How to Prevent Running Knee Injury and Pain?

running knee injuries
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The act of running is a simple yet blissful process of self-discovery and potential maximization while out pounding the roads or trails. Speaking of pounding, the knee joints can be subjected to forces up to three times of body weight when running. As such, knee injuries tend to be a big concern for many. Allow me to share how knee pain does not have to be a part and parcel of running.

1. “Old age” is not a valid reason in itself for knee injuries. When runners tell me they have an injury on one knee due to aging, I jokingly ask if that knee was older than the other! My 67-years-young father used to have one-sided knee pain that would linger around for days after each run and thus inhibit his training routine; however with chiropractic care his knee issues have completely self-resolved and he is finally able to run consistently, leading up to his age-group win at the 10 kilometer race as part of the 2016 Singapore Marathon event.A 2017 study concluded that current runners were 29% less likely than non-runners to experience knee pain, while there was no increased risk of symptomatic knee osteoarthritis in runners (see is enlightening because it dispels the misconception that running ruins your knees; in fact running strengthens your knees by building bone density.“Motion is lotion” for the most part, as long as it is done in the right manner.

2. Take the warm-up and cool-down seriously.Before a race and big workout I would do dynamic stretching at home, followed by a jog and more dynamic stretching at the run site. The purpose of the warm-up is to prime the various body systems (e.g. cardiovascular, respiratory, musculoskeletal) which are all coordinated by the nervous system, increase blood flow to muscles and other connective tissue, as well as to increase joint flexibility. The knee joint is a complex structure involving three bones (patella, femur, and tibia bones) and a variety of connective tissues. If the structures are tight due to insufficient warm-up, there is increased risk of Patellofemoral Pain Syndrome which is the most typical overuse injury in runners. Weak quadriceps and tight hamstrings typically compound this risk so it is worthwhile strengthening or stretching the appropriate muscle groups. After a hard or long run, I am also diligent to stretch (more of the static type) toprevent injuries.

3. Tread softly, literally. Instead of focusing on stride length while running, focus on cadence (i.e. number of steps per minute). Solely trying to go for long strides (while on a low cadence) increases knee injury risk due to the increased joint impact upon landing from unnecessary“hanging” in the air and over-striding. Instead, shoot for approximately 180 steps (i.e. 90 strides) per minute when running at race pace. First establish your individualized cadence baseline by timing yourself for a minute at this pace, then practice that quick turnover in training so it becomes second nature when racing. It is alright to shorten your strides so you can have a faster cadence not just for injury prevention purposes but also because this combination improves running economy.

4. Lose weight if needed. In 2006 at my heaviest I was overweight at 80 kilograms compared to my current 57 kilogram frame, which means that was 23 more kilograms of body weight stress on my knees when running marathons back then! Carrying excess weight increases the impact on your knee joints, thereby increasing risk of injuries and even cartilage degeneration. Running is great for losing weight but while doing so one should take steps to ensure it is done right. I advise starting with shorter easy-paced runs (or even alternate between jogging and walking) especially on soft surfaces like even grass to minimize impact. Cross-training in the initial weight-loss phases can also minimize injury risk.

5. Have a training plan that is progressive.Follow the 10% mileage rule where total weekly run mileage increases no more than 10% week-to-week to allow bones and connective tissue around the knee to adapt. I see too many runner patients getting injuries because they were rushing into intensive training. Take your recovery seriously through rest, proper nutrition, and stretching. Have a weekly training structure so that each run has its purpose, which means you should not be running hard every time (in fact the majority of my runs are run at easy aerobic pace). Be sensitive to differentiating between good and bad pain; for example one should stop a run if there is sharp pain felt.

6. It is possible to rebound back from knee injuries but more important to maintain being injury-free in the first place. Despite being a national marathoner who runs at least once daily and clocks up to 160 kilometers in mileage before a marathon, I have not sustained a single training-related injury since 2010 (coincides with when I started receiving chiropractic care). There is peace of mind that comes from being able to consistently push yourself in training and race season, without having to deal with the psychological scars associated with an injury. Having said that, we happen to see plenty of runner patients that have their initial knee issues improve with chiropractic care. The body is all connected so seemingly small imbalances like a quarter inch leg length difference (due to musculoskeletal tension) could potentially place undue stress on one knee. Multiply that stress with the impact of running over long distances and you realize the injury potential. Another holistic way of checking for biomechanical imbalances would be engaging a qualified coach to evaluate your running gait and form.


In summary, look into the root cause of your knee issues and any imbalances, rather than covering up the symptoms like knee pain. With the right approach, you can go beyond injury prevention and into functioning at optimal potential in the “long run”.

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Ashley Liew
Ashley Liew
Dr. Ashley Liew is a national marathoner with a personal best of 2h 32m 12s (top Singaporean for 2012 and 2015), as well as a Chiropractor. After completing his Bachelor’s degree, he went on to graduate Summa Cum Laude in his Doctor of Chiropractic studies at Sherman College of Chiropractic (South Carolina, USA). During the four years overseas, he not only juggled intensive training but also excelled in studies and internship (Outstanding Student of the Year and Intern of the Month). He currently serves the community in Singapore to help them fulfill their optimum health potential, as well as continues to compete at the national level. In 2016, he was also the First Singaporean to be awarded the Pierre de Coubertin World Fair Play Trophy.

6 thoughts on “How to Prevent Running Knee Injury and Pain?

  1. Dig your post. Why aren’t more people taking the time to learn this information. I stumbled across an article that proved 90 of patients experienced a thirty-percent reduction in pain within six months. I don’t understand or can figure out why people are not pursuing chiropractic services.

  2. I really appreciated your blog. Why aren’t people taking the time to research this stuff. I read a research article that proved 90 of patients experienced a thirty percent abatement in pain within 6 months. It appears beyond me to figure out why people are not pursuing chiropractic assistance.

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