Training Through Knee Pain: What Every Runner Should Know

Smart Strategies to Stay on Track Without Sacrificing Your Knees

Marathon training takes dedication, discipline—and often, some discomfort. But when that discomfort turns into persistent knee pain, runners face a tough decision: press on or pull back? 

At ROC, our orthopedic team helps runners navigate knee injuries while staying focused on the long game—crossing the finish line healthy and strong. Whether you’re logging your first long run or gearing up for race day, here’s how to manage knee pain without derailing your training plan. 

The Most Common Knee Injuries for Runners

Long miles and repetitive stress make runners especially prone to certain knee conditions. The most frequent we see include: 

• Runner’s Knee (Patellofemoral Pain Syndrome): Pain behind or around the kneecap, especially noticeable during downhill running or after long periods sitting. 

• IT Band Syndrome: Pain or tightness along the outer knee, often triggered by increasing mileage too quickly or running on uneven terrain. 

• Meniscus Tears: Sometimes caused by a twist during a run or an old injury flaring up with higher training loads. 

• Tendinitis: Inflammation of the patellar or quadriceps tendons from overuse, poor mechanics, or weak supporting muscles. 

• Osteoarthritis: Older runners may experience knee stiffness or pain due to wear and tear in the joint over time. 

How Runners Can Train Smarter with Knee Pain

1. 1. Adapt your training—Don’t abandon it.
      Dial back intensity or volume for a few days. Swap hill repeats for a flat recovery run or replace a long run with a cross-training session. Your body will thank you later.
      
   2. Prioritize strength work.
      Weak hips, glutes, and core muscles can lead to poor form and knee overload. Just 15–20 minutes of targeted strength training 2–3 times a week can make a big difference.
      
   3. Don’t skip your warmup and cooldown.
      Dynamic warmups (leg swings, lunges, high knees) and thorough post-run stretching can reduce strain and promote recovery.
      
   4. Cross-train strategically.
      Cycling, swimming, and pool running are great ways to maintain aerobic fitness without pounding your knees. These can be especially helpful on recovery days or during cutback weeks.
   5. Ice, elevate, and listen.
      If you notice swelling after a run, use ice and elevation post-workout. More importantly, listen to your body—pain is a signal, not a nuisance.
   6. Get your form and shoes checked.
      A gait analysis can uncover issues that are overloading your knees. Make sure your shoes match your stride and aren’t past their prime (usually 300–500 miles).

When to See a Knee Specialist

If you’ve already cut mileage, changed shoes, and added strength work—but your knee still hurts—don’t push through. It’s time to talk to a specialist if: 

• • Your pain doesn’t improve after a few rest days 

• • You notice swelling, locking, or instability 

• • The pain worsens when climbing stairs or sitting too long 

• • You feel like your knee is giving out during runs 

Our orthopedic knee experts can diagnose the issue and help you develop a customized return-to-run plan. 

FAQ for Runners Dealing with Knee Pain

Q: Should I stop running completely if my knee hurts?
A: Not necessarily. Mild pain may improve with reduced mileage or modified workouts. If pain persists beyond a few runs or worsens, take a break and consult a specialist. 

Q: How can I prevent knee pain during marathon training?
A: Follow a smart training plan with gradual mileage increases, incorporate strength work, rotate running surfaces, and wear supportive footwear. Rest days are just as important as long runs. 

Q: Can I run a marathon with knee arthritis?
A: It depends on the severity. Many runners with mild arthritis can continue running with proper support and training adjustments. Talk to a provider about joint preservation strategies. 

Q: What treatments help runners avoid surgery?
A: Physical therapy, targeted strength routines, orthotics, bracing, and anti-inflammatory options (like injections) are often effective. Surgery is usually a last resort after conservative care. 

Q: When should I see a doctor about knee pain?
A: If your pain interferes with daily life, lasts more than a week, or prevents you from training—schedule an evaluation. Early intervention often leads to better outcomes. 

Stay on Track Without Sacrificing Your Health

Knee pain doesn’t have to mean the end of your training cycle. With smart strategies and expert support, you can manage discomfort and keep working toward your race day goals. 

Schedule an appointment with our running-savvy orthopedic team. 

ROC is a proud sponsor of the 2025 Portland Marathon. This post is part of our “Never Miss a Mile” campaign. To see all of our running tips, please visit our Portland Marathon page.