Running With Pain: How to Modify Your Runs for Hip, Knee, Shin, and Foot Pain

Written by Natalie LaMendola, a RRCA & USATF Certified Running Coach for Running Explained for over 5 years.

Running is a tough ask on your body. Yes, it comes with a long list of health benefits, and the research behind those benefits keeps getting stronger. It's still an incredibly high demand on your musculoskeletal system. And if you're training for a specific race goal, you're pushing your body up to (and often past) its previous limits.

All that to say, it's normal to "feel something" on your runs. Most of them, even.

I've been running for nearly 20 years, including competing collegiately and finishing multiple marathons. I'm thirty years old. It would be unusual for me not to feel at least a little discomfort on my everyday runs.

The good news? Discomfort, and even mild to moderate pain, doesn't automatically mean you're injured. Better yet, it doesn't always mean you need to stop running.

Quick answer: Can you keep running when something hurts? Often, yes. Pain that is mild to moderate, dull or achy, and doesn't get worse as you run can usually be managed by changing how you run. Adjusting incline, pace, cadence, surface, footstrike, or shoes shifts load away from the sore area. Pain that is sharp, pinpoint, worsening during the run, disrupting your sleep, or radiating down your leg is your signal to stop and see a running-specific physical therapist.

Key Takeaways

•       Most running injuries come down to two things: tissue capacity and load distribution.

•       You can't fix tissue capacity mid-run, but you can change load distribution on your very next run.

•       The best modification depends on where it hurts. Slowing down helps hip, shin, and foot pain, but a slightly faster pace can actually reduce total load on the knee.

•       Downhill running is the biggest knee aggravator. Uphill running is the biggest hip aggravator.

•       If pain forces you to modify 3 consecutive runs, it meets the research definition of a running-related injury. Get it checked.

Why Running Injuries Happen: Tissue Capacity vs. Load Distribution

When we look at how most running injuries occur, it mostly comes down to two things.

Tissue capacity is the ability of the tissues in your musculoskeletal system (bones, muscles, tendons, ligaments) to withstand the demands placed on them during an activity. When demand outpaces capacity for long enough, something gets irritated.

Load distribution is how the forces generated during running (from the ground and from your own muscles) are spread throughout your lower body. Change your pace, the slope, or how your foot hits the ground, and you change which tissues take the brunt of each step.

A skilled running-specific physical therapist can assess and help you build tissue capacity over time. But you, the runner, can adjust load distribution yourself the moment something starts to feel off. Below is how to do that, organized by body part and ranked by which factors matter most.

How to Modify Your Runs Based on Where It Hurts

For each body part, the modifications are listed in order of importance. Start at the top. If the first one or two changes calm things down, you may not need the rest.

Hip Pain When Running

The two biggest factors affecting load through the hip are incline and pace. No matter the source of your hip pain, seeking out level ground and temporarily cutting speedwork is usually the first move. Running uphill and running fast both demand more hip flexion and more work from the muscles and tendons around the hip, including the proximal hamstring tendon, which gets cranky when compressed in deeper hip flexion (Goom et al., 2016).

1.    Incline: Avoid running uphill.

2.    Pace: Slow it down and temporarily skip speedwork.

3.    Treadmill vs. outdoors: Doesn't matter.

4.    Cadence: Depends on where your symptoms are. A higher cadence offloads some sites around the hip, but not all.

5.    Footstrike: Doesn't matter.

6.    Shoes: Don't matter.

Knee Pain When Running

The knee is, unfortunately, affected by pretty much every factor on this list. The upside? That gives you a lot of options to modify things and temporarily offload it.

Two nerdy notes worth knowing. First, downhill running dramatically increases the braking (eccentric) demand on your quads and the load at the knee (Lu et al., 2025). Second, slower isn't always gentler here. Research shows that cumulative load at the knee joint is actually higher when running at slow speeds compared to faster speeds, because you take more steps to cover the same distance (Petersen et al., 2015). Shortening your stride also reduces the load per step (Firminger & Edwards, 2016).

1.    Incline: Avoid running downhill.

2.    Cadence: Aim to increase it by 5 to 10%.

3.    Footstrike: Try a midfoot or forefoot strike. Avoid heel striking if your pain is severe.

4.    Pace: Try going ever so slightly faster.

5.    Treadmill vs. outdoors: Treadmill is preferable.

6.    Shoes: Choose a lower heel drop option.

Shin Pain When Running

Like the knee, the shin (more specifically, the tibia) is affected by nearly all of these factors. A hefty amount of research shows the tibia is loaded more by the muscles pulling on it (mainly your calves) than by environmental factors. Even so, changing a few things can help offload the bone, and changing your foot strike angle measurably alters the internal loading of the tibia (Han et al., 2025).

1.    Incline: Avoid both uphill and downhill. Stick to level ground.

2.    Pace: Slow it down and temporarily skip speedwork.

3.    Treadmill vs. outdoors: Stick with outdoors and avoid the treadmill.

4.    Cadence: A 5 to 10% increase may help, but it's lower on the priority list.

5.    Footstrike: Depends on where your symptoms are. Most tibia pain is posterior or posteromedial (the back or inner edge of the shin). If that's you, avoid a forefoot strike.

6.    Shoes: Choose a lower heel drop option.

Foot Pain When Running

Foot pain is mostly about what your foot touches directly: the ground and your shoes. Surface is pretty straightforward. Shoes are grayer, because shoe technology changes constantly.

1.    Pace: Slow it down and temporarily skip speedwork.

2.    Shoes: A higher heel drop can offload the foot more. A rocker-style shoe may need to be avoided depending on where your symptoms are and where the rocker sits in the shoe.

3.    Treadmill vs. outdoors: Stick with outdoors and avoid the treadmill.

4.    Incline: Avoid both uphill and downhill. Stick to level ground.

5.    Footstrike: Depends on symptom location, and even then it only matters for very site-specific pain and very extreme footstrike patterns.

6.    Cadence: Doesn't matter.

Cheat Sheet: Running Modifications by Body Part

Factor	Hip	Knee	Shin	Foot
Incline	Avoid uphill (#1)	Avoid downhill (#1)	Level ground only (#1)	Level ground only (#4)
Pace	Slow down (#2)	Slightly faster (#4)	Slow down (#2)	Slow down (#1)
Treadmill vs. outdoors	Doesn't matter	Treadmill (#5)	Outdoors (#3)	Outdoors (#3)
Cadence	Depends on site (#4)	Increase 5 to 10% (#2)	May help (#4)	Doesn't matter
Footstrike	Doesn't matter	Midfoot or forefoot (#3)	Avoid forefoot if pain is on back or inner shin (#5)	Only for extreme cases (#5)
Shoes	Doesn't matter	Lower heel drop (#6)	Lower heel drop (#6)	Higher heel drop, careful with rockers (#2)

Numbers in parentheses show priority rank for that body part.

When Is Pain Okay to Run Through?

Patients often get frustrated when I ask them to describe their pain. I hear "I'm not very good at describing pain!" or "I hate this question, I never know what to say" all the time. That's completely normal. Pain is a subjective, personal experience, and two people with the same injury in the same spot could describe it a dozen different ways.

What we do know is that certain types of pain are, more often than not, more concerning than others. If your pain fits any of the descriptions in the right column below and hasn't changed in more than a few days, it's time to reach out to a professional.

Usually manageable with modifications	Time to call a professional
Dull, achy, or sore	Sharp
Broad or vague location	Pinpoint, localized to one small area
Stays the same or eases as you run, settles afterward	Worsens as you run or keeps hurting later off the run
Doesn't affect daily life	Limits daily activities outside of running
Doesn't affect sleep	Wakes you up or interrupts your sleep
Stays in one area	Radiates down your leg in any way
Mildly annoying	Concerning to you, for any reason

What If the Modifications Aren't Working?

In the research world, a running-related injury is defined as musculoskeletal pain that makes you restrict or stop running for at least 7 days or 3 consecutive scheduled training sessions, or that sends you to a health professional (Yamato et al., 2015).

So if you've had to modify 3 runs in a row because of symptoms from the list above, reach out to a trusted, running-specific physical therapist. Even if your symptoms are milder or don't match that list, 3 consecutive modified runs is still reason enough to get it looked at.

At the end of the day, these are guidelines, not rules. If your symptoms concern you in any way, that alone is reason enough to seek help.

Frequently Asked Questions About Running With Pain

Is it okay to run with mild pain?

Often, yes. Mild pain that feels dull or achy, doesn't get worse as you run, and doesn't linger afterward can usually be managed by modifying your runs. Change incline, pace, cadence, surface, or shoes based on where it hurts.

Should I stop running if my knee hurts?

Not necessarily. Start by avoiding downhills, increasing your cadence by 5 to 10%, and running slightly faster rather than slower. If the pain is sharp, pinpoint, or getting worse during runs, stop and see a physical therapist.

Does increasing cadence help knee pain?

Yes, for many runners. A 5 to 10% cadence increase shortens your stride, which reduces the load at the knee with each step. It's the second most important modification for knee pain after avoiding downhills.

Is the treadmill better for shin pain?

Generally no. For shin pain, sticking with outdoor running on level ground is preferred. The treadmill is the better option for knee pain, and it doesn't matter much for hip pain.

Is it better to run slower when something hurts?

It depends on the body part. Slowing down helps with hip, shin, and foot pain. For knee pain, running slightly faster can reduce total knee load because you take fewer steps to cover the same distance.

How do I know if running pain is an injury?

If pain forces you to modify or stop your running for 3 consecutive runs or 7 days, it meets the research definition of a running-related injury. Sharp, localized, worsening, sleep-disrupting, or radiating pain is also a sign to get evaluated.

When should I see a physical therapist for running pain?

See a running-specific physical therapist if pain has changed your runs 3 times in a row, if it matches any red-flag description (sharp, pinpoint, worsening, affecting sleep or daily life, radiating), or any time your symptoms concern you.

Not sure where to start? We can help you build a plan that works around a niggle instead of through it. 1:1 coaching or Kickstarter Call  |  Want to build tissue capacity for the long haul?

About the Author

Natalie is a running-specific Doctor of Physical Therapy and certified run coach based in Kansas City. When she's not working with runners at her practice , you can find her chasing her own goals on the run alongside her husband, twin toddlers, and hound dog. Her passion lies in helping runners of all abilities achieve their goals and get back to the miles they love. If you want to hear more listen to Natalie talk about Strength Training on this Episode of The Running Explained Podcast

References

Firminger CR, Edwards WB. The influence of minimalist footwear and stride length reduction on lower-extremity running mechanics and cumulative loading. J Sci Med Sport. 2016;19(12):975-979. doi:10.1016/j.jsams.2016.03.003

Goom TSH, Malliaras P, Reiman MP, Purdam CR. Proximal hamstring tendinopathy: clinical aspects of assessment and management. J Orthop Sports Phys Ther. 2016;46(6):483-493. doi:10.2519/jospt.2016.5986

Han S, Moon J, Lee J, Han S, Sterzing T, Farris D, Rice H. Influence of manipulating running foot strike angle on internal loading of the tibia. Scand J Med Sci Sports. 2025;35(5):e70066. doi:10.1111/sms.70066

Lu Z, Suo B, Deng L, Wang J, Fu W, Zhong Y, Jin J. A review of uphill and downhill running: biomechanics, physiology and modulating factors. Front Bioeng Biotechnol. 2025;13:1690023. doi:10.3389/fbioe.2025.1690023

Petersen J, Sørensen H, Nielsen RØ. Cumulative loads increase at the knee joint with slow-speed running compared to faster running: a biomechanical study. J Orthop Sports Phys Ther. 2015;45(4):316-322. doi:10.2519/jospt.2015.5469

Yamato TP, Saragiotto BT, Lopes AD. A consensus definition of running-related injury in recreational runners: a modified Delphi approach. J Orthop Sports Phys Ther. 2015;45(5):375-380. doi:10.2519/jospt.2015.5741