Runner's Pain Point #4: Knee Pain

In the midst of the craziness with opening our second location (hooray!), we got a little off track with our Runners’ Pain Point series. Nonetheless, we’re back with Installment #4, where we’re covering perhaps the #1 pain point for runners…knee pain.

If you’re looking to run pain-free again, and start hitting new PRs, here’s what you need to know…

Don’t Put Too Much Weight on Your Medical Diagnosis:

Since running as a sport doesn’t typically involve sharp cutting or quick change of direction, the incidence of meniscus and ligament injuries (the things people are always worried they have) in runners is usually very low. So if your knee hurts, and the onset of pain was gradual (it didn’t happen all at once), then you have very little reason to suspect serious structural damage to your knee.

Here’s a short list of the most common diagnoses I see. The terms can sound intimidating, but here’s what it really means if your physician tells you that you have _____________ :

  • Patellar Tendonitis: the big tendon in the front of your knee is irritated

  • Pes Anserine Bursitis: you have pain in the inside front part of your knee

  • Osteoarthritis: Your knee hurts and this is the best explanation I can come up with

(SIDE NOTE on Arthritis: Arthritis does NOT mean doom! Whenever I have a runner come into my clinic who is 40+ with mild-moderate arthritis on their x-ray, I tell them, “Congratulations! You have the knees of a college basketball player!” Did you know that ~35% of collegiate basketball players with no knee pain have significant abnormalities on MRI. If you suffer from joint pain in your knee and have been told that it’s degeneration or arthritis…there’s likely more to it)

  • Patellofemoral Pain Syndrome: You have nonspecific pain in the front of your knee

  • IT Band Syndrome: you have localized pain on the outside part of the knee

  • Patella Chondromalacia: see Patellofemoral Pain Syndrome

The bigger question is not what structures hurt, but WHY. And when it comes to having knee pain as runner…it usually has NOTHING to do with the knee!!


“The knee is the dumbest joint in the body”

I tell my knee pain patients this all the time. The knee is a passive joint. It really just does whatever your hip and foot tell it to do.

If you have a restricted ankle or hip, you’ll give up stability at the knee to compensate around it. Likewise, if you lack stability/control in the hip or foot, movement at the knee changes, and you pay the price at some point.

The analogy you’ll hear a lot is that your knee is like a train on a track. You have your patella (kneecap)…the train…that must glide smoothly between your femur (upper leg bone) and tibia (lower leg bone)…the two pieces of the track.

If you lose control over one end of the track, the train “derails” (not really…more like rides rough), and, over time, pain develops.


Fixing knee pain usually doesn't involve much work on the knee!

Make sure your ankles and hips can move, and that you have adequate stability there, and you'll do very well with treating knee pain.

Fix Your Ankle Mobility:

While there are number of different things that can cause tight ankles, and we tend to approach things differently when one side is limited vs. both, here are some good exercises to improve ankle mobility:

Fix Your Hip Mobility:

A lot of people feel stiff in their hips, but more often than not, those restrictions stem more from poor core/pelvic position or faulty stability patterns than actual, true mobility restrictions.

Diving into that topic is way beyond the scope of this blog post, but just appreciate that fixing stiff hips many times does NOT require traditional mobility interventions. However, when it does, here are some of our go-to's:

Make sure you can stabilize:

Similarly, correcting hip and core stability can get incredibly complex as well, and the most efficient way of regaining it is very different person-to-person. With that said, here are some basic hip stability/control drills that you need to be able to perform competently as a runner:

Hit Your Trigger Points:

Think, muscle trigger points = knots. They’re essentially areas of muscle that get stuck in a constant state of contraction as a result of being overstressed. When they develop, they can refer pain to nearby areas. Trigger points in the quads are very common with knee pain. Here are some typical ones, along with their referral patterns:

Focusing your foam rolling or other self-myofascial work on these areas is an important adjunct to the movement correction work discussed above. However, BEWARE…addressing trigger points without addressing the reason why they developed in the first place is unlikely to yield the result you’re seeking.

(Side Note: hands down, the best way to eliminate muscle trigger points is with a technique we use called trigger point dry needling).

Eliminate Torque:

Your knee is classified as a hinge joint, meaning that it bends and extends primarily in one direction. This requires both ends of the track (the upper and lower leg bones) to be oriented in the same direction. If a degree of rotation (i.e. one twists in, one twists out) occurs at the knee joint, pain is likely to result.

This patterning typically develops because of issues at the hip or foot, but addressing it locally at the knee can be a really important part of rehab.

Usually the lower track becomes limited in its ability to twist in. Here's an easy technique you can use to address this:

...And there you have it.

If you can address the things mentioned above, and not get too focused on treating the site of pain (the knee) vs. the source, you can see really good improvements in knee pain.

Obviously, the more accurate you can be in your interventions, the better the result will be. If you are seeking a long-lasting solution to your knee pain that will allow you to run at your highest level, then >>inquire about our Free, Non-Committal Discovery Session by clicking here<<

Please comment or email with any questions! We are here to help!

Dr. Mike