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.
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 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.
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.
How to run to prevent and avoid knee pain:
Do you think it is more efficient (mechanically speaking) to push yourself forward using ground contact and the most powerful muscle in the body (gluteus maximus), or is it more efficient to try and pull yourself forward MID-AIR using the muscle complex that flexes your hip joint (your quads and hip flexors)?
Hopefully you picked the first option!
To reverse the knee pain pattern while running we have to use our glutes and upper hamstrings as the primary forces of forward movement while choosing a stride that allows the lateral lower hamstring and upper calf fascia to stretch and relax. Moving like this also allows our constantly over-used over-tight quads and quad hip flexors to chill out a bit.
This stride emphasizes using hip and knee EXTENSION primarily, instead of hip and knee flexion. (We’ll use both, but the primary movers have been reversed).
I found this graphic online and could not find a source to credit (please let me know if you’re aware who created this graphic so I can credit them!) I like it for the most part, with a few minor exceptions (stated below).
Let’s talk about the rest of this gait pattern:
Personally, I like midfoot striking as it allows me to hit the ground softly, quickly and without a lot of force that transfers up to my knees and hips. If you look at the above graphic, imagine the runner on the right in full hip and knee extension with the foot making full contact through the heel (not pictured) before pushing off (pictured) and you can see what I mean when I say that running like this allows the calf to stretch for a moment and chill out with each stride.
Also, running like this does use the quads but in a rapid, soft contraction (mostly of the hip flexors, rather than the entire quad complex).
Again, I’m not a running coach but my interpretation of this movement is that it allows for a shorter/faster forward step and a longer/slower push-through of the opposite leg.
This allows us to use our extremely powerful hip extensors, including gluteus maximus, medius and all of the hamstrings to push us off the ground and propel us forward, followed almost simultaneously by a quick thrust of hip flexion from the quads of the opposite leg; this motion takes off where the glutes and hamstrings of the other leg left off, making the best use of that forward movement by pulling us up and forward with one leg (through easy non-aggressive hip flexion) while the other leg continues to push us forward via hip extension.
Essentially, running to prevent knee pain uses a long back stride and a short forward step, ideally with the foot striking the ground under our hips lightly and quickly instead of forcefully hitting the ground in front of our hips, which forces the ankle and knee joints to stabilize our entire body.
There’s also an emphasis on running TALL in this posture. The running graphic above may be deceiving, because I’m not sure it will come naturally for many people to run with the torso forward of the hips without hinging at the waist (as the graphic suggests not to).
If you hinge at the waist you’ll put a lot of emphasis on using your quads and won’t be able to contract your glutes or hamstrings as well, so it is my opinion that to run without knee pain it is preferable to be upright while using the glutes and hamstrings, if a forward torso posture isn’t possible without compromising those muscles. Remember…I’m helping you run without knee pain, not helping you get faster! (Which this graphic is likely trying to do).
Also, if you’re trail running and/or going uphill the temptation to hinge at the waist will be even greater. So you’ll have to slow down a lot to keep using those posterior power muscles, but if running pain-free is your goal instead of winning races…then this is your best bet.
Additional tips to run pain-free:
If you are one of the many people who have the same knee pain pattern I and that most of my clients have, then you *MUST* release the knots of restricted fascia in the lateral upper gastroc or calf muscle. Changing your gait might be enough to let you run without knee pain, but for the best possible outcome you should give yourself a few days to release that calf (and any/all additional areas of the lower body you can make time for), before trying to go for a long run without pain. Click here for that post.
A word about glute activation:
This post is about using your all-powerful booty to run without knee pain. But what if you have a bum bum muscle?! I’m talking about a glute muscle inhibition or inability of one or more glute muscles to fire. If you have a glute muscle that IS inhibited, no amount of trying to work it out will get it firing. If it’s just not wanting to fire (due to being weak or lazy or turned “off” for most of your life), then you have to get it firing (and running this way might just get the process started).
This is a whole other gigantic topic though, and one I plan on covering in depth sometime soon.
Everything I suggest in this post assumes that you have a fairly “average” running gait and no major muscles not firing.
Grab your running shoes and give this a try!
Then come tell me what happens.
Good luck and happy running 🙂