First of all – I am NOT a running coach and this is NOT meant to be advice for how to be faster or a “better” runner; this is my opinion (based on personal experience with knee pain as well as my work with countless knee pain clients) on how to run without knee pain. That’s it.
If you love running and your goal is simply to enjoy running again without knee pain…this post is for YOU.
Running this way might make you slower (or faster), it might feel awkward or fantastic…I leave it entirely up to you to try this as an experiment – and then run this way or not.
Changing how I run (and taking care of my fascia in general) helped me run again after 8 YEARS of not being able to. Personally, I don’t care how fast I run as long as I’m out there bouncing on a trail again without knee pain!
One more quick disclaimer: this post is NOT meant to address knee pain in general. I’m specifically addressing knee pain that only seems to show up while you are running. If you get knee pain while running and it stops as soon as you stop running, then this post applies to you. If you have knee pain 24/7, there are likely other things going on and this post may not apply to you.
What causes knee pain while running?
While there are certainly many causes and types of knee pain, the vast majority of the time knee pain while running has a basic pattern.
Most of the time knee pain while running shows up on the lateral (out)side of the joint, and feels like a knife stabbing you under the kneecap. That sharp excruciating pain can bring you to the ground as the knee gives out.
A lot of people like to blame the IT Band. Understandable, given the IT Band’s size and the fact that it attaches laterally at the distal (far) end of the kneecap.
However, it has been my experience that the IT Band is 3rd in line as the cause, behind two other major players that contribute far more to both the cause and the reversal of this pattern.
Meaning…addressing these two other things often makes the IT Band issue obsolete. Not always, but very often.
The first major cause is fascial restriction (often in the form of huge knots the size of golf balls) in the lateral upper calf or gastrocnemius muscle.
The second major cause (both of these should be considered together), is the fascial restriction within the hamstrings, particularly the biceps femoris where the long and short head meet and where the long head meets the IT Band.
Often there are GRAPEFRUIT sized lumps of inflamed irritated fascia stuck between the IT Band and the hamstring. Please note that these adhesions are NOT within the IT Band OR hamstring muscles themselves, but rather…it is the fascia that wraps both muscle groups that is stuck BETWEEN these muscles (essentially the ITB and hamstring muscles are adhesed together via giant knots of dehydrated or inflamed fascia and all of that tissue is no longer able to GLIDE through movement).
(DO NOT ATTEMPT TO ROLL YOUR ITB TO SOLVE THIS ISSUE!)
It’s also a distinct possibility that your hamstrings are weak, if you sit at a desk all day and don’t intentionally work on strengthening that posterior chain.
All of this creates a powerful force that pulls the ITB and lateral knee ligaments even more laterally, which can cause the patella to slip off the bursa and create a bone on bone feeling (which I believe is that sharp knife-like pain in the knee).
What does this have to do with running?
Many runners use a short quick gait that emphasizes extensive use of the quads and quad hip flexors as well as the calves to create forward movement. This is especially true of trail runners, even more so distance trail runners. The other common stride I see (mostly in marathoners or road runners who run for time on mostly flat surfaces) is to have a long thrusting forward stride that uses extreme hip flexion followed by knee extension that happens in FRONT of them, causing a hard heel strike that forces the knee joints to stabilize their body through the entire run.
The first scenario I described above is certainly the most common, and if you are a barefoot runner or toe striker and your heel barely or doesn’t even touch the ground while running then you are especially likely to create fascial restrictions in your calves.
What all this does while running is put your hip and knee joints into a near-constant state of flexion, and all that overuse of the already restricted fascia within the upper lateral gastrocs combined with fascially restricted WEAK hamstrings (which probably aren’t tight from overuse but actually under-use, especially if you sit at a desk all day with bent knees and contracted/weak hamstrings and run with your quads and calves) means near constant tension on the lateral fascia of the knee joint, including all the tendons, ligaments and bursa.
The IT Band is supposed to stabilize us through sports like running, but its job becomes increasingly difficult with these fascial restrictions constantly pulling it off track (laterally and posterior), combined (possibly, if your foot strikes in front of you) with a gait that doesn’t allow for hip stabilization and instead relies on the knees for that, and to top it all off…so many people are now foam rolling the bejeezus out of their IT Bands in an attempt to change all of this, but the IT Band actually NEEDS to be extremely tight from hip to knee since it is made up mostly of dense fascia (it’s basically a giant tendon) whose job it is TO STAY TIGHT AND KEEP US STABLE. While the fascial adhesions between the ITB and hamstring DO need releasing (strategically), I’m not a fan WHATSOEVER of rolling out the IT Band from knee to hip.
Take a closer look at the knee joint and surrounding muscles.
Now imagine someone tugging on the lateral upper calf tissue while also tugging at the hamstring and ITB tendons that attach to the knee and patellar tendon (the “balls” or knots of fascia are doing the “tugging”); these two things pull everything laterally and posterior, possibly taking the patella with it, creating a nice set-up for bone on bone action unless released from this pattern.
What reverses all of the above as far as running is concerned is reversing the muscle patterns that lead to these restrictions while running, and changing where our foot strikes the ground.