Why You Feel Knee Pain When Running

knee pain when running
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Does knee pain frequently prevent you from running? Has soreness in one or both of your knees forced you to cut your runs short? Knee pain is a common complaint among runners. While the condition is often dismissed as “runner’s knee,” there may be a different reason for your discomfort.

If you have developed knee pain while running, locate the area where the pain is most significant. Then use this guide to target the treatment and exercises that are most likely to help.

Basic Knee Anatomy

Your knee is comprised of more than one joint. 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. Because the joint 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.

Diagnosing Knee Pain

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 you can make.

Nevertheless, it’s important to keep in mind that if the pain persists after a week or so of self-treatment, you should make an appointment with a physical therapist or physician for evaluation and treatment.

Whether you self-treat or choose to work with a healthcare provider, identifying the location of your knee pain is helpful in diagnosing the cause.

Location: 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 iliotibial band syndrome (ITBS), a very common injury among runners.

The iliotibial 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 helps to stabilize the knee and hip when you run.

When the ITB becomes tight, it shortens and the band rubs 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.

Studies have shown that self-treatment may be effective in treating IT band syndrome. Your options include reducing your miles or 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 cut your run short as soon as you begin to feel any pain. Reduce hill training and make sure you run on even surfaces.

If you start to notice the early signs of ITBS (such as tightness or a twinge on the outside of the knee), prevent it from getting worse by doing strength and flexibility work two to three times a week.

Exercises may 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.

To strengthen the area, try some leg exercises that activate the glutes using light weight or no weight at all.

You may also want to see a physical therapist for deep tissue massage.

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. It's also worth having a physical therapist do an assessment to determine any weak areas that may be causing the problem. Those who have ITBS often have weakness in their hips.1

Try to 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. 

Location: Knee Cap

Possible injury: 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.

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 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.

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, compression knee wraps, or 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 after other exercise) when your muscles are warm.

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 may continue to 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 ready to run again.

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 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: Top of Kneecap 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. The condition is also called jumper's knee because it is common in sports that involve jumping.

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.

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.

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. Strength training should focus on eccentric movements (those that involve lengthening the muscle).

Location of Pain: All Over Knee

Possible injury: 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.

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 McMurray test to assess the range of motion and classify the severity of the tear.

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 includes a meniscectomy (removal of the meniscus) or meniscal repair (usually a minimally invasive procedure).

The best treatment for you 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 to 20 minutes every three to four hours for two to three days or until the pain and swelling is gone. Your healthcare provider may also give you some gentle strengthening and stretching exercises to do.

Recovery after surgical treatment usually consists of bracing the knee and non-weight bearing activities for four to six weeks. You will also be given a rehabilitation program that involves stability and strengthening exercises.

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: Over the Kneecap or Inner Knee

Possible injury: Knee 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, 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, 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 exam 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. 

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, ice, and ultrasound 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.

Location: Back of Knee

Possible injury: 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. These cysts may occur as the result of osteoarthritis or meniscus tears.

Baker's knee is 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.

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 health care provider if you see redness or severe swelling in the area.

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Article Sources

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