Have Sore Knees From Running? Here’s Why!

Why Your Knees Hurt When You Run

Knee pain and running goes together like bacon and eggs!

I’ve even joked with some of my running patients that if they haven’t suffered a knee injury yet, are they really a runner?

I’m kidding of course, and this sort of thinking is a little morbid, but it still recognises that knee pain is a problem for a large proportion of people who run!

I’ve been treating knee pain and runners for close to a decade now, both clinically and as a track and field coach. In that time I’ve found there to be a few reasons why knee pain occurs with running, and worked with countless athletes and helped them eradicate their knee pain and continue running, faster and stronger than before!

In this blog I will cover some of the common reasons why people experience knee pain and what you can do to address it. 

Now it’s up to you. If you are a runner who is currently experiencing knee pain, read this blog and apply the concepts and I have no doubt you will experience a positive change in your experience. If you don’t, chances are your knee pain will stay the same.  

You’ve already read this far, so I can only assume that you are invested. So let’s get started!

Does every runner experience knee pain?

Although the data is kinda sketchy, the research suggests that approximately 1 in 5 people in the general population will experience knee pain, with approximately 35% of sports people (runners included) experiencing knee pain. 

So as you can see it’s pretty common. 

The main reasons for this that I see fall into 3 categories:

1. Training age and exposure (load management)
2. Running coordination 
3. Equipment / Shoes 

Let’s now look into each of these closely

Cause #1: Training age & Exposure

I’m not even exaggerating here, 9/10 cases of knee pain that I see in runners, can be attributed to load management issues!

Too often I see novice runners, (sometimes more experienced runners) ramp their running volumes too quickly and with little to no rest in between efforts. Not many people realize that the stress on the body from running is quite extensive, and thus need to be managed.

In specific relation to knee pain, the constant pounding on the joints and loading of the tendons needs to be monitored otherwise, without adequate rest they will be irritated, inflamed and injured. Period. Even the best runners cannot escape this inevitable truth!

So try this before commencing your next block of training!

The 10% Rule

The 10% rule is as follows.

Each week, only increase your training volume by 10%.

So for example if you are currently running 20 km each week, and you want to progress next week, you run 22 kms.

That doesn’t sound like much but if you keep doing that for 4 weeks you gradually progress from 20 km to roughly 30 kms. A 10 km increase over the course of a month. Just imagine how many kms you could be covering if you continued to do that for 3-6 months of consistent training!

The reason for the small changes in load is simple. 

We want to apply kms slowly to the body so it can make the prerequisite physiological adaptations (think cardiovascular, muscle, tendon and bone) without overloading the body too much to the point where the body is worn out, feeling fatigued and prone to injury.

I often see this with many patients who develop patella tendinopathies. They run too many kms too quickly, overloading the tendons in the knee and have to take a forced rest because the pain in their knees is too much!

Don’t let this be you. 

Cause #2: Running Coordination

One thing that a lot of people, including runners, do not realise is that running is a skill. Just like any other skill like throwing and catching, skills need to be cultivated, developed and learned.

A lot of runners that I treat, spend little to no time working on their running technique and coordination. Typically, they just buy a new pair of Asics Kayanos, and before they know it, they are out hitting the trails.

Running coordination is synonymous with running efficiency. If I am able to help a runner be 10 to 20% more efficient with their running pattern, It is likely that the load on their body will decrease by the same amount (conceptually ). Runners that display higher coordination, tend to be able to manage forces throughout the body a lot better than the novice counterparts. This is a concept we call force sharing. 

Here are 3 things that all good runners do to improve their technique and efficiency as a runner: 

1. Swing Leg Retraction
   Swing leg Retraction refers to the ability of the swing leg while it’s in the air to actively start moving towards the ground. The muscle responsible for this is your hamstring and your glutes.  In working to bring your leg towards the ground this helps to tension the muscles on the back of your leg and ensure that your foot lands somewhere underneath your centre of mass. These are extremely favorable qualities to ensure that your knees are not loaded more than they should be, protecting them in the long run (get it? “Long run” haha)
   
   
   
2. Hip Lock

   A hip lock refers to the position of your pelvis after you have established a stance leg and you swing leg is in front of your hips in the running cycle. An adequate hip lock ensures the muscles of your abdominals and hips are tensioned prior to and throughout the running gait cycle to increase stability, improve posture and minimize excessive shearing forces on the hip and knees (from excessive sinking). This is characterized by having level and neutral hips during the stance phase of running. 

   This position is not only performance enhancing but its extremely protective for the knee and ankle, helping to orchestrate better force sharing through the knee and limit excessive loading through this area.

3. Rotations At Toe Off

   One thing that all good runners do at toe off, is control for the rotational forces that occur through the body. At toe off, all of your body weight is balancing on a very small portion of you’re foot, which in turn places a considerable rotational demand on the body. If the rotation demands become too excessive, it’s common for feet to excessively pronate, shins to excessively internally rotate, knees to internally deviate (valgus) and hips to sink to the side. These variables in combination do not bode well for knee function and can contribute to pain in runners.

   Part of this is managed by improving your technique, especially by enhancing your swing leg retraction and hip lock upon landing, as well as developing adequate single leg strength in your legs, hips and core muscles.

As for the three things above, I encourage you to seek out a physiotherapist or running coach who is familiar with the dynamic systems approach to running as they will be able to assist you with developing these qualities. We are at Pro-Form Physiotherapy are well equipped and use these concepts daily to help a number of athletes be better! 

If you’re dealing with sore knees from running, we would love to help you. Come visit us in one of our locations today!

Cause #3: Equipment

Shoes are the chief investment that all runners partake in. Until you immerse yourself in the Rabbit hole that is running shoes, A lot of people actually don’t realize the function of the technology and designs of the footwear that is currently available in the market today. One mistake I see runners make when selecting shoes is picking the wrong shoe for their running style. Let me explain.

Some shoes are built like 4 wheel drives, some shoes are built like sports cars and some shoes are built like F1 cars. 

It wouldn’t make sense to drive a F1 car over Steve trails in rugged terrain, similarly, it would not be recommended to race a four-wheel-drive on an F1 track.

Shoes are no different.

If you are running a marathon, a shoe that is built like an F1 car (extremely light, responsive and fast) may like the support and cushioning required to help you run the length of a marathon.

Similarly, if you are running a lot of trails, a regular jogger likely lacks, the robustness and durability required to support you on those trails.

From the biomechanical point of view, sometimes those “F1 style” shoes, that are extremely lightweight and responsive, also have different geometry. That is to say the shape of the shoe is completely different to others. For instance a lot of those low-profile F1 type shoes are built with a smaller stack height and a smaller ramp height. This means that the thickness of the mid sole is less, providing less cushioning for the shoe and the height from the heel to the forefoot is less which typically encourages more of a midfoot landing while midfoot landing is favourable in a lot of instances if you like the technical  proficiency or haven’t built the tissue qualities to sustain this style of running chances, are you could dump, extra stress on your feet ankles and knees, causing pain, irritation, and potentially injury. So as you can see, not all running shoes are the same. Make sure you purchase shoes that actually fit your needs and I going to help you in the long run.

Getting advice on footwear is a lot easier nowadays with retail outlets, such as the Athletes Foot and Pace Athletic, providing good advice around which running shoes may fit your needs. This is a lot better than try to buy shoes blind from the website.

So in summary, do your research and find a pair that works for you and keep these considerations in mind before purchasing your next pair of joggers.

Now What..

Now that you know the extent of how knee pain occurs, what can you do from here? My first recommendation always is to speak to a qualified physiotherapist, chiropractor or athletic trainer to help guide and advise you.

I’ve had the pleasure of treating a number of extremely good runners over my career, and every single one of them does something more than just running. They get stronger in the gym with a number of specific exercises geared towards making them a stronger, better runner. A savvy physiotherapist, chiropractor or exercise Physiologist is of considerable benefit to anyone looking to start progress or prolong their running career.

I would also encourage anyone who is looking to get into running or improve their running to seek out a coach for the style of running that you’re doing. Trust me this could be the thing that really changes your running.

A coach can help you with some of the technical aspects of your running as well as give you advice on how to structure and periodise your training program so that you can continue to progress and run a high heaps of kms in the safest way possible.

Lastly, understand what your shoes are doing for you. This is the one thing most run is invest a lot of time in money into selecting and making sure you get this right for what you are doing, pays dividends in the future.

So, with that being said, I hope you’re found these concepts useful. Go ahead and start applying these concepts today and this is guaranteed to help you become the best. I know that you can be.

Happy running!