A runner’s case study on knee pain, hip mobility, and running mechanics
For runners, knee pain can be frustrating—especially when taking time off from running does not completely solve the problem.
A recent runner came to our physical therapy clinic in New York City with persistent left lateral knee pain that had started after an increase in running volume. The goal was not only to reduce pain, but also to help the runner safely return to training for upcoming half and full marathons.
This case demonstrates why looking beyond the painful area can be important when treating running-related injuries.
The Runner’s Symptoms
The runner typically ran approximately 150 km (93 miles) per month. After reducing mileage during the winter, training volume increased significantly in the spring, reaching approximately 200 km (124 miles) per month.
In early May, discomfort developed in the left leg.
The main symptoms included:
- Pain or discomfort around the outer side of the left knee
- Discomfort around the upper-lateral area of the kneecap
- A cramp-like or mild strain sensation in the left biceps femoris (lateral hamstring)
- Persistent lateral knee discomfort even after reducing running
- Visible fullness or swelling around the outside of the knee when the knee was bent
- Increased tightness and stiffness along the outside of the left thigh
Interestingly, compression and an IT band strap temporarily reduced the knee symptoms. However, the discomfort would sometimes shift toward the lateral hamstring.
The runner also noticed that compensating for the left leg could eventually create symptoms on the opposite side.
Why Was the Knee Still Hurting?
One of the important findings during the physical therapy assessment was lateral stiffness and poor frontal-plane movement.
Rather than focusing only on the painful knee, we evaluated how the hip and lower extremity were moving during functional activities.
For runners, the hip needs to move efficiently in multiple directions while the body absorbs and transfers force. If movement is restricted in one area, another part of the body may have to compensate.
In this case, the goal was to improve the way the hip and lower extremity moved together rather than simply treating the painful spot.
Functional Manual Therapy for Hip Mobility
Treatment included Functional Manual Therapy (FMT) to address restrictions in hip movement.
We specifically worked on:
- Hip adduction and abduction
- Hip internal and external rotation
- Functional movement of the lower extremity (running form correction)
- Improving mobility needed for a more efficient gait pattern
The purpose was not simply to “loosen” the hip.
We wanted to improve the patient’s ability to access these movements during functional activities such as walking and running.
Connecting Treatment to Running Mechanics
After addressing mobility, we incorporated running form education.
A major focus was learning how to use the hip more effectively during gait and running.
Instead of telling the runner simply to “run differently,” we worked on helping the patient understand how the hip contributes to lower-extremity movement.
This is an important part of our approach at FuncPhysio: mobility and movement are connected.
Improving range of motion is only part of the process. The body also needs to be able to use that movement during walking, running, and other activities.
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What About Marathon Training?
The runner had upcoming races, including a half marathon in October and a full marathon in November.
For a runner preparing for a marathon, completely stopping activity is not always the only answer.
The goal of physical therapy is to determine:
What is causing the symptoms?
What movements need to improve?
And how can we safely progress back to running?
Depending on the individual, treatment may include manual therapy, strength training, running-form education, activity modification, and a gradual return-to-running program.
The appropriate plan depends on the findings of each patient’s evaluation.
The Bigger Lesson for Runners
If you have lateral knee pain, it can be tempting to focus entirely on the knee—or to assume that the problem is simply tightness around the IT band.
But running is a whole-body movement.
Your foot, ankle, knee, hip, pelvis, and trunk all work together to absorb and produce force. When one area does not move or function efficiently, another area may compensate.
That is why our physical therapists look at movement patterns rather than only the location of pain.
Are You Running Through Persistent Knee Pain?
If your knee pain keeps returning every time you increase your running mileage, simply resting until the pain disappears may not address the underlying movement problem.
At FuncPhysio Physical Therapy in NYC, we evaluate how your body moves during functional activities and develop treatment based on your individual goals.
Whether your goal is to return to running, complete your first 5K, or prepare for your next marathon, our goal is to help you understand your body and build a more efficient movement strategy.
Don’t just stop running. Find out why it hurts.
Contact FuncPhysio Physical Therapy in New York City to schedule an evaluation and discuss your running goals.
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