Struggling with Knee Pain with *Any* Downhill Running

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  • #34590

    Hi all,

    I’m posting here more out of frustration than anything else – wondering if anyone here has some advice for me regarding knee pain when running downhill.

    Long story short – I’ve suffered knee pain for a long time, and I was able to get it under control to the point of being gone for 1-2 years, during which I thruhiked the Pacific Crest Trail and did 1000 miles of the Continental Divide Trail this summer.

    Ever since returning to a desk job, my knee pain has returned and will not stay gone. Some of this I attribute to the increase in sitting I have at my job, as well as the lack of daily movement that comes with being employed.

    I originally mitigated the pain via typical banded PT exercises – strengthening the glutes and hamstrings etc. After working with more-advanced PTs and incorporating some PRI, FRC and DNS principles, my body had almost no pain for about 1.5 years – and any little niggles quickly could be dispatched with a good session of work.

    Still struggling though, in the last 2 months since returning to work. I’m not a consistent trail runner – some weeks I barely get 10 miles in on the trails, others I’m 20+, but I do strength training very consistently, with a focus on single-leg quad strength and hamstrings lately.

    Anyone have some general tips? My knee pain is often on the inside of my kneecap, but sometimes melds into general ITB pain as well. It’s only on downhill running, but even the slightest downhill angle sets the pain off.

    FWIW hiking downhill doesn’t seem to cause knee pain – not even with a heavy pack.


Posted In: Mountain Running

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    Anonymous on #34595

    Sorry you’re struggling with knee pain-that’s really frustrating. Your increased sitting no doubt plays a role, but my first thought when reading your post is that there are probably some movement patterns with running (especially downhill) that are causing an imbalance. Hip strength and extension are super important for stabilizing the knee, and while it sounds like you did that with specific exercises, transferring that to the way you run may be the next step. I wrote an article on downhill running here:

    I would focus more time on the posterior chain muscles for strengthening rather than the quads, as sitting shortens the hip flexors and quads, so that it’s more challenging to engage the posterior ones. Some mobility for the front of your hips may also really help. Low lunges (passive, with your back knee on the floor) help open up the front of the hip and the couch stretch (google this one) is terrible/great for stretching the quads. Foam rolling is also helpful for increasing mobility in the hips:

    With more sitting, your glute muscles may have gone on vacation, so doing exercises like bridges help wake them up and bring them back on board.

    Good luck!

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