Knee Pain From Running

Knee pain from running is extremely common. It is not surprising really when forces up to 550% of your body weight can go through the knee when you run.

Sometimes, knee pain from running may be due to an injury sustained while exercising, but this only accounts for approximately 25% of cases.

Running knee pain is usually a chronic (long term) problem caused by overuse from repetitive impact and motion. The pain usually creeps in, gradually getting worse and worse over time.

Here we will look at the causes knee pain from running, what you can do to prevent it and common conditions associated with it. Let's start by looking at why so many people get knee pain when they run.

Knee pain from running is generally caused by a combination of factors that fall into two categories:
a) Training Errors: such as sudden increase in time/intensity of exercise
b) Biomechanical Issues: e.g. flat feet, muscle weakness

A) Training Errors

Poor training technique is a common cause of running knee pain. The most common mistakes people make are:

1) Doing Too Much Too Soon: especially when you first start. It’s very easy to be over enthusiastic!

2) Suddenly Increasing How Much You Do: e.g. distance, time and intensity. This is very common when training for an event/competition

3) Changing Your Running Style: e.g. changing running surface, adding in sprint sessions or moving from flat to sloped surfaces

4) Running Surface: ideally, you want to run on a smooth, soft, level surface. Running on tarmac or cambered roads (one foot ends up being lower than the other) increases your chance of developing knee pain from running

5) Lack of Variety: if running is the only exercise you do, without any stretching, strengthening or other cardiovascular exercise, you are more likely to develop knee pain from running due to muscle imbalance and overuse

B) Biomechanical Problems

Knee pain from running is also often linked to problems with biomechanics, meaning how the different body parts move as we run. Foot position is extremely important but varies greatly from person to person.

People usually fall into one of five categories: 1) normal foot position, 2) flat feet (no visible arch), 3) high arches, 4) over-pronated (foot rolls inwards), 5) over-supinated (foot rolls outwards).

Ideally, when we walk or run, our heel hits the ground and then the weight is transferred to the middle of the foot and then to the toes. If you have poor biomechanics, it alters the way the forces are transferred through the feet and up the leg, making you prone to knee pain.

The most common foot problem is overpronation where the foot arch remains flat and the weight goes through the inside of the foot causing the ankle to roll in as you then push off.

This makes subtle but dramatic changes to how the forces go through the knee, putting more force through the kneecap and the inner side of the joint. If you oversupinate, which is a much less common problem, weight goes through the outer border of the foot.

Muscle weakness and/or tightness also affect the biomechanics throughout the leg and are common causes of running knee pain. For example, weak glutes can reduce your foot arch height.  Visit the knee exercises section to find a whole range of strengthening and stretching exercises.  It may be worth discussing this with your health care professional who can analyse your gait to identify any risk factors. 

To help prevent knee pain from running try the following suggestions:

1) Follow The 10% Rule

If you want to build up your training for whatever reason, it’s important to do it gradually. A good rule of thumb is the 10% rule where you increase your activity by up to 10% a week, be it the length of time you run for or the distance. For example, if you normally run 5 miles at a time, increase to up to 5.5 miles. After at least a week you can then increase by another 10%.

You may find that a 10% increase is too much initally, especially if you are just starting out or are returning to activity after an injury, in which case you might want to work at 5% increases instead. Listen to your body and do what is right for you and you shouldn’t suffer from running knee pain. The 10% rule is a guide, not a mantra!

2) Warm Up & Cool Down

Before and after exercise, make sure you are warming up and cooling down properly. A mixture of stretching, strengthening and cardiovascular exercise really helps to reduce knee pain from running. 

You may be raring to go and warming up and cooling down correctly can seem tedious but it does make a difference and can help to reduce knee pain.

3) Use Good Footwear

Having the right support for your feet helps reduce biomechanical problems which in turn reduces the risk of running knee pain. Remember, everyone’s feet are different so try out lots of pairs of shoes and talk to a footwear expert to make sure the shoes you use have the right support in the right places for you.

Also, remember to change your shoes regularly. Over time, shoes stop providing good support and start to lose their shock absorbing properties. The general advice is to change your shoes after approximately 400-500 miles e.g. if you run 5 miles a day, 5 times a week, you should change your shoes every 3-4 months to prevent knee pain from running.

It can also help to have a couple of pairs of running shoes and alternate them.

4) Avoid Overtraining

This is a particularly common cause of knee pain from running when training for an event/competition. Overtraining is when you exercise beyond your body’s ability to recover. Our bodies need adequate rest and recovery time when we exercise, otherwise performance levels start to decrease.

Warning signs that you might be overtraining include fatigue, mood changes e.g. irritability and depression, decreased appetite, lack of enthusiasm for exercise, headaches, general aches and pains, drop in performance and insomnia.

5) Wear a Knee Support

Ideally, if you have nice strong, flexible muscles, you shouldn’t need to wear a knee support when you run. But if you are getting knee pain from running, you might find a brace really helpful.

If you do feel the need to wear a knee brace to try and reduce pain when you run, I would recommend wearing one that has a hole at the front for the kneecap, as it provides support without putting pressure through the patella. Visit the knee brace section for help finding the right brace for you.

6) Vary Your Exercise

Running is a great way to keep fit, but if running is the only exercise you do, you are missing out. Ideally, you should do different types of exercise to work different muscle groups in different ways.

By doing a range of exercises, you will develop great overall strength (in your muscles, bones and cardiovascular system), flexibility, power, endurance, fitness, balance and co-ordination, as well as losing weight! Good things to do as well as running include swimming, cycling, rowing, pilates, ball sports and strength training.

7) Use Ice

When used correctly, ice packs can help to reduce inflammation and knee pain from running. They can be particularly useful if you are getting pain after running.

Visit the ice therapy section to find out how to use it safely and effectively and the ice wraps section for the best ways to apply ice.

Most cases of knee pain from running are due to one of the following five conditions. You can find out more about each one including symptoms, diagnosis, treatment and prevention strategies by clicking on the links.

1) Runners Knee

This is the most common cause of knee pain from running and is another name for patellofemoral pain syndrome or anterior knee pain – they all mean the same thing. Essentially, it is a problem with how the kneecap moves (known as patellar maltracking).  

It causes an ill-defined ache around the front of the joint, which is often worse with prolonged activity, coming down stairs or after sitting for long periods. Visit the Runners Knee section to find out more.

2) Iliotibial Band Syndrome (ITBS)

When people complain of outer knee pain from running, it is usually due to ITBS. This is when there is tightness in the structures on the outside of the knee which cause friction and inflammation.

The typical symptoms of ITBS are lateral joint pain, swelling and sometimes a popping/snapping sensation.  Visit the ITB Syndrome section to find out more.

3) Jumpers Knee

This is the common name for patellar tendonitis. It is caused by tiny tears and resultant irritation in the patellar tendon from overuse. The patellar tendon sits just below the front of the knee between the kneecap and the shin bone.

The tendon is usually tender to touch, and there is aching, stiffness and knee pain after running or other activities and first thing in the morning. Visit the Jumpers Knee section to find out more.

4) Hamstring Tendinopathy

Inflammation of the hamstring tendons at the back of the leg is the most common cause of posterior knee pain from running, especially when runners do lots of sprint work.

Overuse and friction on the tendons lead to inflammation and degeneration which causes pain. It commonly causes pain when you bend the leg and stiffness, and is usually caused by hamstring tightness – see the hamstring stretches page.

5) Bursitis

Around the knee are a number of bursa, small fluid filled sacs that sit between bones and tendons to prevent friction. These can get irritated from repetitive actions such as running which leads to inflammation and pain.

The symptoms will vary depending on which bursa is affected but typically include pain, swelling and limited knee movement – see the bursitis section for more info. 

If none of these are sounding like your problem, visit the diagnosis section for help working out what is causing your pain. If your pain started as the result of an injury, visit the common knee injuries section.

If you want to do some strengthening or stretching exercises to supplement your running, visit the exercise guide to find the right exercises for you.

Remember, if you are suffering from a new incidence of pain, always consult your doctor.

You can find out more about these common causes of knee pain from running by visiting the relevant sections, just click on the link.

1. Knee Pain Guide
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2. Symptoms
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3. Knee Pain Running

Page Last Updated: 14/9/18
Next Review Due: 14/9/20