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Why Do I Have Knee Pain with Running?

Knee pain is the most common complaint in runners. We can attest to this statistic, both as runners and physical therapists. We see a lot of runners with knee pain! When I was training for a few half marathons early on in my running career, I also experienced knee pain. It can be pretty annoying, especially if you’re trying to train for a race! Nobody has time for pain!

The most common contributing factors to knee pain with running include changes in training volume or strength deficits and imbalances. We’ll touch on both of these, as well as how you can solve your knee pain with running.

Types of Knee Pain with Running

There are a few different causes of knee pain in runners, depending on where your pain is located. The top three are pain under or around the kneecap (AKA patellofemoral pain), patellar tendonitis, and IT band syndrome.

When your pain feels like it is under or around your kneecap, this is called patellofemoral pain. One of the main contributing factors to this type of pain is weak quads. Weak arches or flat feet can also play a role in this type of knee pain.

If your pain is localized to your patellar tendon, you may have patellar tendonitis. The main contributing factor is weakness in your quads. Strengthening your hips and calf is also important to decrease this type of pain, as these muscles play a major role in shock absorption during running.

The third type of knee pain with running is IT band syndrome. Pain with this is more localized to the outside of the knee. Contributing factors to this type of pain include weakness in your hip abductors (outer hip muscles) and weakness in the quads.

Solve Your Knee Pain with Running

As you can see, hip, calf, and quad strengthening is vital to solving pretty much all types of knee pain with running. If your primary source of exercise is running and there isn’t a strength component to your routine, we recommend adding that to your plan. When primarily participating in an endurance activity like running, you should also be performing 15+ reps of strengthening exercises. We have a few different strength exercises you can incorporate a few days a week to address these areas.

Check out the video below for a great example of quad strengthening for runners.

Here is a good (and tough!) exercise to strengthen your hip abductors.

Since your calf muscles play a big role in shock absorption, strengthening the calf can take some pressure off the knees when your foot makes contact with the ground. Perform this next exercise with both your knee straight and your knee bent to work on a few different calf muscles.

Training Errors

Knee pain with running can also be due to training errors. You may develop knee pain if you are running too much, too fast, or making changes in your training too quickly. There needs to be a healthy balance of variability in running, rest, and load. Generally, you do not want to increase your weekly mileage by more than 10%. Training speed can also affect how your knees feel. You should be spending most of your training time running slower than your race pace.

Alter Cadence to Decrease Knee Pain with Running

As you work on improving your quad, hip, and calf strength, you most likely still want to run! Increasing your cadence is a quick change you can make to decrease your knee pain with running. Cadence is the number of steps you take per minute. In order to increase your cadence, you will decrease your stride length and take quicker steps. This will decrease the impact and force that goes up though your joints when your foot strikes the ground. Your knees will be much happier on your next run!

If incorporating strength exercises into your routine, playing with your running program or adjusting your cadence doesn’t seem to change the pain you are experiencing, we would be happy to take a more in-depth look at what is going on. Feel free to reach out to us with any questions!

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