Why surgeons run
The surprising running habits of leading orthopaedic consultants — and the science behind their choices.
By Professor Alister Hart
If running is so bad for your joints, why are orthopaedic surgeons doing it?
It’s a question I’ve been asking my colleagues. I’m fascinated by the idea that surgery, and joint health more broadly, is a puzzle to be solved. Years ago, the BBC described me as The Hip Detective — a name that eventually became the title of my book. The idea was simple: treat each case like a mystery, and follow the evidence wherever it leads.
Movement is Medicine continues that mindset — but with a different kind of mystery. Because if anyone truly understands joint wear, injury, arthritis and pain, it’s orthopaedic surgeons. So why do some of them voluntarily sign up for marathons?
To find out, I spoke to three of the UK’s most experienced orthopaedic knee surgeons. Between them, they’ve treated thousands of runners, replaced knees by the thousand, repaired ligaments for elite footballers, and pushed their understanding through groundbreaking research. These are people who really know knees. They see the damage. They understand the risks. And yet — they run.
What they shared might surprise you.
“I’ve treated elite athletes — and I still run.”
Mr Andy Williams is a world-renowned knee surgeon whose patients include Premier League footballers and Premiership rugby players. He’s also a sub-3:30 marathon runner.
Andrew’s advice to patients is clear-eyed and evidence-based. He encourages strength and flexibility training alongside running — and he doesn’t recommend pushing through pain.
When asked what distance is sensible for most people, he suggests 10K as a good benchmark. But when it comes to marathons, he’s been there himself — three times, all under four hours — and offers this advice:
“Get slim, get strong, train steadily. Make sure you’re able to run at least 30 miles a week a couple of months before the race, and be able to do at least a 15-mile run with a month to go. But don’t run through pain.”
Despite seeing plenty of joint injuries up close — and experiencing his own (including iliotibial band syndrome, Achilles tendinitis, and calf strains) — he still runs and recommends it to many of his patients, when appropriate.
Like all the surgeons I spoke to, he uses MRI imaging to assess knee pain and considers red flags like persistent pain or fluid in the joint before making recommendations.
“I replace more knees than anyone — and I still recommend running.”
Mr Sam Rajaratnam is one of the most prolific knee replacement surgeons in the UK. He’s applied the theory of marginal gains — made famous by British Cycling — to improve outcomes for patients after surgery. That means everything from surgical technique and robotics to wound care and anaesthesia is optimised.
He hasn’t run a marathon, but he understands the appeal. And more importantly, he doesn’t see running as inherently harmful.
“I recommend running to my patients and friends. There’s no universally safe distance — but if your joints are healthy and you build up slowly, it’s one of the best things you can do.”
That said, he doesn’t recommend running after a knee replacement — not because running is bad, but because an artificial joint has different constraints. Like Andrew, he uses MRI extensively to diagnose issues in runners, especially where meniscal damage or instability is suspected. He’s particularly concerned about displaced meniscal tissue, which can cause further joint surface damage if left untreated.
His prevention and training advice? Strength training, proper shoes, gradual mileage increases, and listening to pain.
“I ran a marathon in ski boots — and I still treat trauma patients.”
Mr Paul Harnett is a trauma specialist at one of London’s major centres — and a former Guinness World Record holder for running a marathon in ski boots. He’s run seven marathons in total.
Paul takes a pragmatic view. He’s cautious with patients who’ve had joint replacements — recommending they keep to short distances, like 5K parkruns — but he’s also a passionate advocate for strength training and smart progression in runners of all kinds. He supports ultramarathoners too, provided they increase their training volume gradually.
His “red flags” for knee pain? Limping, night pain, abnormal alignment (like knock knees or bowed legs), or previous ligament injuries. If those are present, he’s likely to restrict running and recommend imaging. But he’s not against running per se — quite the opposite.
“Minimal effective dose is the key. Train smart. Get strong. Recover well.”
Paul Harnett
What do these surgeons agree on?
Despite different specialtisms and personal histories, all three agree:
Running isn’t inherently bad for joints. In fact, it may be protective — especially when paired with good biomechanics and strength work.
Pain should never be ignored. Persistent symptoms need investigating — often with MRI — and treated before they become serious.
Strength training matters more than stretching. Building muscle around the joints supports better function and resilience.
Vitamin D supplementation is unanimously supported by all three surgeons for musculoskeletal health.
So, do orthopaedic surgeons run? Yes — and not in spite of our knowledge, but because of it.
We run with insight. With caution where needed. With attention to form, load, rest, and recovery. And above all, with respect for the remarkable adaptability of the human body. We know joints aren’t fragile. They’re living, dynamic structures — made to move.
Should you run?
It depends — but if three of the UK’s most experienced knee surgeons aren’t scared of running, maybe it’s time to reconsider the old myths.
We’ll explore running injuries and the science of pain in more detail in the next post.
But for now, remember this: your joints are living tissues. They respond to load. The right kind of movement can build them up — not break them down. Let’s run with that.