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.
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.
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!
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Jae Gruenke, GCFP, is a running technique expert and Feldenkrais Practitioner. Known as a “running form guru,” she is the Founder and CEO of The Balanced Runner™ in New York City and The Balanced Runner UK. She has helped runners from beginner to Olympian improve their form to become pain-free, economical, and fast.