If you feel pain or soreness in one or both knees after running, you aren't alone. There are many factors that can contribute to the development of knee pain in runners. In this blog, we will explore common causes of knee pain, strategies to prevent it, and treatment options for persistent pain. While we will focus in on the common condition known as "Runner's Knee," these prevention strategies broadly serve to improve knee function and reduce pain while running.
What is Runner's Knee?
Medically known as patellofemoral pain syndrome (PFPS), runner’s knee is one of the common causes of knee pain for runners, causing discomfort and hindering performance. This condition occurs when the patella (kneecap) doesn't align or move smoothly over the lower end of the femur (thigh bone), leading to irritation and pain.
Symptoms of Runner’s Knee
Patellofemoral pain syndrome typically manifests as a dull, aching pain around or behind the kneecap, especially during or following activities such as running, squatting, climbing stairs, or sitting with knees bent for a prolonged period. This may make your knees feel unstable or tender to the touch. This condition can also cause a feeling of grinding, rubbing, or clicking when you bend and straighten the knee. These symptoms could be indicators of other conditions, so it is important to have a medical professional provide a diagnosis before seeking treatment. Further diagnostics such as an X-Ray or MRI to assess the integrity of the bone and joint may be necessary.
Causes of Running Knee Pain
Several factors can contribute to knee pain while running, these include:
Overuse – repetitive activities like running or working out without proper rest, excessive overload, and putting too much strain on the muscles and tissues around the knee can lead to inflammation and pain.
Muscle Weakness or Loss – weakness in the lower extremity such as the quads, hamstrings, or hip and glute muscles can alter the alignment of the patella (kneecap), causing it to track improperly and rub against the femur.
Biomechanical Issues – issues can arise along the chain reaction from the foot on the ground up into the rest of the body. Factors such as overpronation of the feet, leg length discrepancies, lower limb stiffness or mobility loss, or improper running form can increase stress on the knee joint, predisposing it to injury and pain.
Inadequate Footwear – wearing shoes that lack sufficient support or cushioning, or wearing shoes beyond their recommended wear life, can exacerbate biomechanical issues and contribute to the development of runner’s knee.
Preventing and Treating Runner's Knee Pain
Fortunately, there are several strategies you can implement to prevent and alleviate knee pain while running.
Flexibility & Mobility - one of the most important components of knee pain is a lack of flexibility and mobility, which plays a substantial role in poor biomechanics and can lead to stress on the knee and therefore pain. Doing proper warm-ups and prioritizing mobility exercises can help to improve this.
Proper Footwear – invest in high-quality running shoes that provide adequate support and cushioning for your foot type and running style. Replace your shoes regularly to ensure optimal shock absorption and stability. Additionally, getting a pair of custom-fit orthotic insoles can help to correct issues with your gait.
Gradual Progression – avoid sudden increases in mileage or intensity, as this can strain the knee joint and increase the risk of injury. Gradually progress your training regimen to allow your body time to adapt and recover. Consider hiring a running coach that can program your running to prevent injury.
Cross-Training – incorporate activities such as swimming, cycling, or yoga into your routine to maintain cardiovascular fitness while giving your knees a break from the repetitive stresses of running. Resistance exercises such as fitness and strength classes or personal training can help maintain functional strength.
Professional Help – a skilled physical therapist can assess your condition, identify contributing factors, and develop a tailored treatment plan to address your specific needs. Also, consider a running assessment from a professional that can record and analyze your running to provide a comprehensive corrective program.
Stretches to Prevent Knee Pain While Running
In this video, physical therapist Bryan Hill walks through several stretches that you can do before and after a run to improve your mobility and prevent knee pain. These stretches target the muscles of the leg that contribute to proper knee function, including the calf, hip flexor, lateral hip, and glute.
Physical Therapy for Runner's Knee
If the preventative measures above are not helping to alleviate your pain, consider seeking professional treatment. Here's how physical therapy can help improve patellofemoral pain syndrome and other knee conditions.
Manual Therapy Techniques – physical therapists use hands-on techniques such as massage, joint mobilizations, and soft tissue manipulation to reduce muscle tightness, improve joint mobility, and alleviate pain around the knee.
Strength and Stability Exercises – a physical therapist will guide you through exercises to target the muscles surrounding the knee, particularly the quads, hamstring, glutes, and hip abductors, to improve knee stability and alignment.
Biomechanical Assessment – physical therapists will assess your running gait and biomechanics to identify any abnormalities or inefficiencies contributing to your knee pain. Based on their findings, they may recommend modifications to your running form, footwear, or training regimen to reduce stress on the knee joint and prevent further injury.
Gradual Return to Activity and Self-Management – as your symptoms improve, your physical therapist will guide you through a plan to gradually return to running and other high-impact activities. They will also provide guidance and education to help you manage this condition on your own and prevent re-injury in the future.
Find the Solution to Your Knee Pain
Knee pain can be a frustrating obstacle for runners, but with the right approach, it’s possible to prevent and manage it effectively. By incorporating strength training, stretching, proper footwear, and gradual progression into your routine, you can reduce the risk of runner’s knee and keep your knees healthy and pain-free for miles to come. Remember to listen to your body, prioritize rest and recovery, and seek professional guidance if needed to optimize your running experience. Here’s to happy, injury-free running!
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Emily McGuire is a Marketing Associate and staff writer for Rehab United. With a Bachelor's degree in International Business from UC San Diego, she is a California native with a passion for writing, digital marketing, health, and wellness.
Medically Reviewed By: Bryan Hill, PT, FAFS, CF-L1, BFRC, is the Chief Executive Officer and co-owner of Rehab United Sports Medicine and Physical Therapy. Bryan received his bachelor’s degree in Physical Therapy and Health Sciences from the University of New England and has been a physical therapist in the San Diego community since 1998. Through a close professional and personal relationship with renowned therapist Gary Gray, and as a member of the inaugural class of The Gray Institute for Functional Transformation (GIFT) fellowship, Bryan has been a strong advocate, pioneer, and expert in the principles of Applied Functional Science. Throughout his experience as both a clinician and an educator in the field, Bryan has not only treated a wide range of patient/athlete demographics and diagnoses, but has helped inspire and lead San Diego’s aspiring clinicians to become the future of medicine.