With running season upon us, my practice often sees a sharp increase in injuries. The most common is knee pain. But it is not constant knee pain; it comes and goes.

The story always goes one of three ways. The first scenario is that the knee pain comes on in the beginning of the run -- but then the farther the runner goes, the pain disappears and most often doesn’t come back until the runner starts again. The second situation is knee pain that comes on later in the run, almost at the end, but often the runner feels no pain after the run. The third story is that the knee pain starts later in the run and then does not go away by the end of the run, often persisting for a few hours, making stairs and other activities painful.

No matter the story, affected runners wonder: Why is this happening? Do I need to stop running?

Some runners avoid dealing with the knee pain because they're preparing for an upcoming race and they don't want to derail their training for an event they’ve had their heart set on. They are often afraid to go to the doctor because they are convinced that the first thing they are going to be told is that they can't run anymore.

But, honestly, that is very rarely the case; we very rarely take runners out of a training schedule when they come in with pain. For the pain to stop, you don’t have to stop running. Will it take longer to heal if you continue to run? Yes. But is it worth it to continue to run? Yes.

So, most times we do not recommend that people stop running.

Runners may also avoid seeing a doctor about severe intermittent knee pain because they are convinced they are going to need surgery. Again, most of the time in these cases surgery is rarely the answer. The cause is almost never a structural issue, such as a meniscus tear (which would require surgery). So it’s unlikely a runner will need surgery and miss the race.

However, knee pain that comes and goes should not be ignored. It will not continue to be intermittent if you do not get treated.

Most often, the pain that comes and goes is due to a muscle imbalance. Some muscles are tighter or weaker than others and you may compensate for both. The pain going away is your body hitting a sustainable point of compensation that feels good. But when you run with a certain compensation pattern for long enough, your body has to come up with a new pattern in order to get you to run without pain.

Eventually you exhaust every muscle and your body can no longer compensate -- this is when the pain stays, becoming extremely intense.

Often you have no idea that you are compensating. Your body does it without your knowing it — a knee moving inward, a foot crossing the midline, a hip drop on one side, and so on. The body has many compensation strategies to make the pain stop.

This compensation causes some muscle imbalances. Muscles at the hip and at the foot attach at the knee. As all the muscles of the leg are affected when you compensate, you feel pain in the knee because the knee even if the problem may really exist at your hip or ankle.

For example, one of the common causes of knee pain, is iliotibial band tendinitis, or IT Band Syndrome. The IT band is the large tendon running down the side of the leg from the hip. If it gets too tight, it can rub against the knee causing pain at the bottom of the knee.

Knee pain that comes and goes is very rarely caused by one thing. It is important to address all the causes of the knee pain. If you just address one, the pain will return.

What can you do about knee pain?

First you need to identify all the muscles that are being affected. Then you need to get those muscles treated at a clinic that specializes in treating runners. It is important that the correct muscles are strengthened and lengthened.

One of the things that you can start to do on your own is foam rolling, which is even more important than stretching. It is important that you foam roll every part of the legs on a daily basis. If foam rolling is painful, that is a sign something is wrong. You can also ice your knee for 15 minutes after running.

Watch the video to see how you should be foam rolling your legs.

Even though you can ignore knee pain that goes away, eventually you will need to address the cause of the pain. But you can do it without stopping running.

Heather Moore, PT, DPT, CKTP, is the owner of Total Performance Physical Therapy in North Wales, Norristown, and Hatfield.