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To Run or Not to Run?

Here I raise the ultimate question debated ad nauseam in our postmodern, fitness-crazed world: should I be running for exercise or is it actually bad for me?

Running, a widely accepted form of exercise, is recognized for its cardiovascular benefits as it burns the most calories, decreases visceral fat (the kind of fat that isn’t immediately visible to the naked eye as it wraps around your organs in the abdominal cavity), and lowers blood pressure and cholesterol levels to improve overall heart health. However, many of us worry that this repetitive, high-impact activity might be causing some internal structural damages that don’t offset its cardiovascular benefits. The occasional twinge of knee pain can bring about some unnerving questions and reasonably so as the intention of running is to support a healthy heart and body. Our thoughts immediately race to wonder if we are setting ourselves up for early onset of osteoarthritis or if we are subjecting ourselves to greater risk for repetitive, overuse injuries such as stress fractures or shin splints. Do we push through the pain reciting that obsolete motto of “no pain, no gain!” or do we concede to our fears and call it quits altogether?

So to the ultimate question we have thus returned: to run, or not to run?

Being a passionate runner myself, you’d think my biases would push me to cry out “RUN, obviously!” Truth is, running isn’t suited for everyone and that’s perfectly okay. For those of you who are running-curious, I want to lay down some fun facts and recent evidence-based publications that may or may not sway your opinion over this ongoing indecision. My goal is not to convince you to become an avid runner but rather provide educational information so you can be empowered to make informed decisions about how you want to direct your health and fitness goals.

More than the physical.

The myriad of benefits don’t stop at improved heart function, stronger muscles and bones, and of course the added bonus of weight loss. Research shows that running (or any form of acute aerobic exercise at moderate intensity) releases neurochemicals, most notably endorphins and serotonin, to elevate our mood, ward off depression, and decrease anxiety. More recently, new research has uncovered the role of endocannabinoids, which as its name implies, is similar to cannabis but naturally produced in our beautiful bodies. The endocannabinoid system (ECS) is a complex, intrinsic physiological interplay of neurohormones that help maintain homeostasis. Running releases endocannabinoids to produce relaxation and a sense of calm in us after a good run. In fact, endocannabinoids are more likely related to that alleged “runner’s high” than the formerly credited endorphins as these molecules are smaller and able to pass through the blood-brain barrier for long term effects. Perhaps it is this intrinsic physiological event which explains how running is both my passion and my therapy.

But ouch, my knees.

Many of us fear that running puts us at increased risk for developing osteoarthritis in the knees or hips. We ache, we feel sore, and we associate this pain to some kind of internal, structural damage or the early signs of arthritis. However, the relationship between running and arthritis is not as clear-cut as we may think. In 2017, the Journal of Orthopaedic & Sports Physical Therapy published a systematic review and meta-analysis that analyzed 25 studies of over 100,000 participants to determine whether running increases the risk of developing arthritis. After comparing non-runners, recreational runners, and competitive runners, the results showed recreational runners had the lowest rate of developing knee/hip arthritis. In fact, the research supports that running, even up to 15 years, is a safe and healthy form of exercise that promotes joint health. One of the purported theories for this is a correlated lower BMI which thereby reduces the loading forces on our major lower extremity weight bearing joints.

Mo’ mileage, mo’ problems?

Once upon a time, the “10% Rule” was the golden principle runners and coaches preached without hesitation to prevent injury. Never increase your running mileage more than 10% the rule states. Seems reasonable enough. If your current weekly running mileage is 10 miles, then the next week you merely increase your distance by one mile.

While the principle of progressive overload for physiological adaptation is critical for injury prevention, controlling mileage at 10% is only a small picture of a more complex, dynamic situation. Running injuries result from a wide array of global training errors such as running speed or velocity, volume, and/or frequency. Throw in trail, variable terrain with incline/decline and you’ve got more than you bargained for. As a physical therapist, let me assert here that injury prevention is not only contingent on these training parameters, but also on our unique anatomy, movement preference, and running form. Things to consider are adequate hamstring length, ankle dorsiflexion range of motion, pelvic stabilization, and running efficiency for improved endurance. Mileage tracking for injury prevention, albeit a smart start, becomes more convoluted when past medical history (ie., high blood pressure, asthma, patellofemoral dysfunction, etc) is thrown in the mix. Straying from a one-shoe-fits-all approach is key to formulating the best and most appropriate training plan for you to stay injury-free, create longevity in the sport, and achieve your fitness goals.

HAPT Running Club

Maybe this post sparked curiosity in you to introduce (or reintroduce) running in your life or maybe you’re still on the fence. If you feel the compelling urge to hit the pavement now, let me be the first to send a warm invitation to our newly established Running Club at Healing Art Physical Therapy. Our intention is to build a community of support for recreational runners who want to stay active and healthy without high risk of injury. We welcome you to bring your favorite pair of runners and any questions you may have about your own road with running. Our tentative first debut run date is March 30, 2021 at 6:00 pm. Keep your eyes peeled for the flyer for more details!


Basso JC, Suzuki WA. The Effects of Acute Exercise on Mood, Cognition, Neurophysiology, and Neurochemical Pathways: A Review. Brain plasticity (Amsterdam, Netherlands). Published March 28, 2017

C, D., S, G., RO, N., H, S. and L, M., 2021. Is There Evidence for an Association Between Changes in Training Load and Running-Related Injuries? A Systematic Review. PubMed. Available at: <> 2021. Running and Osteoarthritis: Does Recreational or Competitive Running Increase the Risk? | Journal of Orthopaedic & Sports Physical Therapy. [online] Available at: <>

2021. The Truth Behind ‘Runner’s High’ and Other Mental Benefits of Running. [online] Available at: <>


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