Common Causes of Knee Pain When Running

Do you have side or outside knee pain while running? You're not alone. Soreness in one or both of your knees is a common complaint among runners. While knee pain in runners is often dismissed as "runner's knee," it's important to identify and treat the cause in order to reduce the risk of long-term injury.

It's important to target the area of the knee most affected. Depending on the severity of your knee pain, you may need to see your doctor. Knee pain doesn't have to prevent you from running outside or force you to cut your runs short. The following guide can help you pinpoint the cause of your knee pain and get you back on track with your running schedule.

Basic Knee Anatomy

Your knee is comprised of multiple joints. The tibiofemoral joint connects your thigh bone (femur) to your lower leg (tibia). The patella, or kneecap, is a protective structure that connects to the femur and forms the patellofemoral joint.

These joints are supported by a network of muscles, tendons, and ligaments that help the knee flex, extend, and rotate (minimally) through important movements such as walking, running, kneeling, and lifting.

There are often muscular imbalances that can be managed with exercise or other simple changes, such as wearing a knee sleeve or brace. If the pain persists after a week or so of self-treatment, make an appointment with a physical therapist or physician for evaluation and treatment.

Side Knee Pain: IT Band Syndrome

If you feel a sharp, stabbing side or outside knee pain, you may be dealing with iliotibial band syndrome (ITBS), a common injury among runners. The iliotibial band (IT band) is a band of tissue that runs along the outside of the thigh, from the tensor fasciae latae (TFL) where it attaches at the top of the hip to the outside of the knee. It helps to stabilize the knee and hip when you run.

Causes of Knee Pain

When the TFL is tight, it shortens and puts tension on the IT band. The outside knee area can become inflamed, or the band may become irritated, causing pain. Overtraining is the most common cause, but running on a banked surface, inadequate warmup or cooldown, or certain physical abnormalities may also lead to ITBS.

Knee Pain Treatment

Studies show that self-treatment may effectively treat IT band syndrome for outside knee pain Options include reducing your miles and icing your knee to reduce inflammation. The use of anti-inflammatory medications such as ibuprofen may also be helpful. Studies show wearing soft running shoes can help alleviate the condition.

You can keep running but you should stop running as soon as you begin to feel any pain. Reduce hill training and ensure you run on even surfaces until you've healed.

Prevention

If you notice the early signs of ITBS (such as tightness or outside knee pain), you can prevent it from worsening by doing strength and flexibility work two to three times a week. To strengthen the area, perform leg exercises that activate the glutes using light weights or no weights. It's also worth having a physical therapist assess to determine any weak areas. Those who have ITBS also often have weakness in their hips.

• Strength training: Incorporate regular strength training into your workout routine. Exercises such as single-leg squats, balance training, and clamshells are particularly beneficial for those prone to ITBS. 
• Flexibility exercises: You can perform hip stretches to increase mobility and reduce pain. Make sure you stretch and roll both legs, as some runners focus on the injured leg and develop ITBS in the other leg. You may also want to see a physical therapist for deep tissue massage.
• New running shoes: Like most running injuries, if you don't determine and treat the root cause of the injury, you're likely to experience ITBS again. For some people, better footwear—like Brooks running shoes—helps prevent a recurrence of outside knee pain while running. You can also have your feet and your gait analyzed at a sport-specific running store.

Kneecap Pain: Runner's Knee

If you have soreness around the front of your knee or behind the kneecap, you may have runner's knee, more formally known as patellofemoral pain syndrome or anterior knee syndrome. Running downhill, squatting, going up or down stairs, or sitting for long periods can aggravate the condition.

Causes of Runner's Knee

Researchers have identified different causes of runner's knee: a structural problem in the knee joint; weak muscles; tight hamstrings; tight Achilles tendon or IT band, overtraining; poor foot support; or misaligned gait patterns.

One of the most common causes is weakness in the quadriceps, which hold the kneecap in place so it tracks up and down smoothly. The kneecap will move left and right slightly if you have quadriceps weakness or a muscle imbalance. This movement causes painful friction and irritation.

Treatment

To treat runner's knee, try icing your knees immediately after running. This helps to reduce pain and inflammation. You can also try using kinesiology tape to help reduce swelling and improve circulation while running. Experts also advise elevating the leg and using compression knee wraps and anti-inflammatories like ibuprofen. Arch support in your shoes may also help alleviate pain in some runners.

Stretching and strengthening exercises are also important. Focus on the quadriceps, the muscles that help support and stabilize your kneecap. Simple exercises, such as forward lunges or straight leg raises will help to increase strength in the quads. These exercises should be performed after a run when the muscles are warm.

Prevention

To prevent runner’s knee, make sure that you wear proper running shoes for your foot type. Also, replace your shoes often (every 300 to 400 miles) as lack of shoe cushioning can lead to runner's knee. Good insoles with the right arch support can help with knee pain.

Although some runners can treat and prevent future outside knee pain by following the above steps, others may need further treatment. You may need to visit a physical therapist who can guide you in stretches and exercises. If your runner's knee is caused by overpronation (foot rolling inward when you run), you may need to see a podiatrist for custom-fitted orthotics.

Kneecap to Shinbone Pain: Jumper's Knee

Pain from the top of the kneecap to the top of the shinbone may indicate patellar tendonitis, a common overuse injury. The condition is also called jumper's knee because it is common in sports that involve jumping.

Those with jumper's knee feel pain, tenderness, and swelling near the patellar tendon where the kneecap meets the shin. When the condition is in its early stages, you might only notice it when running.

Causes

Patellar tendinitis is caused by repeated stress on your patellar tendon. Initially, the stress results in weakness in the tendon. If left untreated, the weakness results in tiny tears.

Treatment

Because jumper's knee can mimic other conditions, experts advise that you get diagnosed by a healthcare professional. Once diagnosed, it is likely that you will be told to stop running until the patellar tendonitis heals.

Treatment may include icing the area, elevating your knee, nonsteroidal anti-inflammatory medicines (NSAIDs), and stretching and strengthening exercises. For example, quadriceps stretches are often prescribed. Calf stretches and hamstring stretches are also recommended before exercise.

Prevention

Regular strength training and stretching keep the quadriceps strong and agile to prevent jumper's knee. Strength training should focus on eccentric movements that involve lengthening muscles. But avoid making too many changes to your strength training routine. Additionally, wearing the right running shoes can make all the difference. Make sure your shoes have the right support and aren't worn out.

All-Over Knee Pain: Meniscus Tear

The meniscus is two wedge-shaped pieces of cartilage that act as shock absorbers between the femur and tibia. Meniscus tears can happen when a person changes direction suddenly while running or suddenly twists their knee. Older runners are more at risk, as the meniscus weakens with age.

Causes

Runners more commonly injure the medial meniscus (inside of the knee) rather than the lateral meniscus (outside of the knee). Symptoms of a meniscus tear include general knee pain, swelling all over the knee, a popping sensation knee stiffness (especially after sitting), a feeling as though your knee is locked in place when you try to move it, and difficulty bending and straightening that leg.

Many people can continue walking with a meniscus tear. You may even be able to continue running with a meniscus tear, although it is not recommended.

If you suspect a meniscus tear, visit your healthcare provider for a proper diagnosis. During an exam, they will evaluate the knee and recommend diagnostic imaging, such as an x-ray or MRI. They will also conduct the McMurray test to assess the range of motion and classify the severity of the tear.

Treatment

Treatment for meniscal tears depends on its size and location. Sometimes small tears heal on their own with proper self-care. Treatment for more severe tears can include a meniscectomy (removal of the meniscus) or meniscal repair (usually a minimally invasive procedure). Recovery following surgical treatment usually consists of bracing the knee and non-weight-bearing activities for four to six weeks and a rehabilitation program.

The best treatment will depend on several factors, including the severity of your tear, your age, your activity level, and your willingness to comply with treatment. The current trend in the management of the condition is to try to save the meniscus rather than to remove it with surgery.

Non-surgical management of a meniscus tear usually includes anti-inflammatory medication and icing your knee to reduce pain and swelling. Ice your knee for 15 to 20 minutes every three to four hours for two to three days or until the pain and swelling are gone. Your healthcare provider may recommend physical therapy for gentle strengthening and stretching exercises.

Prevention

To avoid meniscus tears in the future, ensure you're wearing the correct running shoes for your foot and running style since wearing the wrong shoes may make you vulnerable to falls or twisting your knee. Perform exercises to strengthen muscles that support and stabilize the knees so you keep them more injury-resistant.

Inner Side Knee Pain: Bursitis

If you're feeling pain over the top of your kneecap or inside your knee, you may be dealing with knee bursitis. This is an inflammation of a bursa located near your knee joint.

Causes

A bursa is a small, fluid-filled, pad-like sac that reduces friction and cushions pressure points between your bones, tendons, and muscles around your joints. In runners, overuse may lead to pain and inflammation in the pes anserine bursa, located on the inner side of your knee about two to three inches below the joint.

When a bursa is inflamed, the affected part of your knee may feel warm, tender, or swollen when you put pressure on it. You may also feel pain when you move or even at rest. Walking up stairs may become difficult. An examination of the knee by your healthcare provider will help to properly diagnose the condition, as symptoms of pes anserine bursitis are similar to those of a stress fracture.

Treatment and Prevention

To ease the discomfort of knee bursitis, you can use the R.I.C.E. method and anti-inflammatory medications. In some cases, your healthcare provider may recommend a steroid injection to relieve pain. Physical therapy is often recommended and involves stretching, strengthening, ice, and pain-relieving treatments. Your therapist might even recommend submersion in an ice plunge bath.

Physical therapy may alleviate pain and prevent future occurrences of knee bursitis. More invasive treatments for knee bursitis treatment may include aspiration or surgery.

Back of Knee: Baker's Cyst

A Baker's cyst, also known as a popliteal synovial cyst, is swelling at the back of the knee. You may feel pain, but it is more likely that you will feel tightness or stiffness in the area and a sensation of fullness. You are also likely to see a bulge.

Causes

These cysts may occur as the result of osteoarthritis or meniscus tears. Baker's cysts are not specifically associated with running, and runners are not necessarily at higher risk for the condition. Because the condition is usually due to an underlying issue, runners may end up with the cyst.

Treatment

If you suspect a Baker's cyst, see your healthcare provider for a proper diagnosis and to determine the underlying cause. Some of these cysts go away without treatment, but it will be important to address the underlying issue. In rare cases, the cysts can burst, so be sure to contact your healthcare provider if you see redness or severe swelling in the area.