Are you destroying your knees?

Are You Destroying Your Knees?
Why the fear of arthritis might be worse than running itself.

Episode Summary:
"Doc, I had to stop running. My knees are shot." If you've ever heard—or said—those words, this episode is for you. Today, Dr. Fred Bagares dismantles one of the most persistent myths in musculoskeletal medicine: that running ruins your knees. Spoiler: It doesn't. In fact, giving it up might be what’s really causing the damage.

We’ll explore real patient stories, misinterpreted imaging findings, misunderstood pain patterns, and the surprising science behind cartilage health. This one’s not just for runners—it’s for anyone who’s been scared into giving up movement they love.

Timestamps:

[00:00:00] – "My knees are shot." — The myth that won’t die
[00:01:00] – Call to action: If you find this show helpful, please subscribe
[00:02:00] – Sarah's story: When stopping running made things worse
[00:03:00] – Exam findings: Normal aging ≠ joint destruction
[00:04:00] – The science: Running may protect, not destroy cartilage
[00:05:00] – What really causes joint degeneration? (Hint: it's not the running)
[00:06:00] – Real culprits: Poor mechanics, inactivity, fear-based advice
[00:07:00] – Reframing arthritis: Normal, not necessarily pathological
[00:08:00] – Training smarter: Mechanics > mileage
[00:09:00] – Strength and shock absorption: Your cartilage's best friends
[00:10:00] – Strategic recovery: When rest builds resilience
[00:11:00] – Sarah’s comeback: 53 years old and running strong
[00:12:00] – The bigger danger: Fear of damage vs. real health loss

What if the bigger risk isn't running... but giving up on it too soon? Don’t let outdated beliefs rob you of strength, joy, or vitality. Movement is medicine. Cartilage is living tissue. And you don’t have to choose between your knees and your life.

If this episode challenged your assumptions, helped you reframe your rehab journey, or gave you a new lens for working with your patients—please subscribe. It’s free, takes a second, and helps this show reach more people who need to hear this message. And if you’re a runner struggling with pain, don’t wait. Book a clarity visit at www.fredbagares.com and let’s build a smarter path forward.

Transcript

0:00

Doc, I had to stop running. My knees are shot. Last week alone, I heard this from three different patients, three active people who loved running, convinced that they had to choose between their knees and their passion. But here's what's wild. Two of them had less knee pain when they were running regularly than when they stopped. I'm Dr. Fred Bi Garrison. This is The Talking Rehab podcast. Today, we're destroying one of the most damaging myths in sports medicine that running inevitably destroys your joints. Spoiler alert, it doesn't, and believing it might be what's actually hurting you. before we get into today's episode, I just wanted to say thank you, The fact that you're here, that you're listening and that you keep coming back means a lot. I do have a small favor to ask. About 45% of you who listen regularly haven't actually subscribed yet. So if this podcast has made you think differently about rehab, if it's helped you in your own journey or in how you show up for your patients, the simplest way you can show support. For the work is by hitting that subscribe button. It's free. Takes a second and helps more people find these conversations. And my promise to you is I'll keep doing everything I can to make this show better. Every week more real talk, more useful stories, and more content that actually respects your time and your brain. Thanks again for being here. So picture this scenario. You're 45 years old, you've been running for years, and you start feeling some need discomfort after long runs. You mentioned it to your friends, maybe even your family doctor, and suddenly everyone. And suddenly everyone's an expert. Running's just hard on your joints. You're not 25 anymore. Better quit now before you need knee replacements, so you stop and within months you're dealing with weight gain, back pain, and ironically, even more joint stiffness. Does this sound familiar? Let me tell you about. This other patient will call them Sarah. This is a 52-year-old teacher who came in to see me last month. She'd been running half marathons for approximately a decade until her primary care doctor saw some wear and tear on her x-ray of the knee and told her to hang up her running shoes. I felt like I was mourning. She told me running wasn't just exercise, it was my stress relief, my social time, my identity. I hear this a lot from many patients. I can definitely tell that it is. An activity that truly helps control what goes on their mind from a day-to-day basis, so it's very important to them. When I examined her, here's what I found. I saw a little mild cartilage changes that are completely normal for her age. She had great range of motion of the knee and the muscles were very, very strong. But here's the kicker. Her knees actually hurt more in the past six months since she stopped running than when compared to the previous five years of regular training. From a clinical standpoint, this is actually a very, very common and counterintuitive finding that being less active often leads to more symptoms. But, um, to try and make sense of this, let's see what the science actually says. There was a study in the Journal of Bone and Joint Surgery in 2017 that followed recreational runners for 18 years, and in the result they had found that there were lower rates of knee arthritis than sedentary people. Another study published in arthritis and rheumatology found that people who ran regularly actually had healthier cartilage than non-runners. But wait, doesn't all that pounding wear down the cartilage? Here's the thing. Cartilage is like a sponge. It needs compression and decompression to stay healthy. It is the way that it actually receives nutrition through range of motion and also loading. When you load it appropriately, it actually gets stronger and more resilient. Think of it like this, your heart muscle doesn't wear out from beating. It gets stronger when appropriately stressed your joint. Cartilage works the exact same way. So why do we keep believing running ruins joints first, there is a timing bias. Knee pain often shows up in our forties and fifties the same time many people are actively running. We connect the dots even when running isn't the cause. Second, we misunderstand imaging, quote unquote degenerative changes. Sounds terrifying, but there are often just normal aging that doesn't predict pain or function. Third, we ignore the real culprits, poor running mechanics, inadequate recovery, training errors, these cause problems, not the actual running itself. Finally we overlook the bigger picture. When you stop running, you lose muscle mass, bone density, and cardiovascular fitness. You gain weight, your mood suffers, and these changes often cause more joint problems than running ever would. So what are the real villains if running doesn't cause arthritis? What does. Genetics play a huge role. Some people are simply predisposed to joint wear previous injuries, especially with the ones that are untreated, they increase arthritis risk significantly. I. Things like fractures into the joint. Structural injury to the meniscus can also predispose people to having, a more progressive rate of arthritis development, excessive weight. It can also put constant stress on the joints. Inactivity is probably the biggest fill, to be honest. Sedentary people have higher rates of arthritis than active people across the board. Poor movement patterns and muscle imbalances can create abnormal joint stress over time. And these can, uh, and these can occur from other musculoskeletal conditions outside of the knees. Someone who has foot pain or ankle pain problems with their back, they tend to run in a different manner, which is often a inefficient and less mechanically sustainable. pattern, which translates into wearing of the knee joint. the last thing I'll mention is that arthritis is normal. Arthritis is part of the natural history of the knee. Similar to like a tire. It'd be very unusual to see someone in their seventies without any sort of wear on the actual tire. So arthritis is normal. It's not caused by running necessarily, but it is part of the aging process of the knee. Now there is a ceiling. studies have shown that high elite runners, so people that are typically running over 25 miles per week have been shown to have an increased progression of arthritis. So physics still apply. wear and tear is normal. Normal range of motion is needed for the health of the cartilage. But if you're doing high level work. Lots of volume, very low recovery. Again, physics tends to win. Now what's the path forward? so what should you do if you're a runner worried about your joints? First of all, you wanna listen to your body and not just the number Pain that persists or worsens deserves attention, but occasionally soreness after hard workouts is normal. With time and age. Focus on your form over speed. Most running injuries and joint problems stem from poor mechanics. It's not simply just the mileage. I admittedly hate running, but have started to pick it up again, and I'm starting to appreciate some of the nuances of how I land. When I was in my twenties, I would run for speed, and I actually started just focusing on touching the ground, landing softly versus actually landing hard on the ground, and that has made a big difference in how I enjoy running. strong muscles around the joints provide better support and shock absorption than any shoe technology. I think that this is a underappreciated, Factor, that shock absorption does come from the cartilage, but also the surrounding tissue, the ligaments, the tendons, the muscles that they're attached to. So the more you train everything around it, and not just purely strength training, just, but trying to keep everything moving, everything healthy, the better for the cartilage itself because. if the secondary shock absorbers can help take up some of the forces, then that's only gonna help, the overall cartilage in the long run. you want to try and recover strategically. Your body adapts during rest, not during the run itself. And I see this a lot where people. Like to run and usually for a goal like weight loss. and so while that is great, your body does need time to heal, essentially every tissue, muscle, tendons, cartilage, everything needs to be broken down and needs time to heal so that it can build back stronger. But if there's more breaking down than there is recovering, then that's where you start to get into trouble. Lastly, you wanna get a proper evaluation if you're having persistent pain. See someone who understands runners and can differentiate between normal a adaptation and the actual problem. So here's what I told Sarah. Your x-ray shows normal age related changes. Your pain increase when you stopped running because you lost the muscle strength and joint mobility that running provided. From there, we worked on her running forearm. I added targeted strength training and gradually built her mileage back up. Six months later, she finished her first marathon at the age of 53. Her knees, they felt better than they ever have in years. But the bottom line is that we want to flip the script on this myth. The question isn't whether running causes arthritis. It's whether fear of arthritis is causing you to give up activities that keep you healthy. Your joints were designed to move, use them or lose them, isn't just a saying, it's physiology. Running doesn't wear your knees out any more than smiling, wears out your face. If you've been avoiding running because someone told you it would ruin your joints, maybe it's time to question that advice. If you're currently running and worried about every twinge, remember, discomfort doesn't necessarily equal damage. And if you're dealing with persistent pain that's affecting your running, don't just push through it or give it up entirely. Get an evaluation by someone who understands both running and joint health. I'll leave you with this closing thought. What if the real risk isn't that running will damage your joints, but the fear of damage will rob you of decades of health, happiness, and vitality? Don't let outdated beliefs sideline your active life, your future self will. Thank you for keeping those joints moving. I'm Dr. Fred b Garris. This is the Talking Rehab podcast. Thanks again for your time. Take care. Thank you for listening to The Talking Rehab podcast. I hope that this podcast stimulates you to question your own practice and how you approach rehabilitation. I truly appreciate your time and attention. If you enjoyed listening, make sure to like and subscribe to the podcast. I wish you a movement filled day. Take care.