What is it with runners and knees? If you run, you’ve heard “I used to run but it hurts my knees.” Although running is not inherently bad for your knees and staying active helps keep your knees healthy, a lot of runners eventually stop running because it hurts their knees too much.

Older runners, especially men, have to be particularly diligent in their strength training and stretching to avoid knee pain. So which is it? Does running cause people knee problems or are certain people predisposed to knee problems and would have issues regardless of whether they ran or not?

To get to the bottom of this issue, Coach Claire speaks with Yale orthopedic surgeon, Dr. John Fulkerson. Dr. Fulkerson specializes in sports medicine and focuses on treating patella instability, which refers to the kneecap sliding in and out of position.

Dr. Fulkerson has been at Yale for over 40 years and he is leading the way in cutting edge technology to help those who suffer from debilitating knee issues. He talks about who’s most at risk for knee problems, what does and doesn’t work for prevention, the simple exercise that you can do today that can help keep your knees running smoothly and pain free, and why those of us who are fortunate enough to be runners should feel gratitude for our running, even on those bad run days!

Dr. Fulkerson received his medical degree from and also completed his internship and residency at Yale University. His awards include a Lifetime Achievement Award from the Patellofemoral Foundation, a Sports Medicine Fellow Educator Award from the Department of Orthopedic Surgery at the University of Connecticut, Connecticut Orthopedist of the Year, the San Francisco Bay Area Lifetime Achievement Award, U.S. News and World Report Top Doctors, and the Wisdom House Community Service Award (with his wife Lynn).

He founded the International Patellofemoral Study Group and the Patellofemoral Foundation. He has been head team physician for the NHL Hartford Whalers and Hartford Wolfpack, and a team physician for the U.S. Olympic Men’s Ice Hockey and Trinity College in Hartford.

Dr. Fulkerson is known for orthopedic surgical innovation and has lectured worldwide. His publications include Disorders of the Patellofemoral Joint as well as many other chapters and monographs on the same subject. He also published the non-orthopedic book Thin Lines: A Vineyard Journey.

Questions John is asked:

3:00 What every runner wants to know is, is running bad for your knees?

4:44 What other people besides older people need to be careful about running safely? You said that there are some people that maybe aren’t as well suited to running as far as their knees go at least, so who are we talking about here?

5:53 Your specialty is patella instability. Can you talk about exactly what that is and maybe give us a quick anatomy refresher here?

7:11 So patella instability is when the kneecap is actually moving around is what you’re saying?

7:42 The patella groove depth is just genetic, you get it or you don’t? It’s just how you were born? Or does it have anything to do with the activities we do?

8:24 Can you talk about some of the specific problems that runners face with their knees? Give us a definition of what’s runner’s knee?

10:30 You mentioned core instability, and that’s something as I coach I talk to my runners about is that often knee problems are actually a symptom. They’re not actually the problem. It’s something higher up in the chain. The hips, the core, or maybe in the lower part of the leg or the ankles, something like that. Can you talk about how the knee is related to everything else that’s going on in the chain?

11: 57 What are some other exercises besides jumping rope that you recommend that can help with people who complain about knee issues?

12:24 How do you stretch the knee?

13:47 Let’s say we have a runner who complains of knee problems. He is doing everything he’s supposed to be doing, all the stretches, all the strengthening, rock solid core, but still cannot get away from the knee pain. At what point is surgery the best option?

14:59 How does 3-D printing work as a diagnosis tool for knee pain?

16:10 This sounds like cutting-edge technology at Yale. Is this something that is spreading across the country? Are we going to be able to find this in Kansas? Or is this pretty limited at the moment?

17:44 When we’re talking about knees and joints in general and aging, the next thing that tends to come to mind is arthritis. And when I was researching this before interviewing you, I learned that there’s all sorts of different kinds of arthritis which I was not aware of. I thought arthritis was just arthritis but apparently it’s not. Can you talk about arthritis, especially in the knee, that runners are likely to encounter as they age?

20:07 My dad used to jog three miles every other day and he stopped in maybe his 60s because it hurt his knees too badly. Am I going to have the same fate? What do you think?

23:34 Let’s go back to cartilage. You mentioned the various things that happen to our cartilage as we age. Is once the cartilage is gone, it’s gone, or it degenerates to a certain point? Does it regenerate? What exactly is going on with our cartilage?

25:00 How do we take good care of our cartilage? Is it just listening to your body and eating well? Is there something that we can do that will help prevent it if we happen to be prone to this?

26:47 As far as running shoes go, would you say nice, cushioned shoes or a nice drop? I would imagine you’re going to say no barefoot running. What would you say about shoes?

26:41 I have a runner who is in his late 50s and has always had knee problems since I’ve been working with him, and his big thing is downhill running. Downhill running is really, really tough on him. Can you give some insight on why that is and maybe some advice about what he should do?

30:51 Are you saying we shouldn’t avoid downhill running if it doesn’t give us pain?

30:59 A lot of people say that most of the symptoms that we tend to associate with aging are actually more associated with inactivity, and I wanted to get your thoughts on that because I know a lot of people who are runners and their friends say to them, “Oh, well that’s just bad for your knees. Maybe you shouldn’t run.” What’s your take on that?

Questions I ask everyone:

33:48 If you could go back and talk to yourself when you started running, what advice would you give?

35:27 What is the greatest gift running has given you?

36:53 Where can listeners connect with you?

37:17 What are you working on next?

Quotes by John:

“I think that running is a natural activity for people. We wouldn’t be here if we weren’t descended from people who could run. I think it’s a survival skill. So I’d say for the majority of people, it’s very natural.”

“Runner’s knee is a broad term. It’s basically any runner that has pain in their knee.”

“Core stability is the first thing we recommend for many people with anterior knee pain, is just maximizing the core, working on the hip external rotators.”

“One of the things I like to think about is running really is a privilege. For those of us who are able to run, I think it’s great. And we love it, and it’s so hard for people when they lose that ability for any of the reasons that we talked about. It is a privilege that we should enjoy if we can. And so I don’t have the feeling at all that people should not run to protect their joints or something like that. If everything lines up and they’re the right structure, then it’s not a problem. Enjoy it.”

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John Fulkerson, MD < Yale School of Medicine

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