Knee Pain When Running: 3 Most Common Patterns + What To Do This Week
PhysioApproved Guide
A physio-written guide to quickly calm knee joint irritation caused by running while keeping you training smart, and knowledgable about how to support your performing body.
Important: Most running-related knee pain is manageable with the right short-term adjustments and a simple plan. The goal of this page is to help you identify your likely pain pattern and take action today.
Choose the pattern that best matches your pain
Click the option closest to where your pain is located. You can switch patterns at any time.
This pain becomes worse with stairs, running/walking downhill or sitting for too long. GET PHYSIO ADVICE ↓
This pain becomes worse with jumping or increasing your running speed. GET PHYSIO ADVICE ↓
This pain is only found on the outside edge of the kneecap and worsens with running. GET PHYSIO ADVICE ↓
Not sure? Start with the pattern that best matches your pain location during running. If two patterns match, choose the one that describes your most aggravating trigger (stairs/downhill vs jumping/speed vs outside of knee/downhill).
Before we start: should you see a Physio/Doctor immediately?
If any of the below apply, consider getting assessed sooner rather than later:
- You can’t fully bear weight through the leg of the injured knee.
- Your knee has had significant new swelling in the past 24 hours.
- You have heard a “pop” from your knee or your knee is locking/catching.
If your situation doesn’t fit the above, then you will respond well starting with the “What to do this week” steps below.
Pattern 1: Pain around/behind the kneecap (Runner’s Knee)
What this usually is
This pain pattern describes Patellofemoral pain a condition also known as Runner's Knee, due to it's high prevalence amongst runners of all levels and abilities.
Patellofemoral pain is usually a response to load exceeding your knee’s current capacity. Each stride you take requires the knee to bend and straighten repeatedly, and when your total running load rises faster than your knee is ready for, the joint becomes irritated.
That load can increase in two ways:
- More repetition (more kilometres, more frequent runs)
- More stress per stride (steeper hills, faster pace).
For this reason, Runner’s Knee is commonly triggered by ramping up training too quickly - for example, starting with runs that are too long, adding steep hills too soon, or increasing distance and intensity before the joint has had a chance to adapt.
Accordingly Runner's Knee is especially evident during:
- Stairs (especially going down)
- Hill runs
- Squats/lunges
- Longer runs or back-to-back running days
Common mistakes:
- “Testing” the knee repeatedly with hills and speed
- Doing too much too soon after a break
- Resting completely without rebuilding strength tolerance
What to do this week (simple and effective)
Your goal for the next 7 days: reduce irritation, maintain fitness, and start rebuilding tolerance.
1) Reduce the biggest irritators
- Cut hill/downhill running volume temporarily
- Reduce run volume to a level that keeps pain management (see prescribed pain rule below)
- Swap one run for low-impact cardio (biking, incline walk, rower for example)
2) Use the pain-monitoring rule
- During running: aim for discomfort no higher than 3/10 at the knee
- After running: symptoms should settle to baseline by the start of the next day, if it doesn't, this suggest you overloaded
3) Start a 10-minute strength routine (2x/week to start)
Pick 2-3 exercises to start, here are some which might suit your strength levels:
- Glute bridges - 3 sets x 8 repetitions
- Step-downs from a low step - 3 sets x 10 repetitions
- Pistol squats - 4 sets x 6 repetitions
What A Physio Recommends
There are a lot of things that can help, but consistency with the right plan is key. This program is designed to guide you through that process.
View PhysioApproved's Return to Running ProgramWhere external support fits (and when they help)
Supports like braces, sleeves and unloaders don't "fix" the root cause by themselves, instead many runners find they help by:
- Reducing discomfort during runs and stairs
- Improving confidence and perceived knee stability
- Making it easier to keep moving while you build capacity
For Runner's Knee, two options commonly work well:
Option A: Patellar Strap (targeted support)
This simple tool works to stabilise the position of the kneecap during running preventing any unnecessary irritation. Recommended for runners who want a minimal, low-profile yet effective option for training.
Option B: Knee Compression Brace
Specific compression braces work to encapsulate the knee and provide support with stabilising springs and knee cap cushions. Recommended for runners who's knee pain is more persistent and experience any knee instability or clicking/locking.
Pro tip: If you’re unsure on which option is best for you, email us: info@physioapproved.com.au for direct physio advice.
Pattern 2: Pain below the kneecap (Patellar Tendon pain)
What this usually is
This pain pattern describes Patellar tendinitis, a condition where the tendon which connects the kneecap to the shinbone, has been overloaded. This occurs when the Patellar tendon becomes irritated from being asked to handle more load than it’s ready for (usually from jumping, sprints including hill sprints).
You may notice:
- Pain which worsens during with sprinting, hills, jumping, or after hard sessions
- The “warm-up effect” (hurts at first, eases slightly during the run but flares after)
- A localised tenderness just below the kneecap
Common mistakes:
- Stretching aggressively when the tendon is reactive
- Continuing with hills and sprinting because “it loosens up”
- Resting completely (tendons need progressive loading)
What to do this week
Your goal: training smartly to maintain fitness while reducing tendon irritation
1) Temporarily reduce tendon-intense loads
- Scale back upwards hills running
- Remove any sprinting or plyometric training
- Continue to run along flat surfaces permitting pain stays below 3/10
2) Isometric pain-calming exercises (5-8 minutes everyday)
Here are some which may suit your strength levels:
- Wall sit - 30 seconds x 4 repetitions, then progressing to:
- Spanish squat (or supported squat hold) - 3 seconds x 4 repetitions
This helps calm tendon pain and maintain strength.
3) Begin controlled strengthening (2x/week to start)
- Slow squat to a box - 8–10 reps x 3
- Slow step-ups - 8–10 reps x 3 each side
Keep it controlled. Evidence shows tendons respond to consistent, progressive loading.
What A Physio Recommends
There are a lot of things that can help, but consistency with the right plan is key. This program is designed to guide you through that process.
View PhysioApproved's Return to Running ProgramWhere external support fits (and when they help)
Similar to other running pain patterns, supports like braces and straps don't "fix" the root cause by themselves, instead many runners find they help by:
- Reducing symptoms during training and in the days following
- Facilitate reduced but continual training while the body adapts and overcomes injury
For Runner's Knee, there exists one main support option which addresses the patellar tendon directly.
Patellar Strap: targeted relief during activity
A patellar strap provides focused & direct compression to the tendon. Runners often find the relief immediate during runs and tendon-loaded movements. It’s a practical bridge while you deload and rebuild tendon capacity.
How to use a Patellar Strap (PhysioApproved Guide Available)
- Wear during runs and tendon-heavy activity
- Position it just below the kneecap as directed
- Snug, supportive fit - avoid over-tightening
Pro tip: If you’re unsure on which option is best for you, email us: info@physioapproved.com.au for direct physio advice.
Pattern 3: Pain on the outside of the knee (ITB pain)
What this usually is
Outer-knee pain during or after running is consistent with an Iliotibial Band Syndrome (ITBS). This condition is caused by one of the thigh muscles becoming irritated at the point where it connects with the knee.
The ITB pain pattern often involves:
- Sharp/burning sensation on the outside of the knee
- Flare up at a particular point after a certain distance
- Pain which worsens when running downhill
Common mistakes
- Stretching the ITB aggressively as the primary solution
- Persisting with downhills because “it’ll adapt”
- Only resting without improving hip control/strength
What to do this week
For ITB pain patterns, the highest ROI is load management + control/strength, rather than relying on devices like knee braces & straps.
1) Remove the biggest trigger (temporarily)
- Cut downhills and steep routes for 7–14 days
- Reduce volume to a level that doesn’t “ignite” symptoms
2) Add 10 minutes of strength/control work (3–4x/week)
- Side plank - 25 sec x 3 each side
- Hip hikes on a step - 10–12 reps x 3
- Single-leg Romanian deadlift - 8–10 reps x 3 each side, light load
- Step-downs - 8–10 reps x 3 each side
3) Progress back strategically
- Reintroduce distance first (flat routes)
- Add hills later, in small doses
What A Physio Recommends
There are a lot of things that can help, but consistency with the right plan is key. This program is designed to guide you through that process.
View PhysioApproved's Return to Running ProgramYour best next step: Follow the plan above, and if you want a structured pathway back to running, use the Return-to-Running program below.
The Physio-created: Return to Running Plan
If you want a simple, structured system that accommodates for all three patterns - this is for you.
Return to Running: A Step-by-Step Runner’s Protocol
Designed to help you:
- Knowing when you can continue to run while experiencing pain
- Reduce flare-ups while maintaining fitness
- Rebuild strength and capacity progressively
- Follow a clear weekly progression (so you stop guessing)
- Know exactly when to add distance, pace, and hills again
- While raising aware about common mistakes injured runners make and what to do instead.
Coming soon: A short “knee pain running” mini-course (approx. 20 minutes) to walk you through the exact approach and common mistakes. If you’d like to be notified when it launches, check back here.