Knee Injuries in Runners: Causes, Prevention and Physiotherapy

The common running knee injuries

Patellofemoral pain (runner's knee). Aching around or behind the kneecap, worse on downhills, stairs and after sitting. The most common running knee complaint.

Iliotibial band pain. Sharp pain on the outside of the knee, often starting at a predictable distance into the run and worse downhill.

Patellar tendinopathy. Pain just below the kneecap, more common in runners who also do jumping or hill work.

Meniscus irritation. Less common in runners, more likely with twisting or older knees.

Why they happen

Most running knee injuries come from load: increasing weekly distance or intensity too quickly, adding hills or speed work suddenly, or changing shoes or terrain. Weakness in the hips and thighs means the knee absorbs more of the impact.

Running technique plays a role too. Very long strides that land the heel far in front of the body increase knee load. A slightly shorter, quicker stride often helps.

Prevention

• Increase weekly running volume gradually
• Strength train twice a week: squats, lunges, step downs, hip work
• Include variety in pace and terrain, but introduce changes slowly
• Replace shoes when the cushioning has clearly worn
• Pay attention to niggles before they become injuries

How physiotherapy treats running knee injuries

Treatment starts by adjusting the running load, not usually stopping altogether. Many runners can keep some running at a lower volume or on flatter routes.

Strength is the core of rehab. Hip abduction work, single-leg bridges, step downs and squats build the control the knee needs. For tendon problems, specific tendon loading is used.

Gait assessment helps identify technique factors that increase knee load. Small changes, such as a slightly higher cadence, can make a real difference.

Shoes and surfaces

Running shoes and surfaces often get blamed for knee pain. Their role is real but usually smaller than training load and strength. Sudden changes matter most: switching to a very different shoe, moving from a treadmill to hard roads, or adding lots of downhill running.

Shoes should be comfortable and replaced when the cushioning has clearly worn, often somewhere between several hundred kilometres of running, depending on the shoe and runner. There's no single best shoe for everyone.

Varying surfaces, such as parks, tracks and roads, can spread load. Any change should be introduced gradually.

Getting back to running

Return gradually, building distance before speed. Our guide to returning to running safely outlines a practical approach, and our knee exercises section has the strength work.

If knee pain has stopped you running, or keeps returning at the same point in your runs, an assessment usually finds the cause quickly.