Knee Pain and Running

Knee pain is a very common complaint amongst runners. This isn't surprising as it is estimated that around four times an individual's body weight is passed through each knee joint with every step! Running on hard surfaces will also increase this impact. On top of this, biomechanical factors can also result in extra stress on structures around the knee. For example overpronation at the foot places a rotation force on the Tibia (shin bone) and more stress on the medial (inner) joint.

Whilst minor aches and pains at the knee may come and go, there are several injuries which are typically associated with runners and if left untreated, may affect the runner's ability to train. The most common ones to look out for include:

Iliotibial Band Syndrome

IT band syndrome is caused by the IT band flicking back and forwards over the bony outer part of the knee. The more this happens, the more inflamed, swollen and painful it is.

Common symptoms include:

• Pain at the outer knee.


• Pain is commonly worse when running downhill.


• Pain will often come on at the same point during a run, although as it gets worse it may occur earlier.

Patellofemoral Knee Pain (Anterior knee pain)

There are many names for this condition, but basically they all relate to the same idea, that the knee cap (patella) 'mal-tracks'. When the knee is bent and straightened the patella should run straight up and down in a groove at the front of the knee joint. If it doesn't do this and instead is pulled to one side, damage can occur to the cartilage lining the back of the patella, resulting in pain.

Symptoms may involve:

• Poorly localised pain around the patella.


• Pain may occur during or after running.


• Pain is often worse on walking downhill or stairs.


• Clicking or grinding feelings may occur.

Popliteus injury

The popliteus is a muscle which runs across the back of the knee joint. The popliteus can develop tendonitis or go into spasm due to overuse which is usually linked to tightness in the hamstrings or weakness in the quad muscles.

Symptoms include:

• Pain at the back of the knee


• Tenderness on palpation of the muscle, just below the crease of the knee.


• Pain on resisted knee bending with the lower leg rotated outwards.

Patella tendon pain

Pain below the knee cap could be coming from the patella tendon. Whilst tears rarely occur from repetitive motions such as running, tendinopathy (sometimes known as jumper's knee) may occur. This is a degenerative condition causing micro tears in the tendon.

Common symptoms include:

• Well localised pain in the tendon below the knee cap.


• It is usually tender to touch.


• The area may ache or feel stiff after exercise or long periods of rest.


• The tendon may appear thicker or redder than on the other knee.

Treatment of running injuries

The important thing to remember with running injuries is that they happen for a reason. So, when treating a running related injury, always remember that the cause of the injury must be corrected before running is resumed, otherwise the pain will simply return. For example:

• Firstly, check your running shoes


• They should be suited to your style of running and not be worn out! (replace them on average every 400 miles)


• Flexibility is another important aspect to consider


• Tight calf muscles in particular are a massive cause of many injuries, including shin splints and Achilles tendinopathy.


• Muscle weakness and imbalances


• These contribute to injuries such as Patellofemoral pain. If not corrected before returning to running the same problem still exists!

Prevention of running injuries

Prevention is by far the best treatment and many of the factors of treating a running injury should be applied earlier in order to avoid a running injury happening in the first place!

Running shoes, flexibility and strength are all key to avoiding injuries, as are allowing enough rest, alternating running surfaces, cross training and not increasing mileage too quickly. Other prevention methods such as sports massage may also be effective.

For more information on knee pain and running, visit the Virtual Sports Injury Clinic.