Excerpt 3 of 8 · Knee OA

Knee OA in Runners:
Stop Reducing People to an Image

That line captures a belief I hold strongly — and one I think our profession needs to hear more often.

When a runner walks in after being told they're "bone on bone," they've usually already been handed a narrative that running is the problem and stopping is the solution. But the story is rarely that simple.

OA is a clinical diagnosis. You can use imaging to support it, but it does not define it. And when we reduce a complex human being to a single image and a scary label, we set them up for fear, avoidance, and a retreat from the very loading that was keeping them healthy.

In this clip from the new Knee OA module inside Clinical Running Essentials, I walk through:

• Why OA is a clinical diagnosis — and why imaging is optional
• The diagnostic criteria that actually matter: load-related joint pain, morning stiffness, functional limitations, age, and risk profile
• What the Allanore study tells us about OA prevalence in sedentary individuals vs. recreational vs. competitive runners — including the nuance that often gets ignored
• Why the knee is designed for load sharing — and the snowshoe analogy for how contact area increases with greater compressive force
• Ross Miller's work on cumulative load: per-unit-distance load for walking vs. running is not significantly different
• The concept of "cruel optimism" — taking a big, multifaceted problem and offering a simple, singular solution that sounds hopeful but fails most people
• Why 20% of knee replacement patients go on to have persistent pain — and what that tells us about reductionist approaches