With Covid-19 social distancing guidelines and gyms being closed, running can be a great way to burn off some steam and stay in shape!  I have certainly seen a lot more people jogging around my neighbourhood over the past 6 weeks! 

Believe it or not, the #1 reason for knee pain while running could be your ankle.

That doesn’t seem to make sense does it?

Let’s dive in a little further to the anatomy of your legs and how the ankle and the knee function together. Observe the image below:

When you run, your knee has to travel over your foot at some point regardless of whether you heel stroke, mid foot strike, or forefoot strike.

‼️ But in order for your knee to track over the foot, the ankle has to allow that movement ‼️

To be more specific, your ankle needs to have enough dorsiflexion mobility (ie. pulling your toes towards your shin). The image below shows dorsiflexion and plantarflexion:

To be clear, the ankle is a complicated structure and it’s range of motion can be limited by a variety of different structures. However, we tend to see two main causes of poor dorsiflexion:

  • Tightness in the calves
  • Weakness in the front of the ankle (tibialis anterior muscle)

When you run, as your knee tracks over the foot, the calves need to have enough flexibility AND the tibialis anterior needs to have enough strength (eccentric load) to allow dorsiflexion to occur.

If you have BOTH of these issues, your knee is no longer going to track over your foot and guess what? KNEE PAIN. Especially the more miles you log.

Many doctors might suggest that the cartilage in your knee is wearing down. They might recommend an x-ray, diagnose that your inner quad (VMO) is weak, your glutes don’t fire enough, your IT band is tight. These might be partially true, but it is not the #1 reason your knee hurts while running!

TRY THIS EXERCISE: If you have a light band around, or a light ankle weight, you can try this at home to strengthen your tibialis anterior muscle. Try doing 2 sets of 10, keeping your movement slow and controlled in both directions.

You can also try a standing calf stretch (see image below). You’ll want to do 1 set of 3 rep’s with a 30 second hold. This is a great stretch to build in mid-way through your run or after your run (i.e. never stretch cold!).

💥 CONCLUSION: : By addressing muscle imbalances at your ankle, your knee pain should gradually improve over time.  Of course, it’s not always that simple, and you may need a more thorough evaluation to optimize your ability to run comfortably.


Our team of experienced physiotherapists is ready to help you optimize your running and fix your knee pain. If you’d like more information on our services, we’re happy to offer a complimentary discovery phone call to learn more about your injury and pain. Call us at 604-828-2610 to set up a phone call, or email us at info@chipperfieldphysio.ca

CP Runner’s Series: Patellofemoral Pain Syndrome
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