In a lifetime of running the question most often asked by people who don’t run is “Doesn’t running hurt your knees?

Typically they’ll follow up with a story about how trying to run hurt their knees. The logic seems to follow that if running caused their knees to hurt, that must be an inevitable for everyone else that runs.

If their running experience seems to have traumatized them in some way, as in causing them to feel guilty or hate the idea of running at all, typically I’ll empathize and say, “Well, running isn’t for everyone. Walking is one of the best exercises you know. It’s low impact. You get aerobic benefits, and it’s low impact.”

Sometimes people want to know how I’ve happened to avoid knee problems. “You run alot,” they’ll inquire. “Don’t your knees hurt you?”

The short answer is that yes, now and then my knees might hurt a bit. The long answer is that over the years I’ve also torn an ACL (twice) had chondromalacia (injury under the patella) strained the medial collateral ligament upon being hit in the leg by a dog, and banged into this or that athlete playing soccer, basketball, football or some other sport. I’ve also torn a meniscus hurdling a traffic cone (dumb) and had that surgically repaired

The really long answer, and the one that matters most, is that those of us who run for years learn how take care of our knees. I began wearing orthotics in my forties because my feet had weakened and that lack of support caused knee pain due to misalignment of the patella tendon due to biomechanical torque. It cured the problem.

Recently I switched to a less-than-custom shoe insert that works just as well as my prescription orthotics once did. My knees largely feel great day-to-day.

In other words, while my knees have experienced some ballistic trauma over the years, it is basic care that keeps me––and everyone else who runs––moving in the right direction. Strength and lengthening work also work to balance the knee joint, keep the hamstrings from getting too tight and placing healthy stress on major levers such as the Iliotibial band so that they don’t yank things out of place.

It always helps to keep body weight down to a manageable level. The less excess poundage one has on the body, the better it is for the knees. If you run with more than a 30% BMI (Body Mass Index) that’s weight you don’t need. One could argue that healthy knees exist in direct proportion to the top end of one’s recommended BMI. Obesity is not the friend of anyone’s knees.

As one ages, it is beneficial to alternate between running, cycling and swimming. The pounding of running is offset by the spinning of cycling and the water-borne exercise of the pool. Earlier in life, I depended on alternate sports like basketball to prevent injury. If that sounds ironic, it is healthy stress that benefits a younger body. But with an aging body, many joint structures lose pliability and tears can occur in ballistic sports. Even as an enormously active and diverse athlete all my career, by the time I reached the upper 40s the injuries to joints and fascia from playing soccer or basketball were not worth the risk any longer.

Perhaps with an aggressive strength program these problems could be avoided. But probably not forever. Healthy aging means changing some habits to avoid injury.

In my case, with slightly bowed legs to contend with all my life, I’m largely fortunate not to have more knee problems. But that good fortune is also the product of smart choices and balanced work. During rehab work from the ACL tear, I learned how much I’d been neglecting major muscle groups to focus on just a few. The result was that an otherwise functional part of my body, the ACL, bore too much strain during a twisting plant. That ligament tore.

If you’re serious about good knees for your whole life, it helps to consult with a good technical fitness expert or a physical therapist. Your family doctor typically does not know enough about joint structure or training to help you much. If you get hurt, they say “rest it.” But that doesn’t help your cause in the future.

Here’s a link to some basic knee exercises for runners. With luck and practice, you too can say to those who ask, “Doesn’t running hurt your knees?”

To which you can reply, “Nope, I take good care of them.”