When nonrunners think about running, they immediately think about knee pain. It’s fundamental to the popular image of runners. Never mind that running is actually better for your knees than being sedentary, the image persists because so many runners have knees that hurt that there’s an entire injury–runner’s knee–named just for us.
Fortunately runner’s knee isn’t the knee-destroyer our couch potato friends imagine. It’s pain, yes, and sometimes inflammation, but it doesn’t actually harm the knee. It just hurts and keeps you from running as much or as far as you want.
And better yet, it’s often pretty easy to fix. Maybe not through the normal medical means, which can actually be very frustrating–read these key posts on icing, anti-inflammatories, and stretching if you’ve been doing any of those things to try to fix your knee.
The key to runner’s knee is that the pain is caused by how you’re running, and when you make the right changes via the right means the pain will usually just fade away.
How to Cause Runner’s Knee
In my 14 years’ experience working with runners, I’ve found runner’s knee to always appear in conjunction with a hip that’s behind the ankle at midstance.
In other words, at the moment when you’re really on your leg–your knee, ankle, and hip are at their most bent and your head is at its lowest point–if your pelvis is behind rather than directly above your foot, it’s very stressful to your knee.
That’s because this is the moment when you experience the greatest pressure in your body–downward force from your landing as you meet the immovable ground beneath you. Your muscles work at this point in the gait cycle to keep you from crumpling to the ground, and if your hip is behind your foot, as if you were sitting in a chair, then your quads have to work very hard indeed to keep you from sitting down on the ground.
This seems to be very irritating to the kneecap and patellar tendon, and voila, pain.
This kind of midstance alignment is reflected throughout the whole gait cycle, with the pelvis too far back relative to the legs the entire time.
This means that footstrike is often a heelstrike with a relatively straight leg way out in front of the runner. This kind of footstrike has been implicated in knee pain, which has lead to a lot of runners with sore knees trying to land on their forefoot instead of heel.
This seldom helps the knee because it deals only with a symptom–the heelstriking and excessive overstriding–and doesn’t do anything to position the pelvis further forward over the foot in midstance. In fact, a runner who tries to fix their footstrike this way may actually end up with additional problems with their achilles tendons, as I explained in this blog post.
How to Relieve the Stress on Your Knee
The simple answer is to align your hip joint over your ankle joint in midstance. But since your pelvis moves as you run, it’s not particularly effective to try to simply shift it forward. This usually results in a whole lot of excessive muscle contraction, confusion, and awkward-feeling running. It can also have the unhappy effect of causing you to grip your core muscles and try to lock your pelvis in place–an effort that will add stress to your legs rather than reducing it.
The thing that most reliably gets your hip joint over your ankle joint in midstance is what I call your core action, or the twisting and sidebending movement of your pelvis, waist, and upper body. Twisting uses both flexor and extensor muscles and thus prevents either set of muscles from overpowering the others. It balances you over your feet and optimizes both your footstrike and your midstance.
And that’s why it tends to make runner’s knee fade away.
I see it all the time as I help every client who comes to me discover and improve their core action. But I’m not the only one who has success with this. ChiRunning, the running technique method developed by Danny Dreyer, is also known for helping runner’s knee, and it’s for the very same reason. His method includes cultivating the rotational movement of the pelvis.
I’m not aware of other methods that also include movement of the pelvis (heck, it’s hard to find a method or expert who doesn’t actually tell you to stop moving your pelvis, which is a tragedy). But if there are any out there, they’re probably helpful with sore knees too.
I have blogged about this issue a lot and have gotten a truly astonishing number of emails over the years from runners who tell me their knee pain went away simply from reading my blog posts and running with the idea in mind that it’s okay for their pelvis to move.
Every time I get one of those emails it gives me a little more energy to keep writing and teaching, because the ideas that we have about how running works, how we’re “supposed” to run are so powerful. You almost certainly have some image in mind of what running is that guides you both consciously and subconsciously when you run. And though real learning of movement is an experiential process, ideas still affect us, even to the point of causing pain if they’re mistaken ones.
So if your knee hurts maybe just reading this post will help. Maybe reading other posts I’ve written on the subject will help even more, so I recommend you check out my 3-post series on quad soreness, which is the same dynamic.
But maybe you’ll need to actually take some time to feel how to move differently.
I’ve put together my best Feldenkrais lessons for relieving knee stress and improving your core action into a resource called the Runner’s Knee Solution. Get it for free here:
Please leave a comment letting me know how it goes for you or asking me any questions!
8 thoughts on “How to Fix Runner’s Knee”
Great post! Thank you for the information. Do you think the mid-stance position in relation to the ankle also applies to issues with IT band syndrome?
Hi John, actually in general there’s no connection between the two, however an individual runner could have both problems.
Thank you for the exccelent information. I’m sure I will be able to run again.
I love running but my knee was a problem
Hi Jae. I’m Milton and I recently started running longer distances than usual. Two weeks ago I started feeling some pain on the tendon of the outer side and to the back of my left knee. I found your article very I interesting, so I was wondering if you would have a video or images to undwratand the running technique you describe?
Thanks for your blog! I’ve been reading it for 6 years, and it has really helped me. I’ve seen this old post out of a new post link, and I was thinking about running downhill. In trail running, when down slopes are >10%, definitively when they are >15%, you usually need to leave your hip back (as you warn us against) so you can “slow” your running, or you end up speeding up indefinitively, which is not a good idea…when I see professional runners, they clearly go really fast, but myself, I tend to be on the safe side of downhill running, and knees tend to suffer…any opinions on that?
Hi Alberto! I’m glad my blog has been helpful to you. When you’re going downhill, you don’t need to move your hips back to control your speed. You can choose to lean less or more, to run faster or slower, while still making sure your hip is over your foot in midstance. More of a lean = longer stride and faster running. Less lean = shorter stride and slower running. Try that and see how it works for you.
I started having this runner’s knee problem 3 weeks ago.
First it was after 17 km then after some 12km and today after just 8km.
When I change to walking the sensation is that some cartilage or tendon behind the patella relaxes and the pain disappears.
I checked my Netter’s atlas and believe it’s related to the “articular genu muscle” being too tight for some reason.
I also have the ITBS but that’s mainly on the left and goes away if I pay attention to my gait.
Yesterday I walked a bit (before today’s long run) and I noticed there is a way of stepping that is simply loveable: land on outer “pillow”, then spread the foot towards the center and finaly pull the ground with the whole foot (rather than with the outer edge or just the foot thumb).
This kind of gait helps twith ITBS in a way that’s noticeable after just a few steps. It might help with the PFS as well but the effect is not as noticeable. The problem is that I tend to forget about it when I don’t pay attention and then I get pain…
Forty years ago, I had such a problem with persistent patellar tendonitis – particularly when running for months in a location that was flat as a pancake – that I consulted an orthopedic surgeon. After first suggesting that I give up running (sigh), he agreed to help. He concluded that I should imobilise my knee in order for the tendon to heal.
So he put me in a full leg plaster cast, suggesting I leave it on for a month. After three weeks, I was so bored (and lacking in belief that this was the right treatment) that I cut off the cast without consulting the surgeon (whom I never revisited).
Shortly afterwards, I spent a month on leave (from flight training) in Seattle (famously built on seven hills, like Rome). I ran ten miles a day for six days a week, pain-free, and voila, the tendonitis was gone. Based on your article above, I suspect my pelvis placement and action was so much better running uphill than blasting away at fast miles on flat terrain that my body was able to bounce back easily.