There can’t be a runner in the land who hasn’t been warned that ‘running is bad for your knees’ – often by people who’ve never jogged in their lives. The truth is that running is actually good for our joints. But that doesn’t mean that running is pain-free. 

In fact, knee pain is a super common issue among runners. You might feel a dull stab in the front of your knee joint during a 5K jog, or notice an ache set in after you’ve finished running. The question is: why does knee pain happen, and how can we treat it?

Runner’s knee is undeniably a very real complaint, and what’s worse, it turns out that women tend to be more susceptible to knee problems in general – with female athletes up to two times more likely to have an ACL injury than men.

The cause of your pain depends on where it is, says Lyndsay Hirst, physiotherapist at Your Pilates Physio. “If you’re suffering with bilateral pain, meaning both knees are suffering, the usual culprit for that is weakness in the quad muscles,” she explains. 

But things get more complicated when it’s one knee that’s taking more of the strain: “That’s more likely to be a biomechanical issue. With the knee being between the ankle and the hip, it’s hugely influenced by both of those joints.”

For many female runners, it’s hip weaknesses that can cause knee pain: “99%, if not 100%, of my patients with knee problems after running have biomechanical problems with the hip,” Hirst says. 

“What we’ll find is that they have weakness in their glute muscles, and in particular in their gluteus medius muscle. The glute meds job is to externally rotate the femur [thigh bone]. If the glute med is weak, then as you’re running the femur will internally rotate instead, causing an inward twisting of the knee.”

But what about those runners who regularly hit the gym? Loads of us support our time on the road by doing hip thrusts, squats and lunges – so how are we not strong enough to run? 

“Resistance exercises don’t really mimic the action of the muscle during running,” Hirst says. “The firing patterns of the muscles are different to how you would train them on a leg press or hamstring curl machine. Even if it’s just a 5K, which might not sound like a huge amount, it’s something new to your body. You’re asking your muscles to perform a completely different activity to what they used to do.”

Release tight muscles

Releasing tension in the muscles surrounding the knee, like the quads, hamstrings and calves is always a good place to start. “Discomfort or pain in the IT band [the outer thigh] can be caused by all of these muscle imbalances,” says Hirst. 

“Foam rolling is a soft tissue release technique that can reduce the tension in the muscular structure, but I would never suggest doing that in isolation. You need to make sure you’re ironing out the muscle imbalance in the first place.”

Mobilise before running

So, how do we do that? Activating glutes before running, with clams, bridges and other waking-up moves will help you drive forwards without overstraining the knees. But general strength training is essential, too. 

Work the quads and glutes

“Quad loading exercises like squats or single leg knee dips are great, but if it’s those glutes that need work then we really need to focus on form. For example, in those knee dips push the knee out over the toe in order to get the glute muscle functioning.” In addition, make sure your strength work is endurance focused, as that is the skill needed to transfer over to your running. 

Jump more

We also need to get our joints used to that impact, as well. That’s where Hirst recommends plyometric work, such as box jumps, to create the type of contraction that your muscle needs in order in order to survive the run.

Take a proper rest

Rest is also important. If you’re really suffering, take at least a week off from running, Hirst says, then gradually make your way back in by following a Couch to 5K programme, for example. “But do those strength training exercises daily,” she urges.

Remember, proper damage will force you to stop running. An injury will swell and feel hot – rather than aching a little. If that’s you, contact a doctor or practitioner. 

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Images: Getty / Unsplash