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Knee Pain In Runners

Feb 5, 2020 By Michael Richardson

Knee pain is the archenemy of runners. Whether you are training for a marathon or just trying to get in shape, knee pain can derail your progress and can be frustrating to manage. As a family physician and a runner, I have shared your pain throughout my running career. This type of joint pain is common, but there are many ways to treat and prevent running ailments. Check out these tips on how to get back to pain-free running.

1. Patellar tendinopathy

This is one of the most common knee pain injuries in runners despite its common name of "jumper's knee". I see this a lot in athletes who cause too much stress to their knees, especially in activities that require a lot of jumping or pressure to the knees (basketball, volleyball, long distance running, etc).

The pain is located in the front of the knee, below your knee cap but above your shin. It is usually tender to touch and is reproducible when you do a single leg squat.

To treat it, try to incorporate some stretching before and after your run, plus every other chance you get.

Pro tip, before a run, try to engage in active or dynamic stretching (flexing and extending the muscle, increasing the range of motion) as its been shown to lead to better athletic performance. Static stretching (forcibly stretching beyond its baseline) on the other hand, has not been shown to prevent injury before an activity and may actually impair athletic ability as the muscles may become overstretched. By having a good warm up and cool down routine, you may be able to avoid this injury and stay on your running path to success.

2. Patellofemoral Pain Syndrome

This is the type of knee pain I see the most as a family physician. The story is usually along the lines of someone ramping up their training or exercise routine, and then slowly starts to develop knee pain. Everyday activity may seem fine, but going down the stairs hurts…. a lot.

The pain can range from being vague to sharp, and the location can be hard to pinpoint as it can be felt almost all around the kneecap. The driving factor of the pain is from overuse and the kneecap being misaligned when you are running, causing a lot of friction and irritation underneath the kneecap which becomes sensitive and painful.

The best treatment when this type of pain is a brief rest to allow the inflammation to settle to the point where you can walk and do light activity without pain. Stretching during this time may be helpful. The next step is to correct the misalignment with leg and core strengthening, focusing on your quadriceps (front of your legs), hamstring (back of your leg), glutes (your buttocks), and lower back. Try to ease yourself back in your running routine and increase your mileage slowly to prevent reinjury.

Pro Tip: Cross training (activities other than running) is a great way to develop muscles you may be neglecting on your runs. Switching things up not only keeps things fresh and fun, you also reduce your risk of an overuse injury like patellofemoral syndrome and may even improve your overall running performance!

3. Iliotibial (IT) Band Syndrome

IT band pain is my personal archnemesis as it can be quite debilitating and tough to treat. This pain usually is located just above the knee, along the outside of your leg, but can also lead to lower knee pain and hip/glute pain. Your IT band is a thick connective tissue that starts at your hip and extends just past your knee. Pain comes about when the band gets so tight that it starts flicking across the bony protrusions around your knee or hip, causing irritation. Not a fun feeling.

Unlike a muscle, you can't stretch out connective tissue, but you can stretch the muscles it is connected to. Focus on stretching and strengthening your glutes and hip flexors to overcome this nagging pain, and you’ll be back to running in no time.

A common belief is that foam rolling can help IT band syndrome, but this is a half truth. Foam rolling the IT band (rolling up and down the side of the leg) has not been proven to be effective in reducing IT band symptoms but rolling out the glute has been shown to help. This makes sense because although the IT band does not stretch, the muscles connected to it can which may help release the tension.

When to see a doctor

If your knee pain has been lasting more than a week and has not been improving with rest, it may be helpful to talk with your primary care provider. Your PCP will be able to assess you for other more concerning causes of knee pain, such as a stress fracture or a ligament tear, and if an x-ray or an MRI may be needed. They will also be able to connect you with a physical therapist who can provide more structure on your rehabilitation routine and get you better faster.

Unsure on how to manage your knee pain? Come in for an appointment. Happy running!

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Michael Richardson

The One Medical blog is published by One Medical, a national, modern primary care practice pairing 24/7 virtual care services with inviting and convenient in-person care at over 100 locations across the U.S. One Medical is on a mission to transform health care for all through a human-centered, technology-powered approach to caring for people at every stage of life.

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