Your Knee Pain, Decoded: Common Myths About OA in Endurance Athletes

Knee pain sucks—and if you struggle with it, you're not alone. (Most runners and OCR athletes do at some point!) Bottom line: Knees are infamously known as the best and worst joint in the body for good reason. The key is to care for your joints by prioritizing cross training, recovery and eating right. With the proper rehab and enough pre-injury intel, you can circumvent inflammation, osteoarthritis and other game-stoppers down the line. In this series, we team up with DUROLANE® to bring you our top tips from MDs and pro trainers to treat your knees like the gold they are. 

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The knee joint — arguably your body’s most powerful biomechanical tool — can be your best (and worst) asset when it comes to crushing OCR and other endurance sports. And believe it or not, knee osteoarthritis is not just a thing for older athletes. In fact, with the right cocktail of wear, tear and recovery-lack, your knee joints may suffer earlier and your risk of injury increases, according to a recent study in Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. Younger athletes, age 45 and below, are especially tough to diagnose with knee OA because their pain tolerance is just that much higher than an elderly population. (All the more reason to be hyper-careful.) 

“The most common reasons any athlete suffers from orthopedic pain is that the tissues are being asked to do more than what they’re currently capable of handling,” says Dr. Alex Harrison, CSCS, USATF-3, USAW-1, USAT-1 and Renaissance Periodization coach. “This applies to joints and all of their components including ligaments, tendons, cartilage, even bone, and certainly all of the surrounding muscle.” 

According to Harrison, common ways runners demand too much from their knee joints encompass running too fast, too soon (which creates higher impact, more fatigue and greater rates of tissue loading); running too far, too soon (higher volumes of pounding leads to aggravated tissues); and running too frequently (insufficient recovery between workouts causes irritation to healing tissues). 

Even if you’re a lucky athlete who hasn’t yet had a knee injury or debilitating issues, it’s time to play it smart. Here's what you need to know to train wisely—starting with commonly believed myths around knee OA. Use this intel to optimize your performance and, ultimately, stay active longer. We’re busting these misconceptions for good reason: as we return to racing post pandemic, it’s easy to get sloppy. Brush up on the best, most up-to-date information so you can keep flipping tires, hauling boulders and slaying single track as long as humanly possible. 

3 Common Myths About Knee Injuries, Busted 

MYTH #1: Only Aging Athletes Struggle With Knee OA

Not. So. (We repeat! Not so.) Sure, osteoarthritis begins to develop with age as your joints break down—that’s common knowledge—but it can also hit you hard after you suffer a knee injury. (Think: a torn ACL from landing wonky on the monkey bars, a mangled MCL from a misstep on Ape Hanger… in OCR, or any sport for that matter, stuff can sadly go sideways.)  

TRUTH: Younger Athletes Can Suffer from Knee OA, Too

Cartilage and other soft tissues in your knee experience trauma after both repeated beatings and acute injuries. This leads to deterioration of the joint. Once gone, the body can’t regrow cartilage and it’s common to experience bone-on-bone grinding or swelling that comes in hand with OA. 

Constance Chu, M.D. and Professor of Orthopedic Surgery at Stanford University says the most common cause of knee OA is through a sports-related injury, which often happens between the teenage years and 35. “Something like tearing an ACL (which is very common in sports) will cause somebody major pain within 10-15 years of the injury itself,” she says. “About half of an athletic population will have symptomatic radiographic knee OA.” That’s an awful metric when you think about the fact that your chances of living with lifelong knee pain can stem from injuries during your peak-performance period. (Younger athletes are most likely to take risks and push themselves into injury, according to Chu). 

If you haven’t had an injury, don’t hold back BUT treat your knee joints like the gold they are. (A.k.a. Be careful and tender with your knees. Include mobility work in your fitness routine at least 2-3 times per week, and if you feel any weakness, cross train until you can stride out strong again. It’s just not worth the risk.) If you have suffered a knee injury, incorporate lots of rehab. Swimming and biking are excellent, low-impact substitutes for long runs, says Chu. You’ll get the same cardio bang for your buck, without increased injury exposure. 

MYTH #2: Knee OA Is Repairable On Its Own

The truth is—at least at this point in modern medicine—once you have knee OA, you have it for life. Read that again. Cartilage doesn’t heal well and it certainly doesn’t repair itself. Even worse, you don’t have nerve endings in your cartilage, and nerve endings are what signal your brain that there’s pain in the damaged area. Lack of pain signals make it easy to overestimate how quickly you can get back into sports post surgery or when rehabbing an injury. 

Chu says the toughest part about helping her patients recover from a knee injury is preventing them from re-entering too early. She has a study currently in the works at Stanford examining the effects of healing damaged cartilage with hopes that a laboratory solution could be developed down the road to help previous breakdown. But, for now, facts are facts. “I could take a knife and run it right across cartilage tissue, but because there are no nerve endings there, you wouldn’t feel any pain,” she says. “It would make a cut in your skin but your body won’t signal to your brain that you’re pounding too much on that joint and that you should stop.” 

TRUTH: It’s a Lifelong Gig (But It’s Treatable) 

At the point to which you experience pain (like skeletal grinding), your knee joint may be beyond recovery—on its own. However, not all is lost and that doesn’t mean you have to (or should) throw in the towel. You just need to be more conscientious, more in touch with your primary care provider and more aggressive with rehab than other athletes. 

One study in Arthritis says that if OA is limited to part of the knee, arthroplasty (replacing or remodeling the surface of the joint), or unloading osteotomy (a pain-relieving corrective procedure) could be considered as a treatment. These are typically recommended for younger or active patients to avoid a total knee replacement in the long run. 

There are also many non-surgical treatment options clinically proven to help successfully manage symptoms over time. Hyaluronic acid injections, like DUROLANE injections, can help mitigate pain from osteoarthritis and support you as you continue your physical activity. 

EDITOR’S NOTE: We’re not doctors. It’s imperative you consult yours before moving ahead with what’s right for you. 

MYTH #3: Your Diet Doesn’t Matter

What you eat may impact how quickly you can recover from (or mitigate the effects of) a knee injury. There aren’t hard and fast studies (yet) specific to the diet-and-knee-OA relationship, but that’s mostly because scientists are focusing on the evolution of physical treatments at this point, according to Chu. Rheumatology, a branch of Oxford Academic, has looked at how diet and nutrition impact osteoarthritis in general, but not in knees, specifically. It found potential beneficial associations between OA management and diets reduced in cholesterol and higher in micronutrients, like vitamin K, which play a role in bone and cartilage mineralization. 

Knee OA is infinitely and always tied to inflammation and deterioration of cartilage and soft tissue. So, eating an anti-inflammatory, heart-healthy diet can’t hurt, says Chu. (Think about it like this: if you’re sick, do you crave chicken noodle soup (rich in protein, carbs and healthy fats) and juice (replenishing electrolytes)? Or are you dying to eat crappy, processed garbage. Likely, it’s the former. Bottom line: Your body knows best.)

TRUTH: A Healthy Diet Helps with Pain Management

Even though knee-OA/diet studies are a thing of the future, consuming a heart-healthy diet is the way to go, according to Chu. “A lot of research has been done on what’s healthy for the heart to date, and that, in my opinion, is a great place to start,” says Chu. “People look at a heart-healthy diet and say, ‘oh, well that’s great for the brain, too’ and as we look more into the effects on the joints, we find similar evidence that it’s helpful for maintaining joint health as well. Though we don’t have the studies to prove it yet, specific things you can eat that support your heart may also support your joint recovery.”

Heart-healthy diets, in general, tend to be anti-inflammatory and rich in antioxidants. Here’s how it works: metabolically, our bodies convert food into energy using oxygen. Byproducts of this process are called oxidants, or in other words, free radicals. Oxidants damage cell walls and structures, and the genetic material of our cellular makeup. This slows recovery and contributes to poor health, over time. Antioxidants, found in fruit, nuts, veggies and dark chocolate, among other sources, work to deactivate free radicals by binding to oxidants and ushering them out of the body. This helps prevent some long-term chronic diseases and may even help you recover from injury. So yeah, what you eat does matter.

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