Overview

Knee problems are among the most common running injuries, and the two big patterns are pain around or behind the kneecap (patellofemoral pain) and pain on the outside of the knee (iliotibial band syndrome). Tendon pain — patellar or hamstring — is also common with speed work and hills.

The prevention story is consistent: the knee is usually being asked to handle more load than the muscles around it are prepared for. That means prevention is mostly about training load and strength, not about avoiding running.

Who This Is For

Runners increasing mileage, speed or hill work
Anyone returning to running after a break or an injury
Trail and road runners, and multisport athletes whose running volume jumps

Common Risk Factors

A rapid increase in distance, frequency or intensity
Adding hills or speed work before the knee tolerates the current load
Hip and quadriceps weakness, which current guidelines link to patellofemoral pain
Long runs on cambered or tilted surfaces for some people
Worn or unsuitable footwear, and running in shoes past their useful life
Not building recovery into the training week

Training Load Principles

Increase volume and intensity in steps, changing one variable at a time — distance this week, hills the next
Add hills and speed work gradually, and back off if knee symptoms flare
Build in recovery days and lighter weeks; adaptation happens during recovery
If knee pain appears at a specific distance, pace or surface, treat that as a threshold to respect while you strengthen, not a reason to stop running entirely
Running through constant, worsening pain usually makes the problem harder to fix

Strengthening for Runners

Strengthening the quadriceps and hip muscles is the best-supported way to reduce patellofemoral pain and is a core part of managing IT band syndrome:

Two to three short strength sessions per week: squats, step-ups, wall sits and hip-focused work such as glute bridges and side-lying leg raises
Progress repetitions and resistance gradually, using the same load-management rules as running
Keep strength work going through the season, not just when symptoms appear

Recovery and Warning Signs

Expect some discomfort with new training, but it should settle reasonably quickly. See a clinician if knee pain is sharp, constant, keeps you from running at comfortable levels, or comes with swelling, locking or giving way. If you can identify the problem early — patellofemoral pain, IT band syndrome or tendon pain — you can start the right load-management plan sooner.

References

Willy RW, et al. "Patellofemoral Pain: Clinical Practice Guidelines." Journal of Orthopaedic & Sports Physical Therapy. 2019;49(9):CPG1-CPG95. https://doi.org/10.2519/jospt.2019.0302
Neal BS, et al. "Best practice guide for patellofemoral pain." British Journal of Sports Medicine. 2024;58(24):1486-1495. https://bjsm.bmj.com/content/58/24/1486
StatPearls. "Iliotibial Band Syndrome." https://www.ncbi.nlm.nih.gov/books/NBK542185/
Fredericson M, Weir A. "Practical management of iliotibial band friction syndrome in runners." Clinical Journal of Sport Medicine. 2006;16(3):261-268. https://pubmed.ncbi.nlm.nih.gov/16778549/

This information is for education only and is not a medical diagnosis. InjuryAtlas does not replace an assessment by a qualified health professional. If you have severe pain, visible deformity, numbness, loss of function, or symptoms that are getting worse, seek medical care promptly.

Knee Injury Prevention for Runners