Approximately 50 million people run or jog every year, 1.1 million of whom complete a marathon, according to Statista. Runners are passionate about their sport and enjoy the freedom of hitting the trail or pounding the pavement any time of day they please. And runners won the lottery when COVID hit, and the gyms and pools were closed. Sadly, one of the most common reasons a runner will give up the sport is due to injury, and the cause is often preventable.

Philadelphia Doctor of Physical Therapy Chris McKenzie and his colleagues treat many athletes. Of the patients they see, approximately 30 percent are runners, and the vast majority come to them with knee pain. 

“One of the most common issues we see in runners with knee pain is a lack of gluteus medius strength, which causes the femur to adduct and internally rotate,” said Dr. McKenzie. “This rotation causes excessive strain on the back of the patella, the patellar tendon, and the IT band.

The gluteus medius is a muscle in the buttocks that helps stabilize the pelvis and maintain proper alignment of the hips and knees during movement. The knee joint is designed to move in a straight line, and any deviation from this can cause the joint to wear down unevenly over time. A weak gluteus medius can also affect other muscles in the leg, such as the quadriceps and hamstrings, which can further contribute to knee pain or injury. 

According to Dr. McKenzie, there are a few signs that the glutes are weak. The most obvious is knee pain, especially on the inside of the leg. Other signs include difficulty standing on one leg and a tendency for one hip to drop when standing on one leg. Low back pain or pain in the buttocks can also be signs that the glutes need strengthening. 

“There’s a common misconception that running is bad for one’s knees, which is entirely untrue,” said Dr. McKenzie. “But the truth is, a weak or imbalanced body can lead to painful knees.”

Many runners find it challenging to recognize that their hips may be causing knee issues. As a result, they continue to run for extended periods without realizing the damage happening behind the scenes. Additionally, many runners overlook the importance of muscle strengthening, which can increase the likelihood of knee and ankle injuries. Dr. McKenzie recommends taking a proactive approach to avoid being forced to quit running in the future due to pain and injury.

“We recommend that every runner have an evaluation with a physical therapist to ensure no issues are present that may eventually result in an injury. If the physical therapist identifies weakness or imbalances, they can prescribe exercises to help build strength and reduce the risk of injury.” 

As the percentage of runners over 40 continues to climb, the hips must not be ignored – no matter how old a person is. Proper alignment and strengthening are synonymous with a healthy, balanced body. Running doesn’t cause bad knees; a lack of strengthening does. To learn more about physical therapy for knee pain, visit