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When I took up running in college, a friend of mine scoffed at the idea. He hated running and was convinced runners were “wearing out” their joints. He liked to say he was saving his knees for his old age.

So, was he onto something? Does running really ruin your joints, as many people believe?

Runners can get arthritis, but is running the cause?

You may think the answer is obvious. Surely, years of running (pounding pavements, or even softer surfaces) could wear out your joints, much like tires wear out after you put enough miles on them. And osteoarthritis, the most common type of arthritis, usually affects older adults. In fact, it’s often described as age-related and degenerative. That sounds like a wear-and-tear sort of situation, right?

Maybe not. Sure, it’s easy to blame running when a person who runs regularly develops arthritis. But that blame may be misguided. The questions to ask are:

• Does running damage the joints and lead to arthritis?
• Does arthritis develop first and become more noticeable while running?
• Is the connection more complicated? Perhaps there’s no connection between running and arthritis for most people. But maybe those destined to develop arthritis (due to their genes, for example) get it sooner if they take up running.

Extensive research over the last several decades has investigated these questions. While the answers are still not entirely clear, we’re moving closer.

What is the relationship between running and arthritis?

Mounting evidence suggests that that running does not cause osteoarthritis, or any other joint disease.

• A study published in 2017 found that recreational runners had lower rates of hip and knee osteoarthritis (3.5%) compared with competitive runners (13.3%) and nonrunners (10.2%).
• According to a 2018 study, the rate of hip or knee arthritis among 675 marathon runners was half the rate expected within the US population.
• A 2022 analysis of 24 studies found no evidence of significant harm to the cartilage lining the knee joints on MRIs taken just after running.

These are just a few of the published medical studies on the subject. Overall, research suggests that running is an unlikely cause of arthritis — and might even be protective.

Why is it hard to study running and arthritis?

• Osteoarthritis takes many years to develop. Convincing research would require a long time, perhaps a decade or more.
• It’s impossible to perform an ideal study. The most powerful type of research study is a double-blind, randomized, controlled trial. Participants in these studies are assigned to a treatment group (perhaps taking a new drug) or a control group (often taking a placebo). Double-blind means neither researchers nor participants know which people are in the treatment group and which people are getting a placebo. When the treatment being studied is running, there’s no way to conduct this kind of trial.
• Beware the confounders. A confounder is a factor or variable you can’t account for in a study. There may be important differences between people who run and those who don’t that have nothing to do with running. For example, runners may follow a healthier diet, maintain a healthier weight, or smoke less than nonrunners. They may differ with respect to how their joints are aligned, the strength of their ligaments, or genes that direct development of the musculoskeletal system. These factors could affect the risk of arthritis and make study results hard to interpret clearly. In fact, they may explain why some studies find that running is protective.
• The effect of running may vary between people. For example, it’s possible, though not proven, that people with obesity who run regularly are at increased risk of arthritis due to the stress of excess weight on the joints.

The bottom line

Trends in recent research suggest that running does not wear out your joints. That should be reassuring for those of us who enjoy running. And if you don’t like to run, that’s fine: try to find forms of exercise that you enjoy more. Just don’t base your decision — or excuse — for not running on the idea that it will ruin your joints.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Headaches are very common in children and teens. In fact, more than half will suffer from headaches at some point, and by 18 years the majority of adolescents have had them. And while most headaches are part of a viral illness, some are migraines. In fact, recurring migraines affect as many as one in 10 children and teens overall.  

What should you know — and do — if you think your child or teen may be having migraines?

How early do migraines start to occur?

We don’t tend to think about migraines in children, but by age 10, one in 20 children has had a migraine. And migraines sometimes occur even earlier.

Before puberty, boys and girls are equally likely to have them. After puberty, migraines are more common in girls.

Which migraine symptoms are most common in children?

Migraines are often one-sided in adults. In children they are more likely to be felt on both sides of the head, either in both temples or both sides of the forehead.

While it’s not always easy to tell a migraine from another kind of headache, children

• often report throbbing pain
• may experience nausea and sensitivity to light and noise.

The flashing lights and other vision changes people often see as a migraine begins are less common in children. However, parents may notice that their child is more tired, irritable, or pale before a migraine begins — and takes a while to get back to normal after it ends.

What causes migraines in children?

We don’t know exactly what causes migraines. We used to think it had to do with blood flow to the brain, but that does not seem to be the case. It appears that migraines are caused by the nerves being more sensitive, and more reactive to stimulation. That stimulation could be stress, fatigue, hunger, almost anything.

Migraines run in families. In fact, most migraine sufferers have someone in the family who gets migraines too.

Can migraines be prevented?

The best way to prevent migraines is to identify and avoid triggers. The triggers are different in each person, which is why it’s a good idea to keep a headache diary.

When your child gets a headache, write down what was happening before the headache, how badly it hurt and where, what helped, and anything else about it you can think of. This helps you and your doctor see patterns that can help you understand your child’s particular triggers.

It’s a good idea to make sure your child gets enough sleep, eats regularly and healthfully, drinks water regularly, gets exercise, and manages stress. Doing this not only helps prevent migraines, but is also good for overall health!

How can you help your child ease a migraine?

When a migraine strikes, sometimes just lying down in a dark, quiet room with a cool cloth on the forehead is enough. If it’s not, ibuprofen or acetaminophen can be helpful; your doctor can tell you the best dose for your child.

It’s important not to give your child these medications more than about 14 days a month, as giving them more often can lead to rebound headaches and make everything worse!

Are there prescription medicines that can help children with migraines?

If those approaches aren’t enough, a class of medications called triptans can be helpful in stopping migraines in children ages 6 and up.

If a child experiences frequent or severe migraines, leading to missed days of school or otherwise interfering with life, doctors often use medications to prevent migraines. There are a number of different kinds, and your doctor can advise you on what would be best for your child.

Some girls get migraines around the time of their period. If that happens frequently, sometimes taking a prevention medicine around the time of menses each month can be helpful.

When to contact your doctor

If you think your child might be having migraines, you should call and make an appointment. Bring the headache diary with you. Your doctor will ask a bunch of questions, do a physical examination, and make a diagnosis. Together you can come up with the best plan for your child.

You should always call your doctor, or go to an emergency room, if your child has a severe headache, a stiff neck, trouble with coordination or movement, is abnormally sleepy, or isn’t talking or behaving normally.

The American Academy of Pediatrics has additional useful information about migraines, and how to treat and prevent them, on their website.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Most people want to age in place and live at home for as long as possible: according to an AARP survey, three-quarters of people 50 and older are hoping to do so.

But managing this successfully may mean hiring outside help, such as health aides who can assist you with daily activities that have become challenging. You might wonder when exactly it will make sense to seek that service. How will you know when it’s time? What can aides do for you? What are the costs and how can you make the most of their help?

Is it time to hire in-home help?

An easy way to know if it’s time for outside help is if your health takes a sudden turn for the worse — perhaps as the result of a fall that affects your mobility. But more often, the need for professional assistance at home isn’t so obvious. It develops gradually, as certain abilities — such as cooking, cleaning, or driving — become more difficult.

Even if you’re busy, happy, and able to do your own tasks and errands now, there may come a time when the balance shifts and daily activities become challenging.

“A lot of times these observations are made by family members or friends, and they start the discussion about getting help,” says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center.

Start here: Ask yourself hard questions

You don’t have to wait until family and friends urge you to get outside help. Dr. Salamon recommends that you periodically assess your abilities and how well you’re managing on your own.

For example:

• Is it harder to get in and out of the bathtub because of muscle weakness or balance problems?
• Has driving become difficult because of vision changes, arthritis, or other reasons?
• Are you keeping up with your medication regimen, or are you sometimes not sure if you’ve taken pills?
• Are cooking and cleaning becoming much more of a chore than they used to be?
• Do you find grocery shopping or errands a little overwhelming?
• Do you need help bathing or getting dressed?

Be honest about the answers, and let your needs be your guide. “You might not need a home health aide yet. Maybe you only need a cleaning service to come in every other week,” Dr. Salamon says. “But if you need more assistance, it’s probably time to hire health aides.

What do health aides do?

Health aides are professional caregivers. There are two main types of aides.

• A certified nursing assistant (CNA): This is a trained, licensed professional who can provide hands-on physical care, such as helping you get up and down from a chair or bed, bathing, dressing, feeding, brushing teeth, and using the bathroom. A CNA can also perform homemaker services, such as cooking, light housework, transportation, shopping, overseeing medication routines, or sharing meaningful activities or conversation.
• A companion: This is a registered professional who can provide homemaker services but is not trained in body mechanics and cannot provide hands-on care.

The best place to find aides is through a private duty care agency, which vets and employs the aides, and takes care of their taxes and social security withholdings.

How can you find a reliable private duty care company, and what questions should you ask? Dr. Salamon suggests asking for recommendations from friends, your doctor, local senior services, or your local Area Agency on Aging.

How much does hiring health aides cost?

Private duty care is expensive. Costs average $25 to $30 per hour, typically with a three-to-four-hour minimum per week.

Those fees add up quickly. For example, if you need help two days per week for three hours per day, you’ll pay about $600 to $720 per month.

Costs are not typically covered by Medicare, but they are often covered by Veterans benefits. And they are sometimes covered fully or partially by long-term care insurance, state or local agencies on aging, or nonprofit groups.

What might hold you back from getting help you need?

Cost is a factor, of course. Even if it isn’t, you might not jump at the chance to hire home health aides. It could be that you feel you don’t need them yet, or that you’d be uncomfortable with strangers in your home.

But the sooner you can become accustomed to having professionals assist you with parts of your care as they become challenging, the better prepared you’ll be later, when you might require much more assistance. Trying services now can set you up with contacts — and caring people — you might need to lean on more often as time goes by.

How can you get over your reluctance? “Remember that you don’t have to commit to private duty care forever. Just try it for a few hours once a week. If it doesn’t go well, consider alternatives, such as eventually moving into assisted living,” Dr. Salamon says.

How far can a few hours of in-home help go?

What can an aide accomplish if you start out with just a few hours per week? Plenty.

You might want to set up a regular routine that includes doing laundry, changing bed linens, going on a walk with you, and making a large meal that can be frozen into smaller portions. Or you might want to focus on a theme for each once-a-week visit. For example, the aide can help you do errands one week, do some light house cleaning the next week, and help you cook the week after that.

“This is your opportunity to get the help you need, whether it’s with jobs around the house or basic activities of daily living,” Dr. Salamon says. “In the long run, it’s the kind of service that will keep you living on your own longer.”

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Part 1 of a two-part series on making decisions about driving as we age. Read Part 2 here. 

When my grandmother repeatedly clipped the mailbox backing out of her driveway, she always had a ready explanation: "the sun was in my eyes" or "your grandfather distracted me." Our family knew we needed to take action. But no one wanted to be the one to ask her to stop driving. She was fiercely independent, didn't agree that her driving was a problem, and didn't appreciate our concerns.

Maybe there's a similar story unfolding in your family. Or maybe you're starting to wonder about your own skills. As part one in a two-part series, this post aims to help people understand red flags to watch for, and why driving abilities change as people age. It also describes a few ways to improve impaired driving, and challenges to navigate.

A second post will address ways to strike a balance that respects dignity — and safety — while providing action plans for older drivers and their families.

How safe are older drivers on the road?

Unsafe drivers can be any age, particularly when drinking is involved. But fatal traffic accidents have risen in both young drivers and older drivers, according to data from the National Safety Council:

• Fatalities occurring in crashes involving a driver ages 15 to 20 rose nearly 10% between 2020 and 2021, accounting for 5,565 deaths.
• Among drivers 65 or older, fatalities rose 15% between 2020 and 2021, accounting for more than 8,200 deaths.

While younger drivers may be inexperienced or more likely to be distracted or reckless, older drivers often overestimate their driving abilities. That may be one reason many unsafe older drivers continue to drive despite failing driving skills.

Per mile driven, the rate of motor vehicle accidents is higher for drivers ages 80 and older than for almost every other age group, according to the Insurance Institute for Highway Safety. Only the youngest drivers have higher rates. And the rate of fatal motor vehicle accidents per mile driven is higher for drivers aged 85 and older than for every other age group.

These statistics reflect the reality that an older driver may not be the only one injured or killed in a crash — occupants in one or more vehicles may be, too. And then there are pedestrians and cyclists at risk.

Clearly, the stakes are high when any unsafe driver is on the road. For older drivers with waning driving skills, it's important to recognize the problem and understand why it's happening. The following four steps are a good start.

1. Seeing any red flags?

As people get older, driving skills may decline so slowly that it's not obvious worrisome changes are happening. Even when mishaps and near-misses occur, there are so many possible contributors — especially other drivers — that it may not be clear that the older driver was at fault.

Red flags that might mean an older person is an unsafe driver include:

• concerned comments from family or friends
• reluctance of others to ride with them
• input from other drivers (why is everyone honking at me?) or traffic authorities (why am I getting all these traffic tickets?)
• getting lost on familiar roads
• consistently driving too slowly or too fast
• unexplained dents or scratches appearing on the car
• frequent accidents or near-misses.

2. Why do driving skills tend to wane with age?

While people of advanced age can safely drive (and many do!), driving skills may wane due to:

• medical conditions, such as arthritis, neuropathy, or dementia
• medications, such as sedatives or certain antidepressants
• age-related changes in reaction time
• trouble with vision or hearing
• other physical changes related to aging, such as less flexibility or strength
• difficulty processing rapidly changing information. For example, an older driver may be more likely than a younger driver to accidentally press the gas pedal instead of the brake when needing to stop suddenly.

3. What can — and can't — be reversed to improve driving?

Some changes that impair driving can be reversed or a workaround can be found. For example, if driving is impaired due to cataracts, cataract surgery can restore vision and improve driving. If night driving is difficult, it's best to drive only during the day. If memory problems are starting to arise, it may still be possible to drive safely in more limited circumstances.

Driving problems due to advanced dementia or a major stroke affecting judgment and physical skills are much less likely to improve.

4. Accept that conversations about not driving are challenging

If there is no simple way to reverse or work around declining driving skills, accept that there will be many challenges to navigate, whether you're the older driver or a family member.

Challenges facing the driver:

• It's not easy to acknowledge declining function. Driving impairment is an unsettling milestone, an indication that the future may include further loss of abilities.
• It can feel unnecessary and unreasonable. Most older folks facing a decision about whether it's safe to continue driving were good drivers not so long ago. They may still see themselves as competent drivers, and see efforts to restrict their driving as overly cautious or demeaning.
• Denial and defensiveness are common. Even when all the signs are there, it may be tempting for a poor driver to deflect blame (for example, blaming other drivers).
• Not driving is a loss of independence. Sure, there are other ways to get around and nondrivers can certainly be independent. But few alternatives rival the independence that comes with being able to drive yourself. And, depending on where you live, public transportation or other alternatives to driving may be limited.

Challenges facing the family:

• Often, the older driver doesn't share their family's concerns about driving safety. This can lead to arguments, confrontation, and resentment.
• The safety of others is at stake. The older driver with waning skills may endanger many people besides themselves: passengers in their care, other drivers and their passengers, cyclists, and pedestrians.
• It's hard to know when the time is right. Speaking up too soon may lead to unnecessary restrictions on a loved one's favored means of transportation, not to mention family strife. Waiting too long can lead to avoidable tragedy.

Finding a path forward

As for my grandmother, none of us knew what to say. Should we try to get her to agree to stop driving entirely or let her ease into the idea over time? Maybe she could stop driving at night or limit her driving to short distances. Should we bring it to the attention of her doctor and let them direct the next steps? Or should we take an even harder step and report her to the authorities?

If you're asking similar questions — or if you're starting to wonder about your own driving abilities — you may feel strongly that it's important to respect individual preferences, dignity, and independence. Yet you also want to protect everyone from harm.

What are the best ways to strike a balance? Can you test and improve how an older driver is doing behind the wheel? Can you navigate tough conversations in ways that allow room for both independence and safety? These are the subjects to be tackled in Part 2.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD