A study from the British Journal of Sports Medicine says that your knees are predominantly where your legs will get injured when you run.(1) This, of course, can hurt. However, how to prevent knee pain when running, regardless of the type of injury, all boils down to a lot of the same things:
- Getting stronger
- Being more limber
- Improving your technique
- Using better shoes, and
- Proper training
I will describe all these in better detail below. But, I’ll also tell you about a few possible reasons why you’re knees are hurting, as well as give you a timetable for recovery. Let’s get to it!
8 Ways to Avoid Knee Pain from Running
1. Work on your strength, flexibility, and balance
These are things you can work on at your local gym or even at home if you wanted. My point is that if all you do right now for exercise is run, that’s the problem.
Running, in and of itself, can create muscle imbalances around your hips and ankles which, in turn, can affect the biomechanics of your knee.
As a matter of fact, Dr. Steve Gonser – himself a physical therapist, a marathoner, and an Ironman finisher – essentially says running creates a physical bias for your quads and calves. And, the more miles you put on your legs, the more you steer yourself towards that bias.
However, it’s not just about strength. Flexibility and balance, especially around the hips and ankles, are also crucial for injury prevention because these 2 joints control much of your dynamic adjustments.
In summary, here’s a short list of things you should be working on at the gym:
- Hamstrings strength and flexibility. Basically, the stronger your hamstrings get relative to your knee, the better it can provide stability at higher speeds.(2) If they’re tight, stretch them. If they’re weak, train them.
- Glutes strength and control. I’m talking about both your gluteus maximus (your sweet derriere) and gluteus medius (or “side butt” as some people call it). Stronger g.max’s help you create forward momentum while the g.med’s role is to keep your pelvis steady.
- Calves flexibility. These muscles are often overworked in many runners which, in turn, may cause your ankles to turn more inwards. Consequently, this may also alter the line of pull around your knee, leading to a condition called runner’s knee.
- 1-legged strengthening exercises. Instead of doing regular squats and deadlifts, maybe try their single-leg variants. Done properly, this alone has the power to significantly challenge your core and balance while promoting strength.
2. Warm-up before your runs and stretch right after
There are 2 types of stretching you need to know about:
- Static stretching – The type where you hold a stretched position for a few seconds.
- Dynamic stretching – The type where you repeatedly move your joints throughout their full range of motion.
An example of static stretching is touching your toes for 20 seconds whereas dynamic stretching is doing arm circles.
Both of these types can increase flexibility but dynamic stretches are better prior to exercise because the repeated movements also increase the temperature of your muscles. On the flip side, static stretching is better for cooling down because of the inherent inactivity that comes with holding a position.
Now, you might be asking: “Why can’t I do both?”
- For one, research suggests that there’s no added benefit to doing that. So, you’ll be wasting your time.(3)
- Second, and perhaps more importantly, experts such as Dr. Leigh-Ann Plack of the Hospital for Special Surgery believe that static stretching might actually reduce performance and probably even increase your risk of injury.
Here’s an example of a warm-up drill you can do:
- Ankle circles. Do this clockwise and counterclockwise to move your ankles over all of its normal movements.
- Single leg hip rotations. Needless to say, it prepares the muscles involved in rotating your hips and moving your legs from side to side.
- High knees. This works your hips throughout their full flexion while also moving your knees through their full range of motion. Plus, it warms up your hip flexors and quads.
- Heel kicks. It heats up your hamstrings while moving your knee joint through its full flexion and extension.
- Forward jacks with arm swings. This sort of mirrors the movements of an actual run except you do it in place and with less pressure on your knees. It also moves your hip through its full range of extension while warming up your glutes, quads, and calves.
Do each of these for around 45-60 seconds. All in all, this routine shouldn’t take you more than 10 minutes and it already warms up all the major muscles in your legs as well as increase the flexibility of your joints.
And, here are a few stretches you can do after your run:
- Walk. This may not be an actual stretch but it’s a pretty good cool down nonetheless. Do this for 5-10 minutes.
- For your quads. Simply stand on one leg, bend the opposite knee, then use your hands to hold your foot and pull.
- For your hamstrings. Put one foot a full step in front of the other, raise that foot’s ankle, slightly bend the other knee, then lean forward while keeping your back straight. Repeat on the other side.
- For your ITB (iliotibial band). While standing, cross one leg behind the other, lean slightly forward, then lean towards the same side of your lead leg. So, if your right leg is in front of your left, you lean towards your right.
- For your hip flexors. Take a big step forward then lower your body until your hips and knees on your lead leg are at 90-degree angles (the same position you’d be in if you did a lunge). With both feet firmly planted, rock your hips to the front.
- For your calves. Take a big step forward. Then, with both feet firmly planted, bend your lead knee to move your body forward. Remember to keep your rear knee straight through all of this.
Hold these stretches for 20-30 seconds, repeat 3 times, then do the same to the other leg.
3. Lose weight if you have to
According to Harvard, you put 1.5x your body weight when you walk on level ground. And, when you run, Dr. Jon Schriner from Michigan State University says you put 4x your weight on your knee with each stride.
So, let’s say you weigh 200 lbs. That means you can put 300 lbs of pressure on your knees when you walk but it goes up to 400 lbs when you run. Therefore, if you want pain-free knees for as long as possible, it’s best that you stay within your normal BMI range.
(Click here for the National Institute of Health’s BMI calculator.)
4. Use the right shoes (and other accessories)
First of all, brand names don’t matter. You can run on the most expensive Nike’s on the market but if it’s not the right shoe, you might as well wear flip-flops.
Think of it this way: Your body is a chain where each link is capable of affecting everything above and below it.
- If you’re flat-footed, your ankles are also rolled more towards the middle, which then affects every joint above it. Research even says that people with moderate and severe cases of flat feet are almost twice as likely to experience knee and low back pain. (4)
Hence, the need for wearing shoes and orthotics that are designed to counter whatever imbalance you have in your feet. I suggest you check with your podiatrist to get a shoe or insert recommended to you without it involving a sales pitch.
5. Buy new shoes about 1-2 times per year
Statistics from 2017 say that 43% of runners ran 11-25 miles per week (the rest of the percentage ran less).(5)
That’s around 528-1200 miles per year.
Furthermore, another study from the American Journal of Sports Medicine says that shoes retain less than 60% of their shock-absorbing capabilities after 500 miles.(6)
So, if you ran with worn-out shoes that aren’t as capable of dissipating pressure, your joints will take the brunt of the damage – or, more specifically, the cartilage in your knees which, consequently, can deteriorate from wear and tear.
That being said, I did the math – and if you’re anything like the 43% of runners, you’d be doing your knees some good if you bought new shoes about once or twice a year (or every 500 miles, but who’s counting, right?).
6. Minimize running on hard surfaces and uneven terrain
Here’s the thing: I couldn’t find any evidence that running on hard surfaces and uneven terrain is harmful to your knees.
However, my hypothesis – as well as many other experts – is that because hard surfaces such as concrete are less springy than rubberized tracks, your knees may have to do more of the work. The same concept tells us why running shoes and their rubber soles are better for running than golf shoes with metal cleats.
That being said, the key here is to vary where you run. So, if in case solid ground does indeed damage your knees, running on surfaces other than concrete might help reduce the risk of injury.
7. Practice better running mechanics
The way I see it, there isn’t one definitive way to run. Analysis of Usain Bolt’s technique even shows that he could do better yet he’s already cemented himself as the fastest man alive.
That being said, there are a few simple tweaks that generally help prevent knee pain. Here are a few of them:
- Keep your eyes on the road. This helps you see what’s coming and avoid tripping over. It also helps keep your neck aligned with your spine which, in turn, helps relax your shoulders.
- Make sure your shoulders are square, not rounded forward, and not overly pulled back. The latter positions cause imbalances in your torso which may also affect your hips and knees. A good way to make sure your shoulder is square is to pinch your shoulder blades together and then allowing them to relax until they’re right under your ears.
- Don’t clench your fingers (and don’t straighten them up like you’re in a Jackie Chan movie either). The point here is to keep your arms and hands relaxed which, theoretically, helps relaxes your shoulders as well. This means your fingers and elbows are only bent enough that your hands almost touch your hips when they swing and your fingers look like they’re softly holding an imaginary stress ball.
- Lean forward just a bit. This accomplishes 2 things: 1) It pushes your center of gravity to the front which may help propel you forward, and 2) It helps make sure that your foot lands below your hips when you stride. The second benefit inherently takes pressure away from your knees because it’s better for energy transfer.
- Don’t land on your heels. This is normal when walking but with jogging and running, you want to either land on your midfoot (jogging) or forefoot (running). This, again, helps ensure that you don’t overextend your stride. Plus, it’s better for shock absorption because you can utilize your calves better.
8. Train properly and listen to your body
For the same reason you shouldn’t run an Ironman without months of training, you shouldn’t go beyond what your body is capable of at the moment. Doing so only puts you at significantly more risk for injury.
Remember: A proper training regimen is a gradual increase in intensity.
So as a guide, only increase your mileage by about 10% each week. Maybe longer if you feel like your body hasn’t properly adjusted yet. This means if you ran 10 miles this week, you should only add 1 mile to your run next week.
This now brings us to the next part of our conversation.
Why do my knees hurt when I run?
There’s research saying that running injuries are caused by mismatches between the structures of your knee.(8)
Additionally, the same research says that 80% of these injuries are caused by overuse (the rest of the 20% are because of acute trauma).
This makes so much sense because those imbalances – flat feet, weak and/or tight muscles, rotated hips, poor running technique, etcetera – alter the biomechanics of your knee. And, the more you subject your knee to these imbalances, the higher the chances that they get hurt. Age plays a factor, too, of course.
That being said, here are some of the most common knee injuries involved in this sport:
- Patellofemoral pain syndrome (PFPS or runner’s knee)
- Iliotibial band syndrome (ITBS)
- Meniscus tears
Another question you might be asking is this:
Should I stop running if my knees hurt?
The good thing about overuse injuries is that they more than likely will heal with enough rest. So, if you experience acute pain, swelling, and limited range of motion on those joints, I urge you to stop and take a break until you can move painlessly again. If your symptoms persist, however, seek the advice of a proper health care practitioner (like a physical therapist, for example).
On the flip side, a lot of long-time runners experience nagging pain in their knees and they still continue running. That’s okay, too, because their knee problems might be degenerative.
And, according to research, low-to-moderate volume running doesn’t appear to pose a higher risk of developing arthritis.(9)
When Will My Knee Feel Better?
This depends on how severe the pain and other symptoms of the injury are but minor injuries tend to heal in about 2 weeks. Needless to say, more serious injuries will take longer.
What is the most common cause of knee pain in runners?
Overuse injuries cause as much as 80% of knee pain in runners while acute, traumatic injuries account for the rest of the percentage.
How to Avoid Knee Pain from Running
- Fix your muscle imbalances (strengthen weak muscles and stretch them when they’re tight).
- Improve your core and balance.
- Warm-up before runs and cool-down afterward.
- Stay within your normal BMI.
- Improve your technique.
- Wear the appropriate footwear.
- Buy new shoes every 500 miles or so.
- Minimize running on tough, hard terrain.
- Gradually increase the intensity of your runs.
In a nutshell, preventing knee pain all comes down to minimizing the number of unbalanced forces you put on your joint. These forces could either be from weak and/or tight muscles, poor technique, wearing the wrong type of shoes, overtraining, deformities, weight, or possibly even where you choose to run.
The good news is that these can be easily fixed. Some – like improving your technique and getting stronger and limber – may take a while but they’re still very much doable with consistent training.
- van Gent, R N et al. “Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review.” British journal of sports medicine vol. 41,8 (2007): 469-80; discussion 480. doi:10.1136/bjsm.2006.033548
- Rosene, John M. et al. “Isokinetic Hamstrings:Quadriceps Ratios in Intercollegiate Athletes.” Journal of athletic training vol. 36,4 (2001): 378-383. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC155432/
- Zakaria, Alan A et al. “Effects of Static and Dynamic Stretching on Injury Prevention in High School Soccer Athletes: A Randomized Trial.” Journal of sport rehabilitation vol. 24,3 (2015): 229-35. doi:10.1123/jsr.2013-0114
- Kosashvili, Yona et al. “The correlation between pes planus and anterior knee or intermittent low back pain.” Foot & ankle international vol. 29,9 (2008): 910-3. doi:10.3113/FAI.2008.0910
- Statista. “Runners – Average Miles per Week Worldwide 2017.” Statista, Christina Gough, 29 Aug. 2019, www.statista.com/statistics/933796/average-miles-runners-worldwide
- Cook, Stephen D., et al. “Shock Absorption Characteristics of Running Shoes.” The American Journal of Sports Medicine, vol. 13, no. 4, July 1985, pp. 248–253, doi:10.1177/036354658501300406
- Smith, Benjamin E et al. “Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis.” PloS one vol. 13,1 e0190892. 11 Jan. 2018, doi:10.1371/journal.pone.0190892
- van der Worp, Maarten P et al. “Injuries in runners; a systematic review on risk factors and sex differences.” PloS one vol. 10,2 e0114937. 23 Feb. 2015, doi:10.1371/journal.pone.0114937
- Hansen, Pamela et al. “Does running cause osteoarthritis in the hip or knee?.” PM & R : the journal of injury, function, and rehabilitation vol. 4,5 Suppl (2012): S117-21. doi:10.1016/j.pmrj.2012.02.011