Knee pain can hamper you when running and impact your performance in a negative way.
Not only can it be debilitating, but it can put you on the sidelines for weeks or even months as you recover.
But in order to treat knee pain properly, you need to know the cause. There are multiple reasons for knee pain when running.
Let’s have a look at what could be causing your pain, how to prevent it, and how to treat it so you can run pain-free.
Most Common Reasons for Running Knee Injuries
Knee injuries can occur for any number of reasons. The most common reason is overuse, but others include:
- A sudden increase in mileage or pace
- Running on hard, unforgiving surfaces like asphalt
- Weak or tight muscles around the knee
- Being overweight, which places extra strain on the knee joints
- Wearing the incorrect shoes for your foot structure or gait
- Running with poor form, which places stress on the joints and muscles
- Structural abnormalities, like an unusually high/low kneecap
Most Common Knee Injuries
1. IT Band Syndrome (Iliotibial Band Syndrome)
Iliotibial band syndrome is a painful and common lateral knee injury.
The IT band connects to the outside of your hip, runs down the outside of your thigh to your knee, and to the top of your shin bone.
It stabilizes the lateral part of the knee when the joint flexes and extends. With repetitive flexion and extension of the knees from running, the IT band can become tight, inflamed, and irritated.
This causes friction—irritation—when the IT band moves over the bone and causes pain on the outside of the knee. It can also cause referred pain in the hip.
You may also notice a burning or aching sensation when you move that goes away once you’ve warmed up. However, it gets worse over time. You may start to notice tenderness on the outside of your knee or pain that goes up and down your leg.
The pain may be accompanied by a clicking, snapping, or popping sound and feeling on the outside of your knee.
IT band syndrome is especially common in long-distance runners. But it can affect anyone, especially if you’re sitting down for long periods with bent knees. You may also develop IT band syndrome if you wear high heels or climb stairs frequently.
In some cases, IT band syndrome can develop due to weak hip, gluteal, and abdominal muscles, or weak knee extensors, knee flexors, and hip abductors.
Pre-existing conditions such as knee arthritis, bowlegs, flatfeet, or unbalanced leg lengths can cause the IT band to become inflamed.
How Do You Prevent It?
Small actions can be taken to prevent IT band syndrome from developing or recurring.
Always allow yourself plenty of time to warm up, and stretch properly before starting any physical activity. Incorporate a proper cool-down after your run or workout. This will help prevent irritation and inflammation of the IT band.
Structure your training sessions so your body has enough time to recover between them. Make sure to maintain your flexibility by stretching your IT band, hip muscles, thigh muscles, and hamstrings often.
Include strength exercises into your workout program to help correct any muscle weaknesses or imbalances. Focus on strengthening your abdominals, lower back, hips, and leg muscles.
Add some side-to-side movements to your training and pay attention to your running form. Try running on a flat surface or alternate between each side of the road when running.
While you may find it comfortable to run with a long stride, a shorter stride can help prevent IT band syndrome.
Make sure you’re wearing shoes that provide adequate support for your gait—if you overpronate or supinate—and foot shape.
Replace shoes that are worn and no longer provide adequate support. This will prevent excessive stress on your bones and joints when you run, which can lead to IT band syndrome.
How Do You Treat It?
The best way to treat IT band syndrome is to rest. This may mean you have to stop running for a week or two. But to maintain your fitness, you can do low-impact activities like swimming.
Apply ice to the affected area several times a day for 10 to 20 minutes. This will help alleviate pain and reduce swelling. You can also gently massage the affected area either by hand or with a foam roller.
You can use nonsteroidal anti-inflammatory drugs, such as ibuprofen—Motrin—Nuprin, Advil—naproxen—Aleve, or Naprosyn.
2. Runner’s Knee
Runner’s knee, also known as patellofemoral pain syndrome, is a broad term used to describe pain in front of or around the kneecap.
Your kneecap is a “floating” bone that sits on top of the trochlear groove. When you extend or bend your leg, the patella glides up and down this groove. The kneecap is protected by cartilage, which helps it to glide smoothly over the bones.
When the cartilage becomes irritated or inflamed, it causes friction during movement, leading to pain.
You may experience a dull, aching pain, and the kneecap may be tender to the touch. This could be accompanied by grinding, rubbing, or clicking sensations that you may also be able to hear.
You may feel pain when you climb stairs, walk, or sit down or stand up, or if you’ve been sitting with your knee bent for a long time.
While runner’s knee is most often due to overuse from the repetitive motion of running, there are several factors that can contribute to it.
Misalignment of the kneecap will prevent it from moving smoothly through the trochlear groove. This will cause irritation, inflammation, and pain.
Accidents happen. An injury to the knee from a fall, or a dislocation of the kneecap would cause pain.
If you have hypermobility in the joints of your feet—when joints move more than normal because of loose ligaments—or if you have flat feet or overpronate, you could be at a higher risk of developing a runner’s knee.
These conditions change the way you walk, which places excessive pressure on the knee.
Weak or tight thigh muscles can affect the tracking of your kneecap along the trochlear groove.
When you bend or extend your leg your kneecap may be in a higher or lower position than normal. This will lead to irritation and inflammation around the joint.
How Do You Prevent It?
To prevent runner’s knee, you should add strength training exercises to your training schedule.
Strengthening exercises will help to keep the knee stable while you’re running, reduce tightness, and increase flexibility.
Focus on strengthening your core, hips, glutes, quadriceps, and hamstrings. Try adding the following exercises to your training program at least twice a week:
- Step-up
- Clam exercise
- Wall squats
- Standing hip flexor stretch
How Do You Treat It?
Rest your knee as much as you can. Elevate your leg above your heart level when you sit or lie down. You can apply ice to the affected area every 3 to 4 hours, for 10 to 20 minutes. This will help ease the pain and reduce swelling.
You can use an elastic bandage or patellar strap to provide extra support and stability to the knee while it heals. To alleviate pain, you can use nonsteroidal anti-inflammatory drugs.
3. Knee Bursitis
Bursitis of the knee is caused by irritation or inflammation of one or more of the bursae in your knee. These small synovial fluid sacs reduce friction and help cushion the pressure points between your skin, muscles, tendons, and bones.
But when one of them becomes irritated and produces too much fluid, it causes pain and swelling.
Knee bursitis is often caused by pressure placed on the knee for a long time. Bursitis can develop from an injury or chronic overuse of the knee.
Medical conditions such as rheumatoid arthritis can create inflammation in the surrounding tissue, which places pressure on the bursae. This can cause the bursa to become inflamed and painful.
The symptoms of bursitis usually develop over time, but they can also come on suddenly. You may experience pain just below the knee joint towards the inner side, or you may feel pain on the kneecap.
You may notice that the area around the bursae is swollen, warm, and tender to the touch.
How Do You Prevent It?
The best way to prevent knee bursitis is to increase workout intensity gradually. You can increase your mileage and speed by 5 to 10 percent per week.
Add the following exercises and stretches to your warm-up or training program to help prevent knee bursitis:
- Heel slide
- Straight-leg raises to the front
- Floor quad sets
How Do You Treat It?
The best thing you can do is rest your knee, and avoid movements that make your symptoms worse.
Ice the affected area 3 to 4 times a day for 10 to 20 minutes. You can use a mild over-the-counter anti-inflammatory to alleviate the pain. Taping your knee or wearing a knee brace may help.
4. Patellar Tendinitis
Patellar tendinitis—also known as jumper’s knee—is a painful injury to the tendon that connects your kneecap to your shinbone—tibia. The patellar tendon allows you to fully extend your knee.
While patellar tendinitis is most often caused by overuse in exercise or sport, anyone can develop it. It develops gradually and becomes worse every time the tendon is overstressed.
This causes tiny tears to develop in the tissue. Repeated strain will cause the tears to develop faster than the body can heal them.
At first, you may experience mild, sporadic pain and tenderness at the base of your kneecap. You may have a burning sensation in the kneecap followed by some swelling only after you run or do a workout.
As the tendon becomes weaker and more damaged, the pain becomes progressively worse. It can interfere with daily activities like climbing stairs, bending, or sitting.
You may develop patellar tendinitis if you have tight leg muscles, muscular imbalances, or misaligned feet, ankles, and legs.
Medical conditions like rheumatoid arthritis and metabolic diseases such as diabetes disrupt blood flow to the knee. This may weaken the tendon and lead to patellar tendinitis.
How Do You Prevent It?
Fortunately, there are steps you can take to prevent patellar tendinitis.
Make sure to warm up and cool down properly and incorporate stretching exercises into your routine. Increase frequency, intensity, and distance gradually.
Wear a patella brace to support the knee and reduce the amount of pressure on it.
How Do You Treat It?
Rest your knee and avoid activity that puts force on it. You can apply ice to the area and take over-the-counter anti-inflammatory medication to reduce the pain and swelling.
Add the following strength exercises—for the quadricep muscles—to your workout. The movement must be done slowly and deliberately:
- Straight leg lift
- Wall slides
- Single leg knee bends
- Drop squats
5. Meniscus Tear
In each knee, there are two menisci—C-shaped pieces of cartilage. One is on the outside of the knee and the other is on the inside. These act like cushions and protect your thigh and shin bones.
A meniscus tear can be due to overuse, excessive pressure on the knee, or if your knee twists with your full weight placed on it. Runners can tear a meniscus if they suddenly change direction, or if you come to a sudden stop.
If you’ve torn a meniscus you feel a popping sensation around the knee at the time of injury, and as though your knee may give out beneath you.
There will be swelling, pain, and stiffness. When you try to move your leg, it can feel like your knee is locked in place.
You may experience pain on the inside or the back of your knee, and it can be tender to the touch. You won’t be able to put any weight on your knee without it being painful.
How Do You Prevent It?
While it may be more challenging to prevent a meniscus tear, there are precautions you can take. Plan your running route so you can avoid making any sudden stops or direction changes.
Warm up properly before starting any physical activity. Add stretching and strengthening exercises to your workouts to strengthen the quadriceps, hamstrings, abductors—outer thigh—and adductors—inner thigh—muscles.
Consider adding the following into your workout:
- Quadriceps setting
- Straight leg raise
- Hamstring heel digs
- Clams
Give your body time to rest and recover properly between sessions. Also avoid increasing the intensity, distance, and speed of your run.
How Do You Treat It?
Avoid any activity that makes your knee feel worse. Depending on the severity of your meniscus tear, you may have to use crutches while it heals.
Rest the knee as much as possible and elevate it above your heart with a pillow while you’re sitting or lying down. Apply ice to the area for 15 to 20 minutes every 3 to 4 hours.
Use a compression sleeve or an elastic bandage—ACE wrap—to control swelling and promote healing. You can take over-the-counter anti-inflammatory medication to alleviate pain and swelling.
Once the pain in your knee has subsided, you can add stretching and strengthening exercises.
6. ACL and PCL Injuries
The ACL—anterior cruciate ligament, in the front of the knee—and PCL—posterior cruciate ligament, in the back of the knee—are two of the strongest major ligaments that criss-cross the knee joint.
They provide the knee joint with stability and allow it to flex and extend while preventing it from moving side-to-side.
You’re more likely to tear the ACL ligament by coming to a sudden stop, a rapid change in direction, landing awkwardly, or taking a direct hit on the knee.
If you fall while your knee is bent, a misstep on an uneven surface, or are hit hard on the shinbone just below the knee, you can tear the PCL ligament.
If you tear the ACL, you may hear a popping sound at the time of injury. Your knee may feel unstable—like it’s going to give way beneath you—and there can be rapid swelling, pain around the knee joint, and a significant loss in your knee’s range of motion.
The symptoms of a PCL tear are often less severe. If you tear the PCL, swelling will happen almost immediately and there may be some instability of the knee, but the pain will be less.
How Do You Prevent It?
ACL and PCL injuries are common and can be serious, sometimes putting you on the sidelines for a few months. But they can be prevented by taking some simple steps.
Add strength training to your workout program with a focus on strengthening the quadriceps and hamstrings.
Improve your balance, as this can help you avoid unnatural twists and turns that could cause ACL or PCL injuries should you need to stop suddenly or make a quick change of direction.
Warming up properly before you start running will loosen the muscles, which can reduce the severity or prevent an injury. Muscles that aren’t warmed up properly remain stiff and are more prone to injuries.
Wear shoes that fit you properly and provide adequate support for your foot shape and gait. This will reduce the risk of trips, falls, and other awkward movements that may result in an ACL or PCL injury.
How Do You Treat It?
Rest your leg as much as you can. Depending on the severity of the injury, you may have to use crutches while your knee heals.
You can wear a splint to help stabilize the joint. This will reduce the risk of further injury. Apply ice to the affected area for 10 to 20 minutes every 3 to 4 hours.
Over-the-counter anti-inflammatory medication can be used to reduce pain and swelling.
7. Knee Stress Fracture
A knee stress fracture is when a small crack develops in the bone. It’s most often caused by overuse. When the muscles in the leg become fatigued, they transfer the overload of stress to the bone, causing a tiny crack.
This is one of the worst injuries a runner can have. It’s hard to treat, as you can’t just splint the bone. It may take several weeks to months to heal completely.
Stress fractures can be caused by increasing the intensity, frequency, speed, and distance of your runs too quickly. Running with bad form or running with worn-out shoes that don’t provide adequate support can lead to stress fractures.
Running on sloped surfaces or going from a soft surface to a hard surface can cause a stress fracture. Being overweight will increase your risk of stress fractures due to the repetitive loading on your joints and bones.
Existing foot conditions such as low or high arches, Achilles tendonitis, bunions, or hammer toes, can affect how your foot strikes the ground. This can place excessive pressure on the knee, which can cause a stress fracture.
Medical conditions like rheumatoid arthritis, osteoarthritis, diabetes, and hyperthyroidism can cause your bones to weaken. The weakened bones may not be able to withstand changes in your activity and cause stress fractures.
You may find that there’s “pinpoint pain” when you touch the bone, or pain that starts when you begin an activity and goes away with rest. But pain can be present throughout your activity or during daily activities.
There may be aching and swelling around the fracture site. Depending on the location of the fracture, you may experience pain or an inability to shift weight onto the affected leg.
How Do You Prevent It?
To prevent a knee stress fracture, make sure you gradually increase the frequency, distance, and speed of your run.
Wear shoes that have plenty of cushioning—for shock absorption—and provide adequate arch support for your foot shape. If you overpronate, look for shoes that will help control your foot’s motion.
Incorporate cross-training into your workouts, as this can help correct muscle imbalances, strengthen muscles, and help avoid repetitive movements that create stress.
Maintain a healthy diet, as this will help you maintain your weight. Ensure that you get enough calcium, vitamin D, and other nutrients to support good bone health.
How Do You Treat It?
Stop any activity that causes pain and avoid high-impact activities like running for 4 to 8 weeks. To maintain your fitness levels, consider low-impact activities like swimming.
Apply ice to the affected area for 10 to 20 minutes every 3 to 4 hours. You can also massage the affected area for 3 to 5 minutes several times a day.
To reduce swelling, elevate your leg above the level of your heart when sitting or lying down. You can use nonsteroidal anti-inflammatory medicines to help relieve pain and swelling.
Depending on the severity of the stress fracture, you may have to use crutches to keep weight off your leg until the bone heals.
What Should I Do If Home Treatment Doesn’t Improve the Injury?
If you don’t see improvement in your condition within 2 to 4 weeks, see your doctor.
Seek medical attention immediately if you’re unable to walk, your range of motion is severely limited, swelling increases, or if the pain is severe and painkillers don’t help.
