Six steps to overcoming knee pain and injuries

The Running Knee Pain Myth

I can’t figure it out. There seems to be a belief out there that if you run, eventually you will develop debilitating knee injuries. Whenever I tell someone that I am a runner, one of the first questions they ask me is, “don’t your knees bother you?” They seem to think that distance running and knee pain are an equivalency along the lines of eating fast food everyday and being overweight. Why is this?

 Sadly, the anecdotal evidence seems to be in their favor. Very few people that I ran with in high school and college still run today, and the number one reason most of them give for why they had to quit? You guessed it – knee pain. In fact, knee pain is one of the most common complaints of injury among runners. Does this mean that running causes knee pain, or that it is inevitable that distance running will eventually result in a career-ending knee injury? I give an emphatic No!

 Running and knee injuries are not like “peas and carrots”, as Forrest Gump would say. If you are a runner, you don’t have to live in fear of ultimately being doomed to a knee injury. Most knee pain is not only easily treatable, but it is preventable.


Typical knee pain can appear anywhere around the knee joint, including above or below the knee cap (patella), behind the knee cap, or on the inside or outside of the knee joint. It can be a dull ache or a sharp pain. Usually you can find specific spots that hurt more when pressing on them.  Sometimes knee pain is more bothersome while running, other times it goes away after a good warm up but hurts after the run. Often times running too slowly will aggravate knee pain even more than running too fast. Usually, running downhill is more bothersome than running on flat surfaces, while running uphill alleviates the pain.

 Pain on the outside of the knee is usually Iliotibial band syndrome (ITBS). This is a more difficult injury to treat and deal with. If you think you are suffering from ITBS your best bet is to seek the help of a professional, such as a doctor, sports medicine doctor or physical therapist. Most other forms of knee pain, however, can be handled through self-treatment.

 Causes and Cures

Although knee injuries are not inevitable, knee pain is common, even among runners who know how to prevent it. This is usually due to laziness or carelessness. Knee pain can usually be traced to two areas of the body – quads and feet. The knees may be experiencing the pain, but it is usually because of problems in one of these two areas.

 I recently had to endure some knee pain for a few weeks. My training was going very well, so it was a little disappointing to have to go through it. However, it was not a surprise. In fact, I had been expecting just such a thing for a few weeks before it happened. There were four reasons why the knee pain was not a surprise, and why I had no right to complain.

  • First of all, I was running in shoes that had more than 1,000 miles on them (feet). Typically you want to change out your shoes every 300-500 miles, so I was way over the limit.
  • Secondly, I had been running on harder surfaces than usual (feet and quads). Normally I try to run on asphalt roads, soft shoulders or trails for most of my runs. However, recently I had been vacationing in an area where a concrete sidewalk was my only option. Asphalt is a hard surface, but concrete is much harder, and the lack of give is absorbed by the feet and legs, and often the knees.
  • Thirdly, I had recently increased my mileage by a significant amount – from mid-40s to mid-60s miles/week (legs). Any time you make a rapid increase in mileage and/or intensity you are at higher risk of all kinds of injuries.
  • And fourthly, I had not been doing any ancillary work to strengthen my legs (quads).

 The knee pain came on over 3 days, each day worse than the previous. I immediately took action. I used these six steps to attack the problem head-on and eliminate the pain:

  1. Replace running shoes
  2. Run on softer surfaces
  3. Increase leg flexibility, especially in the quadriceps
  4. Increase leg strength, especially in the quadriceps
  5. Back off mileage temporarily
  6. Icing

 All six of these areas are critically important to healing the knees, especially the first four. Remember, if you don’t address knee pain when it first arises you may end up with a more serious injury that takes much longer to get over. I find the best exercises for increasing quad strength are squats, 1-legged squats and lunges. To work on quad flexibility I used the standard quad stretch of bending the leg at the knee and pulling the foot up towards my buttocks. After runs I would hold this stretch for 30 seconds at a time. Before runs, I would use a dynamic form of this stretch, holding the stretch for only 2-3 seconds and doing 5-10 reps with each leg. For icing, I prefer bags of frozen peas. Whatever you use just lay the ice pack on the tender area for 15 minutes 2-3 times a day.

 Most knee pain can be handled by focusing on these six areas If, after making all of these changes for six weeks you continue to have no reduction in pain it is probably time to seek professional assistance. However, I strongly believe you will be successful in 90-95% of cases. What’s more, by staying on top of these six areas you can prevent knee pain from ever becoming a problem in the first place, which is the best solution of all!

 Happy running!