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  • Tegan Taylor

How to be a runner without sacrificing your knees

Done right, running can actually protect your knee health

Running can be a fantastic way to keep fit. It's low cost, doesn't require much specialist equipment, and can be done pretty much anywhere. "But!" I hear you yelp. "What about my knees?" It's true that running is often blamed for knee problems, but experts say that doesn't have to be the case. Let's take a closer look.

Why do we associate running with bad knees? Running isn't inherently bad for your knees — in fact, there's evidence it could actually be beneficial for them, says Christian Barton, a knee pain and injury management expert at La Trobe University. "Our body is designed to take loads like running. We've evolved to do it, and in fact the tissues in our knees — the cartilage and the muscles — will become stronger from doing activities like running," Dr Barton said. Research has found people who are non-runners have higher rates of osteoarthritis than people who are recreational runners. (Interestingly, the trend reverses for people who run competitively.) But this doesn't stack up with the experience of a lot of people who take up running and then wind up injured. In these cases, the culprit is usually doing too much too fast, Dr Barton said. "It's not that running's the problem, it's just that they're not conditioned to do running," he said. "It might be someone who's really sedentary and then they've made a bet with a friend or they have a new year's resolution or something's triggered them to try and get healthier, and they try to build into a lot of running far too quickly. "Another common scenario is people who may be running regularly, and they might be running happily five or 10 kilometres three times a week, and then they set themselves a goal of running a marathon." In both cases, problems occur when people don't give their bodies enough time to strengthen and adapt to the repetitive movement.

What knee problems can crop up when you run? The most common knee complaint among runners is somewhat creatively known as "runner's knee". The technical term for it is patellofemoral pain, that is, pain that's occurring because the patella (kneecap) and the femur (thighbone) aren't playing nicely together. In a healthy knee, the kneecap slides smoothly in a groove at the end of the thighbone with each stride. But if your thighbone is twisting slightly because you're running with your knees turned in, for example, this can push the kneecap sideways so it can't move neatly in that groove. The result is pain behind the kneecap. "Basically the kneecap's been overloaded to be doing more than it's capable of," Dr Barton said. Another common knee problem for runners involves the ITB, or iliotibial band. This band of fibrous connective tissue runs from the hip to the outside of the knee. With overuse or poor running form, it can tighten and cause pain by rubbing against the thighbone.

What about crunchy knees

Plenty of runners (and non-runners) also notice crunching or popping sounds in their knees that might become more pronounced as they do more exercise. While the sound can be off-putting, it's not a problem, Dr Barton said. "A lot of people get concerned that the noise is their bones rubbing together — but the important thing to point out is, if that were the case, you'd have no bone left pretty quickly," he said. "What we think it is, is probably some air bubbles in the fluid in the joint that are popping as you move. "There's a lot of fluid and lubrication in there that protects it, despite the noise." Don't let noisy knees stop you from exercising if the sound isn't accompanied by pain. The noise isn't inherently problematic, and there's anecdotal evidence it may actually decrease as you get stronger, Dr Barton said. "It's really important to encourage people to try not to worry about it because what we do know is that if we avoid doing exercise, that's detrimental to the health of your knee in the long term."

I want to be a runner. How do I keep my knees healthy? If running is a form of exercise you want to do, then go for it — slowly, advised Melbourne-based running coach Melissa Vandewater. "A rule of thumb is 10 to 15 per cent increase per week," she said, adding that training programs like couch to 5K, which slowly progress from walking to running, were a good start. What's more, we all want to run further and faster, but Ms Vandewater urged training one thing at a time. "Only one variable should change. If volume [distance per week] is increasing, then you wouldn't be adding more speed." Building up strength in the body parts most involved in running was also important, Ms Vandewater said. She advised strengthening the legs with lunges, and by practising squats until you're able to do a single-leg squat. "For runners, it's a single-leg activity," she said. "Every time they're loading they're essentially having to keep all of their body weight on that side, times the forces you have when you run." Core strength was also important for keeping the middle of the body strong during a run, she said. Plank exercises, and Pilates-style movements that emphasise keeping the hips aligned can help with this. If you're not sure how to get started, look for a good sports physiotherapist or running coach for advice — you don't have to be a pro athlete for these experts to be helpful. And both Ms Vandewater and Dr Barton said taking a step back from training if you start having niggles was the best way to ensure a long, healthy running career. The take-home message for otherwise healthy people was not being put off by misleading messages about running, Dr Barton said. "Unfortunately, people continue to hear false information, even from health professionals, that people should never run again because it's bad for your knees and bad for your joints," he said. "Running is not bad for your knees. In fact, it's probably good for your knees as long as you're sensible in how much you do and how quickly you build. "If you're consistent and you build up gradually and you continue to run — actually, that will probably protect you."

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