Is Running Ruining Your Knees: Yale's Dr. John Fulkerson

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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