Why does my knee hurt when I run?

Over the past 10 to 12 years there has been a great increase in people who run.  The amount of organized 5k and 10k races that raise money for non-profits or other organizations has exploded.  Look in your local newspaper for  a calendar of outdoor events or on the race calendar of the local track/running club and it seem like there is an organized race every weekend throughout most of the year. 

More and more people are running for health reasons, to compete in their first 5k or first marathon.  Seasoned runners also have more opportunities to compete in different race distances with the increasing popularity of ultra-marathon distances and relay races that take several days to complete.

No matter what level of runner you are –  a novice trying to get into shape or a runner that normally runs 20 – 30 miles a week, knee pain can affect your training, your performance, and your desire to keep running.  Runner’s knee or patellofemoral pain syndrome (PFPS) and IT band syndrome are the two most common causes of knee pain when running.  Both can occur when there is an increase in mileage, a change in running surfaces,  breakdown in the support from the running shoes, or if more hills were added to a normal running route.

SYMPTOMS:  Patellofemoral pain syndrome:  pain above or below the kneecap that usually increases with squatting, kneeling, stair climbing, or running hills (downhill worse than uphill).

IT band syndrome:  Lateral (outside of the knee) pain when the foot first strikes the ground when running.

Knee pain when running does not necessarily have to occur because a specific knee injury or simply because one is overtraining.  The pain or discomfort in the knee could be caused by a muscular or a biomechanical imbalance that is occurring between the hip, knee, and foot.  No matter what the cause, injury versus pain versus discomfort, all will affect performance and tolerance to running.  A biomechanical imbalance could be developing long before symptoms at the knee occur. 

Weakness in the hip stabilizing muscles and muscle strength deficits between the gluteals, quadriceps, and hamstrings could cause the knee to turn inwards or adduct towards the opposite knee every time the foot strikes the ground.  The repetition of this knee movement overtime could result in knee pain – either around the kneecap or on the outside of the knee when you are running.

It doesn’t matter if you are a beginner runner or if you are training for  your twentieth long distance race, specific hip strengthening exercises that are effective at strengthening the hip stabilizing muscles, mainly the gluteus medius are recommended to incorporate in your training regiment to help prevent the annoying knee pain that could cause you to not meet your goals.


  • Sideline Straight Leg Raises
  • Side and Front Stepups
  • Single Leg squats
  • Sidestepping with Bands (Monster walks)
  • Single Leg Deadlift (RDL’S)
  • Single leg bridge  and Side bridge

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Maintaining a strong core and hip muscle strength will help in keeping the knee in proper alignment and position when running.  If pain develops at the knee when running, stop the activity.  No pain, no gain mantra will not fix the problem.  Reducing your mileage and making sure you are properly warmed up and stretched prior to and after running will help in reducing the pain.  Incorporating hip strengthening exercises 3-4x/week could help in preventing knee pain when running. 

If knee pain persists, seeking an orthopedic assessment from a physical therapist would be beneficial. A physical therapist would perform a specific assessment looking for muscular and biomechanical imbalances from the low back, hip, knee, and foot.  A gait analysis or running analysis looking at form and posture could also be very beneficial.  Running does not have to or need to cause knee pain. Certain strengthening exercises will help decrease the load and demand on the knee.

Posted by cjdbones