Three Kinds of Knee Pain, Three Different Weeks of Training
Knee pain does not mean stop running. It means change what the week looks like. Here is how I adjust training for the three knee injuries runners actually get.
I have raced on a knee that hurt. Most runners have. The question is never really "is my knee sore." It is "what do I do with Saturday."
That is the part the internet is bad at. You get told to rest, ice, and stretch, and nobody tells you what the next three weeks of training are supposed to look like. So here is how I actually change a runner's week depending on which knee problem they have, because the three most common ones need three different weeks.
If it is the front of the knee
Diffuse ache around the kneecap, worse on downhills and stairs, cranky after a long drive or a movie. This is patellofemoral pain, what most people call runner's knee.
The training change: get off the downhills first. Downhill running is the highest patellofemoral load in your week and it is usually the thing that tipped you over. Flatten the routes, keep the easy volume, and cut the long run back until the next morning stops being a report card you dread.
Getting off the downhills is the short-term move. The long-term move is building a quad that tolerates them, which is a separate project with its own timeline. I wrote up how that actually gets built in mountain ultra leg strength.
Then build the thing that is missing. Quads and hips, twice a week, loaded properly. Split squats, step downs, and hip work that is actually hard. If your gait screen shows a big overstride, a five percent cadence bump takes real load off the joint without costing you a single mile.
The mistake I see: runners drop volume to zero and do nothing else. Six weeks later the knee feels fine at rest and falls apart at mile four, because nothing got stronger.
If it is the outside of the knee
IT band syndrome has the most recognizable signature in running. It shows up at the same point in the run every time. Mile three, mile four, like a timer.
The training change: use the timer. If it starts at mile four, run three and a half, twice. Two shorter runs give you the same volume without ever reaching the point where the tissue gets angry. Then extend the interval a bit each week. Off the camber, off the track in one direction, off the steep downhills for now.
Then hip strength, and I mean loaded hip strength, not a clamshell warmup. Side plank progressions, single leg deadlift, and step downs where you can actually see whether the pelvis holds level.
Please stop foam rolling the outside of your thigh into oblivion. The band is not tight. It is compressing something underneath it, and you fix that at the hip.
If it is right below the kneecap
Patellar tendinopathy is the one that warms up. Hurts for the first ten minutes, feels great mid-run, then stiffens up on the couch and greets you on the stairs the next morning.
The training change: this one tolerates running better than people expect, and tolerates jumping and hills worse. Keep running. Pull the hills and the hard intervals out for a few weeks. Add heavy slow resistance twice a week and treat it like a training session, not a rehab chore. Isometrics before a run genuinely take the edge off.
The mistake: waiting for it to feel good before loading it. Tendons do not get strong by resting. They get strong by being loaded heavily and slowly, on purpose, for longer than you want to.
A quick way to sort yourself
| Where it hurts | When it hurts | What to change first | |
|---|---|---|---|
| Runner's knee | Around the kneecap, hard to pinpoint | Downhills, stairs, long sitting | Cut the downhills, build quads and hips |
| IT band | Outer knee, one finger on it | Same mile, every run | Split the run, load the hips |
| Patellar tendon | Just below the kneecap | Warms up, then bites after | Pull hills and jumps, add heavy slow resistance |
The thread through all three
Every one of these is the same equation. Load went above capacity. You can fix it by lowering the load, raising the capacity, or both. Only one of those requires you to stop running, and it is the one that never actually solves anything.
That is why the ADAPT method starts with assessment instead of a protocol. Two runners with outside knee pain can need opposite weeks depending on what their hips do at midstance, what their mileage looked like three weeks ago, and whether they have been sleeping five hours and underfueling a marathon build. The knee is where you feel it. It is rarely where it started.
If you want the clinical version, how I tell these three apart on exam, when I put an ultrasound on it, and where shockwave, EMTT, and laser fit in, I wrote the deep dive on the clinic site: Runner's Knee, IT Band, or Patellar Tendinopathy? How to Tell Knee Pain Apart.
Book your evaluation
If your knee has a pattern, we can work with a pattern. Book your evaluation and we will find the driver, then build the week that fixes it instead of the week that just avoids it.