POV: You’re locked in on your health and fitness. You've gained an appreciation for the feeling you get from competing or pushing your own limits. Maybe you've decided to train for a Hyrox or started going to run club in the Atlanta summer heat. Everything is going great. You feel the juices flowing again and can’t get enough of it. Boom, your knee starts hurting. Frustrated, you rest for a week, but when you run again, the pain is still there. Now what...
Knee pain is something that a large percentage of people experience at some point in their lives. Before we go any further, I want you to know that this is normal. Pain scares the hell out of a lot of people, but often out of context. In most cases, it isn’t your emergency alarm system screaming at you that something is broken. Instead, it is a messaging signal from the body to the brain, asking for some sort of change in the way it’s being stressed. When it comes to knees, we need to remember that they are loaded every time our foot touches the ground and accepts our bodyweight. That inherently predisposes them to experience pain from time to time. Similar to our feet, hips, low back, etc.
Okay - so what is it about running that so often leads to a painful knee? Let’s break it down into the simplest forms. Running at its core is a series of single leg hops and landings, over and over again. When you factor in bodyweight plus the ground reaction forces experienced during each step, the knee has been shown to take on 3-6x bodyweight. Specifically, the patellofemoral joint (your kneecap) tends to be the most common area of the knee to become painful. Now you’re probably thinking that running is just really aggressive on the knee, so no wonder it hurts. Right? Wrong. While yes, it’s aggressive, many things are aggressive on our bodies that we don’t equate to being dangerous or harmful. The great thing about being human is that our bodies are extremely resilient. We adapt to the stresses being placed on us. That is the exact process of how we improve cardiovascular function, lung health, strength, power, etc.
The most common issue that creates a painful knee is spiking workload (speed, volume, or frequency) too quickly. Doing too much in any of these three areas can cause knee pain. Let’s break down each.
- Intensity - In running, this is known as pace. It’s important to know what your self-selected pace is if you were to just go out on a casual jog. Track this with a smart watch or Garmin. Knowing this allows you to compare runs to one another and self-assess. A simple thing to keep in mind is that the faster you run, the more force you place into the ground, and that force (ground reaction force) is returned to you. So a faster pace is more stressful on the body, but again, that doesn’t mean that it’s bad.
- Volume - How long is each run? How much distance are you accumulating per week? Key things to consider. As always, this requires context. Are you an experienced runner with a flare up? Completely new to running with a flare up? Or maybe you run here and there in conjunction with other training, but still you have a flare up. Volume can be an issue in all three situations. Spiking training volume too quickly is a very easy way to create a painful knee. As mentioned earlier, the body will adapt to the stresses we expose it to, but this process does require time to increase its capacity for the strain it’s enduring. No matter if you’re an experienced runner or a beginner, it’s super important to be smart about changes in running volume. An easy principle to remember is to increase by 5-10% per week.
- Frequency - Another easy place to make a mistake. As with the other two factors, considering your running history is key. No matter how experienced or inexperienced you are, this is another area that you typically can’t afford to cheat. Your body needs to develop the capacity to increase runs per week. If you’re experienced and are someone who trains for races often, you likely have two things: 1) a solid foundation and 2) prior knowledge of how your body will respond to a new training plan. An inexperienced runner doesn’t have the context from prior experience. My advice is to keep it simple by starting with 1-2 runs per week and adding no more than one run per week until you have reached your desired frequency. Side note, while doing so, make sure you are tracking your total volume to avoid exceeding the 5-10% weekly increase.
Outside of training errors, the two other most common contributors to knee pain in runners are downhill running and overstriding.
Downhill running compared to uphill running has an inverse relationship between the knee and the calf. Downhill = increased knee stress, decreased calf stress. Uphill = increased calf stress, decreased knee stress.
Why is this the case? The quadriceps function as a braking mechanism at each foot contact to control your forward momentum. When running downhill, the braking force is significantly increased to prevent you from falling. Increased cumulative forces at a high frequency or high volume are where we can face some issues. Anyone living here in Atlanta knows that avoiding hills is virtually impossible, so choosing specific routes or finding a flat path/track to include in your running program may require extra planning. Downhill running isn’t something that you need to avoid or be overly concerned about; however, temporarily modifying your training to decrease your exposure is something to consider.
Overstriding is another very common observation in runners with knee pain. This refers to how far in front of your body your foot strikes the ground. To keep it simple, the further that distance, the more stress your body has to manage each step. Changing your stride pattern is not an easy or quick thing to do, especially at your own volition. The simplest approach to take here is to increase your cadence. Increasing your cadence by 5-10% can reduce loads at the knee by 20%.
In summary, many people will experience knee pain during their lifetime, especially those who are active and stress their bodies beyond daily activities (which is extremely important to do!) Understanding the likely culprits of the pain and knowing how to address it is where people often get lost. This is also a time when it’s common to begin attaching beliefs to the pain. Staying active is such an essential part of longevity that losing the ability to train is much more impactful than most will ever realize. Do what you can to stay in the race for life. If this speaks to you or someone you know, we would love to help you create a game plan. Call us today at 404-548-8263 or complete a contact form, and we will reach out to you!
Best,
Dr. Mike Jones, PT, DPT
Board Certified Orthopedic Clinical Specialist
Certified Strength and Conditioning Specialist
Owner/Founder - Stamina Performance Physical Therapy
Dr. Mike Jones
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