How to fix knee pain from running

A lot of clients come to us, after putting up with knee pain when they’re running. What we’ve found is that it isn’t necessarily a problem with the knee. The problem usually stems from somewhere else.

If you suffer from knee pain when running here are 4 quick easy tests you can do to see where the problem is coming from, and what you need to do to fix it.

We aren’t doctors so if your knee is swollen, or you’re in a lot of pain, it could be something that needs investigating. If that’s the case, go and see a GP or a physical therapist.

What’s going on with your knee?

First, we need to explain what’s going on with your knee. Most of the time when runners get pain in their knee - it's classified as a biomechanical dysfunction - which is a fancy way of saying there’s a problem with the way your kneecap (patella) is tracking as you run.

When there’s a problem, the kneecap is pulled away from where it naturally sits. You can think of it as the tyres on your car when the tracking is out... If your tyre is misaligned, it causes uneven wear until eventually, the tyre fails. We want to get everything moving properly so your knee doesn’t suffer in the same way.

In order to do this, we need to look at the bigger picture and see how the ankles and hips are moving and working together with your knees.

Is your ankle mobility causing your knee pain?

First up we’re going to head down to the ankles and see whether your knee pain could be coming from poor ankle mobility.

If your calf muscles are stiff or short, there’s going be less range of motion in the ankle to absorb the load when running. The ankle takes between 37-57% of the force when running. If this joint isn’t as mobile as it should be and can’t take the force you’re putting through it, that force has to go somewhere, and you’ve guessed it, that’s generally the knee.

Stiff ankles also make it more difficult to stabilise the knee too. It alters your movement patterns, which could eventually cause your knee to give way when running.

So that’s why your ankle mobility is so important.

How do I test for poor ankle mobility?

Get out of your shoes and socks, find a wall, and put your foot five inches away, which is a thumb plus an extended fist away from the wall.

Push your knee as far forward as you can directly over the toe. It’s important not to twist out to the side and swivel your hips.

Move straight forward and see if you can touch your knee to the wall. Then repeat on the other side.

If your pain is in the right knee, and the issue is ankle mobility, it’s unlikely you’ll be able to touch your right knee to the wall.

This test will instantly show you whether you have poor ankle mobility on either ankle.

If that’s you, you’ve just uncovered a potential cause of your knee pain, and here’s what you need to do to improve your ankle mobility…

How to fix poor ankle mobility – The Box Stretch

Put one foot on a box or bench and push forward keeping your heel firmly placed (don’t let it raise up) until you feel a good stretch in the back of your calf.

Hold it for a couple of seconds and then ease off.

Do this about 8-10 times, 3 times a week and you should see your ankles getting more mobile and your knee pain subsiding.

Now that your ankles are taken care of, we need to move up to the hips where a lot of runners suffer from poor hip mobility.

Is poor hip mobility causing your knee pain?

When we look at how mobile your hips are, we’re looking at your hip rotation. When you lack hip rotation, in either direction, this will cause the kneecap (patella), to sit and move awkwardly on the femur. The kneecap naturally wants to sit in the middle of the leg, but if a tight hip is pulling it away from its normal position and tracking, you can get inflammation and pain in the knee. Also, if you don't have symmetrical hip rotation, side to side, as you run there are going to be uneven forces placed on the knee joint.

Remember, the knee is only the hinge between the ankle and the hip, so if you have imbalances it’s going to lead to excessive forces on the knee.

A big issue a lot of runners have is limitations in their hip internal rotation, which is why we need to test how much hip internal rotation you have on either side. If there’s a difference of over 10 degrees you may have a problem with your hip mobility.

How can I test for imbalances in my hip rotation?

When you’re doing this test make sure you’re sitting upright. It’s also important that you keep your butt on the chair and don’t raise it up. Now, move your feet out to the side.

If you have an imbalance side to side, it should be easy to see. You can see from the image Ryan’s left side has less internal hip rotation compared to his right, so it’s his left hip he needs to work on.

If you had an imbalance when you do this test you’ve identified a second potential problem that could be causing pain in your knee.

How do I fix poor hip mobility?

To improve internal hip mobility, you do a stretch called the assisted hip airplane, or tippy bird, which was designed by Dr. Stuart McGill as an active flexibility exercise for the glute muscles.

Grab on to something stable – like a wall. Plant the foot that is less mobile on the ground, bring the other foot back.

Then drop your pelvis down on the side that’s lifted, pointing your belly button toward the opposite side of the leg that is lifted as shown in the picture. Better still here’s the chapter of the video that shows this.

If you’re only feeling this stretch in your hamstring or the back of your leg, you need to bend your knee a bit more and stick your butt out so you can shift your hip back. You should feel a good stretch on the top of your butt cheek in the Glute Medius and into the Glute Max.

Hold this stretch for 5 seconds, then relax and come back up. Then, drop back down into position to do the stretch again. You only really need to stretch the side you have a problem with.

After we’ve stretched your hip, we need to check to see how mobile that hip now is.

How to retest your hip mobility?

To test your internal hip rotation, you perform the same test as before and see if your internal hip rotation is any better after doing the assisted hip airplane. We tend to see most people see an improvement after doing the stretch 3 or 4 times but doing this stretch regularly will keep your hips moving well and reduce your chances of getting knee pain when running.

Now that we’ve got your ankle and hip mobility cleared up, we’re going to move on to the 3rd test for fixing your knee pain which is to improve your knee stability.

Why is knee stability important for runners?

The reason we need to have good knee stability is to be able to deal with forces placed on the knee when running. By strengthening the muscles around the knee, you’ll be ironing out imbalances and strengthening the muscles that weren’t as strong before.

How do I test how stable my knee is?

To check how stable your knee currently is, you’re going to do an exercise called the Touchdown Squat.

To do a touchdown squat you're going to stand on one foot, grab the ground with your foot.

Then you need to squat down, tap your heel on the floor, and then come back up.

To know if this exercise is right for you bring your knee in towards your body as you squat down, is that painful? Most people will say it is. Now try it this way…

Keeping the knee in line with the foot, squat down, stick your butt out, bend your knee and slowly lower your other foot to the ground. Does that feel better? If it does and decreases your pain, the exercise is correct for you.

The chances are when you first start doing the Touchdown Squat your pain levels are going to be pretty high so start off on a lower step. As you progress over time, and your pain subsides, you can increase the height of the step.

We recommend doing 2-3 sets of 20 reps. That may seem like a lot of repetitions, but we need to rework your body's endurance and coordination and that takes a lot of reps.

It’s kind of like when a golfer has a problem with his golf swing. If he tries a new swing just a couple of times, he’ll more than likely revert to his old swing as it’s comfortable and easy.

It’s only when he repeats the process again and again that the new, better swing, eventually becomes natural. It really is a case of practice makes perfect…

This is why you need a lot of repetitions with this exercise. We’re retraining your brain and body to move in a more optimal manner. If you keep on top of doing the touchdown squat you’ll get that knee more stable, stronger, and better able to cope with running.

Right, that’s your ankle and hip mobility and your knee stability sorted.

Are my glutes causing my knee pain?

Our 4th tip in fixing your knee pain for good is all about getting your Glutes activated properly and working for you. If both glutes are not activating properly when you’re running, your hamstrings, quads, and calves will be working harder, placing extra stress on them.

We’ve already seen how this can translate into poor mobility, stability and cause knee pain. Improving your glute activation on both sides will ensure you’re running optimally, which is key to getting rid of your knee pain.

How do I test my glute activation?

To test your glute activation on either side, we need to do a single-leg bridge test.

Lie on the floor, bend one leg, push through your heel, this will bring your body off the floor and hold for 5-10 seconds…

When you’re doing this exercise it’s important to note where you’re feeling it as that will tell you whether your glutes are activating properly. When you’re doing the exercise are you feeling it more in the glute, hamstring quad, or your back?

Repeat this on the other leg and again you’re looking at where you’re feeling it? What we're looking for again is an imbalance side to side.

What we tend to find is when people do this exercise, if they have right knee pain then they won’t feel much activation in the right glute. Instead, the other muscles: the hamstring, quad, and back are working overtime to compensate.

So, if there was an imbalance in your glute activation or you weren’t feeling it in your glutes at all, we need to work on your coordination and control of your glutes.

How do I get my glutes firing properly?

To do this we do an exercise called double leg bridges.

The technique is like the single leg bridge test, but now we’re going to use both legs at the same time.

Lie on the floor, bend both legs up, drive your toes in to the ground and push through your heels, this will bring your body off the floor and hold for 10 seconds…

You’re going to build up to doing 20 reps of this exercise, and we’re not going to lie, your glutes are going to be on fire by the end of this!

Final thoughts

So, improving your ankle and hip mobility, building your knee stability, and getting those glutes activating are all going to help you banish that knee pain for good and get you back running pain-free.

This is where the blog would normally end, but we’re coaches, and we know the score.

What we tend to find is people will do this for a week, see some benefit, stop, and then wonder why their knee pain comes back.

Rome wasn’t built in a day… your knee pain won’t be gone in a week.

So, if you want to stay pain-free schedule these exercises into your routine 2-3 times a week and you’ll see the benefits long term.