Understanding knee pains from running and what you can do
by Meghan Griech, PT, DPT, cert MDT, CKTP
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Running is great for our muscles, joints and cardiovascular health. Yet the repetitive nature of running can become irritating on our knees. In fact, knee injuries are incredibly common, accounting for up to 50% of all running injuries.
Knee pain with running can show up in many different locations. Pain around the knee cap (patella) is often referred to as patellofemoral pain syndrome or Runner’s Knee. Pain on the outside of the knee that also has a snapping sensation could be Iliotibial Band Syndrome (ITB syndrome). Pain along the inner aspect of the knee could be from a strain of the Medial Collateral Ligament. Meniscal tears, tears of the fibrocartilaginous tissue inside the knee joint is also a possibility, as is Jumper’s knee (pain at the front of the knee, in the patellar tendon).
Each area of pain has different characteristics of pain, some pains are more achy, while other tissues irritated are sharper.
Patellofemoral Pain Syndrome
Patellofemoral Pain Syndrome, aka Runner’s knee is an overuse injury, meaning too much activity without enough rest/recovery. This is the most common running injury, especially when trying to increase speed or hills to a run. Poor running form, tight quadriceps (thigh muscles) causing a knee cap to sit too high in the joint can also be culprits. This type of injury affects as many as 30% of female runners and 25% of male runners.
In Runner’s Knee, the cartilage in your kneecap gets irritated from the repeated friction and rubbing of the tissues over and over with each stance to swing of the leg for running. This can cause pain while you’re running, squatting, bending or even sitting.
What can you do?
- Stop running, apply cold packs to the painful areas of the knee
- Take a pain reliever like ibuprofen until you are pain-free.
- Strengthen the muscles around your knees, hips, and ankles.
- When you are ready to begin running again, ensure there is no pain during your run or after.
- Take a day break between each run, avoid hills while still in recovery and ice after runs.
Iliotibial Band Syndrome
Iliotibial (IT) band syndrome is another common running injury, especially amongst long-distance runners. The iliotibial band is a long connective tissue from the hip to the outer area of the knee, each bend and straightening of the knee causes compression to the attachment site of the tissue. Over time the attachment site can become inflamed, painful, tight enough to cause a ‘snapping’ sensation.
Like runner’s knee, IT band syndrome often happens when you’ve increased the miles you run or speed.
What can you do?
- Avoid running to let the tissues rest
- Ice your knee to help with pain.
- Take an over-the-counter anti-inflammatory medication to reduce pain.
- When you are ready to begin running again, check your technique especially if you tend to run with feet close together or scissoring.
Patellar Tendonitis is an overuse injury that occurs when a tendon that attaches the kneecap (Patella) to the shin bone (Tibia) is overloaded, causing it to thicken. This is most often in sports players who need to jump a lot – like basketball. It is also caused by overuse or suddenly increasing running distance or frequency.
Inflexibility and tightness of the hamstrings and quadricepts also attribute to the prevalence of patellar tendonitis
What can you do?
- Ice the knee, especially at the tendon below the knee cap
- Rest – avoid running, jumping
- Stretch the hamstring and quadricept muscles
A meniscus tear is a tear of the fibrocartilaginous tissue between you femur and tibia (the two bones that make the knee joint). The knee joint has an inner meniscus and an outer meniscus, the inner meniscus is much more commonly injured or torn.
Meniscus tears are usually caused by repetitive use or by activities that involve twisting, like when you stop suddenly while running or quickly change directions.
What you can do: meniscus have poor ability to heal, but can be present in the knee without causing pain.
- Rest to help reduce inflammation and swelling is helpful.
- Icing the knee joint
- Strengthening the muscles of the hip, knee and ankle
- Returning to activity when pain is improved and monitoring symptoms
- Speaking with orthopedic MD if symptoms persist
Knee bursitis is inflammation or irritation of a small fluid-filled sac, called the bursae, located near your knee joint. The knee joint has many bursae, the most common area affected is the inside of the knee near the hamstring, or Prepatellar bursitis, which affects the kneecap.
Knee bursitis pain can be on the kneecap or just below the knee joint towards the inner side. The bursae can become inflamed from progressing running speed, distant and repetitive strain.
What you can do:
- Rest to help reduce inflammation and swelling
- Icing the knee joint
- Strengthening the muscles of the hip, knee, and ankle
- Returning to running when it no longer causes pain or swelling.
Knee pain is common in runners, especially as they work to increase their distance or pace suddenly, or when running hills. Activities where quick cuts and turns can also predispose the knee tissues to injury. Most common knee injuries can be treated with rest, ice, and over-the-counter pain medication. Return to activity is dependent on tissue response (if there is pain/swelling after an attempt to return to running) and monitoring symptoms.
*Disclaimer: All information in this article is intended for instruction and informational purposes. The author(s) are not responsible for any harm or injury that may result. This information is used to supplement not replace any advice you were provided from your doctor or another medical health professional. No guarantees of specific results are expressly made or implied with this article.