Why do I get Knee Pain when I Run?

Although us humans were ‘born to run’, letting chronic injuries drag on and on can be debilitating. This in turn affects our activity levels and general health. Knee pain may prevent you from running or force you to cut short some of your training. So why does your knee hurt when or after you run? The simple answer is – It Depends!  Have you had your pain over several weeks or months?

If so, then your knee pain is most likely due to 1 of 3 conditions:

1. Runners Knee (PFPS)
2. Iliotibial Band Syndrome
3. Patella Tendon Pain

There are other causes of knee pain, of course, but most knee pain in runners is likely to be one of the above. Here, we are going help you to figure out which type of knee pain you may be experiencing. As with any injury best advice is to go get your condition assessed by a specialist physio. Our therapists have experience treating runners to ensure an accurate diagnosis and a treatment plan suited your needs. Often knee pain develops in runners over time due to poor running biomechanics, muscle weaknesses or inadequate training routines. The good news is that these are all factors that can be successfully addressed with the correct treatment and rehabilitation plan.

• Patellofemoral Pain Syndrome (PFPS)

PFPS also known as ‘runner’s knee’ affects the kneecap at the front, around and under the kneecap. It typically affects runners with poor hip strength and control. It also affects those of us who sit for long periods of time such as office workers. It’s also quite common in growing teenagers. The pain will be general around the knee and is difficult to pinpoint. You will notice it will be aggravated going up stairs and hill climbing. The cause is usually due to the quadriceps and hip muscles. If you have some tightness in some muscles and weakness in others, then the patella will track towards the outside of the knee and cause pain and inflammation.

• Iliotibial Band Syndrome

 If you are feeling a tight, sharp pain on the outside of your knee, you are likely to be dealing with iliotibial band syndrome. The I.T band is a band of strong tissue that runs along the outside of the thigh from the hip to the outside of the knee. It works to help stabilise the knee during running. Due to overtraining and/ or poor neuromuscular control the ITB becomes tight. In turn, the outside of the knee becomes irritated, causing pain. Despite popular belief, regularly foam rolling the I.T band will not solve the problem. Foam rolling may only give short term relief and the condition will most likely return when you go back running. With the help of your physio it is important to ensure good hip and leg strength and control. Addressing previous injuries and running mechanics are paramount.

• Patellar Tendinopathy

Pain from just below your knee cap to the top of the shin bone may be an indication of patellar tendinopathy, a common overuse injury in runners. This is caused by repeated stress on the patellar tendon. This repeated stress results in micro tears within the tendon itself which the body attempts to heal. The tendon doesn’t get a chance to repair itself due to overtraining or a spike in running distance/speed. Therefore, the tendon becomes weak and inflamed. Firstly, you will notice it after a run or the next morning. Eventually the pain is noticeable during running as you haven’t given the tendon adequate time to rest and recover.  Again, it is vital to let inflammation and pain settle down along with addressing the underlying reasons why this developed.

Top Tips to Help your Knee Pain.

1. Ice & Anti-Inflammatories (NSAIDS): This helps to reduce pain and swelling initially. It provides short term relief only. Aim to ice for 15 mins every 2-3 hours for the first 2 days to limit swelling. NSAIDS also help to reduce the pain.
2. Rest your knee: As much as possible, avoid movements that make the knee hurt, like climbing stairs or sitting and standing for long periods. It may sound obvious but it’s important to stop running to avoid aggravating the knee even more.
3. Swim or Cycle: These are good options so that you don’t have to completely stop cardio training. Find a pain free activity you enjoy until your knee fully recovers.
4. Soft Tissue Treatment – Aims to relieve tight and sore muscles by applying and releasing deep pressure to help loosen the muscle tissue. This is targeted to the muscles that may be contributing to your knee pain.
5. Get Professional advice: on your knee injury, running technique and running training plan.

How can Physiotherapy help my Knee Pain?

To avoid ongoing pain during or after running it is best to consult with a physio before it becomes worse. Firstly, physiotherapy will help to reduce your pain and any areas of tightness via manual therapy techniques. Secondly, we will identify any biomechanical issues that may be contributing to the development of your injury. This is a vital part of rehabilitation and can be carried out by your physiotherapist. Finally, we assess whether you have the adequate neuromuscular control and strength in the hips and leg muscles to reduce excessive force on the knee joint.

Our Treatments for Running Injuries Include:

• Manual Therapy & Soft Tissue Massage
• Shockwave Therapy
• Strength and Neuromuscular Exercises
• Biomechanics Assessments- Identifying poor movement patterns
• Mobility & Flexibility Exercises

Factors associated with Knee Pain in Runners

• Poor Running Mechanics
• High BMI
• Poor Range of Motion
• Poor Co-ordination & Strength
• Females have a higher risk due to wider Hip Angle
• Previous Injury

5 Top Tips for Runners

1. Avoid Over Striding: This happens when your foot lands too far in front of your body. It causes increased pressure on landing at the hips, knees and ankles. Aim to land softly to help your foot land closer to the centre of your body.
2. Have a Training Plan: If you have signed up for an upcoming race, your instinct will be to ramp up the mileage ASAP. It’s best to avoid doing this as it takes time for our body to adapt to training. Allow enough time for rest and recovery. Don’t increase your mileage by more than 10 percent each week.
3. Strength Training: Strength training has been proven to reduce the risk of injuries in runners. Focus on the core, hips and thighs to reduce landing forces and prevent injury.
4. Plyometric Training: Running involves complex dynamic movements. Therefore, it is important to prepare the muscles and tendons for this. Plyometric training aims to optimise muscle fibre recruitment, so we can run more efficiently.
5. Rest & Recovery: For you to get the most out of your training it is vital to ensure you maximise recovery. Our bodies go through a cycle of adaptation when we train and rest. Neglecting to refuel appropriately and take enough rest limits improvements. Ensure you are properly hydrated and refuel with carbohydrates and protein.

Symptoms that aren’t caused by the Above conditions:

Here is a list of symptoms that you should not see with any of the above conditions

• Severe Swelling
• Instability with Locking or Clunking
• Sudden onset of symptoms – traumatic mechanism
• Throbbing pain at the back of the knee