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Runner's Knee? Train away your knee pain! Part 1

By Jonny Stahl

Just to clarify things at the very beginning here: Runner’s Knee is in some contexts considered to be Patellofemoral Pain (PFP) or Iliotibial Tract Syndrome (ITB Syndrome). ITB Syndrome in my opinion is another topic which I’m 100% going to cover in another article in the near future, so hold on tight!

Today we’re talking about Runner’s Knee, - Patellofemoral Pain (PFP) - or in other words, pain at the front of the knee.

Site of Patellofemoral Pain in runners

Site of Patellofemoral Pain in runners


Runner’s Knee can be a seriously debilitating injury due to it’s presentation. Of course it’s painful, but above all, it reeeally affects runners because of it’s nagging attitude, constant presence during running and above all, the fact that it just doesn’t go away!

I think most runners will agree with me when I say that it’s not so much the actual pain that affects us the most, but rather the inability to do what we love, when we want to.

And that’s why this article is going to help you.

Runner's Knee

You know the feeling: you go out for a run and you feel good – the conditions are nice and your body feels mobile and strong. After 2 kilometres, however, you start to feel your knee ache again with every step.

It’s not the worst pain you’ve ever encountered, but it hits you nonetheless with each and every step on that leg. The pain increases in accordance with your frustration and all of a sudden, you pull out again after 3 kilometres.

You’ve tried foam rolling it, doing boring as hell “stability” exercises, popping anti-inflammatory pills and icing it.

Yet week after week, the mother fucker comes back, just as you feel like you’re making progress.

I know the pain (physically and mentally), so let me hold your hand and guide you through the process of relieving Runner’s Knee.

Origins vs. Causes

Over the past 9 years, I’ve dealt with countless clients with knee pain, with many of them having Runner’s Knee. If you look online, you’ll read about these same “origins” or “causes” of PFP everywhere:

· Weakness of your glutes

· Tight muscles

· Instability

· Poor technique.

This is then most often followed up by the following treatment recommendations:

· Foam roll your quadricep muscles daily

· Ice your knee 5x daily

· Strengthen your muscles

· Improve stability

· Improve technique.

And while some of this may be in part true, there’s a real lack of guidance on how to actually deal with this properly. This is, in my opinion, largely because most practitioners actually don’t know how to properly manage Runner’s Knee.

Runner’s Knee is an overload issue. Whether this means training overload (ie. A large increase in kilometres) or local overload (the knee patellofemoral joint itself becomes overloaded), overload is still what causes PFP.

If your acute running load changes by 50% in one week for example, then it’s no surprise that something’s hurting. My question when it comes to pain and injury though is always: Why the Patellofemoral region?

Why that area, at that time?

I’m going to provide you with a biomechanical approach to managing PFP, so that you begin to understand the How’s and Why’s, and above all, so that you can eliminate that fucking annoying pain at the front of your knee.

Let’s begin by truly clarifying the causes for Runner’s Knee:

1. Poor biomechanics, which leads to the front of the knee being unnecessarily overloaded over time

2. Poor coordination between muscles. Our muscles work together and have specific roles to play during all phases of the running cycle. If they’re not doing their jobs as they’re designed to, then something else often takes on the extra work load, and in this case it’s the knee

3. An inability to control the pelvis. This is a large reason for the occurrence of the above two points. Our pelvis is our control panel when running, and if we’re unable to actively move the pelvis AND actively restrict extra movement of the pelvis when required, then compensations in movement, force absorption, strength and stability will occur elsewhere

4. An inability to control your Centre of Mass. Your Centre of Mass is a central point in space in which your body mass lies. In many cases, and particular in runners, this is way forward of the actual centre of their bodies, meaning that they are braking the forces of their own body mass with each step

5. Foot plant is too far in front of the body. Same as the above point – if you’re landing with your foot too far in front of your body, then you’re having to brake your own forces with each step, meaning that the knee will have to do a lot more when it comes to force absorption. If you’re not sure what I mean by this, just lean forward until you’re about to fall and see how you stop yourself. That’s what I mean

6. Poor mobility. Many runners have very limited hip internal rotation ability for example, which is exactly what we need to absorb forces from the ground so that we can effectively produce force as we move off the ground.

There’s more to add, but let’s leave it here.

Differences in Centre of Mass due to active movement and change in position.
Differences in Centre of Mass due to active movement and change in position.

Understanding how our Centre of Mass directly influences our movement, our running and how we subsequently load our bodies when we hit the ground is essential to making the changes you need to get rid of your knee pain.

In part 2 of this blog, we’ll go through active solutions to help you kick Runner’s Knee in the nuts and get rid of it for good.

Until then, I hope this has provoked some thought about the true causes of Runner's Knee vs. the symptoms.

P.S When you're ready, here's three ways that I can help you to move, live and perform pain-free:

  1. 1:1 intensive coaching, programming and accountability (all-inclusive), just click here

  2. Online programming and accountability, just click here

  3. Education and consulting for coaches and companies who want to improve their quality of life, just click here

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