As only some of you might know, "knees up mother brown" is an old pub song dating back to the 1800's as well as a football terraces song for West Ham. The song encourages you to get up and dance with high knees. The other is a 90's song by the band James where they encourage us to sit down and read books.
The reason I reference these two songs is to find out which you are, particularly post race or running event. Do your knees allow you get up and dance or encourage you to sit down?
The more I run and the older I get (approaching 51 now) the more I find I have to look after my knees and the surrounding scaffold. Now, I know that not all pain in the knees actually comes from the knees themselves but, being pro-active in how we treat our legs is super important for having a long lasting, relatively pain free, running life.
I've wanted to write this article or blog for a while now, so here it is and I truly hope it helps you to maybe take a little more care of your legs, knees, hips and ankles in a bid to continue your beloved running for many more miles to come.
I have included a simple strength program at the end to bullet proof your knees. As well as included hints and tips for other exercises throughout the article which may help you address some possible causes for your knee discomfort.
Grab a cup of tea and enjoy the read.
Causes of Knee Pain for Distance Runners:
1. Runner’s Knee (Patellofemoral Pain Syndrome - PFPS), Cause:
Repetitive stress on the kneecap, leading to irritation of cartilage.
Weak quadriceps, poor knee tracking, or excessive downhill running.
Prevention:
Strengthen the quadriceps, especially the VMO (short arc quad exercises, step-downs).
Improve glute and hip strength (glute bridges, double and single leg, clamshells, side-lying leg raises ADDUCTORS, ABDUCTORS).
Work on running form: avoid excessive heel striking and overstriding.
Foam roll and stretch the quads, IT band, and hip flexor and quad stretch
Avoid excessive downhill running and abrupt mileage increases.
Treatment:
Reduce running volume temporarily, avoid hills.
Ice the knee post-run.
Strength training: Terminal knee extensions, step-ups, and mini-squats.
Patellar taping or knee braces can provide temporary relief.
Cross-train (cycling, pool running) while recovering.
2. Iliotibial (IT) Band Syndrome, Cause:
Tightness of the IT band causes friction on the lateral knee.
Weak glutes and hip abductors, overtraining, excessive hill running.
Prevention:
Strengthen the Gluteus Medius (single-leg Bulgarian split squats, lateral band walks, clamshells, reverse clamshells).
Improve hip flexibility (hip flexor stretches, pigeon pose).
Foam roll the IT band, but focus on tight quads and TFL (tensor fasciae latae).
Avoid running on cambered roads (uneven surfaces).
Gradually build hill training into your program.
Treatment:
Reduce mileage and avoid downhill running.
Foam roll and release TFL, quads, and glutes.
Strengthening exercises: Side-lying hip abductions, step-downs, and hip thrusts.
Try lacrosse ball massage on tight hip muscles.
Seek physical therapy for manual release techniques.
3. Patellar Tendinitis (Jumper’s Knee), Cause:
Repetitive jumping or running (especially downhill), stressing the patellar tendon.
Weak quadriceps, tight hamstrings, or poor landing mechanics.
Prevention:
Strengthen quads with eccentric loading (slow squats, decline single-leg squats).
Stretch hamstrings and calves to reduce strain.
Avoid rapid increases in speed or hill training.
Treatment:
Ice after running.
Temporarily reduce mileage and intensity.
Strengthen: Slow, controlled eccentric squats (drop squats, slow step downs).
Patellar straps (braces) can help distribute load.
Cross-train with cycling or swimming.
4. Meniscus Tears or Irritation, Cause:
Repetitive stress or sudden twisting movements wearing on the meniscus.
Poor knee alignment due to muscle imbalances. This can be either above or below the knee.
Prevention:
Strengthen hamstrings and quads (stability ball leg curl, resistance band leg curls, step-downs).
Maintain good knee tracking with single-leg exercises.
Avoid sudden changes in direction while running.
Treatment:
Rest and modify training (reduce volume and impact).
Check pelvis for over internal or external rotation. Also check feet and ankles for arch height, fallen arches, flat feet or over pronation/supination or other bio-mechanical inefficiencies of the lower leg.
Ice and anti-inflammatories if swelling occurs.
Gradual return to running with strength work.
Severe cases may require physical therapy or surgery.
5. Osteoarthritis, Cause:
Wear-and-tear of the knee joint over time, previous injuries, or biomechanical inefficiencies.
Prevention:
Keep muscles around the knee strong (quads, glutes, hamstrings).
Reduce excessive high-impact running.
Use supportive footwear or orthotics if needed.
Treatment:
Reduce mileage and avoid hard surfaces.
Low-impact cross-training (cycling, elliptical, swimming).
Joint supplements (glucosamine, chondroitin) may help.
Physical therapy for joint mobility and muscle balance.
Severe cases might require injections or surgery.
6. Tendon Strain or Overuse Injury, Causes:
Weak or tight muscles around the knee.
Excessive running with inadequate recovery.
Prevention:
Strength train quads, hamstrings, and calves.
Stretch after runs and use dynamic warm-ups.
Treatment:
Rest or de-load mileage.
Strengthening and eccentric loading exercises.
Soft tissue work (massage, foam rolling).
7. Bursitis (Inflamed Bursa), Cause:
Inflammation of fluid-filled sacs in the knee due to repetitive motion.
Excessive kneeling or poor biomechanics.
Prevention:
Avoid excessive kneeling (or use knee pads).
Strengthen hip and glute stabilisers.
Treatment:
Ice and anti-inflammatory medications.
Reduce high-impact training temporarily.
Soft tissue work to relieve pressure.
8. Poor Running Mechanics or Footwear Issues, Cause:
Overstriding, excessive heel striking, or improper shoe support.
Weak core and hip muscles leading to poor knee alignment.
Prevention:
Get a gait analysis to assess form.
Wear properly fitted running shoes.
Strengthen glutes, core, and calves.
Treatment:
Adjust running form: shorter strides, higher cadence (~180 steps/min).
Footwear assessment (consider neutral vs. stability shoes).
Strengthening and mobility drills.
9. Overtraining & Rapid Mileage Increase, Cause:
Increasing volume too fast without adequate recovery.
Prevention:
Follow the 10% rule for mileage increases
Rotate between hard and easy days.
Incorporate cross-training and strength work.
Treatment:
Rest and de-load mileage.
Focus on recovery (nutrition, sleep, mobility work).
Gradual return with better planning.
Final Takeaways:
Strengthening glutes, quads, and hamstrings is the best injury prevention. Proper footwear, good running mechanics, and gradual mileage increases reduce knee strain. Listen to early pain signals—DON'T PUSH THROUGH SEVERE KNEE PAIN!Knee-Saving Strength Routine for Distance Runners. Frequency: 2-3x per week
Equipment Needed: Resistance bands, dumbbells/kettlebells (optional), step/box
Activation & Warm-Up: (5-10 min)
1. Glute Bridges – 2 sets of 15 reps
2. Clamshells (with resistance band) – 2 sets of 15/15 - reps/side
3. Banded Side Steps – 2 sets of 15/15 - steps each direction
4. Wall Sits – 2 sets of 30-45 seconds
Strength & Stability (Main Workout):
1. Bulgarian Split Squats (Quad + Glute Focus) - How: Back foot on a bench or step, lower into a lunge, keeping front knee stable.
Reps: 3 sets of 10-12 reps per leg - Why: Strengthens quads and glutes to support the knee.
2. Single-Leg Step-Downs (Eccentric Control) How: Stand on a step, slowly lower one foot to tap the ground, keeping control.
Reps: 3 sets of 8-10 reps per leg - Why: Improves knee control and prevents patellar tracking issues.
3. Romanian Deadlifts (Hamstring & Glute Strength) How: With dumbbells, hinge at the hips while keeping knees soft, return to standing.
Reps: 3 sets of 10 reps - Why: Strengthens hamstrings to balance the knee joint.
4. Lateral Band Walks (IT Band & Glute Medius) How: Place a band above knees, step side to side while staying low.
Reps: 3 sets of 15 steps each direction Why: Strengthens the glute medius, reducing IT band strain.
5. Spanish Squats (Patellar Tendon Strength) How: Use a resistance band around a pole, lean back into a deep squat.
Reps: 3 sets of 10 reps - Why: Reduces stress on the kneecap while strengthening quads.
6. Elevated Calf Raise (Side), Elevated calf raise (back) (Shock Absorption) How: Stand on a step, rise onto toes, then slowly lower.
Reps: 3 sets of 12 reps - Why: Strengthens calves, which absorb impact forces during running.
Mobility & Recovery (5 min):
Quadriceps Stretch – 30 - 60 sec/leg.
Hamstring Stretch – 30 - 60 sec/leg.
Hip Flexor Stretch – 30 - 60 sec/side.
Foam Roll: IT Band, Quads, Hamstrings – 1-2 min/area
Additional Tips✔
Progress Gradually – Start bodyweight-only, then add resistance.✔ Do This Routine 2-3x Per Week for long-term knee health.✔ Combine with Running-Specific Drills (e.g., high knees, skips) for neuromuscular control.✔
Listen to Your Body – Modify or skip exercises if pain flares up. Stay strong and injury-free
Run Strong, Run Long, Run Better.
John Withinshaw Running Coach
JDW Fitness
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