How to run with knee pain, even when you really shouldn’t be running

Last year, I wrote an article about running with knee pain. It’s a more holistic approach to getting back to running given you have enough time to rest and rehab your knees. However, that is not always possible. As a competitive athlete, you may have time constraints. Sometimes you just need to get some running mileage in because of an upcoming competition, etc.

Of course early return to sport is not ideal. It’s `not something I personally or professional condone. But if you are going to run against professional advice anyways, let me help you do it the best you can.

Today, I share with you my tips on how you to run with knee pain, when you really shouldn’t be running.

Pain is not a good indicator of what is your limit

If there is just one thing to take away from this blog post, this is it. Do not use how much or how little pain you feel as a benchmark of what is your limit.

Pain is not an indicator of your limit or how much you can do. Yes, I get that pain is a threat response that has some protective function. But to get to the point where you actually feel pain is simply too much training load.

I know the general advice from chiropractors or physiotherapists is to stop when you start to feel pain. This is terrible advice if you have an active injury, and that you are trying to train on top of it.

Of course not all pain is bad. If your pain is chronic and you don’t have any big event coming up, training to the point of pain or even some pain can be sound advice. However, this is not applicable here.

Small change can lead to big change

As an athlete who needs your knee to perform at 101%, the last thing you want to do is to repeatedly aggravate your knee. This may not seem like much at the start but as the competition draws close, you can potentially seriously piss the knee off.

When we talk about small changes coming together to become a big change, small seemingly harmless aggravations likewise can also cumulatively build up to a massive pain episode.

The last thing you want is to have a painful and inflamed knee on your big day.

Understanding load management is about having a sound predictive model

If you are planning to run IPPT 2.4km cos you think you can do so with no issues but end up with pain, your understanding of load management is flawed. You are underestimating the severity of your injury and/or overestimating your current capacity.

The whole point of load management is being able to control for how much load or stress goes into your body. When it comes to knee pain, we will be most concerned with how much stress you are introducing to your knees.

If you understand load management well, you should be able to predict at what point will your knee start to hurt. With this in mind, you may want to account for a 20% 0r even 50% so you can truly run within what you can without making your condition worse. 50% may sound like a massive buffer but if your knees are sensitised and seem to flare up all the time for no apparent reason, it may be needed.

The whole point of load management, especially pre-tournament, is to be able to train without pain. For most parts, you are trying to keep your knee (and body) fresh for the competition.

You don’t want your knee to be at the brink of falling apart now, do you?

Don’t think in binary progression or regression

Most of us think of our condition as either improving or worsening. It becomes somewhat (falsely) binary or dichotomic. It is intuitive to think that way but this mindset will severely limit the amount of training you can do.

My suggestion is to consider thinking more laterally or more creatively or more out of the box. Call it whatever you want. Let’s say if you cannot run forwards without pain, what are the alternatives to running?

Of course there is always other form of cardio like swimming and cycling. I get that it’s not ideal and sometimes you, as an athlete, just want to run.

May I suggest that you consider running backwards or sidewards?

It sounds so obvious when I share this with others. But most athletes do not actually consider them when managing their own running programming.

Pain with running often mean pain with loading into knee flexion

Most of the time, people who struggle with running get pain with knee flexion. There is almost a focal point in their knee flexion range of motion that a pain will occur. In other words, majority of their knee flexion is actually pain-free but there is a point in the knee bending that is actually painful.

Most of the time, this painful point in the range is not avoidable with running. So it almost always hurt when you run. Or, perhaps it doesn’t hurt initially but would definitely hurt later in the run. Either way, it hurts.

The solution is honestly quite simple. Just run backwards if you can. Reverse running has less impact than forward running. Specifically, it loads the knee less anteriorly or less into flexion, depending on individual. The end result is not just less pain but often pain-free running.

Brilliant, isn’t it?

Sideways running

Sideways running is honestly also helpful. Most of the time, pain with running is due to a knee flexion type loading towards some structure at the front (i.e., anterior) of the knee. When you run sidewards, most of the stress is distributed to the lateral or medial aspect of the knee.

This means you are stressing the painful parts a lot less.

You are still using your knee so I won’t consider it a complete deload of the knees. But at least you are not irritating the parts you are not supposed to.

My preference is for athletes to do reverse running but that’s not always practical. Especially when it comes to running at night or running along the street, you do need to see where you are going.

Sidewards running in these situations may be more practical. At least you can still take glances at where you are going to keep yourself side.

When sidewards running, don’t forget to alternate sides regularly!

Prioritise exercises that do not involve the aggravating movement

If your knee hurts with knee flexion, please do not try to squat your pain away. There are tons of exercises you can do without involving painful knee flexion.

To be clear, I am not saying that pain is bad for you and that you should never train when there is pain. I am saying that you should reduce the probability of having a painful knee for your game day by training wisely.

If you are an everyday individual with the luxury of taking breaks whenever you want, you can indeed afford to train with some part. I 100% agree that pain does not equate damage.

But, um, if you are an athlete, there is no way you are going to perform better in pain than pain-free. So, yes, to allow yourself peak performance, you are going to proactively avoid pain. At least till your competition or season is over.

Exercises with little emphasis on knee flexion

Back to topic, if your knee hurts with flexion, avoid squatting. Exercises that can be helpful can include romanian deadlift, which involves little knee flexion and virtually no movement at the knee joint.

The knee extension machine can allow you to train the quadricep muscles, as per a squat, with an extension movement. This doesn’t hurt for most people with knee pain. If you experience pain returning to start position (i.e., during flexion phase), you can consider reducing the number of times you flex the knee by doing isometric holds or pulses at the top (i.e., more extension) range of motion.

If you die die must squat, you can also follow the same advice by doing isometric holds at a range that doesn’t hurt or pulses either at the top range or at the bottom range of motion.

The key is to reduce movements that aggravate the painful movement. If you can find a range that is not painful to train in, lean into these movements and make the best out of them.