Your Knee Hurts When You Run. Now What?
Knee pain is the number one most common injury among runners and has been for years. There are many kinds of knee injuries that runners can have. Most knee injuries are due to changes in training load, adding too much intensity or duration at once or even due to a change in surface.
Several years ago I had a terrible flare up of IT band pain. I lived in Boston and was training for a spring marathon and we had a late snow. I had a long run scheduled and didn't want to move it so instead of going on the treadmill I ran through several feet of snow up and down enormous snow piles. Prior to my plyful run in the snow my training was going well, but then I introduced completely different mechanics and load too quickly for my body to adapt.
Running biomechanics aren't just about how someone looks on a treadmill. Terrain, fatigue, speed, and running conditions all influence how we move and the loads our bodies experience. You may not be running through snow, but adding a track workout, hill run, or even too many miles can change the demands on your body enough to trigger knee pain.
Different types of knee pain behave and present a differently. If you can differentiate your signs and symptoms it is much easier to know what to do next.
Three common causes of knee pain in runners
Patellofemoral pain (runner's knee)
PFPS is typically felt around or behind the kneecap. Runners may notice pain with going down stairs, squatting, downhill running, or sitting with bent knees for extended periods. Symptoms often increase when training intensity or duration increases too quickly. This pain is more often generalized to the front of the knee and described as achy.
Iliotibial band (ITB) syndrome
Usually causes pain on the outside of the knee or hip. It may begin at a predictable point during a run and progressively worsen if you continue. Downhill running can be particularly irritating. Unlike patellofemoral pain, symptoms are generally more localized to the lateral knee or hip. This pain is more sharp, you may limp or feel like your knee can't bend or straighten well.
Patellar tendinopathy
Usually causes pain just below the kneecap, around the patellar tendon, but sometimes it can be above the kneecap. It can be aggravated by running, jumping, hills, and faster workouts. Some runners notice that pain improves as they warm up, only to return afterward or the following morning. This pain can be achy or sharp in nature.
These patterns provide clues, but they aren't enough to make a diagnosis on their own.You can use the RUNsource app to answer additional questions and explore programs that may help, or schedule an evaluation with your favorite healthcare provider.
What about running biomechanics and strength?
Running mechanics influence how forces are distributed throughout the body. Things like stride length, cadence, hip movement, and knee position can change how much load different structures experience.
There isn't one perfect way to run, but there are common characteristics we look at when assessing running gait.
Research on patellofemoral pain supports exercise therapy and education as the foundation of treatment. Gait retraining may also be helpful for certain runners, particularly when specific movement patterns contribute to symptoms.
Strength training is another important part of rehabilitation. for all injuries including knee pain. Depending on the injury is improving core, quadriceps, hip abduction and rotation, calf strength can help runners better tolerate the demands of running.
Do you need to stop running?
Not always. I rarely tell runners with knee pain to stop running unless I have to. Sometimes modifying training is enough to allow symptoms to settle. Reducing mileage, temporarily eliminating speed workouts, avoiding hills, or adding recovery days may be all that's needed initially.
I encourage runners to pay attention to three things:
During your run: Does the pain stay mild and consistent, or does it progressively worsen? Are you changing your stride because of it?
After your run: Does the pain settle, or does it continue to bother you throughout the day?
The next morning: Are you back to your usual baseline, or are you more painful or stiff?
If symptoms are mild, stable, and return to baseline by the following day, continuing to run with modifications may be reasonable. If pain progressively worsens, changes your running mechanics, or leaves you more symptomatic the next day, your current training load may be too much.
When should you get help?
If you've modified your training and symptoms continue to return, it's time to have someone evaluate your knee. Persistent swelling, sharp, locking, giving way, difficulty bearing weight, or significant pain following an injury should be evaluated sooner.
Sometimes the solution is to temporarily changing your training. Other times, you may need a more specific strength program, adjustments to your running mechanics, or a combination of approaches.
Most runners with knee pain can continue running while recovering. Understanding the injury, paying attention to how your body responds, and making appropriate adjustments can help you get back to running comfortably.
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