Knee Pain: Why The Dull Ache?

by | Injury Q and A

“I’m looking to get fitter in 2014 and have taken up running. After few runs, I have started to get a dull ache in my knees, which slowly increases. I visited the doctor but they weren’t able to find anything, or advise me how I could protect or support my knee. I don’t want to stop but I’m afraid of doing permanent damage. Is there something I’m doing wrong? Should I give up my running?”

– John B

Matt answers…

Thanks for a great question on a topic that affects many people when they first take up running – knee pain! Though proper investigation of any ‘ache’ requires individual face-to-face assessment, one piece of advice that I would give any new runner suffering from aching knees (as well as making sure you are not doing too much too soon!) is to check how much range of movement you have in your thigh muscles.

Of the four thigh muscles collectively referred to as the ‘quadriceps’, the one of particular interest is the ‘rectus femoris’, which I will refer to as RF. In contrast to the other three ‘quad’ muscles, the RF crosses the hip joint and starts on the front of the pelvis. It then extends down the front of the leg towards the knee, where via a tendon it attaches to the main bone of the lower leg (the ‘tibia’). The RF is therefore unique in that it can be used to not only straighten the leg (like the other quad muscles) but also lift the knee up in front of you.

Modern day life encourages many of us to over work the front of the legs and under work the muscles on the posterior leg (glutes and hamstrings). As a result, when running our brain may choose the RF to lift the knee, when in reality we should be working more to drive the leg backwards using the glutes and hamstrings. Over use of the RF may well be connected to why you are suffering from knee pain.

As I have suggested, get checkout out properly but in the meantime maybe try the following ‘kneeling pelvic tilt’ mobility exercise on a daily basis to help relax the RF. As I have suggested, get checkout out properly but in the meantime maybe try the following ‘kneeling pelvic tilt’ mobility exercise on a daily basis to help relax the RF.


1. Get into a kneeling position (as seen in the video).

2. Note how much tension you feel up the back leg, from the knee to up the thigh and across the hip. The chances are you will not yet feel too much but if you do this suggests your RF is particularly ‘tight’.

3. Tilt your pelvis upwards such that the waistline at the front of your trousers moves to the same height or a little higher than your trouser line at the back. In other words, tuck your backside under your hips.

4. Once the stretch sensation reaches a 6/10 ( ‘10’ represents a sensation so painful you have to stop’) , maintain this position until it eventually falls to a 3/10 (about 20 seconds). Once the stretch sensation has fallen, tilt a little more so that it rises to a 6/10 and hold as before for another 20 seconds.

For many runners, the tilting movement will not come easily as it requires a coordination of muscle recruitment that your body may not be familiar with. You may need to practice the movement lying down (tilting your pelvis so your lower back touches the floor) in order to engage the necessary muscles, and then try it again in a kneeling position. Don’t forget to test and compare both sides!

As always, if pain persists for more than 3 runs, get checked out by a suitably qualified Sports Therapist or Physiotherapist, preferably one who has experience of working with runners.

I hope this helps John. Keep in touch and let us know how it goes!

Do you have any experience of anterior knee pain? Was it a struggle to find a solution?  Whether you are a therapist, coach or runner (maybe all three) we would love to hear from you in comments section below!


Submit a Comment

Related Posts

Plantar Fasciitis: What Can I Do?

Plantar Fasciitis: What Can I Do?

“I’ve started getting a dull achy pain in the sole of my foot and back towards my heel. It doesn’t hurt all the time but bothers me when I run and walk sometimes. I know that I have a tight calf in that leg and have to wear high heels for work. What should I do?”

read more