Why do I get knee pain when running downhill?

Are you fine running on the flat and climbs, but suffer knee pain on the descents? Andy Blow discusses three possible causes


Knee pain is more common when running downhill. This is because of exaggerated stress on the joint due to the braking action performed by the quads, as they work to control your acceleration. However, knee pain can have several very different causes and finding out what the cause is will dictate how you can go about treating it. Common scenarios are…


1. Weakness or imbalance in the muscles. If you have weak or imbalanced muscles around the knee joint it can stop the kneecap tracking properly (twisting or pulling to one side when you run), which can be painful when the extra stress of going downhill is imposed. In this instance, gym-based strength training to strengthen muscles and iron out imbalances can be effective. Exercises like single and double leg squats in front of a mirror (to make sure your knee isn’t wobbling in or outwards) are a good place to start.

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2. Foot strike and mechanics. If your anatomical make-up places additional stress on the knee – for example, if you have wider hips that increase the angle of the upper leg or an uneven running gait – this could predispose you to increased knee pain when running downhill. Getting a podiatrist or gait analysis expert to look at both your anatomy and running style is the best way to ascertain the cause of the problem and subsequently prescribe solutions.

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3 Lack of specific conditioning. If you’re relatively new to running and don’t have a base of mileage behind you, the pain could just be part of the adaptive process of becoming fitter. If that’s the case then working within the limitations of the pain and gradually pushing those limits should be effective. If it’s because you rarely run downhill it’s worth trying to find a way to incorporate some downhill running reps into your training. Even if you only have very
small hills nearby you can still do interval sets on them to strengthen your knees.

In summary it’s all about first identifying the cause of the pain, then working out the best way to treat it. 

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