Top Five Causes of Knee Pain When Running

Knee pain while running is a sign of joint dysfunction. Don’t let your knee pain slow you down – learn more about the cause and find the solution.

Group of people running together

It’s no secret that running can be tough on your joints, your knees in particular. In fact, even simple movements that you perform every day put in excess of 8 times your bodyweight through your knee joint.1 We are going to assume that you have been experiencing some nagging knee pain preventing you from running as much as you would like. There are a variety of possible reasons, so let’s start with the possible underlying causes.

Sources of Running Related Knee Pain

The knee joint contains bones, ligaments, tendons, and cartilage, all of which help to transmit force from your muscles and cushion impact during ground contact. Damage to ligaments usually occurs during contact sports, where a sudden miss-step or unanticipated tackle occurs. Bone fractures are usually the result of a traumatic blow to the joint, typically from a serious accident. Injury to the bone and/or ligaments are rarely an issue for runners. More commonly, runners are the victim of cartilage-related injuries, tendon pathologies and joint tracking issues caused by muscle imbalances.

Top Five Running Injuries

Iliotibial Band Syndrome (ITBS)

ITBS is the most common cause of lateral knee pain in runners.2 As your foot touches down in the stance phase and your knee absorbs the initial impact you will feel a sharp pain on the side of the joint. Researchers still debate the mechanical cause of the ITBS pain, possible causes are weak glutes, tight hips, poor running technique, and excessive pronation.2

Counterintuitively, you may have less pain when you run at faster speeds.3 This is because the ITB band is compressed most at around 30 degrees of knee flexion. Therefore workout schemes like high-intensity interval training may be a good option as a temporary respite from longer runs.

Strengthening and mobilizing are the preferred treatment methods suggested by many physical therapists. A particular emphasis is put on the outer glutes. These muscles help stabilize the pelvis (origin of the IT Band) during the stance phase.

Runner stretching thigh

Patellofemoral Pain Syndrome (PFPS)

PFPS is characterized by pain and inflammation under or surrounding the knee cap (patella) during the stance phase. Similar to ITBS researchers and clinicians have not nailed down the ultimate cause of this issue.4 Sex, body weight, age, and joint alignment do not appear to be risk factors for PFPS.4 Quadriceps weakness is the only variable that has consistently been associated with the injury.4 If this condition is affecting your running, consider taking some time off, trying some cross training, and most of all, getting in the gym to strengthen your thigh muscles.  

Patellar Tendonitis

Tenderness and pain with a deep knee bend are the primary symptoms of patellar tendonitis. In runners, this condition tends to occur during periods of unusually heavy training. If not rested the condition can become chronic requiring a lengthy rehab process. In general, tendons heal much more slowly than muscle due to poor blood supply, so try not to get frustrated with slow progress.

Recently isometric training has shown to be effective in reducing pain associated with patellar tendonitis. The preliminary research indicates that 5 x 45s single leg holds on a leg extension machine (video) can provide immediate benefit.5

Osteoarthritis (OA)

Male running on waterfront

If you are over 40 and have begun experiencing some general knee pain within the joint during the stance phase, osteoarthritis is likely the culprit. The articular cartilage that covers the surface of your joints ensures smooth gliding movements between bones. In osteoarthritis, this tissue becomes worn creating bone on bone pressure. Eventually, bony outgrowths (bone spurs) start grow causing further joint stiffness and pain. If your knee arthritis is stopping you from doing what you love – check out this resource: Comprehensive Guide to Knee Osteoarthritis

Meniscal Irritation

Your knee has two menisci. They act as shock absorbers, dampening the impact as you run. With excessive training, they can become irritated as micro-tears occur in the tissue. Cross training can be used as a respite from the high impact of running. Regardless, it may take some time for the meniscus to calm down as it has a poor blood supply. If you want to jog or run despite a meniscus injury, an unloader knee brace could be an option worth looking into.

What’s Next?

  • Regardless of what is causing your knee pain, the RICE method (REST – ICE – COMPRESSION – ELEVATION) is a simple low risk treatment that could provide you with pain relief.
  • If you don’t yet have a firm diagnosis it is strongly recommended that you visit your doctor or a physical therapist.

References

  1. Dahlkvist, N. J., Mayo, P., & Seedhom, B. B. (1982). Forces during squatting and rising from a deep squat. Engineering in medicine, 11(2), 69-76.
  2. Lavine, R. (2010). Iliotibial band friction syndrome. Current reviews in musculoskeletal medicine, 3(1-4), 18-22.
  3. Pegrum, J., Self, A., & Hall, N. (2019). Iliotibial band syndrome. BMJ, l980. doi:10.1136/bmj.l980
  4. Neal, B. S., Lack, S. D., Lankhorst, N. E., Raye, A., Morrissey, D., & van Middelkoop, M. (2019). Risk factors for patellofemoral pain: a systematic review and meta-analysis. Br J Sports Med, 53(5), 270-281.
  5. Rio, E., Kidgell, D., Purdam, C., Gaida, J., Moseley, G. L., Pearce, A. J., & Cook, J. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med, 49(19), 1277-1283.