Knee pain is the bain of lots of runner’s lives, and so, it’s pretty common we get asked for help with knee pain when running.
What causes knee pain when running?
Quite a lot of things is the unfortunate answer. It could be the shoes you’re running it. It may be that you’ve increased how far or fast you’re running a bit too quickly. You could have twisted your knee. You may have weak glutes (bottom muscles) or quads (thigh muscles) which means too much pressure, or unusual pressure is going through certain structures.
With so many things potentially causing pain when you run, it’s not unusual for it to just keep happening, which is why we see so much of it in clinic. The good thing, is that it’s usually relatively easy for us to work out which of these things is causing the problem and how to fix it. So if your knee is hurting when you run, I would suggest seeing someone about it. There are plenty of problems that people can very successfully treat themselves, but this is a tricky one.
The most common reason for knee pain when running we see in clinic
Probably the most common reason we see in our clinics for runners to have knee pains, are biomechanical issues. What this means is that somewhere in the bits of the body involved in running, something is a little weak, tight, mobile, not mobile enough etc which is affecting how you move. These issues aren’t a problem when you do a movement once, or run a very short distance usually. However, the problems come from repetition. Doing the same movement over and over. Ie running!
If something is a little tight, the body is very capable of coping with that for a while. But when the same movement is done hundreds or thousands of times as it will be when you’re running, it becomes a problem. It starts as a little irritation that slowly builds until it becomes a mild niggle. That grows to become a pain.
So, although there are a lot of different reasons for knee pain when you run, here are our top three biomechanical fixes that have helped a lot of runners in clinic. (Though we’d still suggest you see someone to assess your knee properly if the pain isn’t going away quickly. We know runners hate not to be running!!)
Strengthen (and activate) your glutes
Your glutes (Gluteus muscles: Gluteus maximus, medius and minimus) are hugely important in stabilising your pelvis and controlling how your legs move when you’re running. That means if they’re not working quite as they should, they won’t be doing their job as well as they could. And that often leads to unusual or more pressure going through structures around your foot, ankle, knee and hip.
There are lots of different glute strengthening exercises. For simplicity (therefore making it more likely you’ll do them consistently) we often recommend the “clam” exercise. It is simple, but done well, it can work well to strengthen and activate (more on that in a moment) your glutes, particularly gluteus medius which is the most important for runners).
The clam
Starting position: Lie on your side with your knees bent to 90 degrees and your hips bent to 45 degrees.
Action: Lift your top knee off the bottom knee, while keeping your heels together and your pelvis and lower back steady. Return to the starting position.
Key points: Ensure you do not roll your hips backwards to compensate as you perform the movement.
Repeat 10 times then move straight onto the Clam level two…
Start position: Lie on your side with your knees bent to 90 degrees and your hips bent to 45 degrees. Keeping both feet together, lift your feet off the ground, while maintaining your bottom knee in contact with the floor.
Action: Lift your top knee off the bottom knee, while keeping your feet off the ground, your heels together, and your pelvis and lower back steady. Return to the starting position and repeat for the required number of repetitions.
Key points: Ensure you do not roll your hips backwards to compensate as you perform the movement.
Repeat 10 times. Then roll onto the other side and do both exercises, before rolling back onto the original side, and doing both exercises again, before finally repeating on the other side.
So you’ll do two lots of each of the exercises on both sides. Don’t stop between the exercises to rest. Just keep going. Most people feel it working very hard by the end!
Activate
As well as strengthening, we need to activate the glutes before a run. For a lot of us, our glutes have got lazy because we spend a lot of time sitting, where they don’t really need to do much. Activating them before a run basically just reminds the body to use them when we’re running.
So, do your clams, as above, each day. But we’d suggest doing one set of each of those exercises on both sides, just before you run to wake the glutes up and get them firing. Then when you’re on the run, the body is more likely to use them!
Bend your knees
Running with bent knees would obviously be ridiculous. However, what we see a lot of the time is that runners don’t bend their knees much as they take each stride forwards.
What I mean is that they don’t lift their feet up much. This conserves energy and is entirely normal, particularly later in a run when tired. However, what that means is that there is a constant and very similar pressure through some structures of the knee for long periods. Ie things don’t get stretched out or moved much as the runner is almost holding their knee stiff.
So we’re not suggesting you bend your knees hugely all the time, or try and pick your feet up really high, but if you feel your knee pain coming on, try doing a few strides on each side where you either exaggerate lifting your knees up, or exaggerate how much you bend them behind you. It’s simple, but often very effective at stopping knee pain in its tracks if it’s the type that comes on when you’ve been running a while.
Widen your gait
Gait is the way in which someone walks, or runs in this instance. A common issue we see with runners who have sore knees, is that their feet land scissoring in front of each other. Again this is particularly true as they get tired later in the run.
The issue with this is that it puts unusual pressure through structures around the knee that cause irritation.
So, we’re not suggesting running like you’ve got a barrel between your knees, but widening your gait slightly can be a huge help if you have knee pain that comes on when you run. Imagine you’re running down a road, you want your feet to just hit either side of the painted line. You don’t want them landing directly on the line.
Try these but don’t just hope!
So strengthening and activating your glutes, bending your knees from time to time and widening your gait slightly can help. They helped me stop my knee pain when I was training for a marathon. However, as I said, there are lots of reasons for knee pain when running, so if your pain isn’t getting better, please see someone to assess it properly.
We all know that a runner who isn’t running is an unhappy runner, and hoping for the best with knee pain when running, is likely to result in you having to stop running for a period of time. So give these bits a go, but see someone sooner rather than later if the pain isn’t going away.
Need more help?
If you need more help with your knee so you can run pain-free, and you’re close to one of our clinics, please do get in touch with your nearest True Physio clinic so we can discuss your problem and see how best we can help you.
Runners often put off seeing a Physio because they don’t want to be told to stop running. This is the last resort for us, and if, on the rare occasion we do tell you to stop running completely, we will have a plan and timescales for getting you back to it as quickly as possible.
