This is a follow up to Tuesday’s post about the science behind knee pain, if you haven’t read it yet I’d suggest you do so first. Today we’re taking a closer look at it from my individual perspective as a coach and experienced ultra endurance runner.
TLDR;
I ran 744 km in 10 days this August and my knees were never the thing most likely to break, believe it or not. So today I’m diving into why I believe many runners (and coaches) have got it backwards:
Knee pain is not actually a problem, but rather a symptom of a real problem
A couple weeks of rest settles most knee pains, but that doesn’t mean the underlying problem is gone. Remember, it’s a symptom rather than a causation.
In ultra and long distance running what typically ends a session is quiet, slowly creeping in, mental challenges only you can experience.
Written by your favorite coach, Jonathan Fors
In August I ran 744 km down the coastline of Portugal in 10 days.
That's around 74 km a day, ten days back to back, on tarmac, sand and trail.
The question I kept asking myself throughout all of it was “how are my knees still okay?”.
They were fine the whole way, sure some flair ups and pain killers here and there but never as a direct result of knee pain. (try sleeping after chugging multiple energy drinks every day and the whole body is trying to wind down from the stress of getting through another ~74 km).
That's not the interesting part though.
Personally, I believe knee pain is simply a way for your body tell you that you’ve gotten out of balance. And looking at the science, it holds true.
While the panic at the thought of not getting to run for several weeks is understandable, it’s also misguided.
It’s simply an opportunity to improve your overall strength, balance, and endurance.
Why knee pain isn’t necessarily the bad news most runners think
Because it’s loud, starts slowly, and hard to miss.
Knee pain doesn’t come out of nowhere, it starts creeping in weeks or at least days before it becomes a run-stopper.
First during your runs, then the post-run ache, then the everyday life.
Many runners’ first instinct when knee pain bubbles up is to ignore it because “it’ll probably pass, lemme just do a quick run”…
And that’s the catch that gets so many.
Because when you first notice the small, barely detectable niggle, that’s when you should act. Not the next run, not the next week… immediately.
Knee pain is almost always the result of overuse + imbalance of musculature.
The reason it’s so common is not because it’s hard to treat, but rather that we’re all so incredibly stubborn.
Take this in contrast to another common problem ultra runners face – mental fatigue…
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The benefit of being able to point, touch, and squeeze
Knee pain has a clear treatment plan; rest, identify weak areas, strengthen said areas, then slowly come back to running.
Mental fatigue is a whole other beast (and deserves its own post) that has some general guidelines you can apply but really requires a very individual path forward.
Running 5, 12, 24 hours and longer requires insane levels of focus and mindfulness. While there are many benefits to this, it also takes a toll.
Depending on how in-tune with ones’ body an athlete is they might not even know that they are facing a mental fatigue problem.
So if they themselves are not aware, and they’re not working with a qualified coach, it’s hard (read impossible) to treat as well.
Comparing this to something as tangible as knee pain; being able to point, touch, and squeeze on a specific area and say “this hurts” can be a great thing.
Because again, it’s tangible with a clear treatment plan and path forward.
When an athlete tells me their knees hurt, my first question is not about the knee itself.
Here’s some of what I focus on instead:
What the past week has looked like. Stressors, in or outside of exercise, will take a toll on the body. And if the athlete historically haven’t had issues, the problem likely is not a physical musculature one.
What they are and aren’t doing. Often times the boring work like regular stretching, and strength work is the first to go when life gets busy.
What changed around the running. New shoes, a new surface, a new desk they now sit at three hours longer.
So this is why "runner's knee" often traces back to problems further up the chain rather than something being wrong with the knee itself.
Rest is not a plan
The standard advice is to take a couple weeks off and see how it feels.
Personally, I don't accept that as a plan.
That’s kinda like putting bandaid on a leaking hose; it’ll reduce the flow but won’t stop it.
A couple days or weeks will usually settle the pain, because you’ve removed the load that was worsening it.
However, you then come back to the same hips, tight hipflexors, and weak glutes. So the knee has no reason to behave any differently the second time around.
Rest is treating the symptom, not the root cause.
Meaning if you take the two weeks and change nothing else, you haven't treated an injury. You've postponed it.
So what do you do? You read the previous post on the science behind knee pain and how to treat it.