Question for experienced runners

How often and how far do you run?

Not far or often :) 2.5-3 miles about 2x per week

Shoes are the first thing I look at when my knees start to hurt. I pronate when I run, so arch supporting insoles are also top on my list of things to replace regularly.

Recently I had a knee ache that wouldn't go away. I slowed my pace, then used a combination of ice/heat on my knee for 30-40 minutes after runs that were troublesome. I was back to "normal" in about 2 weeks after I started that routine..

I've had bad experience muscling through. Hope this helps.

Things that have worked for me in the past:

(1) Shortening my gate helped my knees a ton
(2) I love Hoka One One shoes -- highly recommend them but unsure they alone would cure a knee issue
(3) Only do dynamic stretches ahead of time. Static stretches ahead of runs for me made a serious hamstring injury much worse.
(4) Highly recommend Suzanne @ SOL PT Seattle to diagnose and treat injuries and imbalances.
(5) Run less for a while :|

Good luck!

Never muscle through it! See a PT first and they can give you some exercises (have your gait analyzed...you might simply need orthotics, new running shoes, or better technique). See Julie Vanni at Biojunction Sports Therapy in Seattle. She’s great. Listen to your body:-)

I had two knee surgeries and stopped running :( Nothing helped. Now I do ballet and nothing hurts! I did run myself into horrible pain before even seeing a doctor (and I did try PT for months). Just a cautionary tale to go and scan your knee, just in case. I had a torn meniscus in both. Hope it's nothing serious for you!!

Try a foam roller after your run!

It depends on where and how your knee is bothering you.

Generally, I am a fan of:
Arnica gel topically and Arnica montana internally to reduce bruising and swelling after a run. Non-fat latte or yogurt after a run, protein to help repair muscle + ligament + tendon damage. Foam roller on my achilles, calves, and IT band a few hours after a run, to relax muscles. Soaking in a hot bath with epsom salts to reduce aches and pains a while after a run, a while after to avoid inflammation.

If the pan is below the knee, then a cho-pat strip can help. If it’s on the sides, weirdly socks with ankle and arch support can help. They reduce wobble in your stride and possible lateral knee pain as a result. I’d also make sure you aren’t hyper-extending, can happen if you go too fast too early when your muscles feel tight or on a cold day.

Of course make sure your running shoes are right for you if you supinate or pronate. Also that the cushioning isn’t worn out! Wet shoes cushion less. And the cushioning only lasts for 500 miles. If you run 20-25 miles a week in one pair of shoes, they get to the end of their mileage in 6 months.

I used to suffer aches in my knees every time I ran. I switched to minimalist shoes, learned to land differently, and now I run more frequently and pain-free. This will not be the solution for everyone, but changing shoes, changing stride, changing how you land can all make a difference. Running with a friend who doesn't suffer pain could help you find some habits to imitate. Analysis from a pro can help too.

I agree with what others have said:
- The right shoes make all the difference.
- It's much more important to stretch after running than before.
- If you do want to stretch before you run, warm up for five minutes first (walking or running) before stretching.
- A good PT is important. I like the folks at Move Mend near the U Bridge.
- A PT can help with shoes too: you can buy a few pairs they recommend, and walk around the PT clinic in each pair. The PT can assess which are best for you. Return the shoes you aren't keeping.

I take a break and get on the bike for a few days.

Based on your description you mostly likely have 'runner's knee' or patellofemoral syndrome.
Usually caused by relative weakness of the inner quads compared to outer quads causing an outer pull on the knee cap where the knee cap no longer sits nicely in its groove and starts 'rubbing'.
So agree with physiotherapy to confirm the diagnosis and strengthen your medial quads

What I've heard / gotten from PT:
- right shoes + use different shoes on different days. Different shoes will put different strains on your body
- try running around 180 Steps / Min. (Apple Watch can show this to you - I run at 165-170)
- Roll your quads
- Don't stretch beforehand, maybe stretch afterwards
- Strengthen your glutes
- Get someone to coach you on running form
- do annoying step down PT stretches

If it doesn't go away:
- Do PT. This is bread and butter PT and should take 1-2 appointments to fix.
- try running in barefoot shoes (but start extraordinarily slow - slower than you think - 2x 1 block week 1, then 2 blocks week 2)

One more thing:-) I’m a fan of Golden and Altra running shoes, but go see Julie. Of course we could get you cycling 😉 goldenharper.net

Hey Liz, I'm going to start by saying - go see a doctor. I used to be a long distance runner. In my 20s/30s I'd do 100+ miles/week. Then my knees gave out. It started slowly. I did many of the things people above recommended, and they did help, but then I started getting pains in my shins and ankles. The most likely causes are arthritis or tendinitis.

Thanks so much for the recommendations. (@Dudley I did buy the Hoka shoes but I'm just now breaking them in.) Good tips on stretching, rolling, heat/icing. There was a time in my life when these things would just go away, but maybe that time has passed. PT sounds like it makes sense and maybe a running coach, too. I am willing to bike but I don't want to stop running!

Hey, Liz. Most of the time a knee in pain in as indication of a weak muscle, and, chances are it has to do with your IT band or with your hip muscles. I went from not being able to run more than 4-miles without knee pain to doing many marathons, once I adopted a few changes in my routine:
1) Like some people already said, shorter strides is better
2) Step with the center of your foot or the front of your foot, and each step must be exactly below your body -- i.e., don't overextend your leg or hit the ground with the back of your foot.
3) Use a roller on your IT band, thighs, and inner thighs.
4) Hip and gluteus stretches before you run.
5) A lot of core exercise -- planks, abs, etc.

You've tapped a river of opinions & expertise here :-). For me, doing as-much-or-more leg strength work as actual running took me from thinking I was done running forever (due to IT band pain) to setting half-marathon PRs.

I use Superfeet insoles in my shoes. I don’t know about preventing pain altogether but I definitely feel like I have much better foot/arch support.

Should probably write them a review, huh? 😋

The leg strength points are also interesting... @simon_dalexy I also do yoga 2x a week and thought I was in reasonably decent shape because of that. More focus needed on inner thighs and IT bands I guess....

Hi Liz Pearce ! My wife and I have been running 16-20 miles/week for the past 12+ years. About 8 years ago I started having some chronic pain in my knee and could no longer run w/o pain. I was pretty bummed out, but there were a few things I immediately did and it helped tremendously. 1) I took a break for a 4-6 weeks - no running and then introduced just lower body strength training - well-rounded muscles in the lower body seemed to help me 2) Once I was ready to run again, I changed shoes - I was previously wearing Nike that were likely far too worn out (and probably not appropriate for my feet). I switched to Asics and Brooks (with in-soles added) and I ensured that I swapped for new shoes once I hit the mile marker for the pair I wore 3) rather than jump back on a flat surface (which tends to be hard on feet/knees), I ran hills for 4+ weeks. Luckily, the triple-hill of McGraw in Magnolia is perfect for that. I would run up and walk slowly down, 10 times each. I have not had any knee issues since then, but switched to Hoka shoes about 18 months ago, which both my wife and I swear by. I have a friend who is an ultra-marathon runner and also loves Hoka. Good luck to you! BTW, no real science to my approach, but it worked for me. ;)

+1 on the shoe comment - I have ran/ walked in just about everything and swear by Mizunos (to be totally honest I'm not a huge runner anymore but I am walking 13 - 16 miles a day and these shoes make a big difference)

Don't run :) I used to love it but for most of us there comes a time when you have to look at other fitness options. Make sure you are checked out properly for the health of your knees. If they are still ok then all the above mentioned advice is good - look at gait, PT, shoes ...

I know you're averse to going to the doctor, but a trip to the chiropractor could be in order. Misalignment in hips can very easily lead to problems in your knees. Worth getting checked out, and at best get some kin tape to add some support while you're there. Aside from that.. epsom salt soaks to aid in muscle/tendon recovery. It really does work.

My technique of not running has worked flawlessly for solving this issue! (Versaclimber + walking)

I go straight to the PT! Recently I had some knee issues and she recommended foam rolling my legs from shin/calf to glutes. She also recommends cross training- yoga and biking are good.

Go see Wimsey Cherrington. She is the best massage/manual therapist I've ever found and she will be able to diagnose what's going on and give you recommendations for sure.

For what you are describing rest would be the first thing. If it becomes chronic you are putting too much strain on those parts. It could be as simp,e as trying to do too much too soon or if there is a structural problem you need to have that checked to see if you need to make a change in your regimen or equipment or both.

Yes like what everyone says do not muscle through! Go to PT even tho you don’t want to. I got awesome care from UW sports medicine. Sorry this is bugging you!

I agree with all the above, PT, rolling, proper shoes (I'm a Hoka girl) Shoes N Feet, etc. When you do get back out there, choose soft surfaces, like a flat wooded trail rather than the sidewalk. I've been told that even the road (asphalt) , vs the sidewalk (concrete) is better on the body. Beware of traffic of course.