Knee Exercises for Runners: What Physical Therapists Recommend

Running can be a great exercise, but it often gets a bad rep. “A lot of people think — mistakenly — that running is bad for their knees,” says Gwen Smith, PT, DPT, a physical therapist at Hinge Health. “They think running damages the joint and causes the breakdown of cartilage and bone.” 

But don’t let this undeserved knock on the knees stop you from lacing up those sneakers. “Running is good for your overall health,” says Dr. Smith. “It improves cardiovascular endurance and mental wellbeing.” Running just five to 10 minutes a day, even at a slow pace, may increase your life expectancy by three years, according to a 15-year study of more than 55,000 adults in the Journal of the American College of Cardiology.

What’s more, studies show that running doesn’t cause knee arthritis. In fact, running may have a protective effect on joints.

That said, like any other part of the body, you need to keep your knees strong, healthy, and flexible so they can perform at their best when you head out for a run, jog, or even a brisk walk. Whether you’re already a runner or looking to get started, knee strengthening exercises for runners are essential for maintaining good knee health so you can log miles for years to come. 

Here, find out what knee exercises are recommended by Hinge Health physical therapists, plus other ways to avoid knee pain when running. 

Running and Your Knees

Despite a common belief that running “wears down” your knees, research doesn’t support it. A 2023 review of 17 studies (which included about 14,000 people), published in the Orthopaedic Journal of Sports Medicine, found that running didn’t increase the risk of osteoarthritis. In fact, runners reported less knee pain than non-runners.

How could that be? Running improves muscle function around joints and increases the production of synovial fluid, a viscous liquid that lubricates joints, reducing stiffness, friction, and inflammation. The impact of running also stimulates bones to get stronger, making it one of the best activities for building bone density and warding off osteoporosis. Those benefits may extend to cartilage, too, according to preliminary research. In an effort to explain how running may protect knees, researchers found that, like bones and muscles, knee cartilage appears to have the ability to get stronger and more resilient with training.

Problems like knee pain that are often attributed to running are more likely related to inadequate preparation and training than the activity itself. 

“Running isn’t bad for your knees,” says Dr. Smith. “But doing too many miles too soon, not having adequate strength, and not knowing how to progress appropriately can lead to an increased risk of injury. Just like any other sport, you have to properly prepare for it, train for it, and build up slowly.”

You also want to take other factors like your age, body weight, and medical conditions into consideration. You may need to build up to running more slowly or make modifications to a running program if you have osteoarthritis, osteoporosis, balance issues, or are overweight. In these situations, consider working with a physical therapist, who can help provide an individualized exercise plan that’s safe and effective. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

“Many people think that they can just jump right into running,” says Dr. Smith. “But it takes preparation.” When you don’t prepare and train, your knees or other parts of your body (hips, back, calves) may end up hurting until your body has a chance to adapt.

What to Know About Runner's Knee 

Patellofemoral pain syndrome, commonly referred to as “runner’s knee,” involves an irritation in the front of the knee or around the kneecap (patella). You may notice a dull, aching pain when walking, running, going up or down stairs, kneeling, squatting, or sitting for long periods of time with your knees bent. 

Despite the name “runner’s knee,” running doesn’t necessarily cause patellofemoral pain syndrome, and runners aren’t the only people who develop it. It can happen to anyone for a variety of reasons. 

Runner’s knee is often related to weak or tight muscles or a change in activity that the body isn’t ready for, like increasing your running or walking mileage or speed too quickly, running or walking on a sloped road, or doing more hills without preparing for them. Foot issues like overpronating (rolling in too much) may also contribute to it. Regardless of what may be contributing to runner’s knee, strengthening exercises can help ease the pain and prevent future problems.

Exercising for Healthy Knees

Running requires stability and strength, but you need to do more than just run to build those components. “You have to train body parts separately to build up the muscles you engage when running regularly,” says Dr. Smith. “Just like athletes train for their sports, you should be doing the same.”

Research shows proper training pays off: A review of 25 studies, in the British Journal of Sports Medicine, found that strength training cut the risk of injuries from sports and activities like running by half.

And that makes sense, since strengthening your glutes, quadriceps, hamstrings, and calves improves balance and hip and pelvis stability for better knee joint mechanics, running form, and shock absorption. 

For the best results, aim to strength train two or three times a week, says Dr. Smith. In addition, make sure you do a dynamic warm-up before your run to prepare your body for activity and reduce your risk of injury. After your run, take a few minutes to stretch to maintain the flexibility and mobility needed for good running form. Tight muscles can increase stress on knee joints. 

These strengthening exercises condition the muscles and tissue that support the knees, from the lower back and abs down to the heels. When these muscles are strong and functioning at an optimal level, you’ll feel better when you’re running, and you’ll be less likely to experience knee problems.

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.

PT Tip: Progress Gradually

This is important advice for runners of all levels, whether you’re just starting to run or looking to increase speed or distance. If you want to reduce your risk of knee pain when running, “start slowly and build up,” says Dr. Smith, who recommends interval training (which involves alternating between fast and slow speeds). 

If you’re new to running, start by jogging for 30 seconds and then walking for four minutes. Repeat the intervals for about 15 minutes. “The goal is to see how you feel, while learning to manage the load and building up your running tolerance,” says Dr. Smith. Once you’re comfortable with those intervals, you can gradually increase to a minute of running and three minutes of walking, then two minutes of running and three minutes of walking, and so on, until you can run for 15 minutes at a time.

If you’re already running regularly, you can also use intervals to get faster. The same intervals still apply. However, you can increase the speed of the shorter intervals, while doing the longer intervals at your usual running pace. This way you can gradually build up the length of time that you’re able to run at a faster pace. 

If you’re looking to increase distance, progress by no more than 10% each week. For example, if you usually run 10 miles a week, add one mile (a 10% increase) to next week’s running plan, then gradually progress, repeating weeks if needed and having tapered (lower mileage) weeks when needed.

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

1. Dhillon, J., Kraeutler, M.J., Belk, J.W., Scillia, A.J., McCarty, E.C., Ansah-Twum, J.K., and 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). doi:10.1177/23259671231152900 

2. Lee, D., Pate, R., Lavie, C., Sui, X. Church, T.S., and Blair, S.N. (2014, August). Leisure-Time Running Reduces All-Cause and Cardiovascular Mortality Risk. Journal of the American College of Cardiology. 64(5) 472–481. doi:10.1016/j.jacc.2014.04.058 

3. Miller, R.H. and Krupenevich, R.L. (2020, August). Medial knee cartilage is unlikely to withstand a lifetime of running without positive adaptation: a theoretical biomechanical model of failure phenomena. Peer Journal. 5;8:e9676. doi:10.7717/peerj.9676

4. Mulcahey, M.K., Hettrich, C.M., and Liechti, D. (2020, October). Patellofemoral Pain Syndrome. OrthoInfo. American Academy of Orthopaedic Surgeons.  https://orthoinfo.aaos.org/en/diseases--conditions/patellofemoral-pain-syndrome/ 

5. Lauersen, J.B., Bertelsen, D.M., and Andersen, L.B. (2014). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine. 48:871-877. doi:10.1136/bjsports-2013-092538

6. Reynolds, G. (2020, October 21). Why Running Won’t Ruin Your Knees. The New York Times. https://www.nytimes.com/2020/10/21/well/move/why-running-wont-ruin-your-knees.html