A Runners Guide to Knee Pain

Usually, when I tell people I have taken up running, they respond with some variation of “Gee, isn’t that hard on our knees.” Well, actually, no. At least until recently.

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About three weeks ago, I started developing a distinct soreness in my knees. At first, I tried denial. It’s not really that sore, I tried to tell myself. But as I continued to run, the soreness worsened.

Then I thought that perhaps I was just over-training. I know it will come as a big surprise, but sometimes I tend to over-do things a bit. So, I backed off and decreased my mileage. Still no luck.

So, I decided to have another look at Danny Dreyer’s book, Chi Running: A Revolutionary Approach to Effortless, Injury Free Running. This is my favorite book on running.

Danny maintains that human beings were made to run. Pain and injuries come from doing it incorrectly. He specifically talks about knee pain in chapter 7, pp. 164—166. He lists the three most common causes:

  1. Foot turnout. If your feet turn out to the side as you run, it torques your knee with every foot strike. Your leg isn’t designed to work this way. This action overworks the ligaments and tendons in the knee and eventually leads to pain.

    He says that the key to fixing this problem is to imagine you’re running on a tightrope, with your feet hitting along a line stretched out on the road directly in front of you. Here’s an illustration from the book:
    Foot Turnout
    I started paying close attention to this. It appears to have completely fixed my problem. I have had zero knee pain for the last week.

  2. Heavy Heel Strike. Danny says that, in his experience, this is the single most common cause of knee pain. Hitting the ground heel first is a braking action. He says that if you’re running like this, it’s like trying to push on a car’s accelerator while simultaneously hitting the brake.

    He elaborates, “If your foot stops and your body keeps moving, your knee becomes the transfer point for all that force. Well, your knees were designed to be hinges, not shock absorbers.”

    The remedy, he says, is two-fold. First, remember to pick up your feet with each stride. Second, run with your upper body in front of your foot strike, so that you are landing on your midfoot instead of your heel. I have also found it helpful just to lead forward a little more than usual. Let gravity do the work.

  3. Downhill running. When you are running downhill, you are putting more pressure on your legs than usual—up to ten times your body weight with each step! This is particularly a problem in Tennessee where I live, because we have so many hills. As Danny points out, this puts a lot of stress on your quads and knees. (It is also another reminder why runners need also to be doing basic strength training.)

    He says that the best way to deal with this is to draw attention away from your quads and knees and focus on the backs of your legs, which is where the main shock-absorbing muscles are located. Contrary to the advice in his second point, when you’re running downhill, land with more of your weight on your heels than on the front of your foot. He also says to relax your legs as much as possible when running downhill.

I’m sure there are situations that these techniques won’t work. But I don’t believe knee pain just goes with the territory. Like Danny, I believe we were engineered to run and knee pain is an indication that we need to adjust our technique. If that doesn’t work, then, by all means, see a doctor. But before you give up, you might want to give these techniques a try.

By the way, you might want to consider attending a one-day Chi Running Workshop or hook-up with a certified instructor. Unfortunately, we don’t have any instructors in Tennessee, but I am going to try and find a workshop to attend.

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  • http://sandro.groganz.com Sandro Groganz

    Just bought the book – thanks!

  • http://brianjones.org Brian

    This is good, helpful advice. As a runner who occasionally has knee soreness, I’m going to implement these suggestions. Thanks Michael.

    Incidentally, I find that if I run in the same pair of shoes for too long, I start to get mild knee, ankle, and foot soreness. The foot soreness is the most pronounced, especially in the second toe on my left foot. A good rule of thumb for me is new shoes every six months. Everytime I put on new shoes, I am amazed again at how much better my legs and feet feel.

  • http://www.freemoneyfinance.com FMF

    Mike —

    When you decide you’ve had enough, I’ll be happy to introduce you to the world of cycling. ;-)

  • http://daveanthold.typepad.com/elevate Dave Anthold

    Michael,

    The biomechanics of a person’s natural running form are unique to the individual. I agree with the comment from Brian that the shoes where down much quicker these days then before. One suggestion would be to buy 2 pairs of shoes and alternating the use of the shoes. This will help your shoes last longer and should correct some of your knee soreness.

    Also, your foot strike may have changed for some reason causing you to vary your running style. Also, if your foot is not striking directly underneath the hip you can develop knee pain and/or hip pain because of overstriding.

    Hope this helps.

  • Regular Visitor

    Newborn baby has kept me from much running lately, but two things I have dealt with (and I’m not a REAL runner – on a good week it’s 10-12 miles):

    1) Shoes – as mentioned, get the right ones for your feet and your running style (bad pronating, flat footed, in my case)

    2) IT Band – stretching and strengthening this ligament that runs from below your kneecap to your hip bone on the outside of your leg does a LOT of good…it gets tight, irritated and prevents your knee joint from functioning smoothly…although that’s probably old news for you half-thoners! I’m just a lowly “jogger” haha.

  • http://www.randyelrod.typepad.com Randy

    Mike,

    Great post. After 20 years of running and completing fifteen marathons virtually pain-free, I realize the importance of the foot strike. It is a big deal. Great information in your post.

    I also suggest daily stretching-even on non-running days and two different brands of shoes. The varied brands gives one’s feet a different feel and pressure which I believe, eases the stress on the same joints day to day.

    I’m happy your knee pain has improved.

    A fellow runner.

    Rany

  • http://www.michaelsampson.net Michael Sampson

    Mike, I gave up running a couple of months back due to extremely sore knees. You’ve given me some new things to explore as I really miss it.

    THANK YOU.
    M.

  • http://carasmusings.blogspot.com Cara Putman

    My husband and I ran our first mini-marathon in May. Mind you, I’ve never run in any kind of race before. It was a great experience until we had to run on the Indy 500 racetrack. My knees didn’t like that slight incline. As I trained, I found that the right pair of shoes could really help with knee and ankle pain. There are stores that will videotape you running and recommend shoes based on your stride. Well worth the time.

  • http://www.michaelsampson.net Michael Sampson

    Another suggestion … after having a sore back for a while, I finally visited an osteopath yesterday. He said that my pevis was crooked (too many years of carrying a child on one side), and my back was misaligned. No wonder my knees hurt!

    M.

  • Scott

    Some great tips, especially the “buy two pairs of shoes and alternate” suggestion. Thanks.

    I had read the same thing about keeping the feet “straight” when you run. I started paying attention to that — now it’s second nature. I can’t say whether or not it made a difference for me, but at least it shouldn’t hurt.

    One thing I’ve also found is if I tie my running shoe laces too tight, my feet start hurting almost immediately when I run. So, I tie the laces very loosely. The shoes are a snug fit, anyway, so I could probably leave the laces untied and the shoes would stay on my feet. Just something else to try, I suppose, if your feet ever start hurting while running — loosen the laces a bit.

    (Note: long, personal “running” story follows)

    Although I do not “enjoy” running, I started running again 3 years ago (after about 9 years of no running).

    Ironically, I started running to help eliminate knee pain I had been experiencing for nearly a decade. In the early 1990s I had “blown out” my knees playing soccer. As a recreational player at that point, I didn’t have any expensive repair surgery (in fact, the doctors said nothing seemed to be torn, just “loose”). I just learned what I could and couldn’t do (mostly, I had trouble with lateral movements) and dealt with it. For the most part, my physical activity consisted of walking about 45 minutes a day to and from work.

    Several years ago, I started hiking in the mountains on a regular basis during the summer hiking season — something that I love doing. However, around here it’s not unusual to climb 900 to 1,000 vertical METERS, and then descend again, in a 6 or 7 hour time span.

    It’s the “descend” part that really got to me — no surprise there, most people end up developing some sort of knee pain after long stretches of downhill walking. The first year I got serious about this, I had such severe knee pain that I could barely hobble around for several weeks after a weekend hike.

    Then, while reading up on how to alleviate knee pain while hiking (basically, the key is to “strengthen” the muscles around the knee), I kept reading that running was one of the best exercises for getting in shape for hiking and for getting RID of knee pain. Seemed kind of counterintuitive — anytime I had tried to run in the past, my knees always felt like the weak link.

    So, I gave it a try. I eased into it very gradually (I followed one of the running site’s “8-weeks to 5K” guides *exactly* and made sure I didn’t “over train” — especially since I’m not necessarily a Spring chicken anymore and when I do over train it takes a bit longer to recover). It hurt like heck at first, but I kept at it. To my amazement, it worked. My knee pain virtually disappeared in most exercise and hiking situations. Although I still have some discomfort when descending steep terrain for long periods of time (many people do), it is like night and day.

    Now, I run regularly (even in the “off season”) just because it is such a great aerobic workout. Even though I don’t “enjoy” running, some days I just feel antsy until I get my run out of the way. It has turned out very well: my knees feel much better, I’m in much better shape, and I lost (and have kept off) nearly 35 pounds (which I’m sure also helped with the knee pain).

    So, in my case, I started running to get RID of knee pain. And it worked.

  • Loopy

    I’ve stopped running recently because of pain in my left knee. Immediately after running I get a stinging sensation inside my knee almost like a paper cut). When this subsides it is just a dull ache but it has gone since I have stopped running.
    I’ve had my feet and running style analysed when buying new trainers as I thought the problem was due to my old footwear. My running style came out as good and the new shoes are no better on my knee.
    Has anyone experienced anything similar or has any advice? I am desperate to start running again as I have sat out far too long!
    Many thanks for your help

  • http://twitter.com/mikeoates mike oates

    Thanks for this post michael. I have had nagging knee issues for 2 years now, I purchased some nike stucture triax 9's to help with overpronation and they helped greatly, but pain would still kick in after around 2.5- 3miles and just yesterday I tried changing the angle of my foot and it seemed to help so I was pleased to find this blog post and will try the tight rope technique as its been bothering me knowing that my cardio is great and my knee is holding me back….heres hoping for longer a run!

  • http://www.reviewbelief.com product reviews

    Recently I just started running in the morning,at first it’s hard,then I can run longer without rest

  • http://TheBackSurgery.co.uk/ Back Pain Surgery

    Just found this article. A few good tips to avoid the dreaded runner’s knee pain. Thanks.

  • emma

    Fantastic!! Thankyou

  • Whdunbar11

    i exercise a lots… I Been speed walking Lately i noticed pain in my right Knee & swollen a little.. I thought maybe i walking too fast so i slow down…. When i got home i noticed my right knee were a little swollen…

  • Chloe Winslet

    lately i felt a knee pain even though i am not a runner..what should i do?

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