Ask The Expert

Knee Pain While Running (Causes and Expert Tips)

We asked a selected group of running and fitness experts for their take on some of the causes and prevention tips for knee pain while running

Knee Pain While Running
(Photo: Adobe Stock)

Knee pain while running is a common issue that can rear its head and cause problems for runners of all abilities at one point or another.

We all know that running is a brilliant form of exercise that can benefit our health in lots of ways. But it can also present some risks when it comes to common injuries and ailments.

So, what are some of the causes of knee pain while running and what can be done to prevent and minimise it?

We asked a selected group of running and fitness experts for their thoughts – and here is what they said.

Editor's note: The content on this website is meant to be informative in nature, but it should not be taken as medical advice. Our articles and the products featured in them are not intended for use as diagnosis, prevention, and/or treatment of health problems. Always speak with a certified medical professional before making any changes to your lifestyle, diet, exercise routine, and/or taking any supplements.

Pinpointing Where The Knee Hurts Can Help You Understand The Issue

Hila Glick, VP of Physical Therapy and Patient Experience at OneStep

It’s hard to tell a runner: If you feel pain, stop running. While that might make sense and help relieve the pain, many runners experience pain before, after or during their run, and feel they just can’t or don’t want to stop.

Knee pain is a general term which includes many possible injuries or problems. It is important to identify where and when the knee hurts to be able to properly understand the issue.

Pain on the outside of the knee that usually comes a few minutes into a run can be a result of Iliotibial band (ITB) syndrome.

Pain under the kneecap that feels worse after running and when walking up or down stairs is most likely Runner’s Knee.

Pain below the kneecap and at the top of the shin, which sharpens during the run itself, is most likely Patellar Tendinitis.

Lastly, pain, swelling and stiffness in the knee during running or even day-to-day activities is most likely Osteoarthritis.

In general, the best advice would be to try and reduce your running load either by running slightly slower or for shorter distances.

Try running on a different surface, wear comfortable running shoes, integrate breaks in between your running routines, think about landing softly, stretch after the run and use a foam roller on your thigh muscles and Iliotibial band.

The good news is that with the help of a physical therapist or general practitioner, recognising the source of the pain can help with creating a recovery strategy to ensure no further or permanent damage is done to the knee joint.

Even better news is that in this day and age of increased digitization, you no longer need to visit a clinic to see a healthcare professional: there is technology in your smartphone that can be harnessed to track your movement while you run or walk, giving you data-backed insights to make your recovery process more efficient and faster.

Running Gait Assessment

(Photo: Adobe Stock)

Knee Pain While Running Can Be Caused By A Number Of Things

Lauren Lobert Frison, Physical Therapist and Owner of APEX Physical Therapy

Knee pain while running can be due to a lot of different things. Where it hurts can help be a clue of what may be going on, but you must remember that it is always best to go see your doctor or physical therapist to get your own specific diagnosis.

If your knee is hurting in the front, just below the knee cap, it is likely patellar tendonitis. This is an irritation of the tendon that helps to straighten your knee. It happens to a lot of people who do repetitive bending / straightening activities (such as running, biking, jumping).

If your knee hurts on the outside, it may be Iliotibial band (ITB) friction syndrome. This means that the large, thick piece of connective tissue that runs from the side of your hip all the way down just past where your knee bends is irritated. This also occurs with lots of repetitive bending and straightening, like in running. This tissue rubs over and over on the side of your knee and can get irritated and cause pain on the outside.

In terms of prevention, it is important to strengthen your hips and thighs. This is often overlooked as people focus on cardio, especially when training for a race.

By strengthening your hips/glutes, this will make your knee more stable and prevent irritation of structures like the ITB. Strengthening your quadriceps and hamstrings will also help allow your body to cushion against the repetitive forces of running and put less stress on your joints and soft tissues.

When you are running, you are on one leg so it is important to do single leg strengthening activities and not just double leg (for example, lunges instead of squats).

Lastly, you cannot overlook your feet! Practice balance on even and uneven surfaces (a pillow for example), with your eyes open and closed.

Strengthen your foot muscles as much as you can and this will help keep everything up the chain more stable and happier! Again, you are on one leg at a time when you are running so it is important to be as strong and stable from the bottom up. This will immensely reduce your risk for pain/injury in your knees and hips as well.

Knee Pain While Running

(Photo: Adobe Stock)

Mobilise Your Hips And Ankles Regularly

Sarah Ruthenburg, Physical Therapist and owner of Evolve Movement Specialists

Knee pain while running can be caused by things such as ITB syndrome (lateral), patellofemoral syndrome (anterior), patellar tendonitis or bursitis (anterior), pes anserine bursitis (medial).

The first and easiest thing to check is your cadence and stride length. Professional runners tend to have a cadence near 180 steps per minute. As a generality, if you are not falling above 160-165 spm, increasing your cadence could lead to big changes in the stress placed on the knee.

To increase cadence, take shorter, quicker steps – your knee should be slightly bent at heel strike and landing underneath your shoulders, rather than far ahead of you. If you listen to music while running, choosing music with a solid beat and speed can help as well.

Mobilise your hips and ankles regularly! Many muscle groups cross both the hip and the knee, or the ankle and the knee. Our hips and ankles are meant to move in many directions. Oftentimes we become stiff in these joints, decreasing efficiency and causing stress to be placed between them – at the knee.

Train your hamstrings and posterior chain and focus on the eccentric portion (where muscle is lengthening) with exercises like single leg RDLs, trap bar deadlifts, single leg bridges.

Be sure you are incorporating slower, easy runs and not running for speed every time. Don’t skip out on your cross-training day, and be sure it includes some light strengthening utilizing muscles in lengthened positions.

While you’re running, pulling up from the ground at the hip and knee with each step can help to decrease stride length and extending too much at the knee at heel strike. Avoid excessive bounce and allow your body to slightly fall forward.

Knee Pain While Running

(Photo: Adobe Stock)

Knee Pain Can Be A Message Telling You That Your Body’s Biomechanics Are Out Of Alignment

Veera Gupta, Certified Sports Chiropractor, Optimum Health Chiropractic

The best way to diagnose knee pain in a runner is to look at their gait while walking and running. Oftentimes, the knee is just the unhappy messenger telling you that the body’s biomechanics are out of alignment.

Once the usual suspects of ACL, PCL, MCL, LCL, and medial and lateral meniscus tears have been ruled out with some very basic orthopedics, the real hunt for the true source of knee pain begins.

The knee is simply the conduit between the ankle and the hip. Without an obvious knee injury, many times the knee is not the source of the problem. If the pelvis is out of alignment even the tiniest bit, it changes the biomechanics of the entire body.

In the lower half of the body, asymmetry is created and can manifest as tight IT bands, hip flexors that don’t fire as well as they should, and knee pain. This is because the pelvis has the hip sockets where the femur bones sit snuggly.

The other end of the femur is half of the knee joint. If left out of alignment for long enough, more biomechanics will compensate and the person could end up with an altered gait, favouring one knee over the other and creating uneven wear and tear on the knees.

In the upper half of the body, arm swing alterations and shoulder and neck tightness may show up. Hip and ankle misalignment, as well as old ankle sprains that have not been rehabbed properly are also common culprits for knee pain.

If the ankle is out of alignment, the normal function of the talus may be altered. The talus is the main bone that connects the ankle with the lower leg and its sliding and gliding properly allows for proper foot flexion. In the stance phase of gait, it dramatically affects support after heel strike.

A seasoned sports Chiropractor will know where bad biomechanics are located by a simple running or gait analysis.

My favorite sneaky tip for runners is to run backwards for a minute or two when the knees start to tighten up. The reason for this is that you switch which muscles are the agonists and antagonists and give the ones you normally use a short break.

Also, when warming up, don’t forget to do sideways motions. We live most of our life going straight and forwards but muscles are designed for other movements too. A little sideways walking and walking backwards can go a long way.

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