In this article, I discuss the three most common causes of knee pain when running and how you can prevent it. If your knee pain persists or you think you may have a full-blown injury, you may want to check out our quick guide to diagnosis and treatment of knee pain in runners. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.
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In this article:
Warm up - Even before an easy run!
Training errors that can cause knee pain when running
Strength training to protect your knees
We've also made a video about this:
1. Warm up - Even before an easy run!
Let me guess, your warm-up for your easy run is just to start really slowwwwly. Been there, done that, got the T-shirt … I actually decided to add this section after doing it again a few days back and my knees feeling really annoyed with me afterwards.
This may work for some people (it worked for me when I was younger!), but if your knees aren’t feeling great during or after your runs, let me explain why you may want to try a simple warm-up.
Warm-ups should consist of movements that:
Wake up your nervous system. This allows for better control and muscle contractions. Your muscles are meant to absorb most of the force and stabilise your knees when you run. You can have the strongest muscles in the world, but if the nerves that supply them aren’t fully alert and active, they can’t contract at full capacity or respond properly to sudden loads and changes in load. This means that your joint will have to carry more of the load and increases your risk of straining your knees. Why aren’t our nerves always alert and ready to fire? Because our brain tries to conserve energy and only fires them up 100% when it realises we want to use them. So, if you go from sleeping or sitting on your bottom to running, you will benefit from telling the brain to start firing those before you get going.
Lubricate your joints and make your soft tissue more pliable. This allows you to move better and the joints are better able to accept and distribute load.
If you choose your moves well, they also ensure that you have good range of motion in your hips, knees, and ankles, which helps to optimise your movement pattern, distributing the load more evenly.
Example of a quick warm-up routine for an easy run
This is the warm-up I do before my easy runs - it is NOT enough for a faster run.
Free squats: 10 reps
Isometric double leg bridge: hold 10 sec, rest 10 sec, do 2 reps
Single leg bridge: 5 reps x 2 sets each leg
Another set of 10 free squats
Lunge dips: spend 2 to 5 second in the lowered position, do 3 to 5 reps each side
Heel drops over the side of a step: 10 to 20 - don't hang at the bottom, just lift up and down slowly.
2. Training errors that can cause knee pain when running
I am lumping these training errors together, because they all tend to lead to the same thing: overuse injuries in the knee (or other parts of the body).
When we run (or do any other physical activity), our bodies sustain microdamage. This is normal and an important first step in how we grow stronger.
Your body then needs some time after your run to recover and repair. The microdamage signals to the body that those specific areas aren’t strong enough for what you want to be doing, so it doesn’t just repair it to the same level, it repairs it to be stronger than before. BUT this can only happen if you allow it enough time to fully recover.
If you train again before your body has completed the repair cycle, you run the risk of the microdamage accumulating and causing overuse injuries like patellar tendinopathy or tendonitis or IT band syndrome.
The most common training errors that can lead to knee pain when running include:
Increasing your running volume too quickly - your body may not be able to increase its strength and endurance quickly enough to keep up with your running demands.
Not allowing enough recovery days - your body may not get enough time to repair and recover.
Doing too much high-intensity running (fast or hills) - high-intensity sessions strains the body more than easy runs and therefore require longer recovery periods.
Top tip: It's difficult to get recovery 100% right, but you can help your body catch up with repair by adding a deload or recovery week (where you decrease the volume and intensity of your runs) into your training plan. It usually works well to do this every 3 or 4 weeks. Your specific training schedule will determine what is best for you.
3. Strength training to protect your knees (try this plan)
Having good muscle strength in your core and legs can help prevent knee pain from overuse running injuries like IT band syndrome, patellofemoral pain syndrome, and patellar tendinopathy.
In addition to absorbing most of the force when you run, your muscles are also meant to help you control your legs, avoiding excessive ranges of motion as you run.
When it comes to knee pain, it’s not only the muscles close to your knees (like the quads or calves) that are important, it’s also the muscles further away (like your core and glutes) that help distribute force and control the movement.
This is why it’s a good idea to follow a strength training plan that includes exercises for your core and all your leg muscles. Make sure you focus on having good technique and control - this will help you optimise your movement patterns. What exercises you should do will depend on your training status and current ability.
Free injury prevention plan in the Exakt Health app
If you’re not sure where to start, I can recommend the Running Injury Prevention plan in the Exakt Health app. I’ve teamed up with Exakt Health to create a plan that consists of various stages, so it’s suitable for absolute beginners as well as experienced runners who have been strength training regularly.
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The app's prevention plan:
Allows you to start at a level that is right for your training and skills
Uses your feedback after workouts to adjust the workout intensities
Teaches you good technique and control
Develops your position sense and balance
Improves your flexibility and range of motion
Includes strength training exercises for your core and all the muscles in your legs
Teaches you about other factors that can reduce your running injury risk, e.g. managing and monitoring training load, warm-ups, and recovery.
How we can help
If you need more help with an injury or would like tailored injury prevention advice, you’re welcome to consult one of the team at SIP online via video call for an assessment and tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.