Patient questions · Knee pain with running
Why does my knee hurt when I run?
Answered by Dr. Q
Move Better · Portland, OR & Vancouver, WA · Updated July 2026
Here's the part worth sitting with: not everyone who runs gets knee pain, and almost no one gets it equally in both knees. So the real question isn't why running hurts your knee — it's why *this* knee, for *you*. The knee is usually caught in the middle, eating the load your hips aren't driving and your foot isn't absorbing. Which of those is yours is what we're actually after.
Ask us anything about your knee pain with running — in your own words. Type a question, or tap one of the ideas below.
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Answers come from Move Better's own approach. This is guidance, not a diagnosis — nothing here replaces a look in person.
The knee is usually caught in the middle
When a runner comes in with knee pain, I’m rarely most interested in the knee itself. Running is about how you create and absorb force, and the knee sits right in the middle of that chain. When the parts above and below it aren’t doing their jobs, the knee is what ends up paying — which is why your knee, and which knee, tells us more than the fact that it hurts.
The first thing I do is watch you skip. Skipping is a great template for running — it shows me whether you’re driving from your hips or just pushing off the ground with your calves.
When the hips don’t drive, one thing overloads
I had a patient recently with almost no hip flexion in their skip. The entire force they used to run was getting pushed through their calves — and the calf is supposed to be a shock absorber, taking the landing and giving it back through the Achilles, not generating all the force. When that chain breaks down, the knee gets the overflow. Do that a few thousand strides at a time, on one side more than the other, and you’ve got your knee, hurting where it does.
Why it’s you, and not the runner next to you
A lot of the runners I see are on the roads in really thick foam shoes. That foam can hide your ability to feel the ground — you quietly lose cadence and hip flexion, the real sources of running power, and the knee takes more than it should. But two people in the same shoes, same route, don’t get the same knee pain. The difference is how you load. Find that, and the fix usually isn’t a knee brace or rest — it’s getting your hips driving and your cadence quick again.
This is general education, not a diagnosis. If you have severe or rapidly worsening symptoms — or any loss of bladder or bowel control — seek medical care right away. Otherwise, the fastest way to know what's driving your pain is to have someone watch you move.