Knee Pain Going Downhill: Causes and Fixes
Why your knee hurts on descents — eccentric load, mechanics, and how to train it out.
What this pattern usually means
Downhill running multiplies eccentric load on quads, knees, and the patellar tendon. Pain only on descents usually points to strength or mechanics, not structural damage.
What to do today
- Walk descents for 1-2 weeks while you rebuild capacity
- Add eccentric quad work (slow tempo squats, step-downs)
- Increase cadence 5-10% on downhills
- Avoid braking — lean slightly forward, shorter steps
When to worry
- • Pain now showing up on flats too
- • Catching or locking sensation
- • Sharp pain you have to limp from
Common causes of knee pain
- Runner's knee (PFPS)
- IT band syndrome
- Patellar tendonitis
- Sudden mileage spikes
- Weak hips and glutes
Could it be one of these injuries?
Patellofemoral pain syndrome (PFPS) — 'runner's knee' — is pain around or behind the kneecap from poor tracking and load distribution at the patellofemoral joint. It accounts for roughly a quarter of all running injuries.
IT band syndrome (ITBS) is irritation of the tissue at the outside of the knee where the iliotibial band crosses the femur. The band itself doesn't 'tighten' — the underlying tissue gets compressed and inflamed from repeated knee flexion under poor hip control.
Patellar tendinopathy — 'jumper's knee' — is degeneration of the patellar tendon just below the kneecap. Common in jumpers and sprinters; in distance runners it usually shows up after spikes in hill work or speed.
Other knee pain patterns
Don't let knee pain become time off.
Stridely catches the trends — readiness, recovery, and pain — before they become injuries.
Start free in Stridely