Running is a fantastic way to stay active, improve fitness and support your overall health. However, if you regularly experience knee pain during or after a run, it can quickly become frustrating.
Whether you are a regular runner, training for an event or simply enjoy an occasional jog, knee pain can affect your confidence and make it difficult to maintain your usual routine.
But what causes knee pain when running? Is it always a problem with the knee itself, or could other factors, such as muscle strength, movement patterns and foot function, be contributing?
At Randell’s Footcare, we understand that the way your body moves is connected. Looking beyond the painful area can sometimes help identify factors that may be contributing to discomfort.
In this article, we explore some common causes of running-related knee pain and explain how a combination of podiatry and physiotherapy may help.
What Causes Knee Pain When Running?
Knee pain is one of the most common complaints among runners. It can develop gradually through repeated loading or appear following a change in training, an injury or an increase in running distance. Some common causes include:
1. Runner’s Knee (Patellofemoral Pain)
Patellofemoral pain, often referred to as runner’s knee, is a common cause of discomfort around or behind the kneecap. You may experience:
- Pain around the front of your knee.
- Discomfort when running, particularly downhill.
- Pain when walking downstairs.
- Discomfort after sitting with your knees bent for extended periods.
- Pain during squats or lunges.
Patellofemoral pain can be influenced by several factors, including training load, muscle capacity, movement patterns and the way the knee responds to repeated activity.
It is not necessarily caused by the kneecap being incorrectly positioned, and an individual assessment is important to understand what may be contributing to your symptoms.
2. Iliotibial Band Syndrome (ITB Syndrome)
The iliotibial band is a thick band of connective tissue running along the outside of your thigh, from the hip towards the knee.
Iliotibial band syndrome can cause pain around the outside of the knee, particularly during repetitive activities such as running. Symptoms may include:
- Pain on the outer side of the knee.
- Discomfort that develops after a certain running distance.
- Pain that worsens when running downhill.
- Tenderness around the outside of the knee.
Changes in training volume, running mechanics and hip muscle capacity may contribute to symptoms.
3. Patellar Tendinopathy
The patellar tendon connects the kneecap to the shinbone and plays an important role in straightening the knee.
Patellar tendinopathy involves changes to the tendon associated with repeated loading. It can cause pain towards the front of the knee, usually just below the kneecap.
It is often associated with activities involving repeated jumping, acceleration and running. Symptoms may include:
- Pain below the kneecap.
- Tenderness when pressing the tendon.
- Discomfort during running or jumping.
- Pain when performing squats or other loading activities.
Managing training loads and progressively improving the tendon’s ability to tolerate activity are important parts of rehabilitation.
Could Your Muscle Strength Be Contributing to Knee Pain?
When considering running-related knee pain, it is important to look beyond the knee itself.
Running places repeated demands on the muscles and joints throughout your lower body. Your hips, thighs, calves and feet all work together to support movement and manage the forces generated with each stride.
If certain muscles lack the strength or capacity to meet these demands, this may influence how your body manages repeated loading.
Hip Strength
Your hip muscles help control movement of the pelvis and thigh during running.
The gluteal muscles, particularly the gluteus medius and gluteus maximus, contribute to hip stability and lower-limb movement. If these muscles have insufficient strength or endurance for your running demands, you may find it more difficult to control movement during single-leg activities.
This does not mean weak hip muscles are always the cause of knee pain, but assessing hip strength and function can help identify areas that may benefit from rehabilitation.
Quadriceps Strength
The quadriceps muscles at the front of your thigh play an important role in controlling knee movement. They help absorb and manage forces during activities such as running, jumping and landing.
Developing appropriate quadriceps strength can help improve your ability to tolerate running-related loads.
Calf Strength
Your calf muscles are particularly important during running. They contribute to propulsion, help manage forces as your foot contacts the ground and support movement through the ankle.
Reduced calf strength or endurance may affect your ability to tolerate repeated running loads, particularly during longer distances or faster sessions.
A physiotherapist can assess these muscle groups and help develop a strengthening programme based on your individual needs.
What Role Does Foot Function Play in Knee Pain?
Your feet are your first point of contact with the ground when running. They play an important role in absorbing, transferring and managing forces as you move.
The way your feet function can influence movement throughout your lower limbs, including the knees.
During running, your feet naturally move through different positions as they adapt to the ground and help propel you forwards. Factors such as foot mobility, strength, ankle movement and overall lower-limb mechanics may influence how forces are distributed during activity.
For some runners, excessive or poorly tolerated foot movement may be one of several factors worth investigating when assessing knee pain.
However, it is important to remember that foot posture alone does not determine whether someone will develop an injury.
There is no single ideal foot position for every runner. The aim of an assessment is to understand how your feet function in relation to your symptoms, strength, running demands and overall movement.
Could Your Running Technique Be Contributing?
Running technique varies considerably between individuals. Factors such as stride length, cadence, speed and running surface can influence the loads placed on different structures.
Sometimes, knee discomfort develops following a change in running habits. For example:
- Increasing your weekly mileage too quickly.
- Introducing more hill running.
- Increasing running speed or intensity.
- Returning to running after a prolonged break.
- Changing footwear without allowing time to adapt.
These changes can increase the demands placed on your muscles, tendons and joints. Reviewing your training routine and allowing sufficient recovery between sessions can be just as important as strengthening exercises.
A running or gait assessment may help identify movement patterns worth exploring, although changing running technique is not necessary or beneficial for everyone.
How Can a Biomechanical Assessment Help?
If you regularly experience knee pain when running, a biomechanical assessment can help build a better understanding of how your feet and lower limbs function. At Randell’s Footcare, a biomechanical assessment may include:
- Discussing your symptoms, medical history and running routine.
- Examining your foot structure and joint mobility.
- Assessing muscle strength and function.
- Looking at lower-limb movement patterns.
- Observing your walking or running gait where appropriate.
- Identifying potential factors that may be contributing to your discomfort.
The findings can help determine whether factors relating to foot function, movement or loading may be relevant to your symptoms.
Depending on the assessment, recommendations may include footwear advice, exercises, activity modifications or custom orthotic devices where clinically appropriate.
The aim is not simply to change the position of your feet, but to understand how your body moves and what may help you return to activity comfortably.
How Can Physiotherapy Help?
Physiotherapy can play an important role in managing running-related knee pain.
Following an assessment, a physiotherapist can develop a rehabilitation programme designed around your symptoms, strength and running goals. Treatment may include:
Progressive strengthening exercises
Targeted exercises can help improve the strength and capacity of the quadriceps, gluteal muscles and calf muscles.
Load management
Adjusting running distance, speed and frequency can help manage symptoms while maintaining an appropriate level of activity.
Mobility work
Where relevant, exercises to improve joint mobility and movement can form part of your rehabilitation programme.
Running advice
Your physiotherapist may help review your training routine and discuss whether changes to your running technique or weekly mileage are appropriate.
A gradual return to running
A structured return-to-running programme can help you rebuild your running capacity rather than returning too quickly and risking further discomfort.
Why Podiatry and Physiotherapy Can Work Well Together
Knee pain when running is not always caused by one isolated problem.
A runner may have reduced calf strength, changes in ankle mobility, increased training loads and movement patterns that all contribute to their symptoms.
This is why looking at the bigger picture can be valuable.
Podiatry can help assess foot function, lower-limb biomechanics and footwear considerations, while physiotherapy can focus on strength, rehabilitation, movement and load management.
Working together allows different aspects of a patient’s movement and physical capacity to be considered.
At Randell’s Footcare and Randell’s Healthcare, we recognise the value of combining these areas of expertise to help patients receive a more complete assessment and appropriate treatment recommendations.
When Should You Seek Professional Advice?
Occasional muscle soreness after running is not unusual, particularly following a challenging session or an increase in training. However, you should consider seeking professional advice if:
- Knee pain keeps returning when you run.
- Discomfort is affecting your ability to exercise.
- You are changing the way you walk or run to avoid pain.
- Your knee feels unstable or regularly gives way.
- You experience persistent swelling or stiffness.
- Your symptoms are not improving despite reducing your activity.
Seek urgent medical assessment if you cannot put weight on your knee, have severe pain, significant swelling or a visibly deformed knee. A hot, red knee accompanied by fever or feeling unwell also requires urgent assessment.
Getting the right advice early can help you understand your symptoms and avoid repeatedly aggravating the problem.
Don’t Let Knee Pain Keep You From Running
Running should be something you enjoy, not an activity you constantly have to work around because of discomfort.
If your knees hurt when you run, it is worth considering more than just the painful area. Muscle strength, foot function, running technique and training loads can all play a role in how your body manages the demands of running.
A combination of appropriate assessment, targeted strengthening and sensible load management can help you work towards improving your symptoms and returning to the activities you enjoy.
At Randell’s Footcare and Randell’s Healthcare, our podiatry and physiotherapy teams can help assess your movement, understand potential contributing factors and recommend an appropriate approach to treatment.
Experiencing knee pain when running? Let’s help you get moving comfortably again.
📞 Call Randell’s Footcare on 01603 737188
📅 Book an appointment online here
Every runner is different. The right approach starts with understanding your individual needs.
