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Published on July 23, 2015

3 Running Mistakes that Trigger Knee Pain

July 23, 2015

woman holding her knee Knee pain while running? Stop, evaluate the root cause and take time to correct it.

You were just getting into your daily run, and then it hit you: a sharp, hot pain in your knee. The moment you stop running, the pain goes away. The longer you run, the more it hurts. What’s going on?

Parsing Pain

You may have an overuse injury. The most common type of injury among runners is patellofemoral pain syndrome (PFPS). Most experts believe PFPS occurs when the kneecap rubs one side of the knee joint, irritating and inflaming the surrounding nerves. Other common knee overuse injuries include patellar tendonitis, bursitis and iliotibial band friction syndrome. The only way to know for sure which type of injury you have is to be evaluated by a medical professional. Fortunately, most knee pain that occurs while running can be significantly helped or even eliminated by addressing one or more of these common running mistakes:

Striking on the heel of your foot

The problem: Foot strike refers to the position of your foot as it lands on the ground. Landing heavily on your heels can exacerbate any existing structural problems in your legs and contribute to knee pain.

The solution: Take shorter strides and quicker, lighter steps, making sure your feet land under your hips rather than out in front of them. A recent study found that running this way may be beneficial for runners who experience knee pain. This will facilitate a more mid-foot strike, directing ground reaction forces to your ankles rather than your knees, which may reduce the likelihood of knee injuries. Harvard University offers helpful information on the biomechanics of foot strikes, including training tips if you’re trying to develop a mid-foot strike.

You may need new footwear, as well. Shoes that have an elevated heel cushion promote a heel-heavy foot strike. Though it may seem counter-intuitive, studies have demonstrated that using a less cushioned shoe (sometimes called a minimal shoe) leads to fewer running injuries when used correctly. The key is to change your foot strike before fully transitioning to a minimal shoe. A running gait expert at your local athletic footwear store can recommend a good transition shoe for you.

Increasing intensity too quickly

The problem: Just like any activity, running requires conditioning. If you go from running one day a week to four, or from running two miles to six, you’re bound to experience musculoskeletal pain. Soreness the day or two after a longer-than-usual run is normal, but sudden, sharp joint pain is a sign you’re trying to tackle too much in too short a time.

The solution: Up your running regimen gradually. Many runners follow the 10-percent rule: Never increase your weekly mileage by more than 10 percent from week to week. If you’re attempting to quicken your pace, decrease your mileage until you can consistently meet your target pace on shorter runs. The same goes if you’re increasing the frequency of your runs. The general rule is to not attempt to increase more than one variable (distance, pace, frequency) at a time.

Having weak core muscles

The problem: Even with proper form and gradual increase in intensity, runners still fall prey to knee pain because their core muscles are simply not strong enough. Weak muscles don’t provide adequate support for your skeletal system, which leaves it vulnerable to misalignment and undue strain.

The solution: On days between runs, perform 15 to 20 minutes of simple strength-training exercises to build up your core muscles. Focus on your glutes, hip muscles, inner thighs and lower abdominals. A recent study found that female runners with PFPS reduced their knee pain by strengthening glute and hip muscles over the course of eight weeks. When running, try to actively engage your core muscles and keep your body tight.

To learn more about proper running form, check out New York Road Runners’ series of instructional videos.

Do you want your stride to be evaluated? Our Physical Therapy department offers a runner's gait analysis!

Pronation: Over or Under?

While running, many people land on the outer edge of the heel and “roll” or tilt their feet toward the inner edge of their foot as they move through the step. This rolling movement from the outside to the inside of the foot is known as pronation. Underpronating means you tend to place your weight on the outside edge of your foot throughout the step. Overpronating means your foot rolls inward excessively. Both decrease your running efficiency and can cause musculoskeletal pain.

But how do you know whether you’re an over- or underpronator? To find out, take one of your old pairs of running shoes and examine the soles. If the outer edge of the heel and big toe are excessively worn down, you may overpronate. If your sole is worn along the outer edge, you may underpronate. Another way to tell is by slightly wetting the bottoms of your feet and walking across a sheet of paper. If you see most of your foot, you have flat feet and likely overpronate. If you only see the heel and ball and a thin outer strip connecting the two, you have a high arch and likely underpronate.


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