Knee pain after running: 4 common causes

If your runs are plagued by knee pain, you are most certainly not alone. The research is clear – the knee is one of the most common areas to experience running-related injuries.

However, despite what your non-running friends and acquaintances may claim, running is not in itself bad for your knees. Many really large scale, authoritative studies of runners show time and time again that runners actually have lower rates of knee osteo-arthritis
than non-runners, or sedentary people.

One study even concluded that running can actually stave off the horrible condition: ‘Increasing evidence indicates that exercise training can improve pain, stiffness, joint dysfunction and muscle weakness in patients with knee osteoarthritis.’

That said, some symptoms of knee arthritis, including pain and swelling, can present during running – though equally they can also appear during day-to-day activities and there are plenty of other potential causes.

We asked sports doctor Jordan Metzl to explain four of the most common causes of sore knees after running, including what their different symptoms might be, and what you can do about them …

Why do I get sore knees after running?

Why do you run? Because it feels good. Because it relieves stress. I get that, because running is also important to me. I’m a 32-time marathoner who knows how frustrating it is to be injured. It’s the reason I became a sports doctor. Ripping my anterior cruciate ligament playing football when I was in medical school was devastating, but it was the single most important event to influence my work. It’s what drives me to help my patients. Almost every day I treat runners with sore knees. Many are freaked out: can I still run? Will I have to switch to swimming? Thankfully, most knee problems won’t keep you off the road for long.

We have great strategies to diagnose and fix many common knee problems that affect runners. Here’s what you need to know about common knee issues that runners face.

Where does it hurt? Pain under your kneecap that feels worse after running and when you walk up or down stairs. This is the most common condition affecting runners of all ages but is most frequently seen in runners under 50.

What’s going on? When the patella (kneecap) moves out of alignment during running and doesn’t track properly in the trochlea, the ridge inside the upper leg bone, the femur. This causes the cartilage under the patella to become irritated, known as patellofemoral pain syndrome, or runner’s knee.

How can I treat it?

    • You don’t need to stop running but reduce your mileage.
    • Strength train with activities that don’t aggravate your knee – the stronger the muscles above the patella, the better the knee will feel. Start with exercises like straight-leg raises until that doesn’t hurt, then squats, then eventually plyometric squats. It’s all about progression.
    • Consider arch supports (orthotics) and more supportive shoes. Foot mechanics, particularly pronation, play a role in runner’s knee.
    • Apply ice for 15 minutes twice per day to reduce symptoms.
    • Take an anti-inflammatory
    • Foam roll your quads – loser muscles mean less loading force on the patella.
    • If the pain continues, see a doctor to get a more definitive diagnosis.

Prevent it:

  • Strength train
  • Foam roll daily
  • Alter foot mechanics
  • Shortening your stride can take pressure off your knees. Aim for 170-180 footstrikes per minute

Read our full guide to treating runner’s knee

2. Patellar tendinitis

Where does it hurt? Pain below your kneecap and at the top of your shin; it sharpens on the run. Also hurts going up or down stairs. The patellar tendon is the band-like tissue that connects the bottom of the patella to the tibia (shin bone).

What’s going on? The force placed on the knee during running can sometimes put too much strain on the patellar tendon.

Treat it:

    • Stop running until you can do so pain-free; cross-train instead
    • Unlike runner’s knee, patellar tendonitis generally does not get better if you try and run through it. I tell my patient: don’t mess with an irritated tendon!
    • Apply ice for 15 minutes five times a day
    • A patellar tendon strap can reduce pain
    • If it doesn’t improve, see a doctor

Prevent it:

Where does it hurt? Pain on the outside of your knee. It usually comes on five minutes into a run and subsides when you’re finished.

What’s going on? The iliotibial band (ITB) runs from your hip to your knee, crossing two joints, both the hip and the knee. ITB syndrome, otherwise known as ITB impingement, is one of the most painful conditions that can befall a runner. It is often described as ‘a sharp pain, like a screwdriver jabbing the outside of my knee after 10 minutes of running’. The pain comes from the tendon rubbing against the outside of the femur, often associated with the development of an enlarged, fluid-filled sac called the bursa, which sits between the ITB and the outside of the femur. When the ITB is tight, the bursa gets squeezed, causing pain.

Treat it:

  • While you can run with a mild form of ITB syndrome, it’s important to recognise if the pain is worsening. In our office, we tell our patients to stop running if the pain is causing a change in your running form
  • See a doctor or physical therapist to get a proper diagnosis
  • Reduce your mileage and cross-train
  • Foam roll your ITB on the soft part of your outer thigh
  • If you overpronate, consider orthotics or motion-control shoes
  • Glutes, glutes, glutes. Squats are essential to build hip and glute strength – one of the best ways to get rid of ITB pain
  • See a doctor if pain persists for possible X-rays, medication, or injections

Prevent it:

  • Strong glute and core muscles are key
  • Foam roll your ITB daily
  • A shorter, quicker stride can help. Aim for 170-180 footstrikes per minute

Read out full guide to treating iliotibial band syndrome

preview for Knee arthritis in runners: Everything you need to know

Where does it hurt?

The symptoms of osteoarthritis (OA) include knee pain and swelling and stiffness in your knee during running or even day-to-day activities.

Wear and tear arthritis (otherwise known as osteoarthritis, shortened to OA) is common in people over 60. The causes of OA are many and include genetics, prior injury and bad luck. There is no evidence that running causes OA.

What’s going on?

The wearing out of hyaline cartilage (lining of the joint) causes bone to grind on bone.

Treat it:

    • Contrary to popular thought, movement acts as an anti-inflammatory. Unless you’re limping badly, keep moving. Activity keeps joints lubricated.
    • Ice the knee regularly and consider an anti-inflammatory medication like ibuprofen.
    • See a doctor. Getting a proper evaluation including a physical examination and X-ray is important to grade the OA in your knee and to help make a plan moving forward. If your doctor says ‘maybe it’s time to give up running’ find another doctor.
    • Consider your feet: depending on the amount and location of OA in your knee (diagnosed by X-ray), certain types of shoes including high-cushion shoes or motion-control shoes might make a difference.
    • Depending on your foot and running mechanics, softer or harder surface might help make running more comfortable.
    • Lubricant injections (viscosupplements) and platelet-rich plasma (PRP) are helpful in reducing OA symptoms.
    • Maximise strength. Strong muscles, including glutes, quads and hips, all can help offload the knee and improve symptoms.

Prevent it:

  • Strength train
  • Find the best running shoe for you
  • Find the most agreeable running schedule for you – and a surface that suits your knees.

Read our full guide to treating knee arthritis

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