If you’ve been suffering from knee pain when running, there are a number of simple (but super-powerful) tips and techniques you can use which will reduce the stress and strain on your knees, and allow you to run without knee pain.
In this article, I’m going show you how to prevent knee pain when running. I’ll share with you ten of the most effective techniques I’ve used with clients to help them overcome Runner’s Knee (Patellofemoral Syndrome) and begin to enjoy your running once again.
Of course, it has to be mentioned that while Patellofemoral Syndrome – the most common type of Runner’s Knee – is the main focus of this article, isn’t the only reason why runners get knee pain. Iliotibial Band Syndrome is another common cause of knee pain in runners, and if your pain is more towards the outside of your knee, be sure to check out this article.
That said, most of the knee pain tips below will help runners with both of these common types of knee pain…
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How can you prevent knee pain when running?
The following running tips will help you to prevent knee pain during and after running. I’m sure they will help you to reduce the stress on your knee joints.
Prepare your knees for running with a proper warm-up
You’ve heard it before, I know. But that’s because it’s true; a good dynamic warm-up before you start running has many benefits, not least that it prepares your muscles and joints, like your knees, for the upcoming demands of running.
Taking the time to preform a simple but effective running warm-up will actually do a few specific things to better protect your knees.
Firstly, the gradual increase in activity will help promote the flow of synovial fluid (think ‘joint lubricant’!) in the patellofemoral joint, where your knee cap (patella) meets the lower femur. These two bones move against one another as you flex and extend your knee, so a smooth interface between the two is important.
Next, by warming-up and activating the important muscles around your hips, your glutes in particular, you’re effectively priming some of the key muscles you need to be doing their jobs so as to provide control, stability and alignment for your knees as you run!
Even something as simple as a few sets of pre-run air squats, as I demonstrate as part of the running warm-up in the video below, will help to activate your glutes for running.
If you’ve been told you need to work on strengthening your glutes for running, you should definitely check out my 12 Week Glute Kickstart Programme.
Pick the correct running shoes for to save your knees
Picking the right pair of running shoes can be really challenging, that’s for sure! However it’s such an important part of you being able to run without knee pain.
Your knees, and the patellofemoral joints in particular thrive on stability and alignment of your knees to be able to function properly, without knee pain as you run. That stability comes from the joints above and below the knees, namely the hips, feet and ankles.
I’ll talk more about hip stability later in this article. However, when it comes to the foot and ankle, the stability provided by the inherent characteristics of your feet and your choice of running shoes will massively influence the way your patellofemoral joint loads as you run.
Because of the repetitive nature of the running gait cycle, small areas of overload around your knees (or anywhere else in your body, for that matter) caused by a bad footwear choice, will build-up over time and potentially cause you knee pain, or another injury.
The best advice I can realistically give you without seeing your feet, is to get yourself to a specialist running store. Not one of the big-box sports outlets, but a proper old school running shop with staff who actually run and geek-out about running shoes.
They’ll be able to look at your running gait and suggest the right amount of support, cushioning, heel-to-toe drop etc… you need in a running shoe to accommodate your individual biomechanics.
If you’re just getting started with running, you might be wondering whether you really need running shoes, or whether the general purpose shoes you wear to the gym would suffice… just save yourself the future pain and invest in some proper running shoes!
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Hit the trails and get off road
Just a moment ago, I mentioned the repetitive nature of running. In fact it’s exactly this type of repetitive pounding that our knees get when running that can cause injuries.
Running is a load-bearing activity, and obviously harder on our knees than swimming or cycling, and that fact isn’t going to change!
But the thing we can change is the repetitive nature of the lading. If you’re only ever running on concrete, pounding the pavements, there won’t be a huge amount variation in the loading your knees experience from stride to stride. However, if you start mixing in other types of less predictable terrain, like trail running, your whole body (knees included) will get much more of a varied workout.
In fact, in my many years of treating injured runners, I’ve met far fewer trail runners with the types of repetitive overuse injuries, like Runner’s Knee, than I have road runners.
Perhaps set yourself a goal of making at least one of your runs each week predominantly off-road?
Increase your running mileage slowly
Patellofemoral pain and Iliotibial Band Syndrome are both overuse injuries, just like most other running injuries. We can talk about the biomechanical factors and importance of running in the correct footwear, but even the strongest, best equipped runner will get injured if they push themselves too hard.
Put simply; if your weekly (or session) running training load outweighs your body’s capacity to recover and repair between runs, you’re setting yourself up for an overuse injury.
Knee pain is a common symptom that runners experience when they begin to do too much running, too soon.
Here’s an article which really explains the importance of training load management in treating Runner’s Knee.
The article linked above proposes a better alternative to the classic 10% rule which is often suggested. But when it comes to progressing your training, one of the mistakes I see runners making is that they embark on a marathon training plan, without doing the preparatory work to get their weekly mileage and long run duration up to a point where starting the marathon plan doesn’t feel like a big jump.
The worst is when people leave it a little later than ideal to start their marathon training plan, and end up “panic training”, effectively trying to make up for lost time, and progressing their long runs and weekly mileage too quickly.
Give your body time to adapt to the demands you place upon it when running!
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Lean forwards slightly as you run
Okay, let’s take a slightly different approach and think about your running technique for a moment.
Researchers looking at patellofemoral joint stress in running have identified that a slight forward trunk lean when running can reduce peak patellofemoral joint stress by more than 10%.
Admittedly, it was a small study with only 24 participants, but it strengthens the concept that how you run will influence the stress and strain that joints and tissues experience as you run. Your running technique matters!
Running with a slight forward lean is certainly something that most elite runners have mastered, and helps to prevent you from over striding, by moving your centre of mass forwards, closer to over your point of initial contact.
Here’s a video I made to help you work on your forward leaning running technique:
Increase your running cadence
Sticking with the topic of running technique; one aspect of how you run that has been researched more thoroughly is running cadence.
Running cadence, or your stride frequency, is simply how many strides per minute you make.
It’s well accepted now that running with shorter, quicker strides for a given pace, is better for your knees than running at the same pace with longer, comparatively slower strides.
An increase in your running cadence as small as 5% can provide enough of a biomechanical change to your running form, that your knees experience quantifiably less loading with each stride.
You can learn more about increasing your running cadence in this article.
One last word on running cadence, before I move on. You’ll often see it suggested that the ideal running cadence is 180 strides per minute, regardless of what type of runner you are, or pace you run at.
I have real issues with this advice, especially when running at an easy long run pace!
Check out this video for a proper explanation for why 180 strides per minute isn’t a one side fits all number for best running cadence…
Protect your knees by not over striding as you run
Both leaning forwards as you run, and increasing your running cadence will help to prevent you from over striding.
What is over striding?
Over striding is when your foot strikes the ground too far ahead of you as you run, effectively increasing the impact and braking forces your body experiences with each running stride.
Your knees will be one of the first places that experience this increased impact and breaking force as you over stride.
Ideally you should be aiming to land your foot beneath your centre of mass as you run, with your foot striking the ground beneath a flexing knee, rather than ahead of a more extended knee.
Don’t worry too much about how your foot strikes the ground (heel strike vs forefoot strike). When we’re looking to prevent Runner’s Knee, it’s more important to address where the foot strikes the ground in relation to the knee and the rest of your body.
I’ve seen it myself many times in the runners that I coach; learning not to over stride is a powerful way of protecting their knees, overcoming the early signs of knee pain, and keeping them running.
It’s been well documented that the easiest way to achieve this is to increase your running cadence, as discussed in the section above!
In my experience, a lot of runners struggle to prevent themselves from over striding in two specific situations:
a) when they get fatigued on the back-end of a long run
b) when they’re trying to lengthen their stride to run faster
The solutions to these two issues?
Well, when you’re feeling yourself beginning to fatigue on a long run, focus on maintaining a good running cadence, and make short-quick strides, rather than plodding along as you get tired.
Without speeding-up your easy running pace, focus on increasing cadence to the point that it feels a little lighter underfoot. Don’t force it though!
If your problem is that you over stride as you try to lengthen your stride and run faster, watch this video…
I’m sure that’ll give you plenty to work on when it comes to improving your running technique to protect you from knee pain when running.
How can you make your knees stronger for running?
Bodyweight exercises like squats and lunges are great for strengthening the major muscle groups around your knees, to make your knees stronger for running. Single leg exercises that work your glutes and challenge your balance will also help to protect your knees.
I can’t believe I’ve made it this far into the article without talking specifically about exercises to strengthen your knees for running.
As I described in the warm up section above, it’s vital to work on stability of the joints above and below the your knees, to allow you to maintain proper knee alignment and control as you run.
That said, you also need to strengthen the muscle groups that cross the knee it self and influence the patellofemoral joint. So we definitely also need to strengthen your quads, hamstrings, adductors and calf muscles!
Here’s a great selection of exercises you can use to strengthen your knees to prevent knee pain when running:
Replace your running shoes regularly
I mentioned the importance of running shoes earlier in this article, and the right pair of running shoes really can help you to prevent knee pain when running.
However, one mistake I see runners making all too often is that they don’t replace their running shoes frequently enough.
As a pair of running shoes begins to clock-up the miles, the degree of support and cushioning that they offer your feel begins to change. You simply won’t get the same support or cushioning from an old pair of running shoes, that you did when they were new.
Many running shoe brands suggest that you replace your running shoes after approximately 500 miles. I’ve always thought that this is a disappointingly short lifespan for a pair of (often expensive) running shoes, but I guess that’s just how they’re made these days!
Practically speaking, I’ve come to understand that some runners are more sensitive to what’s on their feet than others.
In saying that I mean that some runners can seemingly run in all sorts of running shoes, new and old, and never get injured. Others however, seem to almost immediately get injured as soon as they make a slight change to their running shoes.
If you identify as a less “footwear sensitive” type of runner, then you may well get a little more life out of your running shoes.
But if you’ve been suffering with knee pain when running, and your shoes are getting towards (or beyond) that 500 mile mark, it would be worth replacing them.
Fix Your Knee Pain >>
Free Rehab Guide [PDF]
Cool down properly after every run
It makes sense to me to put this point last on the list… but don’t for one second think that this is the least important!
One of the factors that can cause knee pain when running, or knee pain after running is muscular tightness that affects the patellofemoral joint.
Tightness in your quads and hamstrings in particular can have an affect on how your knee cap is aligned and how it functions, potentially resulting in knee pain.
A proper cool down after running will go a long way towards easing tight quads and relaxing tight hamstrings. You might also find it beneficial to spend some time foam rolling your quads (here’s how).
Here’s running cool down routine that you might like to try:
I’m sure that these ten tips will help you to prevent knee pain when running. Check out the link below if you’re currently suffering from knee pain after running and want to know how quickly most runners completely recover from knee pain.