5 ms·

Something about this just reminds me of when I did a literature review in my anatomy class to address the question: "Is running bad for your knees?" I had to d

Something about this just reminds me of when I did a literature review in my anatomy class to address the question: "Is running bad for your knees?" I had to decide which of two sets of peer-reviewed publications that contradict each other was least guilty using the data to support the conclusion rather than letting the data speak for itself and making an honest conclusion. Compared to PhDs, MDs hate designing an experiment and would rather just extrapolate a different conclusion from the same longitudinal study by cherry-picking a different set of variables. The only articles I bother reading from the NEJM anymore are case studies because they're the only publications that consist of mostly-original information.

alasdairking 1y ago
Running experiments is really really hard due to regulations. Difficult to blame doctors for that. https://www.astralcodexten.com/p/book-review-from-oversight-to-overkill https://www.astralcodexten.com/p/book-review-from-oversight-...
- febusravenga 1y ago
  Thanks for this link, very interesting. Notable citation: > A system that began as a noble defense of the vulnerable is now an ignoble defense of the powerful.
Root_Denied 1y ago
The fun part is realizing that any and all exercise comes with risks, and running probably is bad for your knees in the long term - but maybe the long term health benefits to the rest of your body of running outweigh the risk of damage to your knees. Your personal health profile or family history may also put you at higher risk for cartilage degeneration from running, which would shift the balance in the other direction. Blanket statements about medical outcomes like that are useful for medical practice in general, but can be misleading for individuals making health decisions if they ignore other relevant factors. There's also plenty of doctors who will not take those other relevant factors into account and just go by whatever the last training or research they were exposed to (which, incidentally, is also why big pharma companies invest in salespeople to target doctor offices - because it works).
- mlrtime 1y ago
  Right but is simply walking better for you overall? You still get exercise without the forceful impact on knees.
  - cainxinth 1y ago
    You can get almost all of the health benefits of running from walking (weight loss, cardiovascular performance, etc.), it just takes much longer. Also, running is better for the bones (but worse for soft tissues).
  - lanfeust6 1y ago
    Cycling/spin can yield more aerobic intensity with less stress on knees, you can't even get to Zone 2 with walking unless you're very overweight. Of course there are bodyweight options like aerobics, shadow boxing, jumping rope. Skipping rope would be my favorite were it not for the fact that you need a lot of headspace for the rope. This makes it unviable except outdoors or at a gym/facility.
- manwe150 1y ago
  Why “probably bad” though. If you plug that exact query into Google, numerous recent studies will tell you that it is probably good for long term knee health too (stress builds resilience unless prevented recovery time). Which studies are probably right?
  - Root_Denied 1y ago
    "Probably" is being used here because the body doesn't have a really good way to rebuild cartilage, especially as you age, due to lack of blood flow into places like the patella. Knee and hip replacements are on the rise (https://oip.com/the-lowdown-on-the-uprise-of-knee-and-hip-replacements/ https://oip.com/the-lowdown-on-the-uprise-of-knee-and-hip-re...) as well in Boomers, indicating that age related degeneration (with or wihtout a history of running) is fairly universal and expected. There's absolutely some perfect middle ground of "just enough" running that will strengthen, but not deteriorate too quickly, your knees - but again where that point is will vary by individual. It also may not be something that can be determined except in hindsight, partly because medical professionals generally don't start monitoring cartilage until the person is reporting pain or mobility issues (or a known condition they're checking for symptoms of). Point being that statistically there are useful trends in aggregate data that can be observed, but, paradoxically, those trends don't necessarily translate to good general medical guidance. One counterexample where those trends do translate would be something like that peanut allergy study from 2015 that was linked on HN recently about introducing allergens earlier and frequently to babies, resulting in fewer teen/adult allergies.
hshdhdhehd 1y ago
We're you allowed to not reject all the null hypotheses and thus come to no conclusion? For example say 3 papers are rediculous, could you say "they are all rediculous, there is nothing learned, we know nothing new from them"
padjo 1y ago
The question seems really poorly formed! Like there’s never going to be a binary answer to a question like that. The answer is always going to be “it depends” on for example the volume, your physical attributes, recovery, genetics, age etc
- mlrtime 1y ago
  For people that like nuance and details yes. But the point is, most people don't want that, they want to be told what to do or make a binary decision: Good or bad. FWIW I tell people that running is bad for your knees, but relative to other exercises! If someone wants to only run, then go do it... better than nothing.
  - padjo 1y ago
    My take is: running is sometimes bad for your knees, but being sedentary is pretty much always bad for just about everything else.
- president_zippy 1y ago
  I'll give you the principled answer and the cop-out answer. Here's the principled answer: That was just the catchy title, similar to peer-reviewed literature reviews published on nih.gov: not necessarily the creme-de-la-creme, just good enough to pass peer review. I real question is whether concern for cartilage erosion is well-founded, and whether or not it outweighs the scientific consensus that running improves bone density of the tibia and fibula. Again, literature had strong evidence for the latter while the former was still a major controversy in kinesiology. I didn't even touch cardiovascular health, because to be fair we live in a world with bicycles and affordable YMCA lap pools. Here's the cop-out answer: It's a literature review- the very requirements are merely one step removed from those blog articles Harvard Medicine publishes for mass-consumption. I followed instructions, one of which was to adhere to a maximum of 2 1/2 pages, and I got a Northwestern 95 on the assignment.
HK-NC 1y ago
Not what this conversation is about but anyone running and worried about their knees should consider doing a little cycling. Dooesn't have to be fast or high resistance, but it does supposedly "massage" your joints without impact and help cartilage recovery. I definitely noticed a difference with myself and about 2 dozen clients with knee issues from running intensely (military, athletes etc)
- mlrtime 1y ago
  Better yet swimming... but both biking and swimming require a thing, where running does not.
  - mtalantikite 1y ago
    Skipping rope is also a great option. Cardio is up there with running and it's not as hard on the knees. We usually start every session at my muay thai gym with it, and whenever I travel I'll just throw a cheap rope in my bag. I do love just getting out and running though!
- mrob 1y ago
  As somebody who uses both, I personally think a rowing machine is better for general cardiovascular exercise than a bicycle. The work is better spread over your whole body instead of mostly the legs. You can get cheap ones with magnetic resistance that work fine for exercise purposes (the main advantage of more expensive rowing machines is more accurate simulation of rowing in a real boat). Cycling is however a lot more interesting if you have somewhere good to ride.
  - ggm 1y ago
    Or row on water. Before dawn, songbirds and pelicans. Rowing machines are the fallback, not the first choice, just like running machines.
    - strken 1y ago
      If I had to load a boat onto my roof rack and drive to the nearest river at 5am every time I wanted to exercise, I'd do it once a week at the absolute maximum. I don't think it's a reasonable way to exercise for most people.
lm28469 1y ago
Most of my running friends had painful knees until I told them to stop heel striking so bad and over stride, they had minor calf pain for two weeks and never complained again. I have no data but I think most people simply don't know how to run, urbanites will spend $600 on carbon shoes and run like absolute clowns wondering why their fancy shoes don't prevent injuries... run barefoot in a field and you'll get your natural running gait

alasdairking 1y ago

Running experiments is really really hard due to regulations. Difficult to blame doctors for that. https://www.astralcodexten.com/p/book-review-from-oversight-to-overkill https://www.astralcodexten.com/p/book-review-from-oversight-...

febusravenga 1y ago
Thanks for this link, very interesting. Notable citation: > A system that began as a noble defense of the vulnerable is now an ignoble defense of the powerful.

Root_Denied 1y ago

The fun part is realizing that any and all exercise comes with risks, and running probably is bad for your knees in the long term - but maybe the long term health benefits to the rest of your body of running outweigh the risk of damage to your knees. Your personal health profile or family history may also put you at higher risk for cartilage degeneration from running, which would shift the balance in the other direction. Blanket statements about medical outcomes like that are useful for medical practice in general, but can be misleading for individuals making health decisions if they ignore other relevant factors. There's also plenty of doctors who will not take those other relevant factors into account and just go by whatever the last training or research they were exposed to (which, incidentally, is also why big pharma companies invest in salespeople to target doctor offices - because it works).

mlrtime 1y ago
Right but is simply walking better for you overall? You still get exercise without the forceful impact on knees.
- cainxinth 1y ago
  You can get almost all of the health benefits of running from walking (weight loss, cardiovascular performance, etc.), it just takes much longer. Also, running is better for the bones (but worse for soft tissues).
- lanfeust6 1y ago
  Cycling/spin can yield more aerobic intensity with less stress on knees, you can't even get to Zone 2 with walking unless you're very overweight. Of course there are bodyweight options like aerobics, shadow boxing, jumping rope. Skipping rope would be my favorite were it not for the fact that you need a lot of headspace for the rope. This makes it unviable except outdoors or at a gym/facility.
manwe150 1y ago
Why “probably bad” though. If you plug that exact query into Google, numerous recent studies will tell you that it is probably good for long term knee health too (stress builds resilience unless prevented recovery time). Which studies are probably right?
- Root_Denied 1y ago
  "Probably" is being used here because the body doesn't have a really good way to rebuild cartilage, especially as you age, due to lack of blood flow into places like the patella. Knee and hip replacements are on the rise (https://oip.com/the-lowdown-on-the-uprise-of-knee-and-hip-replacements/ https://oip.com/the-lowdown-on-the-uprise-of-knee-and-hip-re...) as well in Boomers, indicating that age related degeneration (with or wihtout a history of running) is fairly universal and expected. There's absolutely some perfect middle ground of "just enough" running that will strengthen, but not deteriorate too quickly, your knees - but again where that point is will vary by individual. It also may not be something that can be determined except in hindsight, partly because medical professionals generally don't start monitoring cartilage until the person is reporting pain or mobility issues (or a known condition they're checking for symptoms of). Point being that statistically there are useful trends in aggregate data that can be observed, but, paradoxically, those trends don't necessarily translate to good general medical guidance. One counterexample where those trends do translate would be something like that peanut allergy study from 2015 that was linked on HN recently about introducing allergens earlier and frequently to babies, resulting in fewer teen/adult allergies.

hshdhdhehd 1y ago

We're you allowed to not reject all the null hypotheses and thus come to no conclusion? For example say 3 papers are rediculous, could you say "they are all rediculous, there is nothing learned, we know nothing new from them"

padjo 1y ago

The question seems really poorly formed! Like there’s never going to be a binary answer to a question like that. The answer is always going to be “it depends” on for example the volume, your physical attributes, recovery, genetics, age etc

mlrtime 1y ago
For people that like nuance and details yes. But the point is, most people don't want that, they want to be told what to do or make a binary decision: Good or bad. FWIW I tell people that running is bad for your knees, but relative to other exercises! If someone wants to only run, then go do it... better than nothing.
- padjo 1y ago
  My take is: running is sometimes bad for your knees, but being sedentary is pretty much always bad for just about everything else.
president_zippy 1y ago
I'll give you the principled answer and the cop-out answer. Here's the principled answer: That was just the catchy title, similar to peer-reviewed literature reviews published on nih.gov: not necessarily the creme-de-la-creme, just good enough to pass peer review. I real question is whether concern for cartilage erosion is well-founded, and whether or not it outweighs the scientific consensus that running improves bone density of the tibia and fibula. Again, literature had strong evidence for the latter while the former was still a major controversy in kinesiology. I didn't even touch cardiovascular health, because to be fair we live in a world with bicycles and affordable YMCA lap pools. Here's the cop-out answer: It's a literature review- the very requirements are merely one step removed from those blog articles Harvard Medicine publishes for mass-consumption. I followed instructions, one of which was to adhere to a maximum of 2 1/2 pages, and I got a Northwestern 95 on the assignment.

HK-NC 1y ago

Not what this conversation is about but anyone running and worried about their knees should consider doing a little cycling. Dooesn't have to be fast or high resistance, but it does supposedly "massage" your joints without impact and help cartilage recovery. I definitely noticed a difference with myself and about 2 dozen clients with knee issues from running intensely (military, athletes etc)

mlrtime 1y ago
Better yet swimming... but both biking and swimming require a thing, where running does not.
- mtalantikite 1y ago
  Skipping rope is also a great option. Cardio is up there with running and it's not as hard on the knees. We usually start every session at my muay thai gym with it, and whenever I travel I'll just throw a cheap rope in my bag. I do love just getting out and running though!
mrob 1y ago
As somebody who uses both, I personally think a rowing machine is better for general cardiovascular exercise than a bicycle. The work is better spread over your whole body instead of mostly the legs. You can get cheap ones with magnetic resistance that work fine for exercise purposes (the main advantage of more expensive rowing machines is more accurate simulation of rowing in a real boat). Cycling is however a lot more interesting if you have somewhere good to ride.
- ggm 1y ago
  Or row on water. Before dawn, songbirds and pelicans. Rowing machines are the fallback, not the first choice, just like running machines.
  - strken 1y ago
    If I had to load a boat onto my roof rack and drive to the nearest river at 5am every time I wanted to exercise, I'd do it once a week at the absolute maximum. I don't think it's a reasonable way to exercise for most people.

lm28469 1y ago

Most of my running friends had painful knees until I told them to stop heel striking so bad and over stride, they had minor calf pain for two weeks and never complained again. I have no data but I think most people simply don't know how to run, urbanites will spend $600 on carbon shoes and run like absolute clowns wondering why their fancy shoes don't prevent injuries... run barefoot in a field and you'll get your natural running gait