A Primer on Running for the Orthopaedic Surgeon

Andrea M. Spiker, MD; Ken B. Johnson, PT; Andrew J. Cosgarea, MD; James R. Ficke, MD


J Am Acad Orthop Surg. 2020;28(12):481-490. 

In This Article

Abstract and Introduction


Long-distance running has become increasingly popular during the past decades. Many running patients pose questions to their orthopaedic surgeons regarding risks, benefits, and running techniques. This article identifies 11 running-related questions that patients may ask and provides information to help answer those questions. This review discusses data on the health benefits of running, common running injuries, the relationship between running and osteoarthritis, recommendations regarding running after orthopaedic surgery, running shoes, and other questions that may arise when treating the running athlete.


Running is an increasingly popular pastime for Americans, reflected in part by the number of participants in running races. In the United States, the number of race finishers has increased by >360% since 1990, from 4.7 million to 17 million in 2015. The proportion of female runners during that time has grown from 25% to 57% of finishers.[1] In 2015, >509,000 people finished 1,100 marathons (competitive races of 26.2 miles) in the United States.[1]

Cardiovascular fitness protects against obesity, chronic disease, brain atrophy (in those at risk of dementia), and cancer.[2] Physical activity at low levels (92 minutes weekly or 15 minutes daily) has been associated with a 14% reduction in death from any cause and a 3-year increase in life expectancy. Each additional 15 minutes of daily exercise is associated with a further 4% reduction in death from any cause.[3] Running can increase cardiovascular fitness and improve physical activity levels, aerobic fitness, and cardiovascular function, as well as metabolic fitness, adiposity, and postural balance.[4]

However, there are risks associated with running, especially at levels and durations considered "above average." Each year, 19% to 79% of runners report lower extremity running-related injuries, most commonly at the knee.[5] Orthopaedic (musculoskeletal) injuries in runners can be acute but are more commonly chronic and caused by overuse. The goal of this review is to present evidence-based answers to common questions from runners to guide orthopaedic surgeons in treating and counseling these patients.