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Knee pain is one of the most common ailments that runners experience. This doesn’t mean that “running is bad for you”, but it's a good idea to figure out the reason for your pain if you want to resolve it before it gets worse. There are a number of potential explanations for pain, but there are four conditions that we see most often at Wagner PT & Performance.

• Patellofemoral pain syndrome

• Iliotibial band friction syndrome

• Patellar tendonitis

• Knee joint osteoarthritis

If you’ve been running for long enough, it’s likely you’ve heard of these, but you probably weren’t really told what they mean. Keep reading to learn why your knees hurt when you run.

One of the Most Common Reasons Runners Have Knee Pain

Patellofemoral Pain Syndrome (PFPS)

This is by FAR the most common condition we see. It happens a lot in runners, but also affects athletes of all kinds. PFPS doesn’t describe any one specific tissue injury, but rather any condition that causes abnormal motion of the kneecap on the femur.

Some of these include:

• Hip weakness

• Muscle imbalance

• Excess movement of the patella (knee cap)

• Inefficient alignment of lower body when running

Patellofemoral Pain Symptoms in Runners

People with PFPS typically report pain generally in the front of the knee or on the underside of the kneecap. Any activity involving loading the knee when it is bent usually causes the most pain.

Some of these activities include:

• Running

• Squatting

• Stair climbing

How Runners Can Fix Patellofemoral Pain

We often find that hip weakness leads to patellofemoral pain. When the hip muscles aren’t strong enough to keep the leg steady and aligned, the knee can collapse inwards and throw off the normal movement of the kneecap. The best way to solve this problem is to work on strengthening the hips.

Exercises like the ones below are great places to start.

Hip Abduction wall slides

Lateral step down

Can The IT Band Cause Knee Pain?

Iliotibial Band Friction Syndrome (ITBFS)

If you’ve ever felt a nagging pain at the outside of the knee while running it may be ITBFS. The iliotibial band (ITB) is that tight band along the outside of the thigh that runs all the way down to the outside of the knee.

The bottom end of the ITB can rub against the bone during repetitive bending and straightening of the knee causing friction and pain.

This is common with a number of activities:

• Running

• Cycling

• Jumping sports

IT Band Friction Symptoms

Pain with ITBS is located at the outside of the knee. Normally symptoms are felt during activity but can linger for a while after you stop. It may also be tender to the touch.

How Can Runners Treat IT Band Friction Syndrome?

ITBFS is a common overuse injury, meaning it is often caused by doing “too much too soon”. We see it often in runners after they’ve increased mileage (either too much or too quickly). Just making sure you allow enough time to adjust to the added mileage can help reduce risk.

Repetitive tension on the ITB can cause symptoms as well. We typically see this in runners with hip weakness. If the hip is weak, the pelvis can dip down which pulls on the ITB.

Exercises to help strengthen the hip, especially with a bent knee, can help prevent this tension.

Clamshell

Split squat

Knee Tendonitis in Runners

Patellar Tendonitis (PT)

Any kind of “itis” indicates inflammation to a tissue caused by overuse. In PT the patellar tendon is inflamed due to overuse of the quads. The patellar tendon is what connects the quads to the lower leg to allow the knee to straighten.

You may have heard of it as “Jumper’s Knee” because it’s common in sports that require repetitive knee bending and straightening, like with jumping.

Patellar Tendonitis Symptoms for Runners

If you have pain at the front of the knee below the kneecap you might have PT. It may be tender to the touch or felt during activity, likely running or jumping. Typically there would be pain during activity performance which gradually subsides as you rest.

How to Fix Patellar Tendonitis

We know how important the quads are for running, so keeping them strong will allow them to respond to the repetitive load we place upon them. Isometric and eccentric exercises are a great way to build tendon strength.

Wall squat with calf raise

Exercises that help strengthen the posterior chain muscles can also help to restore balance between quads and the muscles on the back of the leg such as the glutes.

Hip thrust

Knee Arthritis and Running

Osteoarthritis (OA) in Runners

Usually referred to simply as “arthritis”, OA is the degenerative wear and tear of the joint cartilage. This can come on naturally as we age, or can develop after injury to the knee.

Running a moderate amount has actually been shown to be good for your knees, but running in the presence of inflamed OA may be painful.

Knee Arthritis Symptoms

Typically pain is felt around the knee joint during activity. There may also be a loss of range of motion where you can’t fully bend or straighten your knee. Stiffness is also common, especially after sitting for a long time.

How to Treat Knee Arthritis in Runners

Prolonged or high volume impact activities are most affected by OA. Building strength is crucial to reduce the force of impact to the joint. Weight bearing exercises that don’t require too much knee bend are a great way to build low impact strength without increasing pain.

Deadlift

If weight bearing exercises are too much for the knee, gym machines can be a good substitute to help to lessen the intensity as the knee bends.

Leg press

General Recommendations for Knee Pain when Running

There can be a lot of reasons your knees hurt when running, but if we had to summarize our recommendations for most runners, they would look something like:

• Strengthen your hips (and just strength train in general)

• Be smart about increases in mileage and speed

• If you’re going to change shoes, running surface, etc. do it gradually

• Mix it up. Occasionally do your cardio a different way, do various kinds of strength training and other activities like yoga to give your body some variety.

Running Evaluations in Lakeville, MA

At Wagner PT & Performance, we specialize in working with runners and endurance athletes. Whether you are dealing with an injury or want to optimize your running with our runner’s screen and gait analysis, give us a call.

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