Many athletes accept the fallacy that knee pain is the inevitable cost of running. While it is true that running places a great amount of force on the knee joint, it isn’t always the impact that causes pain. Believe it or not, running actually strengthens the knee joint and the surrounding bones. Have you heard of Wolff’s Law? It states that bones essentially remodel themselves in response to the load placed onto them. The more you expose your bones to the compressive forces (running), the stronger they become. The same applies to tendons and ligaments, as stated in Davis’s Law. If all these tissues strengthen with imposed demands, where the heck is this pain coming from then? The answer isn’t always an exact science, but the pain typically originates from imbalances or weaknesses in the hips or feet, and sometimes both. Give these techniques a shot and you should be able to find the answer to the all-to-common question, “is my running knee pain from the hips or feet?” a key question for running knee pain.

Hip Troubleshooting:

Weak core or glute muscles can lead to wobbly hips, and wobbly unstable hips can cause excessive knee motion in the frontal plane. This type of motion of the knee can lead to irregular distribution of weight during the loading phase and excessive stress on the knee joint. It is all a big chain reaction! The goal here is to stabilize the hips and pelvis to reduce the unnecessary motion of the knee.

Try this out:

Run at an easy pace as you would normally, but this time I want you to try tightening your core and glutes right before landing. Think about tightening the glute of the leading foot. If you find it difficult to do both at the same time, try just one at first. When you can do one of them with ease, think about adding in the second. The goal here is to teach these muscles to engage automatically while you run, which will help strengthen those wobbly hips! If this helped with your knee pain, then weak hips and/or core muscles were the source of your pain to begin with.

Ankle Troubleshooting:

The ankle joint is also a common area of concern in runners. Muscular imbalance as well as flat arches can both lead to irregular distribution of weight during running and disproportionate forces placed on the knees. The goal here is to strengthen the muscles around the ankle and release the tension any tension that you have in the foot and calf.

Try this out:

This one will take a bit of practice, but the idea is simple. Run at a slow pace while curling your toes into the ground during the landing of each foot. This will create a more stable arch for the rest of your body to move off of. If this helps with the knee pain, you most likely have arch instability. In that case, try out the following exercises aimed at strengthening the muscles in and around the arch.

Ankle Myofascial Release:

  • Plantar Fascia

  • Peroneals

Ankle Strengthening Exercises:

  • Toe Waver – Lift your big toe up high while curling the other toes down. Now curl the big toe down while extending the other toes up. Repeat!

  • Toe-Spreader – These are exactly what you might think. Try to create space between all of your toes by spreading them outwards.

  • Arch Creation – Curl your foot by bring the center of the foot toward the ceiling. Flex it up then relax and repeat.

  • 1 Foot-Balance – Start of balancing on one foot with eyes open. Then try it with eyes closed. After you master these, watch the video to try out some hi-low single leg stability!

Sometimes running knee pain isn’t just from the ankle or hip, but both. If you found this to be the case for you, take a step back and focus on the basics. You would be surprised by how many people have imbalances and inefficient gaits when it comes to running. For such a simple activity, it requires a great deal of form and technique that often gets overlooked. As a coach I would record my athletes performing a skill, then play it back to them. Observing yourself through an objective lens like this allows you to connect the dots between what it looks like and what it feels like to perform a skill correctly. Do this with your running and you will have yet another tool to help yourself out in the “long run”! Sometimes you may implement these fixes into your program and find that you are still having running knee pain. Keep in mind that, depending on how long you’ve been effected and the severity of it, healing takes time. The knee may be in such an irritable state that proper form and strengthening exercises won’t clear it up immediately. Focus on the basics and give them time.