Knee painful - skeleton x-ray.Knee pain, especially anterior knee pain i.e., occurring at the front and center of the knee, is a relatively common occurrence in runners.

A study of 347 long-distance recreational runners found that causes and risk factors behind knee pain when running are numerous. For example, anterior knee pain was strongly associated with age and running experience.

The most affected subjects had the running experience of three to five years. Generally, younger and inexperienced runners were more likely to have knee pain than older and experienced counterparts. It is worth mentioning that the risk and severity of knee pain while running is not associated with factors such as gender, hand domination, and race. Most participants had quite similar risk factors for knee pain while running, and they included the following:

  • Tightness of hamstrings
  • Tightness of iliotibial band (a large tendon running down the side of the leg from the hip)
  • Weakness of quadriceps muscles
  • Weakness of hip control muscle
  • Abnormalities with patellar tilt

Knee pain could also occur due to the overuse and sudden increases in intensity, duration, and volume, inadequate sport-specific training techniques, and inappropriate equipment used for sports[i].

One of the most common causes of knee pain in runners is the patellofemoral pain syndrome i.e., runner’s knee. Several risk factors play a role in the development of this condition, including gait abnormalities, excessive foot pronation, tightness of muscles and tendons, among others[ii]. Runner’s knee is best indicated by pain under the kneecap that feels worse after running or when walking up and down the stairs. It happens due to irritation of cartilage beneath the patella after it moves out of proper alignment while running.

Besides the runner’s knee, pain in this joint can also occur due to patellar tendinitis, also known as jumper’s knee. Patellar tendinitis is an injury to the tendon connecting the kneecap to the shinbone. The condition is indicated by pain below the kneecap and at the top of the shin. The pain sharpens while running. The reason why people can experience this type of knee pain while running is that this physical activity adds a lot of stress to the tendon.

Buying wrong running shoes can also contribute to knee pain while running due to a lack of support and poor shock absorption. Some people with osteoarthritis may experience knee pain while running. That being said, running itself does not cause osteoarthritis[iii] as we are often led to believe. The knee pain while running among people with osteoarthritis is mainly due to stress formed by running. Patients with this common type of arthritis are generally advised to engage in low-impact activities instead.


People can experience knee pain while running due to a wide range of causes ranging from experience level to muscle and tendon tightness, and other factors. Even the wrong shoes can contribute to pain. That being said, the benefits of running are undeniable, but to avoid the risk of pain, make sure to work on the performance and get suitable shoes that will provide both comfort and support. If pain is prolonged and persistent, make sure to consult the doctor.


[i] Kunene SH, Ramklass S, Taukobong NP. Anterior knee pain and its intrinsic risk factors among runners in under-resourced communities in Ekurhuleni, Gauteng. South African Journal of Physical Therapy 2018 Sep;74(1):452 DOI:

[ii] Halabchi, F., Abolhasani, M., Mirshahi, M., & Alizadeh, Z. (2017). Patellofemoral pain in athletes: clinical perspectives. Open access journal of sports medicine8, 189–203.

[iii] Lo, G. H., Driban, J. B., Kriska, A. M., et al. (2017). Is There an Association Between a History of Running and Symptomatic Knee Osteoarthritis? A Cross-Sectional Study From the Osteoarthritis Initiative. Arthritis care & research69(2), 183–191.