Ouch. You've been out there getting your kilometres done and something has gone awry in the knee department. Not ideal. Well, in unsurprising news, knee pain while running is nothing new – it's something runners have experienced for yonks.
In better news, there are lots that can be done about it, once you've determined the possible cause of your knee pain. Consider this your full guide to tackling knee pain whilst running, as well as a handy method to picking the right running shoes for you (a big step to combatting knee pain whilst running).
5 possible reasons your knees hurt when running
Runners experience knee pain for a number of reasons and not all of them are possible to self-diagnose. If in doubt, reach out to a physical therapy specialist, either an osteopath or physiotherapist for expert advice. If you're looking for a bit more information about the most common causes and if your symptoms match up with any of them, keep reading. Osteopath Nadia Alibhai breaks down the five most common causes of knee pain when running.
1. Runner’s knee (kneecap pain)
'One of the most common causes is weakness in the thigh muscles (quadriceps). Your quadriceps hold the kneecap in place so that it tracks smoothly,' says Alibhai. 'If the quads are weak when running or if there is a muscle imbalance, the kneecap can move left to right as opposed to smoothly up and down which can cause friction and irritation.'
How to tell: Runner’s knee shows up as pain under the kneecap that feels worse after running and when you walk up and down the stairs.
2. Jumper’s knee (patellar tendinitis)
'Running can lead to repeated stress on the patellar tendon which can lead to inflammation. This tendon connects the kneecap to the shinbone (tibia) which is responsible for extending the lower leg.'
How to tell: Patellar tendinitis shows up as pain below the kneecap as well as the top of your shin. It hurts when going up and down the stairs but can also worsen when running.
3. Meniscal tear
'Runners are more likely to injure the medial meniscus (inside of the knee) rather than the lateral. Pain can be felt all over the knee with swelling over the knee, a popping sensation during the injury, knee stiffness (especially after sitting), the knee can feel locked and it can be difficult trying to bend or straighten the knee,' explains Alibhai.
4. Iliotibial (IT) band syndrome
'The IT band is a band of tissue that runs along the outside of the thigh, from the tensor fasciae latae where it attaches at the top of the hip, to the outside of the knee. When the tensor fasciae latae becomes tight, it shortens and puts tension on the IT band. The outside knee area can become inflamed, or the band itself may become irritated causing pain. Overtraining is the most common cause as well as an inadequate warm-up or cool-down may also lead to Iliotibial band syndrome.
How to tell: This can display as sharp, stabbing pain on the outside of your knee. The pain comes on around 5 minutes into the run and gets better when the run finishes. Depending on severity pain can persist after runs and affect walking. The pain is usually on the outside of the knee.
'The wearing out of hyaline cartilage (lining of the joint) causes bone to grind on bone whilst running and can cause friction and pain.'
How to tell: The knee can look swollen, feel stiff and painful during running as well as day to day activities.
Why can running cause knee pain?
Something that might come as a surprise – it might not be the running causing your knee pain but external factors outside, like weak muscles, the surface you run on or not wearing proper running shoes (tsk tsk). Here's how each one can cause you to come unstuck.
Muscles weakness / imbalances
'When we run, we don’t just go forwards, we may have to nip around bends, dips in the pavements and quick stops especially in busy cities,' explains Alibhai. 'If the muscles around the knee aren’t strong enough to handle the quick stops and change of direction, they may not support the joint thus leading to knee pain. It is important to strengthen and stretch the surrounding muscles for support of the joint.'
The body is both smart and full of imbalances, that's why the more you run the more certain dominant muscles can take over. This can lead to any number of injury issues, not just in your knees. (Remember that strength training for runners thing we mentioned, this is why it's so important. More on how to add more into your weekly workout routine later.)
Harder surfaces (pavements and concrete, for example) absorb less impact as you run which can cause more pressure to travel back through the knee. Softer surfaces such as grass or sediment can lower the instance of knee pain from running.
Poor running form
There is a right way to run, y'know. Now, everyone's bodies are different, we know that. But, there are a few ways to check your form isn't exacerbating the chances of an injury.
First, though, here's how less than brilliant form can affect your knees:
'Running with your knees slightly tilted inwards (possible flat feet or weak gluteus medius) or with tight hip flexors (due to a pelvic tilt/leg length discrepancy) can affect the way you run,' says Alibhai. 'Poor form may lead to putting excess pressure at the knee joint (which can cause knee pain).'
Try to avoid:
Over-striding (landing with your foot in front of you rather than beneath you)
Letting your knee fall inward as described above
Running with a narrow or overlapping footfall
Incorrect running shoes
Wearing the wrong running shoes (or the wrong running shoes for you) can cause all sorts of trouble when it comes to causing kee pain. The span of running shoes available is wide (from cushioned to high-support) and knowing which ones suit you could be the key to happy, healthy knees.
'Incorrect running shoes that have lost support and cushioning can mean more impact from the ankle, knee to the hip,' explains Alibhai. 'Plus, if you are a beginner, running too fast too soon can strain, muscles, joints and ligaments that aren’t strong enough to handle the workload.' Not good.
Alibhai suggests following the 9 guidelines below to find the best shoes for you:
The shoe should fit properly from heel to toe. When putting your foot in, play the piano with your toes, meaning the fit should be roomy enough at the forefoot.
Should feel comfortable with your regular running stride.
Have your feet measured every time you buy and always try the shoes on for fit. Sizes differ between brands.
The sole should be shaped like your foot and smooth wherever it touches, not binding or chafing anywhere.
The back of the shoe, also known as the heel collar. Check to see whether the curve on the back irritates your Achilles tendon
Look for a heel that allows comfortable ankle motion.
The toe box is the part at the upper front of the shoe which is often capped with a reinforced toe bumper to protect from stubbing. Look for a toebox that allows the foot to flex and spread out naturally in both width and length without rubbing your toes.
The outer sole (where the rubber meets the road) should provide durability and traction without adding excess weight or stiffness and should give you stability under the foot.
Forefoot cushioning protects the structures of the foot. Look for a balance between cushioning comfort and a firm push off-platform.
Once you've got to grips with how to pick the shoes for you, shop our edit of the best running shoes for women.
Is running bad for your knees?
It's the age-old question and one people love to weigh in on with (usually) not much more expertise than their own experience. Plus, after that list of veritable knee pain causes, it can seem like running must be bad for your knee joints, right? Not if your strong enough. Alibhai explains:
'Running can be amazing if you strengthen the right areas but if you don’t, it can be one of the most dangerous sports. Running is bad for your knees when the muscles surrounding the knee joint are weak as they can’t support the joint and more pressure goes through the joint. For new runners, it’s important to prepare your knees before running by strengthening the muscles surrounding the knee joint as well as working on your flexibility.'
Strength training is one of the most important things to do as a runner – let's get into why.
Why strength training is so important for runners
'Strength training provides muscle support and strength to the knee joints to protect them whilst running, as well as the surrounding muscles eg. the hips help control the knee and alignment, as well as supporting the lateral trunk movements,' explains senior chartered physiotherapist and Pilates instructor Tracy Ward.
For those not in the know, strength training is anything that forces you to work against resistance as you exercise. And yes, bodyweight training also counts as strength training. It's a brilliant way to build lean muscle tissue, increase muscular strength and, something that's crucial for runners, help with endurance, too.
'Strength training also builds muscular endurance to accommodate for long runs or frequent runs,' explains Ward. 'It provides an additional and different stimulus compared to running, which is only linear. Strength training allows the muscles to continually progress, adapt and grow.'
Helpful resources for runners who want to strength train
Try these bodyweight exercises for runners
Learn the basics of strength training for beginners with our handy guide
Clue up on these major strength training benefits
How often should runners strength train?
'Runners should strength train at least three times per week to maintain or increase muscle mass and muscle strength to support their knees,' says P.volve physiotherapist Dr Amy Hoover. 'The knees are primarily a hinge joint and the lower body should absorb shock through the more mobile joints – the foot or ankle and the hip. This is why hip strength and mobility are so important for runners, as the hip muscles are the largest and most powerful of the lower body.'
However, it's not all about lower body exercises like deadlifts, squats and lunges (although these are very important). Also working on keeping your core strong is one of the most important parts of running with good form. Hoover explains:
'Core strength is also very important to support the spine and pelvis during running and high impact activity. Running is done mostly in one plane of motion, so it develops those muscles the most, namely the quads and hamstrings. However, our bodies need to work in three planes of motion, and we need to work the muscles in all three planes to maintain balance and symmetry in the body.'
Try these core exercises to build functional strength in your abdominals, lower back and glutes.
What to do if you've just experienced knee pain while running
This is what senior chartered physiotherapist Ward says to do immediately after you've experienced knee pain whilst running and what to do if the pain doesn't subside after a couple of days.
'If knee pain occurs, take a day or two to rest with ice applied to the knee. Then, try to identify the cause – did you fall, twist it, new trainers, new route, uneven ground, longer distance, or do too many runs close together?'
'If the pain continues or is unidentifiable, see a physiotherapist for assessment. They can diagnose the injury and provide a rehab plan, as well as advising on footwear, pacing, and scheduling of runs and strength training sessions. Kinesiology tape can also be helpful to relieve pain whilst you complete your rehab, as well as allowing you to return to running earlier.'
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