Preventing Knee Pain from Running

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The number of people who participate in the sport of running, either recreationally or competitively, is increasing every day. The New York City Marathon in 2015 had 50,229 registered participants.

knee pain running

There are many reasons people choose to run including good exercise, increased endorphins, stress relief and the overall joy derived from the sport. The majority of people who participate in running will experience an injury at some point as runners are particularly at risk for overuse injuries due to repeated force over a prolonged period. The knee joint is particularly at risk and, unfortunately, the exact cause of knee pain from running is not always easy to identify.

Iliotibial Band Syndrome (ITBS) is a common overuse knee injury that is experienced by runners. The Iliotibial Band runs down the outside of the thigh from the hip to the shin. It attaches to the knee and helps stabilize and move the joint. When the IT band is tight, inflamed or isn’t working properly, movement of the knee becomes painful. Running can trigger the pain associated with ITBS. In some cases, IT Band pain can be severe and can prevent a runner from participation for weeks or even longer.

Many runners experience swelling and outside knee pain from running and mistakenly believe the problem is due to an injury of the knee. The best test to determine if ITBS is the source of the pain is to bend the knee at a 45 degree angle. If there is an IT Band problem, the pain will present on the outside of the knee. Some ITBS prevention tips include:

  • Walk for one quarter to one half a mile before starting to run.
  • Check your shoes. If the soles are worn along the outside, replace them.
  • Run on a flat surface. If using a track, alternate direction frequently.

Once you notice IT Band pain, rest immediately. Failure to take a break from running can cause ITBS to become chronic, which can be very difficult to fully resolve. While on a running hiatus, cross training is possible. Swimming, pool running and other low impact activities are appropriate. Stair climbing is not advisable because it is too similar to running.

Side stretches can help loosen the IT Band. Ice and heat are other at home methods for helping resolve the discomfort. Sports massages that try to loosen the IT Band are uncomfortable, but significant improvement can occur in the hands of an experienced sports massage therapist.

If the IT Band pain does not resolve, seek help from a qualified orthopedic or sports medicine professional. A cortisone injection may be necessary to break up scar tissue as this can accelerate healing. However, cortisone injections can weaken tendons and ligaments. As a final resort, surgery may be recommended to release and mobilize the IT Band. 

Patellofemoral Syndrome (PFPS) is another injury that falls into the general “Runner’s Knee” category. PFPS usually presents itself as sharp pain in the knee when running. It affects the kneecap and surrounding area, with the epicenter of the pain under or around the kneecap. Although symptoms may vary, the sharp pain primarily occurs at the front of the knee. Some patients report pain as sharp and sudden or dull and chronic.

PFPS can affect one or both knees. Younger, recreational runners and twice as many women as men are affected. Women tend to have wider hips, creating a greater angle from the thighbone to the knee, which increases the stress on the kneecap.

Pinpointing the exact cause can be difficult. The source can be biomechanical such as the patella being larger on the outside than the inside. The kneecap may sit too high in the femoral groove or it may dislocate easily. Worn cartilage reduces shock absorption. The arch of the foot may play a role as well as high arches provide less cushion while flat fleet can pull the patella sideways.

At the first sign of pain, cut back on your running schedule. The sooner you reduce the workload, the faster knee pain from running can be resolved. Strengthen the quadriceps to improve patellar tracking and incorporate hamstring and calf muscle stretches into your routine to prevent over pronation.

The statistics for running injuries can be significant, but that alone should not scare you away from the sport. By approaching running with smart information and preventative tips, it is possible to have an enjoyable and progressive runner’s experience for a lifetime.