11 Nov Knee Pain From Running: A Guide for Perth Runners

Say you’ve signed up for the HBF Run for a Reason or the City to Surf, and training’s been going well. Then, about 5 km into your usual Swan River loop, an ache starts around your kneecap. By the Kings Park stairs it’s properly sore, and walking downstairs at work the next day isn’t much fun either.

The question on your mind is probably “Do I have to stop running?” Here’s the honest answer: usually not completely. Most running knee pain is an overload problem, not damage. It tends to settle when you adjust your training and build strength, rather than with weeks on the couch. There are a few signs, though, that mean you should get it looked at before your next run.

The two most common culprits

Pain around or behind the kneecap (runner’s knee). Clinicians call this patellofemoral pain. It’s the most common knee complaint in runners. It usually feels like a dull ache around the front of the knee that’s worse running downhill, going down stairs, squatting, or sitting for a long time with your knees bent. That’s the “movie theatre sign”.

Pain on the outside of the knee (ITB pain). This is a sharper pain on the outer side of the knee. It often kicks in at a predictable point in a run, say 3 or 4 km, and can make you pull up. Downhills and cambered paths tend to make it worse.

A third one to know is pain just below the kneecap, which can be the patellar tendon. Our article on patellar tendinitis covers that in detail.

Why it happens

Knees rarely get sore out of nowhere. The usual story is that the load went up faster than your body could adapt. That might be more kilometres, more hills, more speed work, a switch to a new pair of shoes, or a jump from treadmill to road. Sleep, stress and a big week at work can all lower how much load your tissues will tolerate too.

Strength matters as well. Your hips, thighs and calves absorb a lot of force with every step. If they’re not quite ready for the training you’re doing, the knee often complains first.

Keep running or stop? A simple guide

Many runners can keep running in a modified way while knee pain settles. A common approach is to use a pain scale from 0 to 10. If your pain stays at about 3 out of 10 or below during a run, and it’s no worse the next morning, that amount of running is generally OK. If it climbs above that, or you’re limping or sorer the next day, scale back.

Ways to scale back without stopping completely:

• Shorten your runs or split them into run-walk intervals
• Swap hills, stairs and downhill sections for flat routes for a while
• Drop speed sessions before you drop easy kilometres
• Run every second day instead of back-to-back
• Keep fitness ticking over with cycling or swimming if running is too sore

Our guide to avoiding shin splints uses the same load principles if your shins are also complaining.

What you can start this week

Strength work is one of the most consistently recommended parts of managing runner’s knee. Simple options include sit-to-stands from a chair, step-ups onto a low step, glute bridges, side-lying leg lifts and calf raises. Do them two or three times a week, slow and controlled, staying at a level of discomfort that’s mild and settles quickly.

Ice or a heat pack can make the knee feel better after a run, so use whichever you prefer. Taping or a knee sleeve helps some people feel more comfortable in the short term. These things are fine for comfort, but they don’t replace adjusting your load and building strength.

Signs it’s more than a niggle

Stop running and get your knee assessed if you notice any of these:

• Swelling that appears within hours of a run
• The knee locking, catching or giving way
• Pain after a twist, fall or sudden change of direction
• Pain at night or at rest that isn’t easing
• Pain that’s still there and unchanged after a week or two of reduced running

Those can point to a joint, cartilage or ligament problem that needs a closer look. If we think you need imaging or a sports doctor, we’ll tell you.

What we’d do if you came in

We’ll talk through your training: how much, how fast, what’s changed and what you’re training for. Then we’ll look at how you squat, step down and balance on one leg, test strength through your hips, thighs and calves, and work out which structure is most likely sore. If it’s useful, we may ask you to jog or hop so we can see how the knee copes.

From there you’ll get a plan with three parts: how much running to keep doing, a strength program you can do at home or in the gym, and a staged return to your normal training. Hands-on treatment may help with comfort along the way.

Our Osborne Park clinic sits inside Fitness Cartel at 454 Scarborough Beach Road, so we can take you onto the gym floor and get you lifting, stepping and hopping as part of your rehab. Our sports physio team there, including Senior Physiotherapist Pádraig Hughes, work with runners of all levels. Not sure who to see? Our physio or chiro guide may help.

Running knee pain FAQs

Should I stop running with knee pain?

Often you don’t need to stop completely. If pain stays mild during a run (around 3 out of 10 or less) and isn’t worse the next morning, modified running is generally OK. Stop and get assessed if you have swelling, locking, giving way or pain after a twist or fall.

How long does runner’s knee take to settle?

It varies. Many runners improve over several weeks to a few months with load changes and strength work. Longer-standing pain can take longer. A physio can give you a more specific estimate after an assessment.

Will new running shoes fix my knee pain?

Sometimes a footwear change helps, but shoes alone rarely fix it. A sudden change in shoes can also contribute to pain. Training load and strength are usually the bigger factors.

What exercises help runner’s knee?

Strengthening the hips, thighs and calves is commonly recommended. Examples include step-ups, sit-to-stands, glute bridges, side-lying leg lifts and calf raises. Your physio can tailor these to you.

Is knee pain on the outside of my knee from running serious?

Outer knee pain in runners is often related to the iliotibial band and usually responds to training changes and strength work. Get it checked if it follows an injury, comes with swelling or isn’t improving.

This article is general information only and isn’t a substitute for personalised advice. Everyone’s different, and results vary. Please see a registered health professional about your situation, and seek urgent medical care if you have severe or worrying symptoms.