Smart Safety Tips for Runners — Avoiding Knee Injuries
Tips for Runners — Avoiding Knee Injuries

Smart Safety Tips for Runners — Avoiding Knee Injuries

Running is popular among fitness enthusiasts — many more people run for health than play golf or cycle. You need very little equipment apart from good shoes. Your business trips or vacations won’t interrupt your fitness regime; you can run (almost) anywhere.

Running is also beneficial. Studies have found that runners have better health. They’re less likely to die of heart disease and cancer, and in general, live longer.

However, running is not entirely safe. Runners are prone to injuries. Nearly all runners have suffered an injury at some time, and many have required medical attention.

Injuries are no fun, to state the obvious. They can be expensive to treat, can force time off from work, and prevent continuing with your fitness regime. Even after complete recovery, the memory of an injury can ruin the joy of running.

The most common injuries associated with running are knee injuries.  Other common injuries are those of the foot, toes, ankle, lower leg, thigh, and lower back.

The type of running also does affect the type of injury. Ultramarathoners, for example, are prone to Achilles tendinopathy.

About 50% of runners suffer an injury each year that prevents running for a while. At any point in time, 25% of runners are likely to be injured.

Runners are injury-prone. A quarter of runners are injured at any given time

Relation With Body Type

People with high body mass index (BMI) are more likely to have knee pain associated with running.

Relation With Age and Experience

Age by itself is not a factor in the occurrence of running-related knee injuries.

However, novice runners more frequently injure their knees.

Common Knee Injuries in Runners

  • Patellar tendinopathy
  • Patellofemoral pain syndrome
  • Iliotibial Band Syndrome

Fortunately, anterior and posterior cruciate ligament injuries are rare in runners. Meniscal injuries are also infrequent while running.

Patellar Tendinopathy

This is perhaps the most common. There is pain on the lower part of the kneecap and in the tendon below the kneecap. You may feel pain on pressing this tendon.

A single-leg squat can help you diagnose this. Extend the good leg, and do a squat on the other one. Significant pain is quite reliable as a diagnostic sign.

Patellofemoral Pain Syndrome

This condition is also known as Runner’s Knee.

Unlike the earlier condition, the location of pain in this condition is hard to pinpoint. Going up and down stairs, running, and squatting are painful. The pain may be severe enough for the knee to give way.

There is usually no swelling. Pain on standing up after sitting for a while (the theater sign) is a characteristic.

Iliotibial Band Syndrome

This is a painful condition caused by the iliotibial band pressing against the lower end of the femur. The pain is worst when the knee is bent at 15-30 degrees.

Initially, the pain only manifests after running some distance. As the condition progresses, running becomes painful almost immediately.


The knee joint is very complex and commonly injured in sporting activities. Though contact sports are considerably more dangerous, runners are also at risk. Most knee injuries in runners are caused by overuse.

Let’s look at what you can do to run without injury. Perhaps the most important is building up lower body muscle strength

Proper training and some precautions can keep you safe.


The Importance of Muscle Strength

Running puts enormous stress on the bones and joints. Your entire body weight, with its momentum, lands on one foot with every stride.

Good muscle strength protects your bones and joints.
Build before you run.

The muscles of the hip, thigh, and legs absorb some of this stress, partly sparing the skeletal system. When the muscles are tired, or weak to start with, the entire burden is on the skeleton, and injuries are common.

Runners with weak hip abductor, knee extensor (quadriceps), and knee flexor (hamstrings) muscle strength are more likely to have injuries. An exercise program to strengthen these muscles will prevent injuries.

Other Tips to Prevent Knee Injuries When Running

The knee joint is a very complex one. Any alteration in the gait can cause uneven distribution of weight and cause injury. If you are limping or have an abnormal gait, do not run till it is corrected.

  • Abnormalities of the lower limbs like unequal limb length, knock knees, bow legs, flat foot arches, or old injuries also predispose to knee injuries while running.
  • Some pain on warming up is common, but should reduce in a while. Pain that progressively gets worse is not normal. Do not continue running.
  • Increasing distance run too quickly is not wise. Increase distance by no more than 10% each week.
  • Shoes are important. Make sure they fit well, fasten them securely, and get new ones after using a pair for 500-600 km (300-350 miles). Inserts or insoles can also help prevent injury.
  • Run on alternate days. On the other days, try another aerobic exercise like cycling, swimming, or walking.
  • Proper running form is essential. Stay upright and don’t lean forward or back. Keep your knees bent to absorb the jerk of landing on each stride.
  • The surface you run on is also important. Uneven surfaces are hazardous. Running on grass or other soft surfaces will protect your knees.

Knee injuries are frequent in runners, but not inevitable. Care towards proper warming up, post-run stretching, and the points mentioned above can keep you going without pain, hospital visits, or missed work.


Kakouris et al. A systematic review of running-related musculoskeletal injuries in runners. 


Ribeiro and Berni. Relationship between Knee Symptoms and Biological Features in Recreational Runners.