle-wise, and you're starting to feel more fit, it's gonna take awhile longer for your knees' tendons/ligaments to stabilize and thus feel less sore. But no you probably didn't break yourself! Cardio is tough. See a PT, and take it easy on yourself! One day at a time. Congratulations on your new lifestyle!
posted by erattacorrige at 2:31 PM on July 27, 2022

I would take a week off (with ibuprofen) and wait to see if it improves, and then buy some running shoes if that seems to be happening. If you aren't seeing improvement with rest and anti-inflammatories, then doctor time. (I did the same thing with "these shoes are fine" and thought I'd really messed myself up, but it turned out ok.)

Oh, and don't just buy whatever running shoes. Go to a running-specific store where they have you try them on and jog down the block a little while they watch your gait, so that they can put you in the right shoes.
posted by Blue Jello Elf at 3:33 PM on July 27, 2022 [1 favorite]

1) Your knees don’t “adjust” in any way you could feel. If your *joints* hurt, you have hurt them.

Delayed onset muscle soreness is pain in your *muscles*, on both sides, that’s only *moderate* and shows up 1-3 days after you exercise. (If it’s on one side only, you may have pulled your muscle. Shouldn’t ever be in your joints.)

2) No pain is what you’re shooting for.

3) I would go now honestly.
posted by cotton dress sock at 4:36 PM on July 27, 2022

To get joint stability, you need to build the muscles around the joints. Squats are not the correct exercise for this. Here is a link to a video with good ones.

If I were you, I'd take a week off, and then start these knee exercises. Do them for two weeks and then start the 0 to 5k program from the beginning. Then do the knee exercises on days you aren't running. After a few months you can dial down the knee exercises and see how you feel.
posted by ananci at 4:41 PM on July 27, 2022 [3 favorites]

Opinions here are all over the map. Mine is that you didn't hurt your knees.
The current belief seems to be that joints require a certain amount of abuse to tell the bearing surfaces to maintain themselves. I think this is correct.
I run barefoot, and not in barefoot shoes - completely barefoot. I realized I had bad knees when I was 7. The only thing that seems to improve them is running. When I run in shoes it hurts my knees a lot.
I've never seen any kind of therapist. Sometimes they're better, sometimes worse. There's no real trend either way. I don't run when something hurts, but the latest theory is that you can. Theories change every few weeks. Last night I didn't realize until I was a couple of miles from home that my calves hurt. It went away before I got home.
I think this stuff varies depending on which joint, which day, how you feel and who you talk to.
Your body is pretty tough. Most runners are in pain some of the time. If I was being honest I'd say that hard core runners are always in pain. I'm not hardcore, so I'm only sometimes in pain. It's not a sign that you've done permanent damage. If it was none of us would be able to walk. We evolved to run.
The only point I don't see mentioned here is that the relationship between the quality of your shoes and joint injuries is backwards. The more money you spend, the more likely you are to hurt yourself. Nobody wants to say this, because people like to have the best gear, but if you run you want cheap shoes without much padding. Or really, any padding.
Running barefoot is best of all, but only if you ask a barefoot runner, and only if they haven't recently stepped on a rock or kicked something.
But the best way to recover from anything is to see how it goes. Most of the time you'll get better without involving professionals, and I think that's best, because the advice they'll give you is just as much based on fashion and opinion as what you'll get on the web.
posted by AugustusCrunch at 7:09 PM on July 27, 2022 [2 favorites]

If your knees were my knees (and they have been) I'd rest them as much as possible until they'd stopped hurting enough to make me wince and slow me down while I walked around indoors, and then I'd take them out every other day walking - not running - until I could walk at least 5km without adverse effects. Only then would I begin to add a bit of running to the exercise mix. And I certainly wouldn't leap straight from walking only to 2:1 walk:run, I'd start out by adding one minute of run to a well established walking routine and ramp that up over at least a month while monitoring my body closely for objections.

Walking any given distance will give you pretty much all the exercise-derived benefits of running the same distance, though obviously it takes longer, and it's way less challenging to joints especially if you're carrying a bit of extra weight.

If you've got knee issues you're more likely to feel them manifesting if you're walking downhill, so picking a particular downhill section on your walking route and focusing your attention on your knees as you go down it will tell you how they're doing. If my knees hurt more at the bottom of a downhill section than they did at the top, I walk all the otherwise-running sections that day.

Exercise is not a quick fix for the damage done by a long-established sedentary lifestyle; getting regular exercise is part of the long game and needs to be treated as such. Increasing the amount of exercise you do is always going to cause you some degree of injury, because that's basically how it works. The key to making the most rapid progress possible is letting your body's reactions be your guide to keeping that degree small enough so that the always-ongoing recovery process from it builds you up faster than the injuries break you down.
posted by flabdablet at 7:10 PM on July 27, 2022 [1 favorite]

Also seconding AugustusCrunch's basic outlook here. The human body is an amazing thing, with care and patience you can teach it to cope with quite absurd levels of physical challenge, and spending up big on assistive tech like super comfy shoes misses much of the point. Barefoot mobility FTW.
posted by flabdablet at 7:14 PM on July 27, 2022

Very doubtful that shoes are the issue. Shoe problems usually cause weird running specific tendon/ligament issues related to how the shoe affects your gait. Plantar fasciitis is the classic example. And as far as padding goes... I ran a half marathon in 5mm soles this weekend, and only started running again this year (after a break of maybe 8 years), so I can tell you that "cheap, no padding" isn't the issue. Shoes DO make a huge difference, but it's not so much about cheap vs. good as it is about getting the right shoes for you. And that's just trial and error.

Re: recovering, I think it's just a matter of patience. All runners have to struggle with this to varying degrees, because tendons and ligaments and knee cartilage are very slow to build up. Take it easy, and don't aggravate any pain you're feeling: if running makes it worse, stop running. Or don't run so hard. Walk.
posted by billjings at 7:25 PM on July 27, 2022

I'm in my 50s and started running (with the free NHS Couch to 5K) during the pandemic. I was previously an active but not sporty person. I've now been running for about 18 months.

1. It's a good idea to find a PT or sports therapist you trust who can help you with these kinds of questions. Mine reassured me more than once that I could keep going, carefully, even though I had some mild pain or discomfort. They can also give you exercises to work on those problem areas.

2. If I have pain that is acute or gets worse when running I stop immediately. If it goes away entirely, lessens or is not getting worse I will usually keep going (based on advice from my PT when things have cropped up). If in doubt I stop. The couch to 5K I did was supposed to take 9 weeks but with the time I had to take off for aches, pains and pulls it took more like 15 weeks. Sometimes I had to take off only a day or two, other times I was off for two weeks. That's fine, I got there in the end.

I try and run on asphalt, grass and gravel as much as possible. This is less stress on the knees but also works my proprioception. I have a history of ankle injury and lack of flexibility so it is important that I keep my ankles flexible, strong and stable. Working them on uneven surfaces is good for this. Also, it is actually good to run slower than you think you should be when doing the couch to 5k. Like really, really slow so that it might feel embarrassing. Your cadence can (even should) be pretty fast but you ideally want to be breathing easily, so that you could hold a conversation when you run. I found that building stamina went best with this slow and steady approach.

I wish you luck! There were a few times I despaired and thought I would have to quit but just taking time off running (and continuing with other exercises like walking, climbing, yoga, HIIT, to maintain fitness) ended up working just fine. The fringe benefit now is that if I do need to take a week or two off running (or climbing or whatever) because of an injury I don't panic because I have other things I can do. For me running has been amazing. It feels so good to move forward on my own power no matter the weather or season. I am grateful every time I'm able to do it and hope I'll be able to keep it up for a long, long time.
posted by Cuke at 7:39 PM on July 27, 2022

OP, I would caution taking advice from those who are seasoned runners who are used to specific types of pain, and who have a lot more knowledge and desire to be used to certain types of chronic pain as part of a lifestyle. While they may know their own body and what is reasonable, you really need to learn and figure out what your own pain level is.

For example, with my physical therapist, I'm doing multiple stretches and weight bearing muscles to stabilize my knees so that I'm able to take load without hurting myself even more. If I were to continue and just tough it out, I would literally be causing more problems for my body, because I don't even know the basics of what good running form is, because being sedentary for so long means I also need to relearn my body and spatial awareness of how it works.

Ultimately, take the path that helps you maintain your physical health and exercise for the long run, and explore the options for what feels good for you. I know for me, right now, with my current fitness and skill level, barefoot running with no padding is a guaranteed way for me to get injured and to never ever try running ever again, but that's my personal story and based on the knowledge of my own body, and I am taking the slow, mindful route so I can learn and ingrain good habits before I try more adventurous things. It could be different for you. Kudos to all dedicated runners out there though!
posted by yueliang at 12:47 AM on July 28, 2022 [3 favorites]

I used to run a lot and my experience is that pain is just one of the rewards of running. I agree that the squats may be causing more pain than the running - even after years of doing hardly any, I can run without knee pain, but a few squats has me in agony the next day.

I would be inclined to keep doing as much as you can, which is likely far more walking than running for the next little while, but keep it up or it will be even harder to get started again, if you ever do. Definitely avoid concrete if you can, even if that means running on the road. Grass is best or, even besterer is a springy athletic track, but that's unlikely to be available to you. If you have sharp or acute pain, rest, though. Definitely stick with the good shoes - the absolute best you can afford and don't wear them ragged, because the soles deteriorate quicker than you would think.

The best piece of advice I ever got when I started running was to 'run as slowly as you can, then slow down some more'. One day you'll be able to think about speeding up, but for now just concentrate on running and ignore how slow you are. If running downhill (or even walking), be careful to keep your stride short to avoid speeding up and minimise the effect that slope has on the impact you get each time you put your foot down. For general muscle soreness, try compression tights - I discovered them when I was doing a lot of walking/hiking training for endurance events and they were the most magical things I've ever worn.
posted by dg at 3:52 AM on July 28, 2022

It could very much be the shoes. If you pronate or have an unusual gait that isn't balanced by your foot wear and if you're running in older shoes that is a recipe for aches and pains. My husband, long out of his college xc days, still trail runs around 55 miles each week and each time he has complained about knee pain it ends up being because he has worn out his running shoes.

Go to a running store and have them look at your gait and fit you for shoes. It's expensive up front, but it's much easier on your body when you are starting as an adult with less physical resilience than a teen first getting into running.
posted by donut_princess at 8:56 AM on July 28, 2022

Another way to modify your gait to help you run with minimal injury is to work with a sports physiotherapist and be diligent in doing the exercises they recommend to reconfigure your leg musculature, which in turn will modify the angles that various bits of you will naturally want to move through as you run. It can be quite surprising just how much gait improvement can be had from a bit of selective muscle building.
posted by flabdablet at 9:29 AM on July 28, 2022 [1 favorite]

I don’t think you broke your knees, and I generally agree with everyone above that checking in with a PT is a good idea. The shoes may well be partially at fault: when my shoes start wearing out I get a very specific pain in my left knee, but when I get new shoes it goes away.
posted by kerf at 9:43 AM on July 28, 2022

I'm not a physio or sports coach and this isn't professional advice -- right now you need to recover, and the apps for getting you moving rarely accommodate activity needed in the days you're not running to help you recover. Almost all my larger running efforts (half-marathons and marathons) caused me to think about recovering minerals sweated out, keeping muscles flexible when not training and paying attention to my body as it recovered from the treatment I gave it so that recovery days would help me bounce higher on the active days.

Get good form running slowly -- work on your flexibility and core strength -- and build cardio strength with non-impact stuff like rowing, cycling and elliptical/cross-trainer. The cardio load of running as fast as you believe you should run is immense, so from your still-young, recovers-quickly 30-something perspective: invest in things that aren't running to make running easier or faster.
posted by k3ninho at 7:50 AM on July 29, 2022 [1 favorite]

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