"I can't run, I have bad knees". I've heard this a lot as a running coach, as knee pain is a very common problem for runners. There certainly can be situations that prevent someone from being able to run without knee pain and in these cases, a different sport could well be the solution. If however, you fall in the camp with those other runners that experience chronic knee pain that comes and goes or flares up as the mileage of your training builds, you may have an opportunity to put it behind you.
One of the biggest things to understand about pain caused by running is that often it's not where it's hurting that you have a problem. Our lower body is considered to be connected by whats known as a "kinetic chain". Which simply means that if there is an issue or weakness in any one part of the chain, pain and breakdown can manifest in another part of the chain. The trap here is that as runners we often think it's our knees that are bad when it's very likely that something else is causing the issue. Because of the high repetitiveness and impact on the body, while running, this break in the chain can turn into an injury.
While this is not an exhaustive list, here are three potential "breaks in the chain" that are known to put a hurt on the knees.
So what is over-pronation? When your foot lands on the ground it's normal for the foot and ankle to roll inward. To a small degree this is exactly what is supposed to happen, but when it becomes excessive the lower leg also starts to roll inward with each foot strike. This rotation can affect the alignment of the knee and cause the patella to track outside of the femoral groove. When this happens, additional friction is placed on the knee joint and that's when the pain comes in.
How do you know if you overpronate? Seeking the advice of a professional such as a podiatrist or running coach that can conduct a proper gait assessment can help to assess your stride. If you're flat-footed there's a higher likelihood that you could be an overpronator
Weakness in the Hip
But wait there's more! We're not done with the chain just yet. The inward rolling of the lower leg can affect the upper leg which can take your hips out of alignment. Hip mobility and tightness is a common issue for runners, often caused by overpronation and also can be a result of weakness in your glutes caused by reduced activation of the muscles. Compound this with the fact that most of us spend a significant amount of time sitting on our butt and not using these muscles. This weakness then allows your thigh to rotate and pull inwards adding further strain to the knee.
A large percent of recreational runners are heel strikers. There are plenty of reasons why this happens, all of which send added stress and shock to the lower body and ultimately the knees. This can often amplify as the intensity of a training program and/or mileage increases. Each time you land heel first, you are creating a resistance and braking effect, that in addition to being hard on the body, is incredibly inefficient.
Ultimately a mid foot strike will create the least amount of impact while promoting the most efficient stride. You may not realize that this is even happening, so how do you start to address this issue? A good place to start is by seeking the help of a running coach who can help assess your gait and identify what's happening.
A powerful tool that I like to use is a video running stride assessment. By being able to see exactly what is happening in your body while you're running, coupled with an expert that can help you dissect the stride, is a game changer. I've helped countless athletes with this approach, most of which had a completely different picture of what they thought they were doing versus what was actually happening. Check out more about this service HERE. Some small adjustments can make a big difference for knee pain.
So the lesson here is that there's more going on that meets the eye when it comes to knee pain. There's a good chance there is something else in the chain that is causing the problem.
Need some help, have questions? Comment below.
Here's to happy pain-free running.