Long-distance runners often hear warnings about how running could wear out their joints. This can cause concern that their regular running routines are harmful to their knees, or may lead to osteoarthritis.

Here we’ll explore whether running can lead to osteoarthritis, and also provide some practical tips to help protect the knees when running.

Can running lead to osteoarthritis?

Contrary to popular belief, running may not be a cause of osteoarthritis. In fact, research indicates that runners generally have fewer cases of knee osteoarthritis compared to those who lead a sedentary lifestyle. Studies also suggest that runners often experience less knee pain.

Running does cause temporary changes in the knee cartilage, but some experts believe this conditions the cartilage over time. So, rather than damage the knee, it can help to improve overall strength and mobility.

Another way running can reduce the risk of knee osteoarthritis, is it helps to lower your BMI (Body Mass Index). Runners typically have a low BMI due to the distances they cover.

However, while running may not necessarily lead to osteoarthritis, you can still suffer various injuries, especially if you don’t take proper precautions.

What factors increase the risk of arthritis?

Running itself isn’t detrimental to knee health, but there are several other factors that can increase the risk of developing osteoarthritis. These include:

  • Age
  • Genetics
  • Overweight/Obesity
  • Previous joint injuries
  • Repetitive stress on the joint

Age is a primary factor, as the wear and tear on joints tend to accumulate over time. However, genetics play a significant role too, as a family history of arthritis means you may have a higher risk of developing it yourself.

Excessive weight puts additional stress on the joints, exacerbating the risk of damage and arthritis. If you’ve had previous joint injuries, or you work in certain occupations that demand repetitive stress on the joints, these factors can also increase the risk of developing osteoarthritis.

Tips for running safely

To protect your knees and ensure that running remains a beneficial part of your routine, there’s a few tips you’ll want to follow.

Start with a proper warm-up routine to prepare your joints and muscles for the impact of running. Choosing the right running shoes is also invaluable. Make sure you look for shoes that offer good support and suit the arch of your foot and running style. Gradually increasing the distance and intensity of your runs can also help avoid overloading the knees.

Another way to protect yourself from knee injury is by incorporating some strength and conditioning around your running, using weights or bodyweight exercises e.g. Pilates. It’s best to seek the advice of a physio/PT/coach for a tailored exercise plan that fits around your running goals and your specific biomechanical needs.

Running should be a joy and a health boost, not a source of pain. By taking the right precautions, you can continue to enjoy the benefits of running without compromising your knee health.

If you experience any discomfort in your knee after running, book a consultation with Mr Shah Punwar.

Mr Shah Punwar, orthopaedic knee and hip surgeon, is pleased to announce a new Central London clinic location at King Edward VII’s hospital in Marylebone.

Consultations are available between 18:00 and 20:00, on alternate Tuesdays.

For enquiries, click on his profile below, or you can contact his team through the usual contact email/numbers.



A recent Australian study has revealed that online physiotherapy, conducted via video conferencing, is just as effective as traditional in-person sessions when treating chronic knee pain.

Carried out during the lockdowns of the COVID pandemic, online physio not only proved viable, but also more beneficial than traditional sessions in some cases. However, despite this evidence, both patients and healthcare providers are sceptical.

Here, we’ll explore the latest findings and the benefits of prehabilitation prior to undergoing knee surgery.

Online physio as effective as in-person sessions

The recent study included a total of 394 adults aged over 45 who were experiencing knee pain. They were being treated by one of 15 physiotherapists enrolled in the research, spread across 27 practices throughout Victoria and Queensland, Australia.

The participants were split into two groups, with one receiving online physio sessions, and the other attending in-person sessions. Both groups underwent five sessions over a three-month period, along with a home exercise plan.

Interestingly, over the three months, those who did their physio online experienced the same benefits as those who did it in person. They were also more likely to attend all their sessions and found it more convenient.

This is great news, especially for those who have trouble getting to a physiotherapist’s office. It shows that online physio can be a reliable option for those in need.

The importance of prehabilitation before surgery

Prehabilitation, or ‘prehab’ involves a structured program of exercises and physiotherapy. It is designed to strengthen the knee and improve its function before the patient undergoes their operation.

Engaging in prehab can significantly minimise knee pain while you wait to have the surgery, as well as speed up recovery. It helps to strengthen the muscles around the knee, improving mobility and leading to improved results after the procedure.

While it is known to have many benefits, physical therapy for knee osteoarthritis isn’t used often enough. This recent research may help to encourage more practitioners to encourage physiotherapy prior to knee surgery.

Other ways to prepare for knee surgery to improve results

Alongside physiotherapy, there are other things you can do to increase the likelihood of a smooth, fast recovery, and achieve optimal results after knee surgery. Lifestyle changes such as stopping smoking, eating healthily, and managing your weight can make a big difference to the results.

Another thing to focus on is making sure you choose the right surgeon. You can follow the best prehabilitation plan in the world, but if you choose an inexperienced surgeon you aren’t going to achieve the best results. Always make sure you are choosing a skilled, experienced orthopaedic surgeon like Mr Shah Punwar.

Schedule an appointment with Mr Punwar today to determine the best way to prepare for your upcoming knee surgery.

Mr. Shah Punwar recently attended the ‘Sports Knee Surgery’ event in Edgbaston, focusing on ACL prevention and rehab. There, an insightful interview unfolded between Leah Williamson, the England Lionesses captain, and Austin Healey, an ex-England Rugby player who has undergone total knee replacement surgery.

Williamson’s experience with an ACL injury, a common injury among women in football, was a focal point of discussion. Coincidentally, Healey also experienced an ACL injury ahead of a World Cup game. She highlighted the challenges and the importance of proper rehabilitation and injury prevention in sports.

Here, we explore some key takeaways from the event, and why women are more susceptible to ACL injuries in high impact sports.

Female football players suffering ACL injuries

Williamson ACL InjurySharing her own experience with an ACL injury, Leah shed light on the critical issue of this being so prevalent in women’s football. Women can suddenly find themselves playing football at elite level from the age of 18. This differs to men, who can begin a structured athletic development programme from the age of 9.

Another aspect is the importance of a proper warm-up before activity. Healy and Williamson discussed how crucial it was to adopt proper warming up protocols from a young age. Now, after the success of the lionesses and with more girls encouraged to take up football, this is more important than ever.

“At school we all do PE, so introduce it there, and make it second nature,” said Williamson.

Her ACL injury, like many others in high-level sports, was exacerbated by the demanding schedule of games, which often does not allow adequate time for rest and recovery. This rigorous scheduling can increase the risk of injuries, making prevention and proper rest periods crucial for athletes.

What is an ACL Injury?

The Anterior Cruciate Ligament (ACL) is one of the key ligaments that help stabilise the knee joint. An ACL injury is a tear or sprain of this ligament, often occurring in sports that involve sudden stops, jumps, or changes in direction.

These injuries can be debilitating, requiring extensive rehabilitation and, in some cases, surgical intervention. The recovery process can be lengthy and challenging, which makes effective treatment and rehabilitation strategies crucial.

ACL injuries typically occur when the knee is forced into an unnatural position, often during high-impact or rapid-movement sports. This excessive stress can cause the ACL, which is crucial for knee stability and smooth joint movement, to stretch or tear.

The severity of an ACL injury can range from a mild strain (where the ligament is slightly stretched) to a complete tear, where the ligament is split into two parts. Recovery and treatment plans vary based on the severity of the injury and the person’s overall health and activity level.

Why ACL Injuries Affect So Many Women in Sports

ACL injuries are particularly prevalent in women’s sports, with athletes in football, skiing, bouldering, and netball often affected.

Factors that increase the risk include:

  • Anatomical differences
  • Hormonal influences
  • The biomechanics of movement in women

Leah’s experience and Healey’s insights at the Sports Knee Surgery talk, highlight the importance of understanding proper warming-up exercises for ACL prevention, and total adherence to prehab should surgical treatment be needed, as well as the rehab which follows.

If you have experienced an ACL injury, schedule an appointment with Mr. Shah Punwar today. With his extensive experience, he can assess the injury and recommend the best treatment plan to help ensure the best recovery. Early intervention is crucial to help you get back to the sport you love.

Each year, thousands of people manage to regain mobility and lead a pain-free life thanks to knee replacement surgery. According to the National Institute for Health and Care Excellence, more than 100,000 knee replacement surgeries are carried out in the UK annually.

While most of these surgeries run smoothly, for various reasons, some patients may experience issues with their new knee. That’s where knee replacement revision surgery comes in.

Here we’ll explore why you may need a revision surgery, and what happens before and after the procedure.

Why you may need a knee replacement revision surgery

The most common reasons you may need a knee replacement revision include:

  • Natural wear and tear
  • Loosening of the replacement
  • Infection
  • Falls

Knee replacements aren’t designed to last forever. They typically last between 10 and 20 years, eventually giving way to wear and tear. As people live longer now, there’s been an increased demand for knee replacement revision procedures.

As well as general wear and tear, occasionally the replacement can loosen. This is easily identified through an X-ray. The plastic component may also wear down, leading to discomfort and reduced functionality.

Whatever the reason, a revision surgery can help patients to get back to living a pain-free life. It benefits from a high success rate, but it can be quite a complex procedure compared to the original replacement.

What happens before a knee replacement revision surgery?

Before having a knee replacement revision surgery, you’ll need to undergo an assessment. It starts with a physical examination, assessing how well the knee bends and its overall functionality. Imaging tests, such as X-rays, help pinpoint the specific issues with the replacement. Blood tests may also be conducted to rule out any underlying health concerns.

After the surgery, a rehabilitation and recovery plan will be provided. Following the surgeon’s aftercare instructions is crucial to ensure best results. This typically includes instructions for keeping the wound clean, partaking in physical therapy, and when you can get back to physical activities.

Other than revision surgery, are there other treatment options?

Depending on the specific issues identified, various approaches can be explored to address the challenges faced by knee replacement. This could range from non-invasive interventions to surgical procedures aimed at rectifying the underlying problems.

In some cases, revision surgery becomes the most viable option to restore optimal function and eliminate any pain the patient is experiencing. This involves removing all or part of the components of the replacement that have failed or are damaged.

If you have had a total knee replacement and are worried about pain, swelling, clunking or feeling unstable then do come and see Mr Punwar for a detailed review.

Undergoing knee surgery can be a daunting process, especially when you’re faced with multiple options. A total knee replacement is usually recommended for treating widespread tissue damage in the knee. But sometimes a partial knee replacement is more suitable.

Designed to treat specific areas of arthritis damage in the knee, a partial knee replacement is a less invasive approach than a total replacement. So, what does this procedure involve, and could it be a better option for you? Read on to discover more.

What is a partial knee replacement?

A partial knee replacement focuses on replacing only one damaged compartment of the knee. It is often referred to as a unicondylar replacement or unicompartmental knee replacement surgery.

There are two main types of replacement you can undergo, including fixed-bearing and mobile-bearing procedures.

In a fixed-bearing partial knee replacement, there’s a rounded component on the femur that sits on top of a flat component on the tibia.

The mobile-bearing procedure features a movable plastic spacer nestled between these components, allowing for slight rotation in the medial compartment. This rotation capability gives it the ‘mobile’ descriptor.

Research has proved that both types of partial knee replacement give favourable outcomes. However, Mr Punwar uses the fixed-bearing partial knee replacement because it has excellent results on the National Joint Registry.

When might it be recommended?

A partial knee replacement may be suggested when only one compartment of your knee is affected by arthritis or damage, and the other parts remain healthy. This could be due to specific injuries, isolated arthritis, or wear and tear localised to one area.

Patients experiencing consistent pain, swelling, or stiffness in one part of the knee, which isn’t relieved by non-surgical treatments could be ideal candidates for the procedure.

Your orthopaedic surgeon will evaluate the extent of the damage through physical exams and imaging tests. This will help to determine if it is the right solution for you.

The benefits of a partial knee replacement

Choosing a partial knee replacement offers several advantages. Firstly, because it’s a less invasive procedure, the surgery typically involves a smaller incision. This can mean less pain postoperatively and a quicker healing process. Also, with the ‘mid-vastus’ technique, the quadriceps tendon is not split, so the recovery is quicker with a faster ability to do a straight leg-raise.

The procedure is usually carried out under a regional anaesthesia, which avoids potential complications of general anaesthesia. Also, it often leads to a shorter hospital stay and a faster return to daily activities. Since only the damaged part of the knee is replaced, preserving more natural bone and tissue, patients also tend to feel that their knee moves more naturally compared to a total knee replacement.

Of course, knee arthritis can continue to spread into other areas of the knee, but a partial knee replacement can help with knee stability, giving additional protection against wear and tear.

Certainly, all these benefits make partial knee replacements an attractive option for those who qualify.

To determine your eligibility for a partial knee replacement, or to find out more, schedule a consultation with Mr Shah Punwar.

Since the Lionesses have been on centre stage, there has been a spotlight on Anterior Cruciate Ligament (ACL) injuries. England Captain Leah Williamson suffered an ACL injury in April, preventing her from competing in the Women’s World Cup. This followed a bout of ACL injuries among other elite female football players.

Here, teaching assistant Lia, talks about her own football ACL injury, and her gruelling rehabilitation after surgery to get back to the pitch.

Lia’s footballing ACL injury – not that uncommon

Lia had been playing football for twenty-four years, and had suffered some serious ankle injuries – but no knee issues.

“As a defender, I slide in to make tackles all the time.” However, when playing a semi-final game with her Sunday league team in Sidcup, she went to make a tackle, but her leg had other ideas. “My knee went one way, and my foot the other,” she says. “I just remember my knee burning.”

After three weeks resting, Lia was keen to return for some light training, but when her leg instantly gave way she realised her injury was more serious than first suspected. Some weeks later, a scan revealed a torn ACL.

Lia is certainly not alone though. Research shows that female footballers are up to six times more likely to suffer a non-contact ACL injury than male players. In fact, both Lia’s sisters had experienced ACL ruptures through football, and both received surgeries. Also, similar to many other cases, Lia’s injury did not involve contact, and seemed to be caused by a sudden change in speed…in her case a sudden stop.

Lia’s ACL surgery recovery

With her mind set on returning to football, surgery was the best way to get her back to her sport. A year later, Lia was set for an ACL repair with Mr Punwar at The Blackheath Hospital. From the moment she arrived, Lia recalls being fully informed on the procedure. “It was all explained. I knew exactly what was going to happen. It was very reassuring.”

Mr Punwar ACL repair surgery uses the UltraSTAR surgical technique with a single, quadrupled semitendinosus graft. After surgery, Lia said she was very naive about how long the recovery process would take. “My sisters said it’s going to hurt, you’ll get to a point where you don’t think you can do another set of exercises. But do them!”

Lia received her physio exercises the morning after her surgery, but found it exhausting. But she pushed through, setting herself small goals and with a strong support network of friends, family and club-mates. “I remember when I was able to walk to the kitchen without my crutches and make a cup of tea. I sent my friends a photo because I was so proud of myself!”

More research into footballer’s ACL injuries needed

Now, almost five months since her surgery, Lia’s physio is going well, and she is looking forward to running again soon. She is hoping to return to football next Spring. That will be 12 months after her surgery, and two years since her ACL injury occurred.

When considering the plight of so many other football players experiencing ACL injuries, Lia says: “It needs to be looked at. More research is needed. And not just in female football. They’re not nice injuries to have – career-ending injuries for some people. Anything that can help prolong people’s footballing careers.”

Knee injuries, specifically those affecting the anterior cruciate ligament (ACL), are increasingly prevalent among young athletes. Furthermore, recent stories following the ‘ACL injury epidemic’ in Women’s Football demonstrates how important it is to ‘tackle’ the issue.

These injuries are notoriously challenging to treat, with a high risk of re-injury, making early prevention paramount. Enter ‘Power Up to Play’, a targeted, evidence-based warm-up program designed to safeguard the athletes of tomorrow from such injuries.

Here, we’ll explore the invaluable role of a proper warm-up, and the importance of the ‘Power Up to Play’ routine.

Why Warming Up Properly is Key to Preventing Knee Injuries

There is a way to lower the risks of developing a knee injury, and it lies in our warm-up routine. Warming up the body before strenuous physical activity significantly reduces the risk of injury. It prepares and loosens the muscles, making them less likely to strain or pull.

For adolescents and young adults, playing sports isn’t just beneficial for their physical health, but also their mental well-being, friendships, and team-building skills. However, these benefits can be marred by injuries such as ACL tears. Sports involving abrupt direction changes, jumping, and knee twisting can spike ACL injury rates, leaving athletes at risk.

A tear in the anterior cruciate ligament poses significant concerns, especially in adolescents. Their bodies are still growing, making the recovery process longer and more complicated. Surgical intervention carries its own risks, including a higher likelihood of re-injury and future joint arthritis, compared to adults.

What is Power Up to Play?

‘Power Up to Play’ is a brief yet powerful warm-up routine that’s been proven to substantially cut down on serious knee injuries when integrated into a player’s regular training or pre-match routine.

Ideally, athletes should follow the program at least 2-3 times a week to ensure safer, more effective performance.

The program involves a dynamic mix of running, plyometrics, stretching, sport agility exercises, and strengthening. It’s vital to maintain correct form throughout all the exercises to get maximum benefits and injury prevention.

‘Power Up to Play’ helps to strengthen key muscles, reinforce robust body positions, and improve stability and control. With a focus on safer landing techniques, the program takes significant strides in knee injury prevention, offering athletes a smarter, safer path to the playing field.

Treating an ACL Injury

While the ‘Power Up to Play’ warm-up program is a valuable tool in preventing knee injuries, it’s essential to understand the steps to recovery should an ACL injury occur.

The course of treatment, whether surgical or non-surgical, hinges on various factors, including the severity of the injury, the patient’s overall health, and their activity levels.

Treatment focuses not only on physical healing, but also providing patients with strategies to optimally recover and get back on their feet. It is critical to approach the healing process with patience, diligence, and proper guidance.

To find out more, book a consultation with Mr Shah Punwar by calling 020 8194 8541.

Having a strong focus on your rehabilitation after surgery can make a huge difference to your results. Also, a young family and an active career were big incentives for Joe to make a strong comeback after his ACL surgery with Mr Punwar.

Here, Joe talks about his ACL experience, and hopes to inspire others to take their rehabilitation as seriously.

Joe’s ACL Injury

It was ten years ago that Joe suffered an injury when snowboarding in France. When he returned to the UK, an arthroscopy revealed existing issues within the knee tissue that may have led up to his injury. The scan showed that as well as trauma, there was a problem with blood supply to the ACL causing a weakness.

Then, Joe faced two choices – either knee reconstruction or managing his ACL condition. Wanting to avoid the risks of surgery, he chose the self-management path. But this meant avoiding impact sports like football and running, two things he enjoyed.

It was some years, and three children later, when participating in contact exercises that were part of his safety training for the police, that his weak knee gave way. This highlighted a need for surgery to fix his knee instability permanently.

ACL Repair Rehab

After his ACL reconstruction, Joe was determined to recover well, both for his family as well as his career. He had already begun some physio before the operation, although he said after the operation he really had to push through it.

“Friends of mine had told me that the success of your repair depends on strictly following the physio, so that’s what I did. Also, the physio before surgery to prepare you for what’s to come.”

“The day after surgery, I remember doing some basic foot pumps. It felt so alien! My body was telling me not to do it. It was only having read up on it and understanding how important it was that I pushed through with the exercises.”

A ‘model patient’ for ACL surgery

The success of Joe’s approach to his rehab was evident at his four-week check-up with Mr Punwar. Joe spoke to another patient that had surgery a week before his own repair. The other, seemingly younger patient, was on crutches, whereas Joe had arrived on foot, and without any walking aids. “I didn’t say anything because I didn’t want him to feel bad,” said Joe.

Mr Punwar has performed successful ACL surgery on patients of all ages. But although there is no age barrier, the ideal candidate is one that is motivated to get back to their activities.

“Dedication to prehab as well as good post-operative rehabilitation is the best way to achieve a full and successful recovery,” says Mr Punwar.

Mr Punwar uses the UltraSTAR surgical technique for ACL surgery, using a single, quadrupled semitendinosus graft. Studies have shown that this method can lead to better outcomes.

Joe gets running for charity

Now a huge convert to physio, Joe is continuing to recover well. He is working through a ‘Melbourne ACL rehabilitation guide’, supplementing his regular post-op physio sessions with a framework of guided exercises.

Four months after ACL repair surgery with Mr Punwar, Joe joined fellow workmates in a ‘Run, Row, Ride’ challenge raising funds for vital rehabilitation equipment, helping those with lymphoedema after cancer treatment. This was his first mile run on a treadmill since the operation 4 months ago and Joe is hoping that it will inspire others.

“This was an amazing day, to be able to be involved in such an important charity event and organised by the people that got me there.”

Joe left a 5-Star review for Mr Punwar on the Iwantgreatcare website as follows:

Shah ACL Review

Experienced consultant knee and hip surgeon, Mr Shah Punwar is now able to offer patients extended appointment times at The Blackheath Hospital, London.

Evening consultations are available between 5.30pm and 8.00pm, on alternate Tuesdays.

Contact the clinic on 0208 318 7722 or email Punwar.admin@lips.org.uk to book an appointment.

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