A hill through the woods, a gravel road, a suburban street, and a path through a city park – all are places that you will find runners. The nonspecific location of running is one of its strongest attributes. You can train just about anywhere, on any type of surface.

However, if you are running with knee pain or wanting to prevent it, is one type of surface better protection than another? That question has been a top one within the running community for decades. 

When you want to figure out the best running surface for your knees, the short answer is, simply, “Grass.” However, some authorities will recommend – based on what they believe to be insufficient scientific evidence to promote one surface – that you should use different surfaces on different days. Let’s look at each perspective, along with how you can get results with treatment so that running with knee pain can be left behind.

The case for grass

Back in 2002, after winning a mile race, Marcus O’Sullivan (an indoor world champion twice) told Runner’s World that he felt stress fall away from his body and replaced with a sense of calm during the summer, when his training was primarily on grass.

Sullivan stated that concrete was extremely hard on his body and that he thought running on it would inevitably lead to chronic injury. “I’m convinced that if you run on softer surfaces, your career will last longer,” he said. 

Although technology has advanced and it is just a single point-of-view, these comments are from such a high-profile runner that they remain generally convincing on how to handle running with knee pain.

The science backs up Sullivan’s opinion to some degree. In one study, 44 adult runners were analyzed for a 2010 report in the Journal of Science and Medicine in Sport. The participants had insoles in their shoes that gauged pressure as they made impact with the ground. One group ran on asphalt and the other on grass. The maximum point of pressure was approximately 12% higher on asphalt than it was on grass. Similarly, a 2012 study of 15 runners, featured in Research in Sports Medicine, also took readings from insoles. Surfaces for that study included grass, concrete, and synthetic-track rubber. That data also shows grass introduced less force to the foot than asphalt did. 

The case for diversifying your route

Can running with knee pain be counteracted by simply choosing grass? It may not be that easy. A professor of movement science at the University of Michigan, Daniel Ferris, Ph.D., noted that the science is insufficient to claim one surface is best because no “gold standard test” (tracking hundreds of runners on various surfaces for a year or more) has yet been completed. 

In the absence of that research, Dr. Ferris suggested using a blend of different surfaces, ranging from grass to trails to the road. “The variety is going to stress different parts of your body,” he said.

How to leave behind running with knee pain

Whether you diversify or continue to use asphalt and other surfaces beyond grass, the above evidence certainly suggests limiting your time on paved surfaces. What else can you do, though? You may need to consider more than your running surface to alleviate your knee pain.

We can help. At Flexogenix, by providing exclusive, personalized care, we make a difference in the lives of our patients. Qualify for a free consultation.