CLAIM:
Random, unstructured running, especially without adequate strength and mobility training, can place excessive stress on the knees and lead to knee pain or injury, rather than improving joint health.
FACT:
Scientific evidence suggests that running itself does not damage the knees, but inadequate preparation, such as muscle imbalances, poor form, or sudden increases in training load, can raise the risk of knee pain and injury. Studies show that factors like hip strength, gradual progression, and overall conditioning influence how the knees tolerate running stress, rather than running being inherently harmful.
It has become a familiar sight in Indian cities - early-morning run clubs, groups clocking kilometres on city roads, and social media feeds filled with running reels. But a viral Instagram video is now questioning whether this popular fitness habit, when done without preparation, may be doing more harm than good.
In a viral reel posted by Dr Manan Vora, an orthopaedic surgeon with over 6.04 lakh followers on Instagram, he warns that randomly running on roads can actually damage your knees rather than strengthen them.
“Run clubs are exploding in India. Everyone wants to get faster, fitter and stronger,” Dr Vora says in the reel. “But as an orthopaedic surgeon who sees knee pain patients for a living, here’s the truth - randomly running on roads can actually damage your knees rather than help them.”
Dr Vora stresses that the key issue lies in how people run. “Remember, I use the word randomly,” he adds, pointing out that one of the most common reasons for knee pain in runners is the inward collapse of the knee while pushing off the ground.
According to him, this problem often originates not in the knee itself, but higher up the chain. “This happens because your glutes are weak, your hips are weak. So instead of the glutes doing the work, your knees twist inward to compensate,” he explains.
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While a slight inward movement may not cause immediate harm, Dr Vora warns that repetition is what leads to injury. “If this happens again and again, it adds a lot of stress on your joints and strain on your ligaments. Eventually, this becomes your default movement pattern, and that’s when your knees start complaining.”
The expert emphasises that running alone is not a complete fitness solution. “Running is great, but it is just not enough,” he says. “You have to do strength and mobility training. Train your hips, train your glutes, train your core.”
Can running without preparation harm your knees?
Scientific research suggests that running itself is not inherently harmful to the knees, but how a person runs, and whether the body is adequately prepared, can influence injury risk.
A 2011 prospective cohort study examining high school running athletes explored whether hip muscle strength before injury was linked to the development of patellofemoral pain (PFP), a common form of runner’s knee. Researchers assessed baseline hip strength at the start of the season and tracked athletes who later developed knee pain.
The study found that runners who developed PFP had imbalances in hip muscle strength, particularly a lower hip external-to-internal rotation strength ratio before injury. The authors concluded that “stronger pre-injury hip abductors (particularly in relation to hip adductors) and weaker pre-injury hip external rotators (particularly in relation to their hip internal rotators) are associated with the development of patellofemoral pain.” They also observed that once pain developed, athletes tended to lose further hip strength, suggesting a cycle of weakness and injury.
Another study examined whether strengthening the hips could alter knee mechanics and pain in runners already experiencing problems. In this cohort study involving runners with patellofemoral pain syndrome (PFPS), participants underwent a three-week hip-abductor strengthening programme. At baseline, runners with PFPS showed reduced hip strength and greater stride-to-stride knee-joint variability compared to pain-free runners.
After the intervention, the PFPS group demonstrated increased hip strength, reduced pain, and less variability in knee movement, though peak knee valgus angle did not significantly change. The authors concluded that hip-abductor strengthening “was effective in increasing muscle strength and decreasing pain,” even if it did not correct all aspects of knee alignment.
However, broader evidence urges caution against drawing overly direct conclusions.
A 2022 systematic review and meta-analysis, which analysed 30 prospective studies involving over 3,400 non-elite runners, examined whether biomechanical or musculoskeletal factors could reliably predict running-related injuries. While the review found slightly lower knee extension strength and hip adduction velocity among runners who developed injuries, the effect sizes were small.
The authors concluded that “the currently available literature does not generally support biomechanical or musculoskeletal measures as risk factors for running-related injury in non-elite runners,” noting that injury prevention recommendations cannot be based on biomechanics alone.
Similarly, a 2022 systematic review of randomised controlled trials evaluating interventions to prevent or manage running-related knee injuries found low-certainty evidence that technique retraining, such as learning to land more softly, may reduce knee injury risk. Other commonly recommended strategies, including footwear changes, graduated running programmes, and general exercise therapy, showed little to no consistent benefit in preventing knee injuries.
More recent evidence continues to highlight the complexity of the issue. A 2024 study on elite middle-distance runners found clear associations between hip strength and running kinematics, particularly knee adduction and pelvic control. The authors noted that hip strength exercises may be important for correcting certain movement patterns, but also emphasised that such deviations can be unilateral and athlete-specific.
Importantly, long-term population studies paint a reassuring picture of running itself. One 18-year longitudinal study comparing long-distance runners with non-runners found that runners were less likely to develop knee osteoarthritis. By the end of the study, 20% of runners showed signs of osteoarthritis compared with 32% of non-runners, suggesting that recreational running does not accelerate joint degeneration in healthy adults.
Other imaging-based studies indicate that while running places higher loads on the knee than walking, it may also stimulate adaptive changes in bone and cartilage, potentially strengthening joint structures over time. Even among individuals with existing knee changes, MRI studies show mixed effects, some structural improvements alongside cartilage wear, reinforcing the idea that responses to running vary widely.
Factors that can increase knee strain while running
Running itself is not inherently damaging to the knees, but certain factors can make the activity harder on the joint and increase the likelihood of pain or injury. One of the most important is poor running form.
While proper form is nuanced, basic principles include maintaining an upright posture, looking ahead rather than down, keeping the arms bent at roughly 90 degrees, and taking shorter, quicker strides. Habitual heel striking, particularly when combined with overstriding, can increase impact forces transmitted to the knees and make runners more prone to discomfort or injury.
Another key variable is inappropriate footwear. Running long distances in shoes that do not suit an individual’s foot type or gait can alter lower-limb mechanics and increase stress on the knee joint. Factors such as cushioning, arch support, stability, and shoe width all influence how impact forces are absorbed.
The surface on which one runs also plays a role. Running is a high-impact activity, and hard surfaces such as concrete and asphalt tend to transmit greater shock through the lower limbs.
Some research suggests that softer surfaces, such as grass, treadmills, or woodchip trails, may reduce impact on the tibia and, by extension, the knees, particularly for recreational runners.
Pain during a run is another important warning sign. Discomfort around the knee, whether above, below, or behind the kneecap, signals that the joint may be under excessive stress. Regardless of whether the pain is dull or sharp, stop the run and allow time for rest, rather than pushing through the discomfort.
Several knee conditions are commonly seen among runners. Runner’s knee, or patellofemoral pain syndrome, typically presents as pain at the front of the knee or around the kneecap and results from repeated stress between the patella and the femur, leading to cartilage irritation. Iliotibial band syndrome causes pain along the outer side of the knee when the IT band, a long band of connective tissue running from the hip to the knee, becomes tight or inflamed. Jumper’s knee, medically known as patellar tendinitis, involves inflammation of the patellar tendon connecting the kneecap to the shin and is marked by pain in the front of the knee. Knee bursitis occurs when the fluid-filled sacs that cushion the knee joint become inflamed, often leading to swelling and tenderness at the front of the knee.
Tips to protect your knees while running
According to Healthline, protecting knee health while running goes beyond correct form and proper footwear. “Start slowly and conservatively. Avoid going too hard, too fast,” it notes, adding that many long-distance runners follow the widely cited 10% rule, which recommends increasing weekly mileage by no more than 10 per cent to reduce injury risk.
It also highlights that tight muscles can increase the likelihood of running with poor form and sustaining injuries. To reduce this risk, it is recommended to do dynamic stretching before a run to prepare the muscles for movement, followed by static stretching afterwards to improve flexibility and aid recovery.
For those who experience mild knee instability or discomfort, supportive gear may offer additional help. “Wearing a knee sleeve while you run can provide some extra support to an unstable knee,” though it should complement, rather than replace, strength training and good running habits.
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS.