If you’re a runner with previous miles under your feet, you’ve likely experienced a running injury before. One of such injuries may have been Runner’s knee also known as patellofemoral pain syndrome. The majority of running injuries are typically around the knee, roughly 50%. You may seek professional care from a physical therapist or a yoga instructor for Runner’s knee pain. And you may even seek a movement professional like Modern Movement Clinic that can give you a more accurate diagnosis but even more so rationale in how you got the knee injury in the first place.
At times you may be told to stretch tight muscles and strengthen weak muscles and thus be given stretches and rehab exercises and told: “you need to stop running”. Maybe you even hear things like “running is bad for your knees”. We’re glad you found this article because we are here to set the record straight. We will break down what ACTUALLY is runner’s knee, how it can happen, how yoga can SOMETIMES help (what you can do as an alternate), and how to possibly even KEEP RUNNING while injured. Let’s begin.
Runner’s Knee – What Is It?
There are some common symptoms we have with this diagnosis. Pain on the front of the knee or anterior portion around the patella that can be either dull or sharp depending on how acute this may be is a common identifier of PFP. Outside of runners, cyclists and athletes who do repetitive jumping can experience this as well due to the forces involved with sport specificity.
With running, you may notice running downhill is more painful along with taking the stairs (going down). You may also notice speed or running on your forefoot may make the pain worse. This is one of the most common running injuries endurance athletes face especially if they have either previously injured this area or are new to the sport. Fear not though, with a little explanation on how this happens and some better planning for moving forward, you can get back to pounding pavement soon enough.
How Does Runner’s Knee Happen?
When doing research on this article, we looked at a few different articles and they got complicated quickly. Patella’s not fitting into their trochlear groove, not tracking correctly, muscles pulling patellas every which way. You leave thinking your body is a hot mess and there’s no way you’ll ever overcome.
You want to see someone who sees the whole picture and doesn’t treat for just symptoms. This may be something you’re experiencing. You may be getting a litany of things that are “wrong” with you like “your hip flexors are short”, “your hips are tight”, “your glutes are turned off” with virtually no explanation to how this came to happen (this can’t happen, by the way, it’s B.S. terminology some therapists use because they lack the capacity to explain things effectively) or what to do about it all.
Truth be told for how popular this injury is (runner’s knee), hardly anyone has a structural problem. You’ve been built the same way since you started walking upright. Your body ADAPTS to what it receives. I always explain to my running clients that we never wake up on day 1 of our running career saying “well…I guess it’s time to go run a marathon”. We all know that wouldn’t go well. We train UP to that and our body ADAPTS.
Consider two terms: load and capacity. At this current time of your training, your knee experiences loads of running and whatever else thrown at it. The body needs recovery periods to build something called capacity. Think of capacity like the endurance in your lungs. Some runs are easier than other days and others you feel you are really huffing and puffing. The knee can behave much the same way. Muscles are going to be tight; they’re adapting to the stress you’re giving them and trying to make you stronger.
To be clear:
✅ Runner’s knee has little if anything to do with your patella tracking in any certain way. That’s old school and prehistoric mentality that has no research validity.
✅Has more to do with how well your body is recovering (capacity) from your training or life’s stressors (load).
✅“Tight muscles” are tight because they protect your body from the load applied with running and inherently getting stronger. Your tendons actually get thicker the more you run. How cool is that?!
✅Running doesn’t require much flexibility because it is a mid-range of motion sport. You’ll likely have a harder time running if you’re very flexible. This is because there is an element of controlling this range as you land with each step.
Yoga for Runner’s Knee Pain Can Help…Sometimes
We do general mobility assessments with our runners, and we see common themes. Most are not what the general population would consider flexible. Whether they can’t touch their toes or squat with perfect form, it doesn’t matter.
What matters is:
✅Are the right and left sides relatively close in range of motion and function?
✅Does the affected side illustrate a difference (in flexibility or strength) compared to the other side that we find important?
You’ve watched Paralympians and Special Olympians along with Olympic-level runners perform before. They all have tight muscles here, prosthetics there, asymmetries here and there and all perform at an awe-inspiring level. What we are saying is, before you go stretching everything with yoga, know why you’re doing it so you’re not doing more harm than good or even worse, wasting your time.
Yoga can have the benefit of building some flexibility or mobility under the circumstances. Even more so, the element of how relaxing yoga can be has the biggest benefit.
We tend to do our mobility routines IN our strength program. If you want to relax then we suggest finding a good vinyasa style-based class at your local yoga studio where you move around much more as opposed to holding a stretch for a long period. With running injuries, holding a stretch for a long period (commonly seen in the hip flexors) can make the pain worse. This is not to say you can’t do restorative yoga for Runner’s knee pain or you shouldn’t stretch. Everyone is different, but we know from our long working experience with runners what we typically see which is why we like our mobility more dynamic and at times even loaded (with weight).
Here’s a YouTube video of some of the common movements we use for mobility along with some stretches you can use to improve mobility and performance. Let’s talk about how we can gauge if we should keep running, adjust our running, or stop for the time being.
Can I Keep Running? – Running With Knee Pain
Stop me if this sounds familiar. You get hurt, you decide to see a therapist or an ortho.
They tell you one of two things:
❌You should stop running.
❌Running is bad for your knees.
Is this creating PTSD flashbacks for you? You’re not alone. We see a lot of runners who have been told that they don’t need to stop at all or simply just need some program modification. Here are a couple of good rules of thumb to see if you should stop completely:
Are you noticeably running differently to compensate (aka limping, hobbling) for your run? Is someone saying “Franny…what the hell is wrong with you”?
Are you continuing to hurt into the next day or 24 hours after?
If you said yes to these then perhaps you should take up walking for a bit as it can still build tolerance in the tissues as we never really want to rest completely. Mixed with cross-training, getting care from a qualified therapist, you’ll be back running very soon.
If the pain is manageable and you’re able to run through a small amount of pain that usually goes away that evening or the next day, you can continue to run but might suggest modifying your program to have less volume, fewer downhills, and possibly even some walk: run intervals.
One last really good suggestion is modifying your cadence or how many steps you take per minute. Cadence typically dictates how long your feet are on the ground and how long your stride length is. Studies have shown that a 5% increase of your cadence can have a positive effect up to 20% at the knee. This requires some practice so check out this video on Youtube on how to properly do this to find out what your common cadence is now and how to modify it. You can also use Spotify playlists to find songs that have common beats per minute to match the cadence.
We hope that after reading this you realize that having runner’s knee or knee pain is not a death sentence. You can train through with a little intelligence and modification, such as our take on yoga for runner’s knee pain! We’re happy to help elucidate this even more if you’d like as we work online as well with lots of running clients. Feel free to reach out and let’s see how we can get you back to conquering miles again.