If knee pain won’t stop bothering you on your runs, you may find some comfort in knowing you are not alone. The knee is one of the most common body parts to experience running-related injuries, research suggests.
But, despite what some of your non-running acquaintances might claim, running is not in itself bad for your knees. Many large scale, authoritative studies show time and time again that runners actually have lower rates of knee osteoarthritis than non-runners, or sedentary people.
In reality, running can actually prevent this horrible condition, one study concluded: ‘Increasing evidence indicates that exercise training can improve pain, stiffness, joint dysfunction and muscle weakness in patients with knee osteoarthritis.’
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That said, you may feel some pain and swelling, which are symptoms of knee arthritis, during a run – although this can also happen during day-to-day activities, and there are many other possible causes.
Sports doctor Jordan Metzl explained to Runner’s World what four of the most common causes of sore knees after a run are, what their symptoms are and how you can treat them.
Why do my knees hurt after running?
Why do you run? Because it feels good. Because it relieves stress. I get that, because running is also important to me.
I'm a 32-time marathoner who knows how frustrating it is to be injured. It’s the reason why I became a sports doctor. Ripping my anterior cruciate ligament playing football when I was in medical school was devastating – but it was also the single most important event to influence my work. It's what drives me to help my patients. Almost every day I treat runners with sore knees. Many freak out. Can I still run? Will I have to switch to swimming? Thankfully, most knee problems won't keep you off the road for long.
We have great strategies to diagnose and fix many common knee problems that affect runners. This is what you should know about the most frequent running-related knee injuries.
Runner's knee
Where does it hurt?
Runner’s knee feels like a pain located below your kneecap that worsens after running and when going up or down stairs.It is the most common condition affecting runners of all ages and is most frequently seen in runners under the age of 50.
What's going on?
When the patella (kneecap) moves out of alignment during running and doesn’t track properly in the trochlea, the ridge inside the upper leg bone, the femur, causes the cartilage under the patella to become irritated. This is known as patellofemoral pain syndrome, or runner's knee.
How to treat it
- You don't need to stop running – instead, reduce your mileage.
- Strength train with activities that don't aggravate your knee – the stronger the muscles above the patella, the better the knee will feel. Start with exercises like straight leg raises until that doesn't hurt, then squats, then eventually plyometric squats. It's all about progression.
- Consider arch supports (orthotics) and more supportive shoes. Foot mechanics, particularly pronation, play a role in runner's knee.
- Apply ice for 15 minutes twice per day to reduce symptoms.
- Take an anti-inflammatory.
- Foam roll your quads – looser muscles mean less loading force on the patella.
- If the pain continues, see a doctor to get a more definitive diagnosis.
How to prevent it
- Do strength training.
- Foam roll daily.
- Alter your foot mechanics.
- Shorten your stride to help to take pressure off your knees. Aim to do 170-180 foot strikes per minute.
Read our full guide to treating runner's knee
Patellar tendinitis
Where does it hurt?
Patellar tendinitis exists as pain below your kneecap and at the top of your shin – it sharpens on the run and also hurts when you go up or down stairs. The patellar tendon is the band-like tissue that connects the bottom of the patella to the tibia (shin bone).
What's going on?
The force placed on the knee during running can sometimes put too much strain on the patellar tendon.
How to treat it
- Cross-train, and avoid running until you are pain free.
- Unlike runner's knee, you will not diminish the effects of patellar tendonitis by running. I warn my patients about messing with an irritated tendon!
- Apply ice for 15 minutes five times a day.
- Use a patellar tendon strap to help to reduce pain.
- If it doesn't improve, see a doctor.
How to prevent it
- Do strength training.
- Stretch your quads and hamstrings.
- Foam roll daily with a focus on your quads and hamstrings.
Read our full guide to treating patellar tendinopathy
Iliotibial band syndrome
Where does it hurt?
Iliotibial band syndrome manifests itself as a pain on the outside of the knee. It usually starts about five minutes into a run and lets up as soon as the movement ends.
What's going on?
The iliotibial band (ITB) runs from your hip to your knee, crossing both joints. ITB syndrome, otherwise known as ITB impingement, is one of the most painful conditions that can befall a runner. It is often described as 'a sharp pain, like a screwdriver jabbing the outside of my knee after 10 minutes of running'. The pain comes from the tendon rubbing against the outside of the femur, often associated with the development of an enlarged, fluid-filled sac called the bursa, which sits between the ITB and the outside of the femur. When the ITB is tight, the bursa gets squeezed, causing pain.
How to treat it
- While a mild form of ITB syndrome is manageable on a run, you should keep an eye on the pain and watch out if it is worsening. In our office, we advise our patients to stop exercising if the pain is affecting their running form.
- See a doctor or physical therapist to get a proper diagnosis.
- Reduce your mileage and do some cross training.
- Foam roll your ITB on the soft part of your outer thigh.
- If you overpronate, consider orthotics or motion-control shoes.
- Glutes, glutes, glutes. Squats are essential in building hip and glute strength and are one of the best ways to get rid of ITB pain.
- See a doctor if pain persists for possible X-rays, medication or injections.
How to prevent it
- Build strong glute and core muscles – this is key.
- Foam roll your ITB daily.
- Try to do a shorter, quicker stride. Aim for 170-180 foot strikes per minute.
Read out full guide to treating iliotibial band syndrome
Knee osteoarthritis
Where does it hurt?
The symptoms of osteoarthritis (OA) include knee pain and swelling and stiffness in your knee during running, or even during day-to-day activities. OA is common in people over the age of 60. OA has many causes, including genetics, prior injury, and bad luck. There is no evidence that running causes OA.
What's going on?
The wearing out of hyaline cartilage (the lining of the joint) causes bone to grind on bone.
How to treat it
- Contrary to popular belief, movement acts as an anti-inflammatory. Unless you're limping badly, keep moving. Activity keeps joints lubricated.
- Apply ice to the knee area regularly and you may take anti-inflammatory medication like ibuprofen.
- See a doctor. Getting a proper evaluation including a physical examination and an X-ray is important to grade the OA in your knee and to help make a plan moving forward. If your doctor says 'maybe it's time to give up running', find another doctor.
- Highly cushioned shoes or motion-control shoes might help with the pain, depending on the amount and location of OA in your knee. This is diagnosed by X-ray.
- Depending on your foot and running mechanics, running on a softer or harder surface might help to make things more comfortable.
- Lubricant injections (viscosupplements) and platelet-rich plasma (PRP) are helpful in reducing OA symptoms.
- Strength train, especially your lower body. Strong muscles, including glutes, quads and hips, can all help to offload the knee and improve symptoms.
How to prevent it
- Do strength training.
- Find the best running shoe for you.
- Find the most agreeable running schedule for you – and a surface that suits your knees.
