Why Does My Knee Hurt When I Run Longer Distances?
Knee pain showing up every time you increase your running mileage? Learn why this can happen, whether you should keep running, and what may be contributing to it.
You feel great running three miles.
Then you start training for a 10K, half marathon, or simply decide you want to run a little farther...
and suddenly, your knee starts hurting.
Maybe it happens during the run. Maybe you feel fine while running but notice it afterward. Or maybe every time you try to increase your mileage, that same knee pain comes back.
One of the first things many runners think is:
“Something must be wrong with my knee.”
But knee pain while running doesn’t automatically mean that your knee is damaged, and it doesn’t necessarily mean you need to stop running altogether.
A better question is:
What changed, and is your body currently prepared for the amount of running you’re asking it to do?
Why does my knee hurt when I increase my running mileage?
Running is a repeated physical demand.
Every run asks your muscles, joints, tendons and bones to tolerate load over and over again.
As you increase your distance, pace, hills, speed workouts, or number of running days, you’re asking your body to tolerate more.
Sometimes your symptoms appear around the same time your training changes.
But here’s something important:
There is no perfect mileage number that automatically causes an injury.
Research looking at running distance, duration, frequency, intensity, and recent training changes has found mixed results. That means we can’t simply say:
“You increased your mileage too quickly, and that’s why your knee hurts.”
Running injuries are usually more complicated than that.
A systematic review of 36 studies involving more than 23,000 runners found conflicting evidence connecting specific training variables with running-related injuries. The authors also concluded that the popular “10% rule” is not supported as a universal rule for every runner. PubMed Central
Your training history, recovery, previous injuries, sleep, strength, and overall training demands can all matter.
Source: Esculier JF, et al. The Association Between Running Injuries and Training Parameters: A Systematic Review.Journal of Athletic Training. 2022.
Is the problem actually coming from my knee?
A common type of knee pain in runners is called patellofemoral pain, often referred to as “runner’s knee.”
It is usually felt around or behind the kneecap and may bother you during activities such as running, squatting, stairs, or other movements that place demand on the knee.
But here’s something I want runners to understand:
Feeling pain in one area does not automatically tell us why that pain developed.
When I evaluate a runner with knee pain, I’m not only looking at the knee.
I also want to understand:
What changed in her training?
How much is she currently running?
Did she recently add hills, speed, or longer runs?
How well can the knee tolerate load?
What does her hip strength and control look like?
How is the ankle moving?
How does she move during a squat, step-down, or running task?
Is she recovering between workouts?
Has she had previous injuries?
The goal is to put the pieces together rather than blame one body part.
Current best-practice guidance for patellofemoral pain recommends understanding the person’s symptoms, history, physical findings, goals, and individual presentation before deciding what treatment makes the most sense. British Journal of Sports Medicine
Source: Neal BS, Lack SD, Bartholomew C, Morrissey D. Best practice guide for patellofemoral pain. British Journal of Sports Medicine. 2024.
Still modifying your runs because of knee pain?
If your knee pain keeps coming back every time you increase your mileage, it may be time to understand what your body is currently struggling to tolerate.
At Gravitate WellSpace, we help active women understand what may be contributing to recurring pain so they can build a plan around the activities they want to keep doing.
Does hip weakness cause knee pain when running?
This is where social media can make things overly simple.
You may have heard:
“Your knee hurts because your glutes are weak.”
It’s not that straightforward.
We can’t look at one weak muscle and automatically say it caused someone’s knee pain.
What we do know is that exercise is an important part of treating patellofemoral pain.
Research has found that hip-focused exercise and combined hip-and-knee exercise programs can improve pain and function in people with patellofemoral pain. PubMed Central
Current best-practice guidance also supports knee-targeted exercise, with hip exercise and other strategies added depending on the individual person. British Journal of Sports Medicine
So yes, your hip may be something worth evaluating.
But I wouldn’t tell you:
“Your hip is definitely causing your knee pain.”
We need to look at the whole picture first.
Do I need to stop running if my knee hurts?
Not necessarily.
And this is probably one of the biggest fears I hear from active women:
“Are you going to tell me I have to stop running?”
My goal isn’t automatically to take running away from you.
The goal is to understand what your body can currently tolerate and then determine what needs to change.
For one runner, that may mean temporarily reducing mileage.
For another, we may modify speed work or hills.
Someone else may be able to keep running while beginning a progressive strengthening program.
Current best-practice guidance for patellofemoral pain emphasizes education and exercise as the foundation of care, with additional strategies selected based on the individual person. British Journal of Sports Medicine
So the answer usually isn’t simply:
Run through it.
Or:
Stop running completely.
There is a lot of room between those two options.
What should I do if my knee keeps hurting when I increase my miles?
First, pay attention to the pattern.
Ask yourself:
What changed before the pain started?
Did I increase my mileage?
Did I increase my long run?
Did I add hills?
Did I start running faster?
Did I add more running days?
Did I increase strength training at the same time?
Am I recovering well between workouts?
Now ask:
What happens when I decrease the demand?
Does the pain settle?
Does it return every time you build back up?
That information matters.
The next step is understanding why your current capacity and your training demands may not be matching very well.
For many runners, strengthening is going to be part of the solution.
But simply downloading five “runner’s knee exercises” from Instagram is not the same as having an individualized plan.
The exercises need to make sense for:
your symptoms + your current strength + your running goals + your training schedule.
Does knee pain mean I’m damaging my knee?
Not necessarily.
Pain is important, but pain and tissue damage are not always the same thing.
That doesn’t mean you should ignore pain.
It means pain gives us information.
Instead of immediately assuming:
“My knee is getting worse.”
I would rather ask:
“Why is this activity currently exceeding what my knee can comfortably tolerate?”
That question usually gives us more useful information.
Current best-practice recommendations for patellofemoral pain emphasize education and understanding symptoms within the person’s broader clinical picture rather than treating pain as a simple measurement of tissue damage. British Journal of Sports Medicine.
When should I have my knee pain evaluated?
If knee pain keeps returning every time you increase your training, you’re consistently changing or avoiding workouts because of it, or it is getting worse rather than better, it may be worth having it evaluated.
You should seek medical care sooner if you experienced a significant injury or have symptoms such as:
major swelling
inability to put weight on the leg
significant instability
locking of the knee
fever
severe or rapidly worsening pain
And you don’t have to wait until you are completely unable to run.
One of the things I hear often is:
“I can still run, but I know something isn’t right.”
That can be a good time to start asking better questions before pain becomes the reason you stop training altogether.
The biggest takeaway
If your knee starts hurting every time you increase your running mileage, don’t immediately assume that:
running is bad for you
or that:
your knee is damaged.
And don’t assume there is one magic muscle that needs to be “fixed.”
Instead, look at:
what changed in your training
what your body can currently tolerate
your strength
your movement
your recovery
your previous injuries
your current training demands
Then build a plan from there.
Because if your goal is to keep running, the answer shouldn’t only be:
“Stop running.”
The goal should be figuring out how to help your body become more capable of doing the things you want it to do.
Still having to modify your runs because of knee pain?
If every time you increase your mileage your knee starts bothering you again, we can help you understand what may be contributing to it.
At Gravitate WellSpace in Coral Gables, we work with active women who want to keep running, lifting, and moving without constantly wondering whether pain is going to stop them.
We start by understanding your symptoms, your movement, your training, and what your body is being asked to handle.
About Dr. Melody de Heusch
Dr. Melody de Heusch is a Doctor of Chiropractic with a Master’s degree in Sports Science and Rehabilitation.
Her work focuses on women’s health, sports rehabilitation, movement, strength, and longevity.
At Gravitate WellSpace, she works with active women who want to better understand what may be contributing to their pain and build the strength and capacity needed to continue doing the activities they love.
References
Neal BS, Lack SD, Bartholomew C, et al. Best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice and expert clinical reasoning. British Journal of Sports Medicine. 2024;58:1486–1495. British Journal of Sports Medicine
Esculier JF, et al. The Association Between Running Injuries and Training Parameters: A Systematic Review.Journal of Athletic Training. 2022. PubMed Central
Manojlović D, Kozinc Ž, Šarabon N. Trunk, Hip and Knee Exercise Programs for Pain Relief, Functional Performance and Muscle Strength in Patellofemoral Pain: Systematic Review and Meta-Analysis. Journal of Pain Research. 2021;14:1431–1449. PubMed Central
This article is for educational purposes only and does not replace an individual medical evaluation.