Common Causes of Knee Pain and How to Prevent Them

written by Jen Van Allen, 

One of the biggest oft-repeated myths is that running is bad for your knees.

But mounting research has shown that this is simply not the case. In fact the regular aerobic and muscular strengthening that running provides may even help protect the knee. Most recently, a study published in June 2016 issue of the journal Arthritis Care & Research, concluded that there is no increase risk of arthritis among runners.

That said, plenty of runners encounter knee issues from time to time. Often they experience patellofemoral pain—the condition that’s often referred to as “Runner’s Knee” and typically creates an ache in the bottom or front of the knee. Another common problem is IT band pain, which typically creates pain and tightness on the bottom outer corner of the knee.

If you do experience pain that persists or worsens as you run, and after you’re done, don’t try to run through it. See a doctor. Here are some of the most common causes of knee pain and insights on potential solutions.

The culprit:

Weak glutes. Weak glutes and poor control of the glutes causes the hip to drop and causes the knee to move inward, creating a torque, says says physical therapist Kerri Kramer Webb, founder of Fast Track Sports Medicine & Performance Center in Merrifield, Virginia.

The solution: 

Strengthening the glute muscles—particularly the gluteus medius, the broad, thick, radiating muscle,on the outer side of the pelvis—is essential to preventing and treating knee pain, says exercise physiologist and running biomechanist Adam St. Pierre, owner of Boulder, Colorado-based ASTP coaching. Start with basic exercises like side-lying leg raises or clamshells, and progress to kneeling exercises like fire-hydrants. Eventually you’ll want to progress to standing exercises. “Standing exercises are the most effective because you must work on balance and stability to stand on one leg, while moving the other leg,” he says. “I’ve seen people clear up severe ITB pain with 2 weeks of regular glute strengthening.”

The culprit:

Worn-out or ill-fitting shoes. Many runners are reluctant to replace their shoes on a regular basis, especially when they don’t look worn out. But if a shoe doesn’t offer the support your particular foot needs, or the cushioning on the shoe breaks down due to routine wear and tear, you can start to develop all sorts of aches and pains that can throw your training off track. Typically shoes wear most along the medial (inside) edge, says St. Pierre. This can cause the feet to overpronate, or tilt inward more than normal, and that can lead to poor knee alignment when you’re running. “The knee is the middle man and takes the hit” of the bad mechanics, Webb adds.

The solution:

Go shopping! No, shoes aren’t cheap. But the money and time that you spend to find a high-quality pair of shoes that offer your feet the support they need, is money, time (and stress!) that you won’t have to spend at the doctor later because you’re in pain. Replace your shoes every 300 to 500 miles. Keep track of your mileage in your training log. When you go shopping, be sure to bring the shoes and socks that you’ve been wearing along with any orthotics or inserts that you typically use. Have your feet measured, even if you think you know your size. You may need a bigger size than your street shoes, your feet may have grown over time, and your feet may be different sizes. A Fleet Feet sales pro can watch you run in the shoes and analyze your gait, and help you find the best shoe for you.

The culprit: 

You’re overstriding—landing with the foot too far in front of the body. This is the most common cause of knee pain in runners, says St. Pierre. “It causes a jarring force, especially when running downhill, which often leads to irritation of the patellar tendon (directly under or behind the knee cap).” What’s more, a slow stride rate can decrease the spring in your step—the integrity of the tendons, and the ability to absorb and bounce back from the ground.

The solution: 

Reduce the length of your stride, and increase your stride rate, he recommends. When your foot hits the ground, your knee should be flexed 30 to 40 degrees, says Webb. What should your stride rate be? It depends on your pace. Here are St. Pierre’s suggestions: if you’re running 12 to 15 minutes per mile, you might find that a 160 to 165 stride per minute rate would keep you pain free. If you’re running a 10 to 12 minute mile, you might 165 to 170 strides per minute may be more appropriate. If you’re averaging 8 to 10 minutes per mile, shoot for 170 to 175 strides per minute. If you’re running faster than that, shoot for 175 to 180 strides per minute.

The culprit:

Tight quads and hip flexors. Sit at a desk all day, every day? That may be contributing to your knee pain. “Most people in today’s seated day and age have tight quads and hip flexors,” says St. Pierre.

The solution:

You can benefit by stretching the quads and hip flexors on a regular basis, both before and after running, St. Pierre recommends.