How to Fix Knee Pain From Running

Knee pain is the most common complaint we see in runners, and most of the time it is not a sign that something is damaged. It is a sign that the knee is being asked to do more than it is currently prepared for.

What is usually going on

The two most common presentations are patellofemoral pain, felt around or behind the kneecap, and iliotibial band related pain on the outside of the knee. Both tend to appear when something in your training has changed: more distance, more hills, faster sessions, new shoes, or a return after time off.

Pain around the kneecap is often worse going downstairs, sitting for long periods, or on the descent of a hilly run. Pain on the outside of the knee typically builds at a predictable point in a run and settles quickly with rest.

Neither of these means your knee is wearing out. Cartilage and tendon respond to load. Too much too soon irritates them. Sensible, progressive load builds them up.

What to do first

Do not stop running entirely unless you have to. Complete rest often makes the return harder. Instead, reduce volume rather than eliminate it. Cutting weekly distance by 30 to 50 per cent is a reasonable starting point.

Take out the aggravating variable. If hills or speed work brought it on, park those first. Shorten your stride slightly and let your cadence come up, which for most runners reduces load through the knee.

Keep pain during a run at or below a 3 out of 10, and make sure it settles within 24 hours. If it is still sore the next morning, you did too much.

What actually fixes it

Strength. Almost every runner we see with knee pain is under strong through the hips and quadriceps for the running load they are attempting.

Start with the basics twice a week: single leg sit to stand, step downs, split squats, and calf raises. Two to three sets, working to a hard but controlled effort. Progress by adding load or range over six to eight weeks. This is not glamorous and it is not quick, but it is the thing that changes the outcome.

When to get it looked at

Book in if the pain is not improving after two to three weeks of sensible load management, if the knee swells, locks, or gives way, or if you cannot weight bear normally. Those are different problems and they need assessment rather than a home program.

If you are in Norwest or Dural and want a plan built around your actual training, that is what we do.