Knee Pain and Running

Running and Knee Pain

There is a conversation taking place on facebook in a runner’s forum about knee pain and running.  What you are about to read is the exchange I had with the author of the original post.  Check it out below.  And will you do something?  If you know someone with knee pain that you think this would speak to, will you pass the link along?

The Question:

Ok fellow runners…ever since I took a week off post 1/2 marathon I can’t run more than 2.5 miles without excruciating knee pain. Never once happened before. This is bullshit! Help!!!

My Response:

Knee pain is a postural issue. It has less to do with a problem at the knee and more to do with mobility and stability dysfunction at the hips, feet, upper back, core, and shoulders. For any adjustment to be effective, the entire biomechanical chain must be addressed.  Not just the knees.

No Pain sign. Knee Pain Running.I work on postural dysfunction in four (4) stages:

Knee Pain Running

1. Pain: Your range of motion must be, first and foremost, PAIN FREE! This means, if it hurts to do… DON’T DO IT!!! If your knee hurts to run, squat, or lunge, etc… hold off on these exercises until you can do them without pain.  What to do about the pain?  I address the pain through movement assessment, hands on massage therapy, and a personalized exercise program. I recommend finding a highly movement therapist who uses walking and running gait assessment and has experience successfully treating these types of injuries. I typically see a significant reduction in pain within 2-4 treatments.

Practicing some full body self massage using a foam roller may also provide some temporary relief from the pain.

2. Mobility: Once the pain is reduced, you will need to work on improving your functional range of motion, such as the ability to perform a functional deep squat or lunge. IN MY OPINION, IF YOU CANNOT PERFORM A FUNCTIONAL DEEP SQUAT OR LUNGE, YOU SHOULD NOT BE RUNNING! PERIOD!!! These are progressive movement patterns that lead up to running. Babies learn to squat-ass-to-the-grass BEFORE they learn to walk and run.  You must do the same.  So do it.  And on top of training for functional lower body mobility, you will need to work on upper body mobility as well. When your thoracic spine, scapula, and neck are restricted, your hips will not function properly.

3. Stability: Now that you have improved Range-of-Motion (ROM), you will need to train your body for stabilization with this renewed ROM. This is the basic definition of posture. The ability of your body to stabilize throughout your entire ROM. For more on posture, read:

What is Posture

Here are some super basic corrective exercises to get you started.

The Foundation of your Posture – Injury Prevention Begins at your Foot

Corrective Exercises for the Hips

Corrective Exercises for the Scapula

4. Conditioning: Running is a very basic movement pattern. It is also a very small percentage of our overall functional movement pattern. If the only form of exercise you are doing is running… you are running directly into a potential injury. Your body needs to be conditioned throughout it’s entire movement ability. Full body functional movement is vital to overall health and vitality, as well as running ability. Another way to think about this is: How do you want to feel when you’re 70, 80, 90, or 100? Do you want to run comfortably in advanced age? Conditioning your body through full functional movement patterns, which includes running, is the key to both of these questions.

I encourage you to hire an expert team to help you through this process. The investment now will save you thousands in your long term pain and health. I suggest hiring a therapist to help with the pain; a movement coach to help improve your posture; and a running coach to teach you how to run (years and years of sitting on our butts means that we don’t know how to do this very basic movement pattern – even if we run frequently). Here is a link with tips on finding a quality therapist and coach:

Five Steps to Choosing a Professional Therapist

Good luck.

The Response:

Jesse, in a perfect world I would LOVE to be able to hire all of those folks to help me out. I have contacted an ART (Active Release Therapy) doctor in hopes they’ll be able to help me a little bit. As for the rest I’m going to have to go it alone or go through my HMO (which everyone knows could take years) to get to a physical therapist. My knees don’t actually hurt unless I’m running. I can do squats and everything w/o knee pain…it’s when my glutes get tight about mile 2 that everything goes to pot. So I’m sure some of it’s my form and some of it is that I’m just too tight. I will continue to work on it and stop running for the time being. Perhaps yoga is in my future…

My response:

I completely understand the issue of cost. At the bare minimum, I encourage you to invest in a foam roller, softball, lacrosse ball, and golf ball. This will allow you to do a great amount of the massage work on your own. The foam roller alone should make a huge difference with your pain during running. It may take a few weeks. Here is another article on foam roller therapy that has a bit more detail to it.

How to Treat and Prevent Injury and Become a Better Runner

Finding a good teacher, Part II

When looking into a PT, I recommend really vetting them out. You want the most educated, experienced, passionate, top of their game professional available. You are looking for a highly skilled therapist, preferably one who includes manual therapy; as well as multiple other modalities; and looks at the entire movement system, not just your knees. If they treat the knees in isolation, find another therapist! Hopefully, it won’t take too long, but you are better off taking your time searching for a high quality therapist who is the best fit than to settle on someone who isn’t.

Can you really do a functional squat?

The majority of clients that I see, at the time they come in, say that they can do a squat. The fact is they cannot do a “functional” squat. This is what I consider a functional squat:

This Is A Functional Squat

Baby squatting with perform form. Knee Pain Running.
If you can’t do this from standing to sitting to standing keeping your shoulders down and back, without your heels coming up, your feet rolling out, or without pain then you can’t do a functional squat.

Here is a great little video from Barefoot AngieBee describing squatting

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2 Replies to “Knee Pain and Running”

  1. Hi!! That’s very interesting!! I am about to conduct a research project for my Master’s thesis looking at whether standing Pilates will have any effect on knee pain during running. Am on holiday at the moment but will look at your post in mod detail when I get back to work next week.

    1. Thanks Laura,
      I look forward to hearing more about your research project. Please keep me informed.

      Jesse James

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