Over the years of being a Pilates teacher, I observed that knee pain complaints from clients are getting more prevalent. Within this week, I have two clients with knee pain (on the inside) which they have not experienced before or have not experienced for quite sometime.

Probing further I found out they experienced knee pain after a run.


She does not run regularly but decided to do a short run for a cardiovascular workout. Immediately after the run, she experienced knee pain (on the inside).

These could be the possible causes:

I. Feet with fallen arches; overpronation

With overpronation, the client has poor foot stability. When running, which is on single leg, the knee would tend to roll in, affecting the proper tracking of the patella.

With such clients, you would see “inward” rolling of the knees during standing plie in parallel and second positions.

II. Knock knees

For this particular client, she also has knock knees. This misalignment could be the reason for the overpronation of the feet.

With knock-knees, the outside of the knee is compressed while the inside of the knee is under tensile force (i.e. “pull” force). During running, the inside of the knee could be under further stress with overpronation.


She runs regularly – at least once a week for about 5km each time. She experienced knee pain after her last run, which she did not feel before. It is interesting to note that this client changed to a new pair of running shoes for this particular run.

This client has the same feet instability i.e. overpronation as Client I, although less serious. However, instead of knock knees Client 2 has less ankle flexion. Lack of ankle mobility can cause the foot to overpronate to compensate thus causing the knee to roll inwards during running.



With such clients you would see “inward” rolling of the knees during a deep squat (see right hand side figure in the diagram above).

As Pilates teachers, it takes time and practise to understand and help clients with issues like knee pain. It is not a simple process because the human body is complex and other factors can sometimes interfere such as shoes, running surfaces, and changes in training.

However, through education and experience the Pilates teachers can assess the misalignments through movements and determine the possible areas to focus.

Written by LayYong

  1. These articles are so helpful. I myself have knock knees and run whenever I get a chance to. Learning to be a qualified teacher, this really helps with my own practice as well as what I must understand to better help my clients. Many thanks, love your blog Lay Yong. <3

  2. Thanks for this great article. It is very helpful to one who has suffering from knee pain. A Pilates programme on the Reformer will optimize knee function.

Leave a Reply to Ricky Margan Cancel reply