Your knee has started aching on runs, maybe around the kneecap or on the outside of the knee. It is frustrating when running is part of how you feel good. For most recent knee pain, you do not need to stop completely. Adjusting your runs, and building back step by step, can help your knee settle while you stay on the move.

Why knees get sore with running

Knee pain in runners usually comes from load going up faster than the knee can adapt. A jump in weekly distance, more hills, a new event, speed work or a change in shoes can all tip the balance. Pain around the kneecap is especially common in runners.

In most cases, the knee is irritated rather than damaged. And running itself is not bad for your knees. Research suggests recreational runners have lower rates of knee osteoarthritis than people who do not run.

Reading how your knee responds

A simple traffic-light check can guide your running:

• Green. No pain, or a mild ache that settles within an hour. Carry on.
• Amber. An ache that lingers into the evening but has settled by the next morning. Keep running at the same level rather than adding more.
• Red. Your knee is sorer, stiffer or more swollen the next morning, or you are limping. Ease back next run.

Adjusting your runs

Some changes that can help while your knee settles:

• Run shorter distances, or split runs into running and walking intervals.
• Run at an easy, conversational pace.
• Choose flat routes, as downhill running loads the front of the knee most.
• Leave out speed work, hills and long runs for a week or two.
• Run on even surfaces, like paths or a treadmill.

How you run

A few small changes can ease the load on your knee:

• Take slightly shorter, quicker steps, which can reduce the load on the knee with each stride.
• Run tall, looking ahead.
• Avoid overstriding, where your foot lands far out in front of your body.
• If the pain is on the outside of your knee, a slightly wider step can help.
• Check your running shoes are not too worn.

Cross-training

If running feels uncomfortable for a while, other activities can keep your fitness up. Cycling, swimming and using a cross-trainer are often easier on a sore knee.

Building strength

Strengthening the muscles around your hips and knees helps your knee cope with running. Research suggests combining hip and knee strengthening works better than knee exercises alone. Something to try two or three times a week:

• Sit to stand or box squats, lowering slowly.
• Reverse lunges, going only as deep as feels comfortable.
• Bridges. Lie on your back with your knees bent, lift your hips, then lower slowly.
• Side-lying leg lifts. Lie on your side and slowly lift your top leg, then lower.
• Heel raises. Rise onto your toes, pause, then lower slowly.

If you would like to follow along, VIDA has short videos of sit to stands, lunges, bridges and heel raises you can use at your own pace.

Building back gradually

When your knee has been in the green for a week or so, you can start building back up. Something like this tends to work well:

• Start with run and walk intervals on flat ground.
• Gradually increase the running parts, and reduce the walking.
• Build up to continuous running at an easy pace.
• Add distance gradually, then bring back hills and speed work last.

Running with a friend or to music at a conversational pace can help you resist the urge to speed up. Change only one thing at a time, like distance or pace, and check how your knee feels the next morning before adding more.

Warming up

A short warm-up can help your knee feel more ready. Walking briskly for a few minutes, then a few leg swings and gentle bodyweight squats, can ease you into your run.

Outside of running

Long spells of sitting with your knees bent can make a sore knee stiff. Straightening your legs every so often, or getting up for a short walk, helps. Your VIDA pain check-in is a good way to keep track of how your knee responds as you build back up.

What to take away

• Most recent knee pain in runners means adjusting, not stopping.
• Running itself is not bad for your knees.
• Use the traffic-light check to guide each run.
• Run shorter, flatter and easier, with slightly quicker steps.
• Strengthen your hips and knees and build back gradually.

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