Nearly every runner has found themselves defending the well-meaning words of caution from a loved one: “Running is bad for your knees!”
The concern that running will damage your knees has persisted for years, despite the fact that research has shown that marathoners and long-distance runners may have healthier knees than sedentary age-matched peers.
However, this isn’t to say that running is a surefire preventative measure from osteoarthritis and degenerative joint disease in your knee. For this reason, some runners are faced with the news that they need a knee replacement.
But what does this mean for running? Can you run after a knee replacement? Can you run with a knee replacement?
In this guide, we will discuss running after a knee replacement and share expert advice from Dr. Dave Candy, DPT, a Board-Certified Specialist in Orthopedic Physical Therapy and Owner of More 4 Life PT, who works with runners returning to the sport after a knee replacement.
We will cover:
- Can You Run After a Knee Replacement?
- When Can You Start Running After a Knee Replacement?
- What Should Runners Expect to Feel When Running After a Knee Replacement?
- Does Running After Knee Replacement Increase Your Risk of Injuries?
- Risks Associated With Running After a Knee Replacement
- 5 Tips for Returning to Running After a Knee Replacement
Let’s get started!
Can You Run After a Knee Replacement?
Running after knee replacement surgery used to be an absolute “no” in the eyes of most orthopedic surgeons due to the fear that high-impact exercise would prematurely wear down the prosthetic joint and decrease the lifetime of the knee replacement.
However, the good news is that in light of the continually-advancing technology in joint replacement surgeries, many surgeons are now more in support of their patients returning to running after a knee replacement.
With that said, returning to running after a knee replacement still isn’t particularly common nor universally recommended by joint replacement surgeons.
According to the International Congress for Joint Reconstruction, a survey of 549 preoperative runners (51.4% who had a total knee replacement) found that 30.5% of the runners expected to return to running after surgery, while 69.5% did not.
However, only 11.8% of the runners actually returned to running after joint replacement surgery.
Of this minority, 64.6% returned to running 2 to 6 months after surgery, and 86.2% returned to running within 12 months.
Interestingly, not all operating surgeons supported their patients returning to running after a knee replacement.
For example, 29.5% of the runners had been told that they could not return to running, 35.2% were told that they should only do low-impact activities, and only 5.1% of runners were told that they could return to their preoperative running level.
A survey of 120 knee replacement experts from 31 countries found that 68% support their patients going back to running after a knee replacement after six months.
So, can you run after a knee replacement?
“Anecdotally, there are people who have gotten back to running marathons after joint replacements,” shares Dr. Candy. “That’s the extreme case. However, if running is a big part of your life and brings you happiness, quality of life, and other health benefits, there’s no reason that you can’t get back to at least some degree of running.”
When Can You Start Running After a Knee Replacement?
The most important thing to establish here is that every runner is unique, and recovery after a knee joint replacement surgery may differ.
What’s “normal” or expected may differ from how things actually play out for you.
With that said, the typical advice is to wait at least 4-6 months after a knee replacement to start running.
Dr. Candy says that you may feel good and have minimal to no pain after just a few weeks, but it takes about 3 months for the bone to fully heal.
Starting back too soon can not only jeopardize your recovery but can also lead to other injuries that set you back even longer.
Moreover, there’s a good chance that you weren’t able to do much running up until the time of your surgery, depending on the severity of your arthritis and the pain that you experienced during exercise.
These issues will need to be addressed during the rehab and recovery period before it is safe to resume running after a knee replacement.
Otherwise, you are setting yourself up for injuries, if not also damage to your new prosthetic knee joint.
So, how do you know when you’re ready to run?
Is it safe to just start after that magic 4-6 month mark after the bone has fully healed?
Not necessarily. When assessing when it’s safe for you to start running after a knee replacement, you have to consider the degree of physical function you’ve recuperated in the post-op period.
“You should at a minimum be able to walk with a normal gait, pain-free, and be able to perform single-leg hops landing on one leg without pain,” advises Dr. Candy. “That’s essentially what you do over and over when running, and you need to be strong enough to absorb the impact force of your foot hitting the ground before attempting to get back to running.”
It is important that you obtain medical clearance to run after a knee replacement from your surgeon or physical therapist prior to trying any running.
It’s always best to err on the side of caution and take a measured approach to resume running after a knee replacement.
What to Expect When Running After a Knee Replacement
Depending on how much running or other forms of physical activity you were able to do leading up to your knee replacement surgery, there’s a good chance that you might be pretty deconditioned when you are finally after to start running after your knee replacement.
For this reason, it’s completely normal and expected to have some muscle soreness. However, while soreness is normal, pain is not.
You should not feel any pain in your knee during or after running. If you have pain, you need to stop running immediately and consult your surgeon or physical therapist.
It is also possible that you will have some swelling around the joint when you first start running, but this should resolve quickly and should not be associated with pain.
If it is, you should seek medical attention before continuing to run.
Finally, it’s important to remember that you do have a foreign joint in your body after undergoing a knee replacement, so it’s normal to have different sensations in your knee than you are accustomed to when you first start running after a knee replacement.
Does Running After a Knee Replacement Increase Your Risk of Injuries?
Dr. Candy says that running after a knee replacement doesn’t really increase your risk of injuries relative to runners who haven’t had a joint replacement, as long as you wait to start running until you’re fully healed, have corrected any muscle imbalances or weaknesses, and progress slowly.
Muscle imbalances in the muscles controlling the hip and knee can lead to IT band syndrome, runner’s knee, and pes anserine bursitis (pain on the inside of the knee where the hamstrings and inner thigh muscles attach to the shin).
“Since the kneecap is not replaced during even a total knee replacement, runners are subject to pain behind the kneecap, or patellofemoral pain, from the kneecap cartilage rubbing up against the thigh bone and prosthetic knee joint,” adds Dr. Candy.
Risks Associated With Running After a Knee Replacement
In general, running after knee replacement can be safe, provided you are listening to your body and progressing slowly.
However, Dr. Candy says that if you resume running too early or too aggressively, there is a risk of destabilizing the joint replacement.
Additionally, if you return to high mileage training, there is a chance that you will wear down your prosthetic knee joint over time, necessitating a second joint replacement surgery.
5 Tips for Returning to Running After a Knee Replacement
Any time that you return to running after an injury or extended time off, it can be difficult to get back into the groove.
Running is very taxing on the body, and depending on how long it has been since you were able to consistently train, running after a knee replacement can feel really challenging and defeating.
Here are some tips for returning to running after a knee replacement:
#1: Prepare Your Body
According to research, the single best thing you can do to get you back to running after knee running as quickly and efficiently as possible is to stay fit up until the day of your surgery.
Although it may not be possible to run, particularly if your knee joint degeneration is severe, it should be possible to stay active by doing some other form of low-impact exercise.
Swimming, cycling, deep water running, walking, and the elliptical machine are all good examples of alternative cardio exercises you can perform to maintain your aerobic fitness leading up to your surgery.
This will make the cardiovascular demands of running after a knee replacement more manageable.
Additionally, it’s crucial that you maintain the strength and range of motion in the knee joint, hip joint, and surrounding muscles before heading into surgery.
This will help expedite your recovery in terms of regaining strength and mobility in your knee after the surgery.
Single-leg, multi-joint exercises such as lunges, single-leg Romanian deadlifts, single-leg mini squats, single-leg glute bridges, and single-leg leg press are the most effective means of strengthening the leg before your knee replacement.
These exercises best replicate the unilateral demands of running, so they will help prepare your body to transition back to running after a knee replacement.
That’s not to say that bilateral exercises such as squats and hamstring curls aren’t effective, but it’s most important that your weaker surgical leg can support the stress of running.
Additional exercises such as calf raises, side-lying leg raises, and step-downs can also be helpful.
All exercises should be performed pain-free; otherwise, you should modify or avoid them.
Single-leg balance exercises are also quite helpful.
#2: Progress Slowly
Progressing your running after a knee replacement surgery is not all that different as it would after any other injury or period of extended time off.
However, it helps to view yourself as a beginner.
Start with just easy walk/run intervals, gradually progressing the length of the run intervals.
In terms of mileage, heed the 10% rule, meaning that you should not progress your mileage more than 10% from one week to the next.
The only exception here is during the first week or two of training, it is okay to bump up a little more aggressively so long as you don’t have any pain.
#3: Supplement With Cross Training
Running is a high-impact activity, so it is tough on your joints, bones, muscles, and connective tissues.
Depending on the activity restrictions and limitations you had because of your knee prior to your surgery, it might be 6-12 months since you’ve run consistently by the time you’re ready to run after a knee replacement.
For this reason, you are best served to treat yourself like a beginner runner.
Do not run more than 2–3 times per week to begin (using the walk/run approach) so that you don’t overdo it on your musculoskeletal system with the stress and impact of running.
You can supplement your running workouts with cross-training exercises on alternate days as long as you don’t have any pain.
Low-impact cross-training exercises such as cycling, swimming, rowing, deep water running, the elliptical machine, stair climbing, and even walking can be great adjuncts to your running routine.
These workouts will help improve your aerobic fitness, which will make running feel easier while simultaneously reducing the stress and strain on your body relative to running.
#4: Work With a Physical Therapist
Following a customized rehab program is the best way to get back to running after a knee replacement as quickly and seamlessly as possible.
Work with a physical therapist who has experience treating runners returning to the sport after a knee replacement.
He or she can tailor the program to exactly your needs and help you every step of the way.
#5: Stay Positive
Running after a knee replacement might not be a smooth and seamless process, but if you listen to your body and stay patient and positive, you should be able to get back to the sport you love.
Now that we’ve answered, can you run after a knee replacement, and the outlook is pretty good, be sure and keep your body as fit as possible before the surgery,