Natural Approaches to Knee Health for Runners
Introducing Katie Stone, Naturopathic Practitioner, from the Editor
I have had intermittent rashes for years. I went to dermatologists who gave me various medicines. I even tried allergy pills. Then, I met Katie Stone, who is both an award winning marathon runner and a naturopathic practitioner. She correctly identified my problem, which is an allergy to dairy. When I started taking whey powder along with my weight training, that was when the rash started again. Her advice to stop eating dairy has made all the difference. She has also dealt with runner’s knee problems. So I asked her to write an article about natural approaches to knee care for runners.
A marathon runner and Naturopath’s view of knee care for runners.
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 suffocatingly hot. I’ve pounded 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 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??
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.
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. It’s by examining all these details that the naturopath is able to 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!
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 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:
– 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 were designed to provide extra support to the knees. Suddenly, after a ten-year hiatus, my dear old coach was out running again. So 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 inevitably linked. 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. The risk of running injuries, however, can be reduced, and so can the severity.
Preventing Knee Problems – Naturally
As 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 the diet in order to replace those that are used up with physical activity, and to support the daily repair of muscle and cartilage.
Studies have shown 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 mineral directly to where it’s needed most, giving your body with the best chance of maintenance and repair.
- Omega 3 Fats
Known as the ‘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 healthy 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.
- Glucosamine and Chondroitin
Glucosamine is the stuff of our tendons, ligaments and cartilage. It’s been suggested that glucosamine helps to reduce the risk of osteoarthritis by improving cartilage formation and lubricating the joints. In doing so, it may relieve the pain of arthritic knees and maximize cartilage repair. Glucosamine supplements are usually available together with chondroitin, which is also a part of 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)
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.
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-mineralisation 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 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.
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.
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 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 drinks, 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.
Fast food, processed foods and fried food is high in saturated 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
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 colours. But they’re now being hailed 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 1000km), 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 to 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 which 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, such 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 Naturally
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 your knees from ever being injured, it IS possible to reduce the magnitude of an injury. The key is to act as soon as possible. Even the smallest niggle should not be ignored; that’s your body warning you that something isn’t right. Taking action early on could save you untold pain, money, and yes, heartache!
- 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 favourite. 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 are able to mould’ 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 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’s been shown to relieve the pain of arthritis. It’s often used in joint supplement products alongside other minerals.
Turmeric Latte Recipe
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.
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
First, make a turmeric paste by combining 2 parts turmeric powder with 1-part boiling water. Mix well. Any extra can be stored in the fridge for up to 5 days. If you’re new to the taste of turmeric, start with one teaspoon and build up.
- Gently warm the coconut milk in a small saucepan. Make sure it doesn’t boil.
- Add the turmeric paste, followed by the ground ginger, vanilla, cinnamon and ground cardamom.
- Combine the coconut oil with the mixture, then gently heat all ingredients together until liquified.
- Using a stick blender or even just a wire whisk, blend to create a foam. Continue to stir until frothy and heated through.
- Add honey or stevia and stir.
- Pour into a glass or mug and sprinkle with a little cinnamon (or ground cardamom). Serve!
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