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A Marathon Runner and Naturopath’s View of Runners’ Knee Health

By Katie Stone

I’m a runner. A keen, dedicated (to the point of obsession) runner.

I run every morning, no matter where I am in the world, and no matter whether it’s raining, snowing or suffocating hot.

I’ve pounded the pavement in Delhi, Kuala Lumpur, Tokyo, Ho Chi Minh, and Bangkok (albeit not without some difficulty!). I come from New Zealand, where long-distance running is a pretty big deal. So far, I’ve run five marathons and one ultra-marathon.

I’ve made the podium in four of those marathons, and I was the first woman in the ultra. Which, by the way, was an “entry-level” ultra: only 60km. People often ask me, how do you run that far? Don’t you get injured? Don’t you get bored?? As for injuries, I am no stranger to runner’s knee health care, having had my share of knee issues.

I’m no “expert” on running. I run because I enjoy it, and I compete when I feel like it. I am, however, a qualified naturopath (BNatMed), so I know a thing or two about being able to run and keeping my body – especially my knees – in good shape.

Yes, I’ve had my share of injuries over the years. But after studying natural medicine and holistic therapies, I’ve been able to treat any problems that come up and advise a few of my running friends, too. It’s time to share a few of the tried-and-true natural approaches to knee health that I’ve learned over the years.

Benedict Lust, founder of naturopathy in the US

Benedict Lust, founder of naturopathy in the US

What Is a Naturopath?

Contrary to popular belief, a naturopath is not the same as a homeopath. Homeopathy is based on treating specific ailments with specific, minute remedies. Naturopathy is about treating the cause of a problem by examining the whole person – their diet, lifestyle, health history, activities, mind, and body.

A naturopathic consultation involves sitting down with the client for an hour or more and asking detailed questions about every aspect of their health and lifestyle.

By examining all these details, the naturopath can link the cause-and-effect of various problems and come up with a solution that best suits the client. There are lots of naturopathic solutions to treating problems that come up with running. As you’re probably aware, knee health is a big issue.

Running Ruins the Knees? It Doesn’t Have To

If you’re a regular runner, you’ve no doubt been told that “running will ruin your knees!” Although knee problems are indeed common among runners, there’s no reason your knees will end up arthritic and painful by the time you’re forty-five.

A study by the University of California showed there were no significant differences in the rate of knee osteoarthritis between runners and non-runners. Another study by Helsinki Research Institute for Sports and Exercise Medicine in Finland tracked the development of osteoarthritis in different sportspeople: shooters, runners, weight-lifters, and soccer players.

They found that the incidence of osteoarthritic knee problems was 3 percent among shooters, 14 percent among runners, 29 percent among soccer players, and 31 percent among weight lifters. So, no – it’s not necessarily running that will ruin your knees!

anatomy of the knee

Anatomy of the Knee

How the Knee Functions in Running

Understanding how the knee works is key to preventing injury. When you know which part of your knee is under the most strain, it’ll make more sense to put preventative measures into place. It’s no surprise that the knee takes a lot of impact when running.

When walking, each heel-strike causes a force equivalent to several times your weight to travel up your leg travels up your leg. With running, the shock of this force increases substantially. Runners knee health care guidelines include this consideration in your training. For runners, the problem usually begins where the kneecap intersects with the thighbone (femur).

Unlike the hip and the shoulder, the knee lacks a deep-fitting socket to act as a hinge. Instead, as the knee swings, it pivots to accommodate the thigh bone. Because the thigh bone is longer on one side than the other, it pulls on the four major ligaments of the joint with every flexion, extension, and rotation. These ligaments are the bands that hold the knee joint together, with some passing right through the knee itself. With each step, the kneecap rubs against the cartilage in your knee.

Over time, this friction can lead to painful inflammation. Anterior knee pain or patella-femoral syndrome is the medical name for a burning, aching sensation in or around the kneecap. The good news is that all these knee-breaking issues can be treated – or even better, prevented!

Knee Problems Runners Have and Why

With the above studies in mind, it’s clear that runners can and DO suffer from knee problems. In fact, of all the injuries that runners are most vulnerable to, one of four involves the knee. It’s the most commonly-injured joint! Knee injuries can include:

Runners Knee Patellofemoral pain area

  • Kneecap – also known as ‘Runner’s Knee’
  • Iliotibial Band Inflammation (IT band)
  • Meniscus and/or cartilage wear and tear
  • Patellar Tendinopathy

I know many runners who give up running because they’ve been told their knees are beyond help. There are lots of physiotherapists and doctors out there who advise against running and tell their patients that the impact on the knees will lead to problems later in life.

In fact, my own coach had given up running himself – because his doctor had told him to. Then, a year or two ago, he found a brand of shoes that provide extra support to the knees. Suddenly, after a ten-year hiatus, my dear old coach was out running again.

With the proper methods, runners’ knee health care becomes possible. There are lots of websites out there that will tell you running and injury are inevitable. I even found a study that suggests 30-50 percent of runners will get injured during any particular training year.

The thing to remember is that injuries happen – and they happen whether you’re running, or whether you’re walking down the street. You can reduce the risk of running injuries, however, and so can their severity.

Preventing Knee Problems – Naturally

As I explained above, naturopathy is about treating the cause, not the symptom. When it comes to preventing knee problems, the naturopathic approach involves several very important factors: diet, lifestyle, health history, and exercise.

Diet and Supplementation

Runners need an extra supply of nutrients in their diet in order to replace those that are used up with physical activity and to support the daily repair of muscle and cartilage.

Studies show that mineral supplements are an easy and effective way to support knee health and reduce the symptoms of knee pain. A good quality supplement provides a therapeutic dose of vitamins and minerals directly to where your body needs it most, giving you the best chance of maintenance and repair.

  • Omega 3 Fats are known as ‘healthy fats.’ Omega 3 is vital for keeping cells supple and functioning well. Omega 3 nourishes the cell membrane of joint tissue, allowing for proper flexibility and fluidity. It also sets the stage for repair and health maintenance.

Cells high in Omega 3 cool the body more quickly, reducing inflammation, and thus reducing the risk of disease. Fish oil also helps to reduce the “bad fats” (triglycerides) in the blood and raise the “good fats” (HDL). This makes the blood less viscous, improving healthy circulation, and reducing the risk of heart disease or other chronic illnesses.

Eat: Oily fish such as sardines, mackerel, salmon. Plant-based Omega 3’s include chia seeds, flax seeds, and walnuts.

Supplement: High-quality purified fish oil liquid or capsules. One to three grams of fish oil every day can help reduce the overall intensity of joint problems like stiffness, tenderness, swelling, and discomfort. There are also omega-3 fatty acids that help increase blood flow during exercise, which also helps reduce joint pain and swelling.

Glucosamine supplements are usually available together with chondroitin, which is also a part of the bone and connective tissue and helps to improve joint mobility.

Eat: Bone broth soups made from chicken or beef bones (organic where possible)

Supplement: Capsules are available, usually as a joint supplement containing a variety of compounds

  • MSM (Methylsulfonylmethane)

    MSM molecule image graphic

    MSM graphic image

Although not as well known, MSM is essential for the building and maintenance of connective tissue – joints, skin, and hair. It’s a sulphuric compound that helps to break up calcium deposits in the joints, improving joint flexibility, reducing inflammation and stiffness, and improve cellular function.

Vitamins and Minerals

  • Calcium Calcium is essential for building and supporting bone structure. It’s also required healthy muscle contraction and balancing electrolytes. Eat: If you’re lactose intolerant (which many people are!), then dairy isn’t the best source of calcium.

Try tofu or non-dairy nut milks that have been fortified with calcium. Supplement: Calcium citrate is the most bioavailable form of calcium supplement. Cheaper forms can cause constipation and digestive issues.

  • Trace minerals: Zinc, boron, iron, potassium Each of these minerals are required for healthy electrolyte balance and re-mineralization of the bones. Muscles also depend on minerals for repair and contraction.

Eat: Wholefoods in their natural form (raw and organic where possible) are a good source of minerals. Unfortunately, due to the low mineral content of the soil, many foods lack the therapeutic dose of minerals we need each day.

Supplement: Look for a good quality brand of multi-vitamin that recommends divided doses throughout the day. Large amounts of vitamins and minerals taken in one go won’t actually be absorbed well by the body.

  • Vitamin C Not just for the immune system! Vitamin C is required for the production of collagen, the stuff of our skin, joints, and connective tissue. It’s also a powerful antioxidant that helps to fight free radicals generated by exercise. It’s these free radicals that can cause cell damage, inflammation and pain.

Eat: Fruits high in Vitamin C include kiwifruit, berries, blackcurrants. Supplement: Vitamin C absorption is helped with bioflavonoids. Sodium ascorbate is also usually better absorbed by the body.

  • Magnesium One of the most important minerals, magnesium is required for over 300 biochemical reactions that take place in the body every day. These include muscle contraction and relaxation, cell repair, mineral uptake, energy metabolism, and many others. If you experience muscle cramp regularly, you’re likely to be low in magnesium.

Eat: Mineral-rich foods include shellfish, lean meats, and dark, leafy greens. Supplement: Magnesium is available in oral form as a powder and capsules, or as a topical spray. Best forms of magnesium include citrate, amino acid chelate, glycinate, chloride.

blackberries, raspberries,blueberris

Berries are rich in vitamins, minerals, and antioxidants. Eat Lots of These

What To Avoid To Prevent Knee Problems

So, now that you know which foods and dietary supplements will help to improve the health of your knees, let’s look at the things that WON’T help – or will make things worse.

Sugar

Sugar is a pro-inflammatory food. Sugar causes your blood sugar to spike, which results in a release of insulin.

Numerous studies have shown that, if sugar is regularly consumed to excess, it can lead to all sorts of serious health problems. Although many runners believe that their high level of physical activity justifies eating sugar because it provides energy, the truth is that there are much healthier ways to get an energy hit!

In fact, sugar can be disastrous to any athlete’s body, particularly runners. Excess sugar in the diet has been linked to:

  • Weight gain. A heavier body increases the amount of pressure on your joints
  • Increasing uric acid levels in the blood. This is caused by the liver’s inability to process fructose, one of the most common forms of refined sugar. This, in turn, can lead to gout, a painful inflammation of the foot.
  • Spiked blood sugar levels. The higher the amount of sugar in the blood, the higher the levels of inflammatory cells called cytokines. Inflammation is a major cause of pain and disease.

Fizzy, Carbonated Drinks, Alcohol

Carbonated drinks such as soda are the worst insult to the health of your bones and joints. First, these drinks are usually loaded with sugar – most sodas can contain up to 11 teaspoons of sugar per can. (see above for why that’s bad!).

Second, the phosphoric acid in carbonated drinks tends to bind with trace minerals (magnesium, zinc, and calcium) in your lower intestine. Instead of those minerals being absorbed by your bones, they’re passed out as urine, depleting your body of the very nutrients it needs.

Saturated Fats

transfat filled foods

Many packaged and processed foods are loaded with saturated and transfats. Minimize Eating These.

Fast food, processed foods, and fried food is high in saturated fats and trans fats, which contribute to a multitude of problems. Not only does saturated fat put you at risk of weight gain, but it is linked to inflammatory processes in the body, which, later on, can cause or exacerbate arthritis and pain.

Avoid or limit saturated fats by replacing them with healthy fats – i.e., those that are high in monounsaturated or polyunsaturated fats. These include oils made from fruits, nuts, and seeds, such as avocado, olive, chia seed, coconut.

The Right Shoes for Runners

While some people believe that it’s possible to run in just any old shoe, you’d be surprised to find just how much your running improves in the RIGHT shoe. The right running shoe is one that suits your running style, the shape and width of your foot, your arches, the terrain you’re running on, and, most important of all, the vulnerability of your knees.

Shoes Should Support The Knees A few years ago, the book ‘Born To Run’ had everybody rushing out to buy minimalist running shoes. While the theory of these zero-drop shoes seems sound, the truth is that they’re not for everyone. The minimalist shoes have since been replaced by the opposite – the maximally cushioned shoes.

It’s a design that was pioneered by Hoka One One a few years ago and has since been followed by other major shoe brands including Nike, New Balance, Hoka One One, Saucony, and Brooks. The “super support” shoe is an innovative design that provides ultimate cushioning to the bones and joints.

The super-light foam cushioning in Hoka One One shoes helps to reduce the shock to your knees when your foot hits the ground. Admittedly, the shoes look rather strange: they have oversized foam midsole, a modern profile, and bright, quirky colors.

Last update on 2020-08-11 / Affiliate links / Images from Amazon Product Advertising API

HOKA ONE running shoes are known for max-cushioned kicks. They feel light and breezy when they are worn and offer a more comfortable ride for those everyday running sessions. The brand was founded in 2009 by two French trail runners, and it began as just a minimalist shoe trend before it reached its peak.

They were offering a pair of running shoes designed to cradle the runner’s feet while also cushioning them. They wanted runners to feel as if they were floating. They ended up working with a chemist to come up with a new kind of EVA foam that was soft and lightweight. The cushion is just enough for runners who are on tough terrain and aren’t too heavy as to weigh them down.

Other recent developments HOKA is making include:

  • Cushioning system with soft foam in the heel and firmer foam in the forefoot
  • Shock absorption and energy return for the runners
  • Midsole construction without rigid plastic materials often used in other support shoes
  • Matryx upper made with Kevlar fibers to increase the durability of the shoe

A Life Saver for those with Sore Knees

But they get accolades as a lifesaver for those runners with aching knees, allowing those who have given up their running to get back into the game.

Shoes Should Last The Distance Another major factor in knee health is the wear and tear on your running shoes. Most shoe retailers recommend replacing your running shoes every 300-400 miles (or 600km), although this may depend on the type of surface you’re running on most regularly. The more worn out your shoes are, the less support they’ll be providing your shoes.

Cushioning and stability are vital to protecting knee cartilage, not to mention shock absorption. Don’t let pain or discomfort be the first sign that you need to replace your shoes!

Where to Run: It’s Not All About The Road Terrain matters!

The type of environment you subject your knees will have a major impact on their long-term health. Fortunately, running is certainly not limited to the road. There’s a huge variety of run-friendly places and spaces to get your jog on.

Trail Running

It doesn’t take a rocket scientist to figure out that running on a trail is less damaging to the knee joint than running on the pavement. Trails have a much softer surface that absorbs the impact of the foot hitting the ground, which in turn reduces the shock to the knee.

Sports medicine experts recommend trail running over road running for this very reason, explaining that the force normally transmitted from the pavement through to the knee is dissipated on the trail. Knee injuries or knee pain can be aggravated by the impact of the foot on tar seal, whereas trail running provides a softer landing.

Gym Running

Some people are gym bunnies, some aren’t – but the gym can be a lifesaver when a knee injury prohibits your usual running routine. Treadmills are designed to provide a cushioned platform to run on, which absorbs more of the impact than a typical concrete or tar seal surface would.

The main problem with treadmill running is that, unlike the road, the terrain doesn’t vary – so there’s a risk of repetitive motion injury. This is why it may be a good idea to alternate between the treadmill and other surfaces.

Water Running/Aqua Jogging

Possibly the best form of exercise for a runner with sore knees! Many runners prefer aqua jogging to cycling or gym machines because they’re in the same range of motion as they are when running and using similar muscles.

Studies have even found that aqua jogging provides a similar cardio benefit to cycling in terms of oxygen consumption and heart rate elevation. Other research has even suggested that aqua jogging at a slow-to-moderate intensity is more demanding on the cardiovascular system than cycling. To get the most out of aqua jogging, try wearing a floatation belt. This will help to maintain normal running biomechanics.

Treating Knee Problems with Natural Approaches

Even when you’re eating the right foods, taking supplements, and following a healthy exercise regime, injuries can still happen. Sometimes they’re running-related, and sometimes they’re not. It’s simply the case that knees take a lot of physical wear and tear.

While it’s not entirely possible to prevent knee injuries, it IS possible to reduce the magnitude of an injury. The key is to act as soon as possible. Don’t ignore even the slightest inkling of a problem; that’s your body warning you that something isn’t right. Taking action early on could save you untold pain, money, and, yes, heartache!

ice bag applied to knee

If you hurt your knee or if it’s just plain sore, the fastest easiest thing to do is apply an ice pack. It reduces swelling and pain.

I.C.E

Knee pain can be the result of any number of afflictions: injury, arthritis, irritation, or even cysts. All of these problems will usually involve some degree of inflammation, which in turn is typically accompanied by swelling, pain, and redness.

The R.I.C.E method is a tried-and-true runner’s favorite. And it’s very simple! R = rest. Keep your weight off the knee for as long as possible. That means sitting down!

I = ice. As obvious as it sounds, ice is the number one treatment for reducing acute inflammation and bringing down swelling. Most health practitioners recommend applying ice for 10-20 minutes a day, up to three times a day.

Use an icepack or fill a bag with ice cubes and wrap in a towel before applying to the skin. A bag of frozen peas is particularly good – the peas can mold around the joint. A wheat bag is also good: it can be frozen and used straight out of the freezer.

C = Compression. A compression bandage such as an elastic wrap, knee support sleeve, or simply a soft fabric dressing helps to reduce the blood flow to the area, which in turn reduces the swelling.

Consult a health professional regarding which bandage is best for your particular knee problem, and how tight it should be. Be careful not to wind the bandage so tight that it cuts off circulation altogether!

E = Elevation. Get your knee UP. The trick is to keep it raised higher than your heart: this helps to reduce blood and fluid building up in the knee area. Use pillows or a chair to arrange yourself comfortably.

If you’re an avid follower of natural health remedies on the internet, you’ll no doubt have heard of the amazing benefits of turmeric. Turmeric is a bright orange spice common to Asian cooking and has long been used in traditional medicine.

Its benefits are particularly coveted by runners – both as a preventative and a treatment. Because it’s high cardio and causes an intense impact on the joints, running is a major contributor to inflammation in the body. That’s why turmeric should be in every runner’s diet!

Turmeric’s active ingredient, curcumin, is a powerful antioxidant that counters inflammation in the tissues. It’s also a rich source of phytonutrients that aid repair and maintenance of weary muscles. Turmeric’s anti-inflammatory powers are so great; it can relieve the pain of arthritis. Many supplement formulations use it alongside other minerals.

Turmeric Latte Recipe

turmeric latte

A Turmeric Latte is Loaded with Nutrients and Anti-Oxidants. You can also put turmeric in salads, soups, and just about any dish you like for some added spark

While the thought of taking turmeric in anything other than curry may surprise some people, this creamy latte is certainly very palatable.

This is a fantastic healthy beverage that I try to drink at least once a day when training for a marathon. And yes, the pepper and coconut oil are necessary – they work together to improve the bioavailability of turmeric’s health properties.

Almond milk or coconut milk makes for a delicious, dairy-free beverage.

Ingredients 1 cup unsweetened coconut milk 1-2 tsp turmeric paste (see instructions for making this below) 1 tsp organic cinnamon powder A dash of vanilla extract 1 tsp ground raw ginger ¼ tsp ground organic cardamom (optional) ½ – 1 Tbsp. Extra-virgin organic coconut oil Honey or stevia to taste Pinch of black pepper.

Method First, make a turmeric paste by combining 2 parts turmeric powder with 1-part boiling water. Mix well. You can store any extra in the fridge for up to 5 days. If you’re new to the taste of turmeric, start with one teaspoon and build up.

  1. Gently warm the coconut milk in a small saucepan. Make sure it doesn’t boil.
  2. Add the turmeric paste, followed by the ground ginger, vanilla, cinnamon, and ground cardamom.
  3. Combine the coconut oil with the mixture, then gently heat all ingredients together until liquified.
  4. Using a stick blender or even just a wire whisk, blend to create a foam. Continue to stir until frothy and heated through.
  5. Add honey or stevia and stir.
  6. Pour into a glass or mug and sprinkle with a little cinnamon (or ground cardamom). Serve!

Run Along!

Runners knee health care keeping your knees healthy and pain-free is simple if you take the naturopathic approach. The trick is to look at the ‘whole picture,’ rather than focus on the pain alone. Pain in any part of your body is a sign that something is wrong (obviously!).

The solution lies not in covering up the problem with painkillers – as a doctor might suggest – but in investigating the source of the pain. Treating the source means the solution is long-term. As mentioned before, prevention is the best cure.

If you’re running regularly and never had a knee problem in your life, that doesn’t mean you won’t! Give your body the best chance it has of going the distance by taking preventative measures now – whether through diet, rest, footwear, or the terrain you run on. Who knows how many marathons you might end up running?

Knee Health for Runners FAQ

Can alternative remedies offer runners a better route to pain relief?

Alternative remedies of pain relief for runners include things that place a much greater emphasis on biomechanics, nutrition, and alignment. Homeopathic therapies have also been found by some to help them access the body’s natural healing potential. However, before any treatment or remedy, you need to be assessed by your doctor or physical therapist to see what methods would work the best for your situation.

How can you reduce stress on your knees by improving overall form and posture when running?

To reduce stress on your knees while running, you need to have the right form and learn the proper techniques. To do this, evaluate your stride and establish new muscle memory. You also need to make sure to have a good pair of running shoes. Take into consideration the shape of your arches and find a running shoe that provides you with the support you need. You should also avoid overstriding. Your foot should land below your hips as you run in good form, rather than out in front of you.

Does running cause osteoarthritis?

There is no evidence that running does or doesn’t cause osteoarthritis. The risk of developing this condition should be evaluated on a more individual basis and based on other factors. You then need to weigh the benefits of running as an exercise to the possible risk that can be involved.

What are the possible causes of chronic knee pain for runners?

Runner’s knee is one of the more common causes of knee pain for runners and is due to overuse, trauma to the kneecap, misalignment of the kneecap, flat feet, weak or tight thigh muscles, arthritis, and inadequate stretching before exercise. Ligament tears and meniscus tears are also common and can cause pain in the knee joints as well.

What is the most common injury in runners?

There are several common injuries runners can experience. Some of them include Runner’s Knee, Achilles Tendinitis, hamstring issues, plantar fasciitis, shin splints, Iliotibial Band Syndrome, and stress fractures.

How do you heal a running injury?

Rest is of the utmost importance when you are trying to heal a running injury, followed by ice and cold therapy and compression. You can use splints to help support and control the swelling and inflammation while also stabilizing the area.