Common Causes of Knee Pain When Running

knee pain when running
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If your knees hurt when you run, you're not alone. Soreness in one or both of your knees is a common complaint among runners. While knee pain in runners is often dismissed as "runner's knee," it's important to identify and treat the cause in order to reduce the risk of long-term injury and pain.

If you have developed knee pain while running, it's important to target the area that's most affected. Depending on the severity of your knee pain, you may need to see your doctor. Knee pain doesn't have to prevent you from running outside or force you to have to cut your runs short. The following guide can help you pinpoint the cause of your knee pain and get you back on track with your running schedule.

Basic Knee Anatomy

Your knee is comprised of multiple joints. The tibiofemoral joint connects your thigh bone (femur) to your lower leg (tibia). The patella, or kneecap, is a protective structure that connects to the femur and forms the patellofemoral joint.

These joints are supported by a network of muscles, tendons, and ligaments that help the knee flex, extend, and rotate (minimally) through important movements such as walking, running, kneeling, and lifting.

When you start to feel knee pain, you can take steps to diagnose and treat the condition on your own. Many times, there are muscular imbalances that can be managed with exercise or other simple changes. If the pain persists after a week or so of self-treatment, make an appointment with a physical therapist or physician for evaluation and treatment.

Because the joint surrounding the knee supports the weight of your body and is used heavily in both basic daily movements and sports, the incidence of injury in this area is high.

Side Knee Pain: IT Band Syndrome

If you feel a sharp, stabbing pain on the outside of your knee, you may be dealing with iliotibial band syndrome (ITBS), a very common injury among runners. The iliotibial band (IT band) is a band of tissue that runs along the outside of the thigh, from the tensor fasciae latae where it attaches at the top of the hip to the outside of the knee. It helps to stabilize the knee and hip when you run.

Causes

When the tensor fasciae latae becomes tight, it shortens and puts tension on the IT band. 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.

Treatment

Studies have shown that self-treatment may be effective in treating IT band syndrome. Options include reducing your miles and icing your knee to reduce inflammation. The use of anti-inflammatory medications (such as ibuprofen) may also be helpful. Some studies have also found that wearing softer running shoes may help to alleviate the condition.

You can keep running, but you should stop running as soon as you begin to feel any pain. Reduce hill training and make sure you run on even surfaces until you've healed.

Prevention

If you start to notice the early signs of ITBS (such as tightness or a twinge on the outside of the knee), you can prevent it from getting worse by doing strength and flexibility work two to three times a week. To strengthen the area, try some leg exercises that activate the glutes using light weights or no weights at all. It's also worth having a physical therapist do an assessment to determine any weak areas. Those who have ITBS also often have weakness in their hips.

  • Strength training: Incorporate regular strength training into your workout routine. Exercises such as single-leg squats, balance training, and clamshells are particularly beneficial for those prone to ITBS. 
  • Flexibility exercises: These include rolling the IT band with a massage tool like a foam roller or a tennis ball. You can also perform hip stretches specifically designed to increase mobility and reduce pain. Make sure that you stretch and roll both legs, as some runners focus on the injured leg and then develop ITBS in the other leg. You may also want to see a physical therapist for deep tissue massage.
  • New running shoes: Like most running injuries, if you don't determine and treat the root cause of the injury, you're likely to experience ITBS again. For some people, finding better running shoes helps to prevent a recurrence. Visit a sport-specific running store to have your feet and your gait analyzed.

Kneecap Pain: Runner's Knee

If you have soreness around the front of your knee or possibly behind the kneecap, you may have runner's knee, also known as patella femoral pain syndrome or anterior knee syndrome. Running downhill, squatting, going up or down stairs, or sitting for long periods of time can aggravate the condition.

Causes

Researchers have identified different causes of runner's knee. The condition can be caused by a structural problem in the knee joint. It can also be caused by weak muscles, tight hamstrings, a tight Achilles tendon or iliotibial (IT) band, overtraining, poor foot support, or misaligned gait patterns.

One of the most common causes is weakness in the thigh muscles (quadriceps). Your quadriceps hold the kneecap in place so that it tracks smoothly up and down. But if you have quad weakness or a muscle imbalance, the kneecap moves slightly left and right. This movement causes painful friction and irritation.

Treatment

To treat runner's knee, try icing your knees immediately after running. This helps to reduce pain and inflammation. Experts also advise elevating the leg and using compression knee wraps and anti-inflammatories like ibuprofen. Arch support in your shoes may also help to alleviate pain in some runners.

Stretching and strengthening exercises are also important. Focus on the quadriceps, which are the muscles that help support and stabilize your kneecap. Simple exercises, such as forward lunges or straight leg raises will help to increase strength in the quads.

Stretching the hamstrings and rolling your IT bands can also help. These exercises should be performed after a run (or other exercise) when your muscles are warm.

Can I Run With Runner’s Knee Pain?

You should take time off from running when you notice the onset of runner's knee, but you don't have to quit exercise entirely. You can cross-train as long as the movement is pain-free. You'll know that it's safe to start running again when you're able to run with a normal gait and without pain. If you find that you change your movement or compensate because of pain, you're not quite ready.

Prevention

To prevent runner’s knee in the future, make sure that you wear proper running shoes for your foot type. Also, replace your shoes often (every 300–400 miles) as lack of shoe cushioning can also lead to runner's knee.

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 guide you in 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.

Kneecap to Shinbone Pain: Jumper's Knee

Pain from the top of the kneecap to the top of the shinbone may be an indication of patellar tendinitis, a common overuse injury. The condition is also called jumper's knee because it is common in sports that involve jumping.

Those who have jumper's knee feel pain, tenderness, and possibly swelling near the patellar tendon (where the kneecap meets the shin). When the condition is in its early stages, you might only notice it when running. As it gets worse, however, you'll notice it throughout the day, even when you are not exercising.

Causes

Patellar tendinitis is caused by repeated stress on your patellar tendon. This tendon connects the kneecap (patella) to the shinbone (tibia) and is responsible for extending the lower leg. Initially, the stress results in weakness in the tendon. If left untreated, the weakness results in tiny tears.

Treatment

Because jumper's knee can mimic other conditions, experts advise that you get diagnosed by a healthcare professional. Once diagnosed, it is likely that you will be advised to stop running until the patellar tendonitis heals.

Treatment for the condition may include icing the area, elevating your knee, nonsteroidal anti-inflammatory medicines (NSAIDs), and stretching and strengthening exercises. For example, quadriceps stretches are often prescribed. Calf stretches and hamstring stretches are also recommended prior to exercise.

Prevention

Regular strength training and stretching helps keep the thigh muscles strong and agile to prevent jumper's knee. Strength training should focus on eccentric movements (those that involve lengthening the muscle). But avoid making too many changes to your strength training routine all at once. Additionally, wearing the right shoes can make all the difference. Make sure your running shoes have the right amount of support and aren't worn out.

All-Over Knee Pain: Meniscus Tear

The meniscus are two wedge-shaped pieces of cartilage that act as shock absorbers between the femur and tibia. Meniscus 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.

Causes

Runners more commonly injure the medial meniscus (inside of the knee) rather than the lateral meniscus (outside of the knee). 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.

Many people are able to continue walking with a meniscus tear. You may even be able to continue running with a meniscus tear, although it is not recommended.

If you suspect a meniscus tear, it is best to visit your healthcare provider to get a proper diagnosis. During an exam, they will evaluate your knee and may recommend diagnostic imaging, such as an x-ray or MRI. They will also conduct a test called the McMurray test to assess the range of motion and classify the severity of the tear.

Treatment

Treatment for meniscal tears depends on the size and location of the tear. Sometimes small tears heal on their own with the proper self-care. Treatment for more severe tears can include a meniscectomy (removal of the meniscus) or meniscal repair (usually a minimally invasive procedure). Recovery following surgical treatment usually consists of bracing the knee and non-weight-bearing activities for four to six weeks and a rehabilitation program.

The best treatment will depend on several factors, including the severity of your tear, your age, your activity level, and your willingness to comply with treatment. The current trend in the management of the condition is to try to save the meniscus rather than to remove it with surgery.

Non-surgical management of a meniscus tear usually includes anti-inflammatory medication and icing your knee to reduce pain and swelling. Ice your knee for 15–20 minutes every three to four hours for two to three days or until the pain and swelling are gone. Your healthcare provider may recommend physical therapy for some gentle strengthening and stretching exercises.

Prevention

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 knees so you keep the knees more injury-resistant.

Inner Side Knee Pain: Bursitis

If you're feeling pain over the top of your kneecap or on the inner side of your knee below the joint, you may be dealing with knee bursitis. This is an inflammation of a bursa located near your knee joint.

Causes

A bursa is a small, fluid-filled, pad-like sac that reduces friction and cushions pressure points between your bones, tendons, and muscles around your joints. In runners, overuse may lead to pain and inflammation in the pes anserine bursa, located on the inner side of your knee about two to three inches below the joint.

When a bursa is inflamed, the affected part of your knee may feel warm, tender, or swollen when you put pressure on it. You may also feel pain when you move or even at rest. Walking up stairs may become difficult. An examination of the knee by your healthcare provider will help to properly diagnose the condition, as symptoms of pes anserine bursitis are similar to those of a stress fracture.

Treatment and Prevention

To ease the discomfort of knee bursitis, you can use the R.I.C.E. method and anti-inflammatory medications. In some cases, your healthcare provider may recommend a steroid injection to relieve pain. Physical therapy is often recommended and usually involves a program of stretching, strengthening, ice, and pain-relieving treatments.

Physical therapy may alleviate pain and prevent future occurrences of knee bursitis. More invasive treatments for knee bursitis treatment may include aspiration or surgery.

Back of Knee: Baker's Cyst

A Baker's cyst, also known as a popliteal synovial cyst, is swelling that occurs at the back of the knee. You may feel pain, but it is more likely that you will feel tightness or stiffness in the area and a sensation of fullness. You are also likely to see a bulge.

Causes

These cysts may occur as the result of osteoarthritis or meniscus tears. Baker's cysts are not specifically associated with running, and runners are not necessarily at higher risk for the condition, but because the condition is usually the result of an underlying issue, runners may end up with the cyst.

Treatment

If you suspect a Baker's cyst, reach out to your healthcare provider to get a proper diagnosis and determine the underlying cause. Some of these cysts go away without treatment, but it will be important to address the underlying issue. In rare cases, the cysts can burst, so be sure to contact your healthcare provider if you see redness or severe swelling in the area.

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