Oct 20, 2025
Running with Knee Pain
Running and Knee Pain: Causes, Prevention, and How Physiotherapy Can Help
Running is one of the most effective and accessible forms of exercise. It improves heart health, builds endurance, strengthens muscles and bones, and supports mental well-being. But for many runners, knee pain can become an obstacle that limits performance and enjoyment.
The knee is a complex joint that absorbs significant force with every step you take. While running is often blamed for knee pain, research shows that running itself is not harmful to the knees when done properly. In fact, regular running can strengthen the tissues that support the joint. The real challenge arises when training errors, muscle imbalances, poor biomechanics, or inadequate recovery overload the knee beyond its capacity.
At Proactive Health Physiotherapy in Richmond, BC, we work with runners of all experience levels to understand the cause of their knee pain and guide them toward effective treatment and long-term prevention. This article explores why knee pain happens, the most common running injuries, how physiotherapy can help, and how you can protect your knees so you can run pain-free for years to come.
Common Causes of Knee Pain in Runners
The idea that running inevitably damages the knees is one of the most persistent myths in fitness. Studies show that recreational runners are less likely to develop osteoarthritis compared to people who do not run. Movement helps nourish cartilage and strengthens the muscles, ligaments, and connective tissues that support the joint.
The issue is not the act of running itself but rather how you run, how much you run, and whether your body is prepared to handle the demands you place on it. Factors such as muscle weakness, poor movement mechanics, overtraining, and improper footwear often play a much larger role in knee pain than running does.
Knee pain is not a single condition but a symptom with many possible causes. Identifying the underlying source of your pain is the first step toward effective treatment. Below are the most common running-related knee issues we see at Proactive Health Physiotherapy.
Risk Factors for Knee Pain in Runners
Knee pain is one of the most common issues runners face, and it rarely happens without underlying causes. Often, it’s not the act of running itself but a combination of biomechanical, training, and lifestyle factors that increase your risk. Understanding these can help you prevent problems before they start.
1. Poor Running Mechanics
Subtle issues in your running form, like overstriding, excessive inward knee collapse, or poor hip control, can place repetitive stress on the knee joint. Over time, this added pressure can lead to irritation and pain, especially around the patella (kneecap).
2. Muscle Imbalances and Weakness
Weak hips, glutes, or core muscles often force the knees to absorb more impact than they should. When stabilizing muscles aren’t doing their job, the knees compensate, increasing the risk of conditions like runner’s knee (patellofemoral pain syndrome) or IT band syndrome.
3. Overtraining or Rapid Mileage Increases
A sudden jump in distance, speed, or intensity doesn’t give your body enough time to adapt. This overload can strain the tendons, ligaments, and cartilage around the knee, triggering pain and inflammation.
4. Inadequate Footwear or Support
Worn-out running shoes or footwear that doesn’t match your gait type can alter how forces are distributed with each step. Poor support contributes to overpronation or misalignment, which directly affects knee tracking and joint health.
5. Limited Mobility or Flexibility
Tightness in the quadriceps, hamstrings, calves, or hip flexors can pull on the structures around the knee and disrupt proper alignment. Restricted ankle or hip mobility can also force the knee to compensate during running.
6. Pre-existing Conditions or Structural Factors
Flat feet, knock knees, previous injuries, or structural differences in leg length can all increase susceptibility to knee pain. These issues may require custom orthotics, targeted physiotherapy, or strength work to correct underlying imbalances.
Common Running-Related Knee Injuries
Runner’s Knee (Patellofemoral Pain Syndrome)
Runner’s knee is the most common cause of knee pain in runners. It refers to pain around or behind the kneecap, often triggered by running downhill, climbing stairs, or sitting for long periods.
Common Causes of Runner's Knee:
Muscle imbalances, especially weak quadriceps or glutes
Tight iliotibial band pulling on the kneecap
Overuse or sudden increases in training volume
How physiotherapy helps runner's knee: A physiotherapist can identify muscular weaknesses and biomechanical issues contributing to runner’s knee. Treatment may include strengthening exercises, mobility work, manual therapy, taping techniques, and gait retraining to restore proper movement patterns.
Iliotibial Band Syndrome
Pain on the outside of the knee is often caused by iliotibial band syndrome. The iliotibial band is a thick band of tissue that runs from the hip to the shin. Repetitive friction of this tissue over the thigh bone can cause irritation and inflammation.
Risk factors of Iliotibial Band Syndrome:
Always running on the same side of a road or track
Rapid increases in mileage or intensity
Weak hip stabilizers
How physiotherapy helps Iliotibial Band Syndrome: Physiotherapy treatment for iliotibial band syndrome focuses on strengthening the hip muscles, improving movement control, and releasing tension in surrounding tissues.
Patellar Tendinopathy (Jumper’s Knee)
This condition involves tiny tears in the patellar tendon, located just below the kneecap. It often develops from repetitive stress, especially in runners who include hills, sprints, or jumping drills in their training. Tendons heal through controlled loading. Resting completely often delays recovery, while the right exercises help the tendon regain strength and resilience.
How physiotherapy helps Jumper's Knee: A physiotherapist will guide you through a structured loading program tailored to your injury stage. They will also address contributing factors like muscle imbalances and technique issues, ensuring the tendon heals properly and becomes stronger.
Meniscus Tears
The menisci are two C-shaped pieces of cartilage that act as shock absorbers in the knee. Tears can occur suddenly due to twisting or gradually from repetitive stress.
Symptoms of Meniscus Tears:
Locking or catching sensation in the knee
Swelling or stiffness
A feeling that the knee might give way
How physiotherapy helps Meniscus Tears: Not all meniscus tears require surgery. Physiotherapy can help reduce pain and swelling, restore mobility, strengthen the muscles around the knee, and improve overall joint function. Early intervention often leads to better long-term outcomes.
Osteoarthritis and Degenerative Knee Pain
Older runners or those with a history of injury may experience degenerative changes in the knee joint. However, moderate running is not only safe but can help reduce osteoarthritis risk.
How physiotherapy helps with Osteoarthritis: Physiotherapists can provide targeted exercise programs to improve strength and joint function, recommend activity modifications, and use manual therapy to improve mobility and reduce discomfort. Education on pacing, footwear, and training load helps keep you active safely.
Why Knee Pain Often Starts Elsewhere
It is important to understand that knee pain is rarely caused by the knee alone. The joint acts as a hinge between the hips and ankles, so dysfunction in either area can place excessive stress on the knee.
Common biomechanical contributors:
Flat feet or excessive pronation, causing the knees to collapse inward
Weak hip muscles failing to control leg alignment during movement
Limited ankle mobility increases impact forces
At Proactive Health, we conduct a detailed biomechanical assessment to identify and address these root causes. Correcting issues at the source not only relieves pain but also prevents future injuries.
Can You Run With Knee Pain?
Whether you should continue running depends on the type and severity of the pain. A simple traffic light guide can help you decide:
Green light: Mild discomfort that does not worsen with running and resolves within 24 hours. It is generally safe to continue.
Yellow light: Moderate pain that lingers or slightly alters your stride. Reduce training volume and consult a physiotherapist.
Red light: Severe pain, sharp pain, or pain that causes limping. Stop running and seek professional evaluation immediately.
Physiotherapists are trained to assess whether your pain is safe to run through or requires rest and targeted intervention.
How Physiotherapy Helps Knee Pain for Runners
At Proactive Health Physiotherapy in Richmond, we take a comprehensive, evidence-based approach to treating running-related knee pain. Our goal is not just to relieve symptoms but to address the root cause and help you return to running stronger than before.
Here is how physiotherapy supports recovery:
Comprehensive Assessment
Your recovery starts with a detailed assessment of your movement patterns, running technique, strength, flexibility, and footwear. We also review your training history and discuss when and how your pain occurs. This holistic approach allows us to create a targeted plan tailored to your specific needs.
Manual Therapy for Pain Relief
Manual therapy techniques, such as joint mobilizations and soft tissue release, can help reduce pain, improve range of motion, and restore normal joint function. These techniques are often used early in treatment to make movement more comfortable and support healing.
Customized Exercise Programs
Exercise therapy is at the heart of physiotherapy treatment for knee pain. Your physiotherapist will design a personalized strengthening program to build the muscles that support the knee and improve movement mechanics. Exercises typically target the glutes, quadriceps, hamstrings, and core muscles to enhance stability and shock absorption.
Gait Analysis and Technique Coaching
Small changes in running form can significantly reduce knee stress. Using gait analysis, physiotherapists can identify inefficient movement patterns and teach you techniques to improve stride, cadence, and posture. These adjustments often prevent future pain and improve running efficiency.
Education and Self-Management Strategies
Knowledge is a powerful tool in injury prevention. We educate runners on how to manage training load, choose appropriate footwear, recover effectively, and recognize early warning signs of injury. Our goal is to empower you with the tools you need to stay healthy and active.
Preventing Knee Pain Before It Starts
The best treatment for knee pain is prevention. Incorporating a few key strategies into your routine can dramatically reduce your risk of injury and keep you running for years to come.
Improve Flexibility and Mobility
Tight muscles and restricted joints can alter running mechanics and place more stress on the knees. Regular stretching, foam rolling, and mobility drills can improve tissue quality and movement efficiency.
Physiotherapists often prescribe mobility routines tailored to your needs to ensure your joints and muscles are working optimally.
Progress Training Gradually
One of the most common causes of knee pain is doing too much too soon. Increase your weekly mileage by no more than ten percent and include recovery weeks in your training plan. Avoid sudden spikes in distance or intensity that can overload tissues.
Check Your Running Form
While there is no single perfect running form, certain mechanics can reduce knee stress. These include a slight forward lean from the ankles, a cadence around 170 to 180 steps per minute, and landing with your foot under your center of mass.
A gait analysis from a physiotherapist can reveal if your form is contributing to pain and guide you in making safe, gradual changes.
10. Choose the Right Footwear
Shoes should match your foot type, running style, and the surfaces you train on. Worn-out shoes or improper support can increase knee stress. Replacing shoes every 500 to 800 kilometres is generally recommended.
Physiotherapists can assess your gait and help you select footwear or custom orthotics that support proper alignment and reduce injury risk.
When to Seek Physiotherapy for Knee Pain
Do not wait until knee pain stops you from running completely. Early intervention leads to faster recovery and better outcomes. Seek professional help if you experience:
Pain that lasts more than two weeks
Swelling, redness, or warmth around the knee
Locking, catching, or instability
Pain that worsens with activity or affects your sleep
At Proactive Health, we specialize in treating running-related injuries and helping athletes return to pain-free performance as quickly as possible.
Returning to Running After Knee Pain
If knee pain has forced you to take a break, returning too quickly can lead to setbacks. A structured return-to-run program is essential.
Reduce load and let pain settle: Pause or modify running until daily activities are pain-free.
Rebuild strength and mobility: Address weaknesses and imbalances before returning to high-impact activity.
Gradually reintroduce running: Start with walk-run intervals and progress slowly.
Correct contributing factors: Adjust footwear, surfaces, and technique as needed.
A physiotherapist can design a safe and effective return plan tailored to your condition and goals.
Run Stronger and Pain-Free With Physiotherapy
Knee pain does not have to end your running journey. With the right approach, most runners recover fully and return stronger than before. Physiotherapy is not only about treating injuries — it is about building resilience, improving performance, and preventing future problems.
At Proactive Health Physiotherapy in Richmond, BC, we help runners understand the root cause of their pain, build the strength and stability needed to support their knees, and return to the sport they love. Whether you are dealing with discomfort, recovering from an injury, or looking to prevent future issues, we are here to guide you every step of the way.
Book Physiotherapy in Richmond BC
Do not let knee pain stop you from reaching your goals. If you are experiencing pain while running or want to improve your performance and prevent injuries, physiotherapy can make all the difference.
Book your physiotherapy appointment today and take the next step toward pain-free running and stronger knees.