How To Prevent Knee Pain When Running: Tips and Exercises

Whether you jog a couple times a week or you’re training for a 5K (or even a marathon!), you may be interested in learning how to prevent knee pain when running. It’s an understandable concern — more than a quarter of all runners report that they’ve experienced knee pain at some point.

While knee pain when running can be frustrating and uncomfortable, you don’t have to let it derail your running routine, reassures Katie Schaner, PT, DPT, a physical therapist at Hinge Health. “It’s perfectly safe to keep running as long as the knee pain doesn’t alter your running pattern,” she explains. Even if it does, there are ways to find relief and prevent it in the future.

Read on to learn how to prevent knee pain when running, especially with exercises recommended by Hinge Health physical therapists.

Why Do My Knees Hurt When I Run?

Your knees take the brunt of running — research estimates that each knee absorbs 3.6 pounds per pound of body weight while you jog. But that doesn’t mean running will wreck your knees. In fact, it’s the opposite: A 2023 review in the Orthopedic Journal of Sports Medicine found that running was actually protective long term against knee pain. “Motion is lotion: If you use your knee muscles and joints regularly, they get the lubrication they need to reduce your risk of developing knee osteoarthritis,” explains Dr. Schaner.

Still, there are some reasons why your knees may ache, including:

• Going beyond your movement sweet spot. “We often see knee pain if runners increase their volume of training too quickly,” explains Dr. Schaner. “Our bodies are very good at adapting to running, but if you suddenly start to run — or run more than your knees are ready for — it can put increased strain on the muscles and tendons that surround the joint.”

• Changing terrain. Perhaps surprisingly, there’s no difference in knee pain among people who run on softer trails and people who run on pavement. But if you switch from one to the other, you may notice some knee pain. “Your knees may just need more time to adapt to the change,” says Dr. Schaner.

• Muscle weaknesses and imbalances. When muscles aren’t strong, or groups of muscles are imbalanced, your knees may overcompensate and absorb more of the stress that comes with movement. “Many runners have strong quadriceps, but weak hip abductors and hamstrings,” explains Dr. Schaner. “When one side of your leg is stronger than the other, it changes your leg mechanics and can lead to discomfort.” 

• Patellofemoral pain syndrome (runner’s knee). Runner’s knee is an irritation of your kneecap, where the lower end of your thigh bone connects with your kneecap. Runner’s knee can cause many symptoms, including pain while running.

• Iliotibial band syndrome. This condition occurs when the iliotibial (IT) band, a rigid band of tissue that runs from your hip to your knee, becomes inflamed. “We see it a lot in athletes with muscle imbalances, because they are overusing certain leg muscles, like their quads, to run,” says Dr. Schaner.

The above exercises are recommended by Hinge Health physical therapists to help avoid knee pain when running, and they can also help prevent common knee injuries. When all the structures that support your knee are strong, your knee joint won’t have to take on more pressure than necessary, which can lower your risk for knee pain.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatment Options for Knee Pain When Running

Most knee pain that is triggered by running can be treated at home. Here’s what Hinge Health physical therapists recommend.

• Physical therapy. If knee pain returns or persists with every run, a course of physical therapy may be in order. “A physical therapist can look at all the muscles in your legs, hips, and core, and figure out which ones need to be strengthened and which ones need to be more mobile and flexible,” explains Dr. Schaner. They can also recommend the best strengthening and stretching exercises, like the ones above, to help you gain the knee strength and flexibility necessary to get you running comfortably again. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Modify your activity. No, you don’t need to stop running. But you should add in some cross training, such as biking or swimming, at least temporarily, to work on muscle balance in your legs, advises Dr. Schaner. When you run, watch your pain levels. “If your knee pain before you start is at a two on a scale of one to 10, you’re probably safe to go up to a pain level of about four during your run, but don’t do more than that,” says Dr. Schaner. Otherwise, you may push your body past its sweet spot.

• Apply heat. Both ice and heat have been shown to help relieve knee pain. But to help with healing, Dr. Schaner recommends the latter. “Ice blunts the inflammation response, which your body needs to repair itself,” she explains. Apply moist heat like a hot water bottle to your knee for 10 minutes, three times a day.

• Over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for knee pain when running. It’s important to make sure that you are safely able to take these medications, based on your medical history.

Tips for How to Prevent Knee Pain When Running

Knee pain when running is usually due to several different factors. You can’t prevent them all, but you can take steps to make it more unlikely that this discomfort will derail your workout. Here’s how to run without hurting your knees. 

• Strength train at least twice a week. You don’t have to splurge on a fancy gym membership, either: “Simple exercises that use your body weight are fine,” reassures Dr. Schaner. “We just want to make sure that your legs are strong enough for running.”

• Only change one thing at a time. When it comes to running, three external factors can raise the risk of pain or injury: a change in distance, a change in speed, and a change in elevation. “Focus on one thing at a time,” advises Dr. Schaner. “If you normally run at a steady pace on flat roads, it’s not a good idea to run sprints up hills. Keep change gradual.”

• Warm up and cool down. Take a few minutes before your run to do a light warm up, such as walking lunges. This will increase blood flow to your muscles, reducing your risk of injury. Research shows that cold, stiff muscles are more likely to get strained or sprained during exercise. Stretch at the end of your workout to keep your leg muscles elongated and flexible.

• Listen to your body. If you feel tired, or your knee is really achy, trust yourself and either take the day off or cross train instead. “If you’re exhausted, you won’t gain any benefits if you try to push yourself on a long run, and you may end up worsening your knee pain,” points out Dr. Schaner. Take a yoga class instead or go for an invigorating swim.

• Pick the right shoe. There’s no running shoe that’s perfect for everyone, says Dr. Schaner, but there are a few things to keep in mind as you seek out the best option for you. “Your shoes should feel comfortable and supportive to you,” she stresses. Make sure that you get properly fitted, so that your sneakers are not too small or too large. If you buy a new pair, wean yourself off the old ones gradually, she adds. “New shoes change the forces on your joints, so rotate between the two pairs until your body gets used to the new ones,” she advises.

• Eat a healthy, balanced diet. There aren’t certain magic foods that will help relieve knee pain when running, but try to emphasize unprocessed foods such as fruit, vegetables, lean sources of protein like chicken or fish, and healthy fats like avocado and olive oil, advises Dr. Schaner. “You need to eat enough high-quality foods to fuel your activity and aid your recovery,” she says. Research suggests that this sort of Mediterranean-style eating pattern can help relieve symptoms of knee joint pain.

• Get plenty of rest. Sleep is important to help improve your knee pain. Poor sleep quality also raises levels of inflammation in your body, which can increase your pain levels, according to a 2020 study in the Journal of Rheumatology.

PT Tip: Land Quietly

“Running should not be a pounding activity,” advises Dr. Schaner. “You want to quickly turn your feet over and move forward. It conserves energy, and it’s a lot less stress on your knee joints.” By maintaining a light, quick stride, you can reduce the impact on your body help prevent knee pain when running. 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

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2. D’Lima, D. D., Fregly, B. J., Patil, S., Steklov, N., & Colwell, C. W. (2012). Knee joint forces: prediction, measurement, and significance. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, 226(2), 95–102. doi:10.1177/0954411911433372

3. Dai, Z., Neogi, T., Brown, C., Nevitt, M., Lewis, C. E., Torner, J., & Felson, D. T. (2020). Sleep quality is related to worsening knee pain in those with widespread pain: The Multicenter Osteoarthritis Study. The Journal of Rheumatology, 47(7), 1019–1025. doi:10.3899/jrheum.181365

4. Dhillon, J., Kraeutler, M. J., Belk, J. W., Scillia, A. J., McCarty, E. C., Ansah-Twum, J., & McCulloch, P. C. (2023). Effects of Running on the Development of Knee Osteoarthritis: An Updated Systematic Review at Short-Term Follow-up. Orthopaedic Journal of Sports Medicine, 11(3), 232596712311529-232596712311529. doi:10.1177/23259671231152900

5. Herman, K., Barton, C., Malliaras, P., & Morrissey, D. (2012). The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review. BMC Medicine, 10(1). doi:10.1186/1741-7015-10-75

6. Mellinger, S., & Neurohr, G. A. (2019). Evidence based treatment options for common knee injuries in runners. Annals of Translational Medicine, 7(S7), S249–S249. doi:10.21037/atm.2019.04.08

7. Veronese, N., Koyanagi, A., Stubbs, B., Cooper, C., Guglielmi, G., Rizzoli, R., Punzi, L., Rogoli, D., Caruso, M. G., Rotolo, O., Notarnicola, M., Al-Daghri, N., Smith, L., Reginster, J.-Y., & Maggi, S. (2019). Mediterranean diet and knee osteoarthritis outcomes: A longitudinal cohort study. Clinical Nutrition, 38(6), 2735–2739. doi:10.1016/j.clnu.2018.11.032