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How to Prevent Knee Pain While Running

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Every runner fears the day their knees might start to ache. But, in truth, your fate isn't sealed: In a study published in Arthritis Care & Research, older folks who had been runners in their youth were not at any greater risk of knee pain later in life than those who never laced up their sneakers. What's more, those who had logged the most miles throughout their life actually had the least knee pain, regardless of age.

The secret: You have to protect your knees from the start. "While it is a common fallacy that running is bad for your knees, running is still a repetitive motion, so many injuries stem from muscle imbalances that add up over time," says Ian Sharman, USA Track & Field Certified Coach and head coach at Sharman Ultra Endurance Coaching. Avoid knee pain before it starts with these eight tips. (Related: 6 Reasons You Get Knee Pain When Running)

1. Get fitted for the right shoes.

"The foot is made up of 26 bones, 33 joints, 19 muscles, and 107 ligaments, and these take the brunt of the pounding with each step of the day," explains Pamela Kopfensteiner, D.P.T., physical therapist at Professional Physical Therapy in New Jersey. You need running shoes that support your natural construction—high arches, pronation, supination—and diffuse the impact shooting up the rest of your leg. Hit your local running store and ask for a gait analysis, which will tell you exactly what support you need, Kopfensteiner suggests.

2. Strengthen your hips and core.

You've probably heard by now that even if you're a runner, you should be strength training (after all, it can take you one step closer to a PR). But there are certain areas to pay special attention to when it comes to preventing knee pain. A study of 400 healthy female runners published in Medicine & Science in Exercise & Sports found that, over two years, women who developed runner's knee had much greater pelvic instability—that is, weakness in their hips—compared to runners who didn't experience knee issues. Meanwhile, a study in the Journal of Athletic Training found that almost 80 percent of aching runners who strength trained with a focus on their hips and core or knees and thighs reported significantly less knee pain after just three or four weeks of lifting.

Women should focus on hips and core strength most, says D. S. Blaise Williams III, Ph.D., director of VCU RUN LAB at Virginia Commonwealth University. Kopfensteiner agrees: "Running is unique in that there is a 'flight' stage—a point in time when neither foot is on the ground," she explains. "While in midair, it's your core's job to control the rate at which your extremities return to the ground. When the control is increased, the force shooting through your joints when landing decreases and prevents injury to the knee joints."

Strength train once or twice a week. Start with planks, side planks, medicine ball core rotations, clamshells, fire hydrants, and open chain hip abduction. Then move up to jump squats, jumping lunges, and single leg landings. Once you conquer this, add uphill sprints to your training routine, Williams adds.

3. Don't rush training.

If you signed up for a start-of-summer race, your instinct is probably to ramp up your mileage ASAP—but that's actually one of the worst things you can do. "It takes time for the body to adapt to training, and your ligaments and tendons improve slower than the muscles since they get less blood flow," explain Sharman. "Even if your muscles feel ready to take on more and more, it's important to allow enough time for the support around the joints to catch up." A good rule of thumb: Don't increase mileage more than 10 percent each week. (Psst: Here are five beginner running injuries—and how to avoid each.)

4. Train off-road.

"Running on trails and hills can increase the variety of movement and build up a more even level of strength and stability through the legs and joints," Sharman says. Williams adds that while there isn't a big difference among pavement, track, gravel, or trails as far as knee torque and impact are concerned, there are variables for how unstable the surface is or how much you need to pay attention (think: roots, curbs, cars). "All of these conditions result in the muscles contracting for stability, which results in shorter, more controlled steps—which is why many runners report more comfortable runs on trails or grass," Williams explains.

Aim to veer onto different terrain at least once a week. (The closer you get to the event, though, the more you should train on that terrain, Sharman adds—so pavement for a road race, trails for a trail race.) The one terrain to stay away from? Sand. "A run on the beach sounds romantic but it results in a huge load on the calf muscles that you may not be ready for," Williams adds.

5. Lean forward.

"The way the foot hits the ground when running contributes to forces which impact the knee joint," says Kopfensteiner. Leaning slightly forward while running can decrease these forces. And in fact, a study in Medicine & Science in Sports & Exercise found that leaning slightly forward during a run transfers your weight from your knees to your hips, thereby reducing pain. Try it: Flex more at the hip and allow your torso to come forward seven to 10 degrees, the study author suggests. (Related: Simple Form Tweaks to Make Running Feel a Thousand Times Easier)

6. Increase your stride rate.

"Stride rate is likely the most important factor we know of right now that is easily changeable and reduces both acute and cumulative load on the knee," says Williams. Shorter steps that propel you to a faster pace decrease the force the quadriceps place on the knee cap, he explains. And in fact, a small study in the Journal of Orthopedic and Sports Physical Therapy found that when runners go slow, they do decrease the load on their knee per stride, but they actually increase the load over their entire run since every stride adds up. When the study participants ran faster, they reduced the overall stress on their knees by 30 percent compared to their easy pace. There is no single optimal number, Williams says, but if you are below 160 steps per minute, you should try and increase that by 5 to 10 percent.

And that's way easier to do than it sounds: Determine your steps per minute by getting on a treadmill and having your friend track how many times your right (or left) foot strikes the ground in 60 seconds. Double that number. If it's above 160, you're in the clear; if it's under, calculate a 5 percent increase, then turn to Spotify's running playlists and enter your goal BPM. Your brain and legs will automatically try and match the new cadence, though it'll take about four to six weeks of practice to make it habitual, Williams adds.

7. Stay in control downhill.

"The tendency when running downhill is to overstride or reach out," Williams points out. Remember, you want shorter steps to decrease the force on your knees, so maintain your stride rate when going downhill, he suggests. Plus, it's a quad killer if you launch down the hill too fast—so stay in control.

8. Replace your running shoes.

Running shoes are specifically designed to absorb the shock each time your foot pounds the pavement. But the more you wear them, the more worn down the shock absorption becomes, increasing the forces shooting up your joints—a recipe for knee pain, Kopfensteiner says.

While it's true that shoes break down over time, it's not clear how many miles or months sends them into the graveyard, Williams adds. Expert opinions range between advising you toss your shoes every 300 miles to every 600 miles—which is a massive difference. "Some runners are tough on their equipment while others are not, but most runners will feel when they need new shoes," he adds. If you start to feel pain anywhere in your lower half—especially your knees—check out the bottom of your shoe. If the tread is significantly worn, if there are creases in the midsole, or if you can more easily bend the shoe, it's probably time for new kicks.

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