Rachel is a runner in pain and asked the Guru for advice…

August 7, 2014

Hi there,

I’m looking for some guidance on how to deal with a very sore knee. I’ve been a 5km runner for at least a year now and pushed this up to 10km recently. Unfortunately, my left knee doesn’t want to keep up and gets very sore to the point where I have to stop. Could you offer any advice? I stretch regularly but the pain won’t go away when I run.

The Guru needed a bit more info:

Hi Rachel

Sure I can help…where about is the pain. Inside, outside, deep inside, under the kneecap?

What makes it worse, or better?

Let me know

The Guru

So Rachel gave more info:

The pain is inside throughout the knee, not just the cap. It sets in after about 4km of running and gets so painful I have to stop. It gets a bit better once I stretch out my thigh but sets in again soon after I start running.

I wonder whether it’s my running shoes? They’re really thick-soled and I was given orthotics by Profeet in Fulham even though I don’t have flat feet! My personal trainer suggested I try shoes with a thinner sole.

Any advice you could offer would be greatly appreciated and apologies again for the delayed response.


August 7, 2014

Thanks Rachel

I think this sounds like runners knee – which is a terrible description apart from that it’s made worse by running! Stretching you quad is the give away.

I think the pain is coming from the way your kneecap tracks over the front of your thigh bone (femur). The backside of your knee cap is covered in a lovely, shiny cartilage (and so is the front of the femur). There is a little groove that the kneecap sits in and slides up and down as you bend and straighten your knee.

If the kneecap doesn’t sit “straight” – when it’s a bit dodgy is drifts to the outside it therefore sits poorly in the groove. So your poor kneecap sits grottily (!) in the groove and then is pulled up and down for 4kms worth of knee bends. The shiny cartilage is there to protect the bone surface, but after excessive motion the cartilage fails and the bone takes the brunt of the force. Bone doesn’t really like this and so swells very slightly (well the bone makeup does) and increases the bone pressure…..all a bit too anatomical, but this pressure causes the pain.

Stretching your quads helps to temporarily realign (horrid word) your kneecap in the groove, alleviating the bone pressure.


Start with the obvious causes, and shoes are right up there. It’s not about sole thickness, but it’s about the right shoes marrying with the right foot. If your foot needs stability then the shoe should provide it. I’m not sure the orthotics from PF are orthotics (to control motion) I think they are foot beds to enhance what you’ve already got.

I’d be tempted to go back to PF and ask them to have a look at you again in view of the fact your knees are hurting with new shoes.

Other causes can be how you’re training, how you sit at work and how good your single leg, gluteal (med especially) control (not strength) is – your training should be nailing this…

The Guru
Six Physio

Then Rachel asked a few more questions:

Thank you so much for this response – so reassuring to finally have some answers.

Can I please follow up with a few questions? What is the optimal style of training to adopt to prevent further injury? What is the best way to sit at work? I’m actually a student so I do sit for long periods of time. Also, what exercises can I do to build up my single leg gluteal control? I will also return to Profeet as you suggest to let them know I’m having problems.

Thank you so much for your time,


And the Guru replied:


Slowly increase your running distance. Try to vary not only the distance but also the speed you run at – faster, shorter. Try not to over stride – keep your stride length shorter if in doubt (cadence). Add in some interval training and keep in the gym to improve your strength.

Laptops without an external keyboard will make you slouch when you sit. Slouchers have stiffer mid backs and have much less ability to control their gluts in a standing/walking/running position, because they can’t get out of their slouched posture. Sit with a rolled towel in the small of your back.

Single leg stuff like lunges, single leg squats, crab walking BUT your form must be ace


The Guru
Six Physio

Guru Responded

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