Running downhill may leave your knees feeling tender. The discomfort stems from microscopic damage to muscles that your body repairs day by day.

Tight leg muscles often cause this pain. Consulting with an expert gait analysis specialist on your foot strike and running mechanics could provide relief.

1. Overstriding

Overstriding is a common running injury that can result in knee pain. This occurs when one’s foot lands too far ahead of their center of mass and creates too much braking force on tibia, ankle, and knee joints causing greater impact that increases impact and leads to injuries such as stress fractures, plantar fasciitis and patellofemoral pain syndrome (Runner’s Knee).

Physical therapists or athletic trainers can assess whether you’re overstriding and offer guidance to correct it in your form. For instance, they might suggest hip flexor stretches and mobility exercises to increase hip and lower leg mobility and decrease impact load on joints. They might even suggest minimalist running shoes to shorten stride length and reduce impact load on legs.

Studies have revealed that increasing your cadence can significantly lessen load on knees, hips and ankles. If you find yourself overstriding too often on runs, we suggest gradually increasing it by 8-10 steps per minute over several weeks and let it become part of your regular runs.

2. ITB Syndrome

Illiotibial band syndrome (ITB) is a prevalent issue for runners and cyclists alike, often resulting in knee pain on the outside when going down hills or exercising for longer periods. Symptoms may include sharp or burning pain on the outer side of your knee, tenderness to touch, swelling over that area as well as tenderness to touch during exercise sessions; generally only experienced during physical exertion but may affect you when going up or down stairs or sitting with knees bent for extended periods.

Traditional thinking was that ITBS was caused by an ITB rubbing over its bony prominence on the bottom outside of your thigh bone – known as lateral femoral epicondyle – back and forth, but new research indicates it does not move. Therefore, ITBS may result from compression of fat structures, or inflammation of an ITB bursa sac filled with fluid.

Treatment for ITB syndrome focuses on relieving pain and inflammation by resting from aggravating activities, icing, and taking anti-inflammatory medication. Your physiotherapist will work closely with you to reduce the risk of injury recurrence as soon as possible and get you back into regular exercising activities as quickly as possible.

3. Overpronation

Overpronation refers to the tendency for feet to roll inward and flatten on contact with the ground, often known as ‘flat feet’ and often leading to arch pain, shin splints, knee pain and IT band syndrome as a result of increased heel strike impact on lower legs and hips and reduced natural shock absorption by feet.

Supination (rolling outward), is the opposite of overpronation and often leads to injuries such as shin splints, stress fractures and ankle injuries due to uneven weight distribution. Supination may also cause tightening of tendons and muscles in calf and foot muscles and affect balance negatively.

4. Poor Posture

Knee pain when running downhill may be caused by alignment issues. Your hips and ankles should be in their appropriate places and no tight or loose leg muscles should exist; otherwise your iliotibial band could rub against the bony bump on the outside of your knee (the lateral epicondyle) when running and this could irritate it further.

Your quads should support and balance your kneecap when running, but if they become weak or imbalanced it could cause you to run with an unnatural gait pattern. When running downhill your body must take shorter steps and increase cadence for maximum efficiency.

Overtraining injuries can make your iliotibial band more sensitive to contact. If this is happening to you, try cutting back on running volume until the muscle and tendon tissues recover; otherwise visit a podiatrist or physiotherapist who can assess your alignment and recommend suitable treatment solutions.

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