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My knee hurts and I can’t run downhill! What should I do?

Being a runner with knee pain can be a drag. The worst thing a PT or a doctor can recommend to a runner is to rest and see how it does. Right?! We all have been there… But all that is on your mind is ‘how can I return to running??’ 

Anterior knee pain (the runner’s knee) is a very common cause of knee pain in runners. It hurts in the front of the knee, around the patella, and is usually worse with running/ walking downhill or down stairs and after long periods of sitting. There may be crepitus (crackling noise) associated with it. It usually happens with an activity that is a lot more than your knee could tolerate – after that first hike downhill after winter, when your knees were not adapted to it, or after periods of long sitting (driving long distances).

There are some facts surrounding patellofemoral knee pain that may surprise you:

  1. It is NOT defined by cartilage damage! In other words, knee pain does not mean cartilage damage (van der Heiden AJSM 2016).
  2. While crepitus (crackling noise) is present in those with patellofemoral knee pain, it is NOT associated with reduced function.
  3. Exercise therapy – mostly quadriceps and glute strength are the standard of care (Willy RW, JOSPT 2019).  
  4. Absolute rest is CONTRAINDICATED (it will not cure your knee)!

What can you do to for your knee pain? 

  1. Exercise is absolute BEST! Find a qualified and experienced PT or a personal trainer in your sport who will take you through the progression. They will be able to fine-tune your exercises to your sport.
  2. What about bracing and taping? Think about these as a ‘bandaid’ – it may relieve your pain temporarily WHILE you are getting stronger. Eventually, you wean off the brace/ tape to full, painfree training. 
  3. Do shoes make a difference? Highly cushioned shoes INCREASE the load on the knee, while less cushioned shoes DECREASE the load on the knee but increase the load on the foot and Achilles (Esculier JF, 2015). So- for your anterior knee pain, try to get into lightly cushioned shoe – but wean into it under supervision. Visit your local running shoe store.
  4. Activity modification: patellofemoral pain gets aggravated with weightbearing knee flexion. Avoid walking downhill/downstairs during the painful periods. Walking on level ground may be better than biking for a while. Rather than squats, do strengthening exercises where you keep your knee only slightly bent.

Zuzana Rogers PT, ScD, SCS, COMT

Helping recreational and elite runners of all ages to return to running safely and pain free…for life.