Why You Might Have Knee Pain When Running

knee pain when running
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Does pain in your knees frequently prevent you from running or force you to cut some of your runs short? Knee pain is a common concern among runners and often gets lumped under the general category of “runner’s knee,” making it difficult for runners to figure out how to treat it and prevent it in the future.

Where Does It Hurt?

Check out the descriptions below to determine why you may be feeling knee pain when running and what you can do about it. Of course, it’s important to keep in mind that if you’re feeling pain and don’t notice any improvement after a week or so of self-treatment, you should make an appointment with a physical therapist or doctor for evaluation and treatment.

Location of Pain: Side of Knee
Possible Injury: Illiotibial Band Syndrome

If you feel a sharp, stabbing pain on the outside of your knee, you may be dealing with illiotibial band syndrome (ITBS), a very common running injury among runners.

The illiotibial band (ITB) is a band of tissue that runs along the outside of the thigh—from the top of the hip to the outside of the knee. It stabilizes your knee and hip during running. When the ITB becomes short, the band rubs too tightly on the bone. The outside knee area can become inflamed or the band itself may become irritated, causing pain. Overtraining is the most common cause, but running on a banked surface, inadequate warm-up or cool-down, or certain physical abnormalities may also lead to ITBS.

To self-treat ITBS, give yourself plenty of rest, reduce your miles and ice your knee frequently to reduce the inflammation. Anti-inflammatory drugs such as ibuprofen can also help get the swelling down, but make sure you take them with food. You can keep running, but cut your run short as soon as you begin to feel any pain. Cut back on hill work, and make sure you run on even surfaces.

If you're starting to notice the early signs of ITBS (ITB tightness and twinge at the outside of the knee), you can prevent it from getting worse by consistently doing strength and flexibility work done two to three times a week. Rolling your ITB with a massage tool such as the Stick or a foam roller on a regular basis can also make a huge difference.

You may also want to see a physical therapist for deep tissue massage. Try some leg-raise exercises to strengthen your hips and be conscientious about stretching your ITB and quads. Make sure you're stretching and rolling both legs, as some runners focus on the injured leg and then end up developing ITBS in the other leg.

Like most running injuries, if you don't determine and treat the root cause of the injury, you're likely to suffer from ITBS again. If you've had it in the past, make sure that you're wearing the right running shoes for your feet and running gait. It's also worth having a physical therapist do an assessment to determine any weak areas that may be causing the problem. Those who suffer from ITBS often have weakness in their hips.

Try to incorporate regular strength training into your routine. Exercises such as single-leg balance moves, side leg lifts , and clamshells are particularly beneficial for those prone to ITBS. Regular foam rolling of your IT band is also crucial to ITBS prevention.

Location of Pain: Knee Cap
Possible Injury: Runner’s Knee

If you have soreness around the front of or possibly behind the kneecap, you may be dealing with runner's knee, also known as patella femoral pain syndrome or anterior knee syndrome. Runner’s knee is often aggravated by running downhill, squatting, going up or down stairs, or sitting for long periods of time.

Runner's knee is usually caused by weakness in the middle quadriceps muscles and tight hamstrings or IT bands. Your quads should hold your kneecap in place, so it tracks up and down. But if you have some muscle weakness or imbalance in your quads, your kneecap moves left and right and ends up scraping your cartilage, causing painful friction and irritation.

To treat runner’s knee, you can reduce the pain and inflammation by icing your knees immediately after running. Work on strengthening your quad muscles, which will help support and stabilize your kneecap. You can do simple exercises, such as forward lunges or straight leg raises. Stretching your hamstrings and rolling your IT bands can also help.

You should take a couple days off from running or cross-train, as long as it's pain-free. You know it’s safe to start running again when you're able to run with your normal gait and not compensate because of knee pain.

To prevent runner’s knee in the future, make sure you’re wearing the right kind of running shoes for your foot type. Also, make sure you're not running in worn-out shoes, as lack of shoe cushioning could also lead to runner's knee. You should replace your shoes every 300-400 miles.

Although some runners can treat and prevent future runner's knee by following the above steps, others may need further treatment. You may need to visit a physical therapist who can give you the proper stretches and exercises. If your runner's knee is caused by overpronation (foot rolling inward when you run), you may need to see a podiatrist about getting custom-fitted orthotics.

Location of Pain: Top of Knee Cap to Top of Shinbone
Possible Injury: Patellar Tendinitis

Pain on the top of your knee cap to the top of your shinbone may be an indication of patellar tendinitis, a common overuse injury. Patellar tendinitis is caused by repeated stress on your patellar tendon, which runs from the kneecap (patella) to the shinbone (tibia). The stress results in tiny tears in the tendon, which your body attempts to repair. You’ll feel pain as the tendon becomes inflamed and weakened.

You may first notice the pain after a run, but it eventually gets worse, as the tears in the tendon multiply, and you’ll then start to feel it while running.

To treat patellar tendinitis, try self-care measures first, such as icing the area and taking a few days off from running. You should consult your healthcare professional if you notice a lot of swelling, the pain continues or worsens, or interferes with your ability to perform daily activities.

Location of Pain: All Over Knee
Possible Injury: Meniscus Tear

The symptoms of a meniscus tear include general knee pain, swelling all over the knee, a popping sensation during the injury, knee stiffness (especially after sitting), a feeling as though your knee is locked in place when you try to move it, and difficulty bending and straightening that leg.

Meniscus (knee cartilage) tears can happen when a person changes direction suddenly while running or suddenly twists their knee. Older runners are more at risk, as the meniscus weakens with age. Runners more commonly injure the medial meniscus (central meniscus attached to the tibia or shinbone) rather than the lateral meniscus (on the side of the knee).

Treatment for meniscal tears depends on the size and location of the tear. Sometimes small tears heal on their own with the proper treatment.

Your doctor will most likely recommend rest (no impact activities), anti-inflammatory medication, and icing your knee to reduce pain and swelling. Ice your knee for 15 to 20 minutes every 3 to 4 hours for 2 to 3 days or until the pain and swelling is gone. Your doctor or physical therapist may also give you some gentle strengthening and stretching exercises to do. If a tear is large, unstable, or causing locking symptoms, you may need surgery and subsequent physical therapy.

To avoid meniscus tears in the future, make sure you're wearing the correct running shoes for your foot and running style, since wearing the wrong shoes may make you vulnerable to falls or twisting your knee. Do exercises to strengthen the muscles that support and stabilize the knee, so you keep your knees more injury-resistant.

Location of Pain: Over the Kneecap or on Inner Side of Knee Below the Joint
Possible Injury: Knee Bursitis

If you’re feeling pain over your kneecap or on the inner side of your knee below the joint, you may be dealing with knee bursitis, an inflammation of a bursa located near your knee joint. A bursa is a small fluid-filled, pad-like sac that reduces friction and cushions pressure points between your bones and the tendons and muscles near your joints. When it’s inflamed, the affected portion of your knee may feel warm, tender and swollen when you put pressure on it. You may also feel pain when you move or even at rest.

In runners, overuse may lead to pain and inflammation in the anserine bursa, located on the inner side of your knee below the joint. To ease pain and discomfort of knee bursitis, you can use the R.I.C.E. method of self-treatment.

If you don’t notice any improvement after seven to ten days, get checked out by your healthcare professional. Your doctor may refer you to a physical therapist or specialist in sports medicine, who can prescribe exercises to improve flexibility and strength. This therapy may alleviate pain and prevent future occurrences of knee bursitis. More invasive treatments for knee bursitis treatment may include corticosteroid injection, aspiration, or surgery.

Location of Pain: Back of Knee
Possible Injury: Distal Hamstring Bursitis

If you’re feeling pain at the back of your knee, right at the top of your calf, you may be dealing with another type of bursitis, distal hamstring bursitis. It’s usually a result of hamstring tightness and friction, which causes the bursa to become inflamed.

To treat distal hamstring bursitis, you should work on loosening up your tight hamstring, through stretching, rolling, and massage. If it's extremely tight, you may also need physical therapy with cross-frictional massage, electrical stimulation, and ultrasound.

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Article Sources
  • Knee Bursitis, http://www.mayoclinic.org/diseases-conditions/knee-bursitis/basics/definition/con-20030816. Updated April 2014.
  • Maharam L. Running Doc's Guide to Healthy Running, Velo Press, 2011.
  • Meniscus Tear - Overview, http://www.mayoclinic.org/diseases-conditions/torn-meniscus/home/ovc-20262344, Updated January 2017.
  • Patellar Tendinitis, http://www.mayoclinic.org/diseases-conditions/patellar-tendinitis/basics/definition/con-20024441, Updated January 2015.