Understanding Running Knee Pain

Pain associated with running can contribute to some forms of overuse injuries. Constantly subjecting the structures holding the joint to mechanical stress as with running, without allowing adequate time for recovery, is a recipe for developing knee pain. For example, excessive jumping, running, or deep lunges are all potential factors for knee pain. However, knee pain for runners is rarely a “do or die” scenario. In fact, many knee injuries with runners, if detected early, can easily resolved with proper treatment.

Statistically, runners who consistently run over 30 miles in a week are more prone to developing knee pain. A sign of a potential problem with runners is when a runner starts to feel knee pain after running a shorter distance on subsequent runs.

The kneecap or patella is a small bone that burdens a complex joint function. It is subject to displacement and friction; two common causes of knee pain in runners. A muscle imbalance in the lower extremity is a common factor contributing to knee pain with runners. The meniscal cartilage separating the distal femur (thigh bone) and the proximal tibia (shin bone) is stressed and compressed with running. The hard marble-like articular cartilage that covers the ends of both of these bones and the back of the patella are vulnerable to injury based on activity, age and work volume.  Over time, with insufficient rest or excessive workloads, the articular cartilage and the menisci are susceptible to degenerative changes.

Bad shoes, especially ones that contribute to excessive supination or pronation with running creates a discrepancies with the normal synergistic muscle stress on the patella.  This change in “patella tracking” is a typical factor with knee pain.

Diagnoses such as patellofemoral pain syndrome (PFPS), chondromalacia, Jumpers knee, patellofemoral tendonitis, ITB syndrome, pes anserine tendonitis, distal quadriceps strains and bursitis are common conditions associated with knee pain in runners.

Signs & Symptoms of Knee pain associated with running

  • Perception of pain after running or with prolonged standing.
  • Knee aching and discomfort with rest.
  • Difficulty bending the knee joint past 70 degrees after running.
  • Any point tenderness near the patella or knee joint lines.
  • Perceiving a popping sensation with knee flexion.
  • Any swelling within or around the knee, which increases with running.
  • Clinical evaluation of a Quadriceps angle or “Q Angle” greater than 15 degrees.
  • A lateral displacement of the patella when compared to the other knee joint.
  • A grinding or crepitation behind the kneecap with volitionally bending and straighten of the joint.

Professional Treatment for knee pain

  • Elevate your legs, “rollout” the front & sides of your thighs and then ice your knees immediately after running.
  • Practice and embrace a lower extremity flexibility program, period.
  • Be consistent with a quadriceps and hamstring strengthening routine that is completely painfree for the knees and does not allow the knee to bend past 90.
  • Spend the money to wear running shoes that fit properly with the necessary support.  Your local running store can easily be your MVP when it comes to avoiding running injuries.
  • Avoid running every day.  Mix in other sports such as swimming, elliptical trainer and biking to improve your fitness without injuring your knees.  “Cross train, cross train, cross train!”
  • Minimize your distance on paved roads.  Find golf courses and off-road trails to reduce the compressive forces on your entire body.
  • Ingest more anti-oxidant containing foods such as fruits and vegetables as a natural way to consume anti-inflammatories.
  • Knee straps, shoe insoles and knee sleeves may prove to be helpful at reducing knee pain with running.
  • A thorough evaluation by a physical therapist or runner-friendly physician is a great way to rule-out potential sources of knee pain such as a leg length discrepancy, plantar fasciitis, hip arthritis, low back misalignment, excessive ankle pronation, cartilage tear or tendon abnormalities.

Asking the Right Questions like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. Is this injury related to my running?
  2. What type of exercise or therapy can I do to minimize or eliminate this pain and avoid surgery?
  3. Do I need further diagnostic tests to assess this injury?
  4. Are my running shoes a factor to my pain?  If yes, which running shoes would you recommend?
  5. Do I need to be concerned with any long-term issues with this condition?

Elite Sports Medicine Tips from Mike Ryan

  • Minimal Miles – Run less while your improve the factors that are contributing to the pain. Common sense is priceless at this point of the injury management plan.
  • Minimize the Meds – It’s easy to pop the pills.  Treat knee pain the smart way by eating healthy and following my advice.  Your stomach will thank you.
  • Drain Your Legs – After every run, elevate your legs while pumping your ankles to drain the waste products and excessive fluids from your your legs for at least 5 minutes.  Start your recovery NOW.
  • Do What Made You Sore – An easy short run on a soft surface the day after a hard run will help reduce muscle soreness.