Dr. Bernard Lee on Knee Pain in Runners — As Published in The Straits Times

If your knees hurt when you run, stopping may not be the answer

Knee pain is one of the most common reasons runners in Singapore scale back or quit their routine. The instinct — stop, rest, hope it goes away — is understandable. But for many runners, it is the wrong call.

In May 2016, Dr. Bernard Lee Mun Kam, Consultant Pain Specialist of Singapore Paincare Center, contributed a clinical column to The Straits Times. It appeared in the DocTalk series of the Mind & Body section on Tuesday, 24 May 2016, under the headline “When Running Wears Out the Knees.“

DocTalk is a column in The Straits Times where specialist doctors write directly for the public — explaining real patient cases, walking through diagnosis and treatment, and making complex clinical decisions accessible to everyday readers. Dr. Bernard Lee wrote this piece in his own name, drawing on his clinical experience treating joint pain and musculoskeletal conditions at Singapore Paincare Center.

The case he described was a 45-year-old avid jogger, Ms Lee who had been running almost every day for five years. Her story is one many active Singaporeans will recognise.

The Case Dr. Bernard Lee Wrote About

Ms Lee had been jogging regularly for five years when her knees started to hurt. At first it was manageable. Then walking up and down stairs became painful. Getting up from a chair was a struggle. She stopped exercising altogether.

Her GP prescribed anti-inflammatory painkillers and supplements. She was given glucosamine and chondroitin, tried knee braces, tried infrared lamps. Three months passed with little improvement.

A specialist examination and X-ray of both knees led to a diagnosis of osteoarthritis — a chronic condition in which the cartilage lining the joint breaks down, eventually exposing the bone beneath. She was told she needed total knee replacement surgery.

She wanted to know if there was another way. And whether she would ever jog again.

What Dr. Bernard Lee Shared in The Straits Times

Writing in the DocTalk column, Dr. Bernard Lee used Ms Lee’s case to explain how knee problems develop in joggers — from early overuse injury through to late-stage osteoarthritis — and the range of treatment options available at each stage.

On why joggers wear out their knees faster

The meniscus is the cartilage cup that holds the two moving parts of the knee together and absorbs impact with every stride. Joggers put this structure under repeated stress. Dr. Bernard Lee noted that serious, competitive joggers tend to wear out their knee joints earlier than non-joggers — a 30-year-old regular jogger may have the knee cartilage of a 60-year-old non-jogger. The damage accumulates quietly, over years, before pain becomes obvious.

On why early treatment matters

Once cartilage degeneration reaches a moderate or late stage, it may be irreversible. The inflammatory and wear-and-tear process can continue even after pain is managed. This is why Dr. Bernard Lee’s article emphasised that knee pain in runners should not be dismissed as ordinary soreness. The earlier the cause is identified and addressed, the more options remain on the table.

On glucosamine — what the evidence actually shows

Supplements such as glucosamine are widely used in Singapore for knee conditions. Dr. Bernard Lee noted that studies suggest roughly 35 per cent of patients taking 1,500mg of glucosamine sulphate daily may see benefits for cartilage regeneration — but around 60 per cent of the general population may have no meaningful response. Supplements may play a supporting role, but they are not a substitute for proper diagnosis and targeted treatment.

On the knee pain treatment that turned things around for Ms Lee

Ms Lee had moderately severe arthritis and a medial meniscal tear. Rather than proceeding to knee replacement surgery, she opted for a minimally invasive outpatient procedure — an injection of artificial gel and platelet-rich plasma (PRP) directly into the affected knee joint and meniscal tear.

PRP uses the patient’s own platelets, concentrated from their blood, to stimulate the body’s natural healing response. The procedure was done bedside, under local anaesthesia. Her pain improved dramatically within minutes of the injection. There was no hospital stay. Three days later, she was doing brisk walking and swimming.

She was advised to move away from competitive jogging going forward — sustained high-impact activity on a joint with established cartilage loss carries ongoing risk — but she had her mobility back, and her quality of life with it.

On staying active when the knee is compromised

For patients with moderate to severe osteoarthritis, Dr. Bernard Lee noted that the knee still needs regular movement to circulate joint fluid and prevent stiffness. The answer is not to stop moving — it is to move differently. Swimming, aqua aerobics, hydrotherapy, and cycling are all low-impact options that keep the joint active without the repetitive loading of running.

About Dr. Bernard Lee Mun Kam (李文鉴医生)

Dr. Bernard Lee Mun Kam is the Founder and CEO of Singapore Paincare Holdings Limited and a Consultant Pain Specialist at Singapore Paincare Center. He has over 20 years of clinical experience in pain management.

His career includes two landmark institutional appointments: he established the Chronic and Interventional Pain Management Service at Tan Tock Seng Hospital (2002–2007), serving as Director of the Pain Management Unit in the Department of Anaesthesia, and he founded Singapore’s first Women’s Pain Centre at KK Women’s and Children’s Hospital (2009–2018).

Dr. Bernard Lee developed the Painostic® methodology — Singapore Paincare’s proprietary diagnostic framework that evaluates pain across four dimensions: patterns, pathology, perception, and psychology. This approach moves beyond imaging to identify the true source of chronic pain and guide more personalised treatment.

He also founded the Singapore Paincare Academy, a training institute for allied health professionals, and led the group’s listing on the Singapore Exchange (SGX) in 2020 — making Singapore Paincare the first publicly listed pain management group in Singapore.

His clinical specialties include spine and back pain, shoulder pain, nerve pain, joint pain, headache and facial pain, musculoskeletal conditions, and cancer pain.

Frequently Asked Questions About Knee Pain in Runners

Why do my knees hurt when I run, even though I’ve been running for years?

Knee pain in long-term runners often develops from cumulative cartilage wear rather than a single injury. The meniscus and joint cartilage absorb impact with every stride, and over years of high-mileage or high-intensity running, this wear can outpace the joint’s ability to repair itself. Pain that builds gradually over months — rather than after one specific incident — usually signals that the underlying structure needs assessment, not just rest.

Is it safe to keep running if my knees hurt?

It depends on the cause. Some runners can continue with modified training while the underlying issue is being treated. Others need a temporary break from high-impact activity. Stopping altogether without investigating the cause is rarely the right answer — the goal is to identify what is causing the pain and address it, so you can return to an active lifestyle. A pain specialist can advise based on a proper examination and imaging where appropriate.

What is the difference between runner’s knee and knee osteoarthritis?

Runner’s knee (patellofemoral pain syndrome) refers to irritation or softening of the cartilage beneath the kneecap, usually from overuse or misalignment. It is common in younger active runners and often manageable with conservative treatment. Knee osteoarthritis is a degenerative condition where joint cartilage gradually breaks down over years — more common from middle age onwards. The two conditions can occur together and share similar symptoms, which is why proper assessment is important.

What are the non-surgical treatment options for knee osteoarthritis in Singapore?

Options may include physiotherapy, strengthening exercises, anti-inflammatory medication, and minimally invasive procedures such as intra-articular injections. These injections can deliver hyaluronic acid to lubricate the joint, corticosteroids to reduce inflammation, or platelet-rich plasma (PRP) to stimulate healing. They are typically outpatient procedures with minimal downtime. Whether any option is appropriate depends on the individual’s diagnosis and the stage of the condition.

What is PRP therapy for the knee and how does it work?

Platelet-rich plasma (PRP) therapy involves drawing a small amount of the patient’s own blood, concentrating the platelets, and injecting them into the affected joint or tissue. Platelets contain growth factors that can stimulate repair and reduce inflammation. For knee conditions such as meniscal tears and moderate osteoarthritis, PRP may support healing and provide pain relief. It is performed as an outpatient procedure under local anaesthesia, with minimal downtime. Results vary and PRP is usually part of a broader treatment plan.

When should a runner with knee pain see a pain specialist rather than waiting it out?

If knee pain persists for more than three weeks despite rest, or if it is affecting daily activities such as stair-climbing or getting up from a chair, or if conservative management has not helped, a specialist assessment is worth seeking. A pain specialist evaluates not just the joint structure but the full pain mechanism — including nerve involvement — and can offer a broader range of options, including minimally invasive procedures.

Read the Original Article

This blog post is based on Dr. Bernard Lee Mun Kam’s contribution to the DocTalk column in The Straits Times, published on Tuesday, 24 May 2016 (Section B10, Mind & Body), under the headline “When Running Wears Out the Knees.”

The original article is available at:
https://www.straitstimes.com/singapore/health/when-running-wears-out-the-knees

Book a Consultation at Singapore Paincare Center

If knee pain is limiting your running — or your daily life — a proper diagnosis is the first step. At Singapore Paincare Center, our pain specialists use the Painostic® methodology to assess the full picture of your pain and recommend the most appropriate path to treatment.