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6 Reasons Running Makes Your Knees Hurt

This is going to sound rant-y. Because it is.

Long-distance running has become a staple in the fitness world and, in my opinion, has overstayed it’s welcome. I’ve seen countless more injuries from running than squatting, deadlifting, and fire-eating, combined. These are usually nagging injuries, caused by years of wear and tear and improper body mechanics.

For most, running is the first step. If you want to lose weight and start burning calories, start running. Everyone knows how to run. Anyone can buy a pair of running shoes and some fancy UnderArmour gear and hit the streets. Think about marathon runners, they eat a ton of food before a race so they must burn a ton of calories. Well, you’d be correct.

But marathon runners are running six-minute miles. That’s a hell of a lot faster than your ten-minute mile 5k pace.

A friend of mine has been a distance athlete almost his entire life and has been participating in triathlons since he’s left the high school track arena. And he’s pretty damn good at them. And I know he’d agree with me when I say this:

If you aren’t training to be good at a long distance event, don’t bother doing long-distance exercise.

Now, before the internet exercise gremlins come after me, let me share my reasoning for why I hate long distance exercise.

  1. Long-distance athletes consume a far greater amount of carbs (and calories in general) than the average person, but they need it. Weekend warriors who are following suit tend to follow this path in terms of carb intake, but do not share the same intensity of exercise.
  2. Related to #1, long-distance athletes tend to under-consume protein (because they over-consume carbs). This is not good for overall body composition and health and will not assist you in your quest to develop a physique like Captain America.
  3. Long-distance athletes are partially successful at running because they’re built to run, not because they run a lot. Square-peg-round-hole theory.
  4. Long-distance jogging does not generally make use of full hip extension, all while strengthening the hip flexors. (Because everyone needs stronger, tighter hip flexors. THAT WAS SARCASM.) In general, the demands of long-distance running necessitate crappy biomechanics.
  5. Most weekend warriors do not understand the science behind running sneakers to make an educated selection.
  6. There are quicker, more fun (read: badass) ways to get lean and fit.
  7. Like I mentioned in the beginning, I’ve seen a far higher injury rate related to long-distance running as opposed to any kind of strength training.

Long-distance internet gremlin.

But again, this post isn’t about choosing to run. Frankly, I don’t mind if people enjoy long-distance running and want to run themselves into tomorrow. I’ve ran distance. And in all honesty, I’ll probably run again.

This post is about the most frequent reasons I see people’s knees bothering them after running distance.



Iliotibial Band Syndrome

Otherwise known as IT band syndrome, this is probably the most over-diagnosed of all the problems that I see from running. When people’s knees hurt, they always think they have IT band syndrome.

Well, you might.

Especially in females (due to a larger Q-angle), the IT band tends to become really tight after frequent long-distance running, mostly due to the bio-mechanics of the movement. Although it may be slightly more common in females, it is pretty common in males too.

IT band syndrome generally causes pain in the lateral part of the knee and can generally be relieved by foam rolling the IT band. This also includes the TFL, a small, hard-to-find muscle near the lateral part of the hip.

The High-Impact Nature of Running

Running is a high-impact activity. Even for somebody who isn’t necessarily overweight, the impact of body weight against a hard surface, such as asphalt or concrete, can compound on itself and cause strain on the bones and connective tissue within the ankle, knee, and hip.

It’s not rocket science. The actual impact is not the problem, it’s the repetitive nature of hundreds of thousands of foot strikes over a career of running. This repetitive stress generally doesn’t become a problem except in the case of career-runners. In other words, I’d recommend sorting through these other reasons before you consider repetitive stress as your source of pain. Running a couple 10k races probably won’t cause this.

Heel-Striking and Pronation

Running sneakers these days cause us to heel-strike. Heel-striking causes us to pronate to provide extra support. Of course, the support in most running sneakers counteracts the pronation that’s caused by the heel-striking. But, if you are wired to heel strike and your sneakers don’t provide the arch support, you will pronate.

Pronation leads to internal rotation of the femurs and, thus, knee pain.

Sneakers are both the problem and the solution. I advocate making sure your sneakers have the support and stability to prevent pronation and absorb the impact from the running. Either that or repatterning your running gait and going with a minimalist style sneaker. One downside to minimalist sneakers is a shorter stride length, so you will be slower.

Uneven Hips and Pronation

People with uneven hips will end up with a functionally short leg that they favor in most activities, including things like squatting and running. Uneven hips can lead to a host of problems with the knees and lower back.

Uneven hips are usually caused by imbalances between adductors and abductors and can be easily fixed with a little bit of foam rolling, stretching, and strengthening of the right muscles.

However, the functionally long leg will tend to pronate, leading to the same internal rotation of the femur and knee pain.

Weak External Rotators of the Femur

The biggest problem with running from my perspective (and my biggest beef with running in general) is the lack of full hip extension. Running over-develops the hip flexors, quadriceps, and hamstrings (especially the biceps femoris) and does not develop the glutes. With only running, and no strength training, a lack of glute development will lead to anterior pelvic tilt, lower back pain, and internal rotation of the femur and tibia (see any patterns here?).

One of the primary jobs of the gluteals is to externally rotate the femur. Without the glutes to externally rotate the femur, the femur internally rotates and causes pain in the knees. In addition, muscles like the sartorius become overactive, further inhibiting the glutes and tilting the pelvis anteriorly.

Immobility in the Ankles and Hips

Throughout the body, different joints and muscle groups have different demands in terms of mobility and stability. The knees require stability. The joints on either side of the knees (the hips and ankles) require mobility so that the knees can remain stable.

Without mobility in the hips and ankles, the knees will become unstable.

This will lead to pain.

So What Can You Do?

Well, you can quit exercise altogether and become a couch potato?

Buy one of these and roll around on it.

The conclusion we can draw here is that knee pain is generally not caused by the knees. Except in arthritic conditions, which aren’t as commonplace as is thought, knee pain is generally caused by compensation patterns caused by dysfunctions in other parts of the body. So now that I’ve given you a bunch of reasons why your knees hurt, what can you do do counteract them?

  • Foam roll the lower extremities (glutes, hams, quads, IT band, calves, adductors, peroneals, and tibialis anterior)
  • Match your running sneakers to your running style – if you’re going to purchase sneakers with no medial support (or any shock absorption for that matter), you better not be heel-striking
  • Strength train – strengthen the hip extensors, core, and fix any imbalances you have in the hips
  • Keep the hips and ankles mobile in all three planes
  • Make small increases in your running distance and intensity (acute overuse could cause strain in any number of muscles and injury will only worsen compensation patterns)

I hate running. It takes too long and is no fun. But if you enjoy running and your knees hurt, try a few of these things and see how they work. Or just stop running and start sprinting. Cause it’s awesome.

Also, because no one ever escaped a lion in the Serengeti with their seven-minute mile.

Probably couldn’t outrun him, either.

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