How to Beat Runner's Knee This Marathon Season

Don't let a potential injury ruin your marathon experience


It's that time of year again when runners start to gear up for marathon season. Whether you are new to running, or a seasoned veteran, everyone is susceptible to injuries, especially in the knees.

We use our knees all the time but they somehow they stay strong. What weakens them is too much repetitive or high-impact activities over a long period of time, Dr. Armin Tehrany, board-certified orthopedic surgeon and founder of Manhattan Orthopedic Care. Track is one the worst sports for these joints.

One of the most common injuries, especially among avid runners, is the aptly named Runner’s knee. It is damage to the cartilage, a semi-hard and flexible tissue that covers the end of your bones, under the kneecap.

The stress on the joints from running for a long time can cause irritation where it rests on the bone. The pain gets worse if you’re running uphill or up and down stairs. There may even be some swelling.

Quads and hamstrings

No injury is 100 percent avoidable but it’s important strengthen the quads and tight hamstrings to avoid runner’s knee. “They are also key for balance and flexibility,” Dr. Tehrany says.  

Quads are usually stronger and in better shape. “A lot of people, especially men, don’t work on the hamstrings because these muscle are are in the back of the knee and guys don’t see them in the mirror,” he adds. Don’t neglect them.

See a specialist

The tissue gets too tight when people run too much. There are no common pre-injury symptoms runners can be aware of, Dr. Tehrany adds. They won’t feel the tension with their bare hands. “You don’t realize you have a problem until it causes a lot of pain.”

That’s why it’s important to go to a physical therapist to check if the muscles are tight. “Most avid runners do for checkups,” he adds.

Run on softer surfaces

“The softer, the better,” Dr. Tehrany says. Knees feel better on clay as opposed to asphalt because it offers more protection, he adds.

Swapping out the hard asphalt for softer ground can benefit your legs and knees very much; it’s easier on them. Reduce the amount of shock on your joints, muscles and bones and you won’t get tired very soon, which may be a sign your workouts are ineffective.

Support gear

“People need to understand that if they are running, they need as much cushioning as possible,” Dr. Tehrany says. The safest sneakers are the ones with enough of it to make the running shoes softer on the inside.

Proper arch support is also key, Dr. Tehrany adds. It’s very individual and it has to be checked out by a sports medicine specialist who can make a specific recommendation, he adds.


“The older we get, the tighter we get,” Dr. Tehrany says. “Stretching exercises are a very good prevention method,” he adds. One of his favorite methods is using a foam roller. Use it to stretch out tight IT band and hamstrings.

Using a roller is extremely functional for runners as a means of increasing mobility, flexibility and reducing recovery time between training runs. Including a brief rolling session immediately after your run can reduce the build-up of lactic acid in your muscle fibers— meaning you can avoid being incredibly sore.

Strength training

Strength training can help, according to a study, in handling and reducing the pain. Gait retraining can help as well.

Another study showed that circuit training improved more running parameters than the more intense strength-training protocols. Specifically, members of the circuit training group saw gains in maximum running speed, speed at the ventilatory threshold (or the pace at which one starts to breathe heavily), and VO2 max. 


“Every situation is different,” Dr Tehrany says. “Pain in the knee doesn’t have to be runners’ knee.”

Run on softer surfaces and cut back your running mileage. You have to reduce the workload. Don’t increase it more than a couple of miles a week as you get better.

The most popular methods are more conservatives, such as physical therapy, stretching, applying ice or heat, electrical stimulation, and ultrasound therapy, Dr. Tehrany adds.

More readings:

The Common Causes of Knee Pain and How to Treat Them

Tips to Train Like a Marathoner

Marathon Training Must-Haves