6 Causes, Symptoms, and More

Causes of knee pain when running can range from patellofemoral pain syndrome (PFPS), or “runner’s knee,” to poor form while running. Patellar tendinitis, or “jumper’s knee,” is another condition that may cause pain under or below your kneecap. Wearing the wrong shoe for your foot shape and stride can also cause knee pain or sore knees after running.

Running is a high-impact exercise. Your joints have to repeatedly absorb and react to high levels of force. Runner’s knee causes pain at the front of the knee or around the kneecap.

Causes of runner’s knee include:

• Poor kneecap alignment from weak, tight leg muscles
• Poor running form
• Repetitive motions

Symptoms

Runner’s knee typically causes pain under the kneecap or at the front of the knee while running. Other symptoms include:

• Pain during activities when you have to bend your knee (e.g., climbing stairs, hiking, etc.)
• Pain in the front of your knee after sitting for a while
• Popping or crackling sound when you bend your knee

Treatment

Runner’s knee is often a sign of overuse, which means you’ll want to rest it for at least two weeks. The RICE method can treat runner’s knee: rest, ice, compression, elevation. You can also take non-steroidal anti-inflammatories (NSAIDs) like ibuprofen and naproxen. It might help to see a physical therapist to address any muscle weaknesses, particularly in your hips.

Prevention

Increase your mileage slowly and strategically to minimize your risk of overuse injury. Pair your running with plenty of cross-training, stretching, and resistance training to support balanced muscles.

If your iliotibial (IT) band experiences extra strain when you run, you may have weak hip muscles. The IT band is a long strip of connective tissue that runs from the outside of your hip to the outside of your knee. It can rub against your thigh bone or knee enough to cause irritation, swelling, and pain when you run. These symptoms can signal a condition known as IT band syndrome (ITBS).

Symptoms

You will feel pain on the outside of your knee and may even notice some popping or clicking sensations. Pain typically appears when you finish running but can be present at any point in your workout. It may be more painful when you run up hills or increase your stride.

Treatment

Allow at least one week to allow any irritation to decrease if you have ITBS pain. Regularly foam rolling and stretching are also important. A healthcare provider might explore physical therapy and corticosteroid injections if your symptoms are severe.

Prevention

“A good routine of stretching tight muscles and strengthening hip muscles will do wonders for keeping ITBS from affecting your workout routine,” Thanu Jey, DC, CSCS, clinic director at Yorkville Sports Medicine Clinic, told Health. Spend time stretching during the day and add some hip-strengthening exercises. Examples include side-lying abductions and clamshells.

Jumper’s knee is an overuse injury. The patellar tendon, which connects your knee cap to your shin bone) becomes inflamed and even torn in some cases. The impact of jumping and similar movements typically causes jumper’s knee.

Symptoms

Jumper’s knee typically presents as pain just below the kneecap, where your patellar tendon attaches to your shin bone. You may also notice pain when you first start running, get up from sitting down, or stretch.

Other symptoms include:

• Bruising
• Cramping
• An indentation at the bottom of your kneecap
• Kneecap movement toward your thigh
• Tenderness
• Trouble walking

Treatment

You may also check whether you need new running shoes. A knee brace can lessen some of the force put on your patellar tendon.

A healthcare provider may recommend imaging if jumper’s knee escalates to a potential tear. Corticosteroid injections have been shown to further weaken the tendon.

Prevention

According to Sabrina Strickland, MD, a sports medicine doctor at Hospital for Special Surgery in New York, change your running shoes every 250-300 miles. Add quad-strengthening exercises, such as squats and leg extensions, to your routine. These exercises can protect your patellar tendon from future trouble.

Arthritis is inflammation of the joints. The articular cartilage, or a smooth, shiny covering on the bones of the joints, wears down. You may develop osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis of your knee.

Symptoms

Your kneecap may feel painful and inflamed if you have any type of arthritis in your knee. Other symptoms include:

• Locking, sticking, or buckling knees
• Pain that seems to change with the weather
• Pain that’s worse in the morning or after you have rested
• Stiff and swollen joints

Treatment

Arthritis has no cure, but you can manage painful symptoms. The type and progression of your arthritis will determine the treatment, such as:

• Alternative therapies: These include acupuncture and magnetic pulse therapy. More research is needed to prove their effectiveness.
• Assisted devices: You may need canes, walkers, and knee braces to alleviate pressure on your joints.
• Lifestyle changes: Minimizing activity that triggers symptoms, adopting low-impact exercises, and managing your weight can reduce stress on your joints.
• Medications: Over-the-counter (OTC) pain relievers and oral and topical NSAIDs can alleviate pain. Talk to a healthcare provider before trying a new medication.
• Physical therapy: This can improve strength, flexibility, and mobility.

Prevention

There’s no guaranteed way to prevent arthritis. Limiting repetitive motion and stress on your knees is the most effective way to minimize symptoms.

Imbalances in the muscles involved in running—whether strength imbalances or uneven levels of tightness—can throw off your form. Poor form ultimately increases the risk of overuse injuries. Exactly what these imbalances look like and how they affect your form varies from runner to runner.

Symptoms

Knee pain can be highly variable. “It can hurt anywhere in the knee joint,” said Jey. “You’ll usually feel it on the inside of the knees or within the kneecap.”

Treatment

Good form is essential if you want to run pain-free. Consider seeing a physical therapist who works with runners. They can analyze your gait to identify what’s exactly going on and prescribe strengthening exercises to help you regain balance.

Prevention

A physical therapist or running coach can check your form to see if you are just getting started with running or are planning to increase your mileage. They can also give you any necessary tips or corrective exercise suggestions before you ramp up.

Knee pain that results from wearing the wrong shoes stems from a lack of arch support. Your feet tend to overpronate, or fall inward. Overpronation causes your knees to bow inward, which places more stress on your knees, ankles, and hips.

Symptoms

Pain anywhere in your knee could indicate you need different shoes. You’ll likely feel pain on the insides of your knees in the case of overpronation due to shoes that are not supportive enough, said Jey.

Treatment

You may visit your local running store or a podiatrist for recommendations for running shoes that deliver arch support. Consider custom orthotics, which will offer support exactly where you need it most.

Prevention

Finding the right running shoes for your feet can take trial and error. Spending the time and money at a reputable running shoe store can help eliminate some of this.

You can take several steps to prevent overuse injuries and other causes of knee pain when running. Try the following prevention techniques:

• Build up the intensity of your workouts gradually: You may consider low-intensity options like bicycling, walking, or swimming to build endurance.
• Choose the right shoes: Make sure your shoes fit properly and are designed for the type of running you do, such as long-distance or trail running.
• Practice good form: Poor form can increase the risk of injuries. You may talk to a physical therapist or running coach about maintaining good form.
• Stretch: Try stretching about two times per week. Hold each stretch for 15-30 seconds, and do not bounce.
• Try cross-training: Incorporate different types of exercise, such as swimming or walking, to work all your muscles.
• Warm up and cool down: Take 5-10 minutes before and after each workout. Warming up increases blood flow to your muscles, and cooling down brings your heart rate to normal. 

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Any level of knee pain can be an indicator that you need to stop and further examine the cause. You may put yourself at risk for more issues in the long term.

Safety is key when it comes to taking knee pain seriously if running is a significant part of your life. “If your pain does not go away after exercise or is persistent every time you perform an activity, it is worth getting the knee evaluated,” said Jey. “This will also help prevent further damage, which could keep you out for extended periods.”

Swelling is another key indicator that it’s time to see a healthcare provider. Unexplained knee swelling can indicate a serious health concern.

No matter your running level, you may notice your knees hurt when you run. Several possible causes could be behind this pain, including runner’s knee, jumper’s knee, the wrong shoes, or incorrect running form.

You may experience knee pain, tenderness, swelling, or more severe symptoms. Rest and consider seeing a healthcare provider if your knee pain persists to avoid further injuring yourself.