Running gets a bad wrap for being bad for the knees.  Any time an activity and an injury (think tennis elbow) get linked together, that’s usually taken as a sign that if you do that activity long enough that you will experience that issue.  There may be some kernel of truth to that thought, but there are tons of people who run who never experience knee pain.  In fact, many long distance runners tend to have fewer signs of arthritis and instances of knee pain than those who don’t run¹.  What gives?

Like any activity, how often and how well someone runs will determine their likelihood of injury.  Running has some additional factors such as mobility, muscular endurance, and cardiovascular endurance that also factor in.  Assessing someone’s running form takes an expert eye and is beyond the scope of this article, and running dosage has already been discussed here.  This article will primarily focus on mobility and muscular endurance of the joints around the knee.

With regards to running, here are some areas you’ll want to address in order to avoid a running injury:

• Ankle Dorsiflexion – If you’re a heel striker, you will need excellent dorsiflexion (the ability to bring your shin over your toes).  Having sufficient dorsiflexion helps reduce the amount of stress that gets transferred to the knee.  Here’s a good test and stretch to see how your ankle holds up.  Here’s some info on the different types of running, including heel striking.
• Calf Muscle Endurance – Most people will think to do calf raises, which is definitely going to help.  For running, a lot of the action occurs with the knees bent.  As a result, a calf muscle called the soleus takes a lot of the stress while running.  If the soleus fatigues, that stress goes to the knee.  You can target the soleus by doing calf raises with your knees bent.  Try for multiple sets of high reps, working up to 20+.
• Hip Extension – Running is such an efficient way for travel in part because muscles can be used like a rubber band.  The hip flexors (the muscles on the front of the hip/groin) are one such muscle group.  If they’re not able to lengthen, you’ll likely not get a great deal of propulsion forward unless your knee is working overtime.  The hip flexors can be stretched a number of ways, but here’s one of the most effective ways to stretch your hip flexor.
• Glute Endurance – The glutes are vital for proper knee health.  They make sure the knee tracks properly over the foot and help propel you forward while running, saving the knees from a great deal of stress.  For runner’s, muscular endurance of the glutes matters so much more for every mile you go.  Try heel taps as a way to build up endurance of your glutes (and quads!).  After you’ve practiced these for a few weeks, set a timer and see how many you can (properly) do in 1-2 minutes.

As mentioned above, the idea of the runner’s knee is a myth. But that doesn’t mean you can’t have knee pain from running. If you’re having issues with knee pain, or any other problems with running, seek out a physical therapist. Physical therapists, especially in a city like Eugene, work with runners all the time, and they have the expertise to get you back on your feet.

Got questions?  Feel limited in what you’re able to do?  The staff at Limitless Physical Therapy in Eugene, OR can show you how to be limitless. Contact us to connect with on of our PTs. Or follow us on Facebook.

***The above information, including text, images, and all other materials, is provided for educational purposes only, and not as a replacement or supplement to professional medical advice.  Please contact a certified healthcare professional or your primary physician for any personal concerns.

1. Chakravarty EF, Hubert HB, Lingala VB, Zatarain E, Fries JF. Long Distance Running and Knee Osteoarthritis A Prospective Study. American journal of preventive medicine. 2008;35(2):133-138. doi:10.1016/j.amepre.2008.03.032.