Prevent Knee Pain While Running

Whether you’re getting ready for your morning jog or you’re getting ready to train for a race, there are a lot of different factors that come into play to make sure that you’re ready for your next run. Factors can include your shoes fitting correctly or making sure that you’re maintaining a certain pace to get a good workout in. On top of all the things that could be going through your mind before and during your race, you then start to realize: My knee is hurting.

Two thoughts then follow:

What is going on?

What can I do about it?

Knee pain is a common injury for a lot of individuals. In fact, a recent study showcased that one of most common afflictions of the knee is due to overuse from running. In that study, 80% of knee injuries were caused from overuse, and up to 50% of those injuries had pain focused around the knee.

Even though research has demonstrated that your knee pain can potentially be an overuse injury that can stem from running or jogging, it can be helpful to understand what exactly could be going on with your knee, which is why we’re going to highlight the different pain areas you could be feeling while running and what could potentially be contributing to that pain.

Pain is often a sign that something is going on internally with your body. When you start to feel or notice pain, both your body and brain are trying to send you a message that you need to potentially address something. When your body starts sending these signals, it’s best to listen before it gets worse so you can prevent bigger injuries and ensure that you’re capable of exercising and running pain-free.

Before beginning any exercise or stretching routine, you should consult with a qualified healthcare professional.

Take a look at some signs to watch for, ways to alleviate the knee pain that you’re facing, and what you can do to potentially prevent future knee pain or knee injuries while running.

What is going on in my knee?

It goes without saying, pain is complex. We would like to think that the pain we feel is coming from one specific structure that can be quickly identified with a few clinical tests or a scan, but the reality is it’s not that easy. Oftentimes, we think that pain can come at face value, where if one area hurts it must be that specific area that is affected. When in reality, there are a bunch of different elements that can impact the type of pain we feel and where we feel it.

Many factors contribute to our perception of pain, including the underlying tissue, stress, sleep, emotions, and much more. So while it might seem that your knee pain while running may stem from the actual act of running itself, there are many contributing factors that could lead you to develop knee pain or other types of discomfort that you experience while running.

Here are a few common areas of the knee that can become irritated with running.

Front of the Knee

Patellofemoral Pain (Runner’s Knee)

This is a common condition that you have probably heard before that simply refers to pain felt at the front of the knee, typically either below the knee cap or behind it. Some early symptoms of Patellofemoral Pain include discomfort when you’re going up or coming down stairs.

Learn more about how our physical therapists help patients treat Patellofemoral Pain or Runner’s Knee.

Patella Tendinopathy (Tendonitis)

Tendinopathy simply means “pain of the tendon”, which is frequently seen in explosive, jumping sports, but can also be seen in runners. Tendonitis can often occur when an individual overuses the tendon.

Outside of the Knee

Iliotibial (IT) Band Pain

The Iliotibial Band has gotten a bad rap for years as the scourge of runners everywhere, but it is likely more complex than your IT Band being “too tight”.

The IT band is a thick, strong piece of tissue that connects from your hips to the outside of the knee, where it can become irritated with the repetitive motion of running.

Learn more about how our physical therapists help treat patients who are suffering from Iliotibial (IT) Band Pain.

Lateral Collateral Ligament/Lateral Meniscus

While not as common to injure without a specific twisting event, both the Lateral Collateral Ligament (ligament on the outside of your knee) and Lateral Meniscus (shock-absorbing, semi-circular disc inside the knee) can become irritated with running.

Inside of the Knee

Pes Anserine Bursitis

You have probably heard about the dreaded “Bursitis” from your grandmother, friends, and the postman – but what does that actually mean?

Bursae are fluid-filled sacs that typically sit between tendons and a bone to reduce friction.

When somebody is diagnosed with “Bursitis,” they are being diagnosed with inflammation of the bursa. There are over 150 bursae in the human body, which is why it seems like everyone has been diagnosed with it at some stage.

The large Pes Anserine Bursa sits on the inside of the knee just below the knee joint. There are three tendons that run over the top of this bursa. Either the bursa itself, the tendons (tendinopathy), or a combination of both can become irritated or inflamed with repetitive running.

Medial Collateral Ligament/Medial Meniscus

The Medial Collateral Ligament (MCL) and Medial Meniscus are not as commonly injured without a specific twisting event. Repetitive motion from you knee falling inwards can place increased stress on the MCL and medial meniscus which can result in irritation to those structures.

Back of the Knee

Calf Strain

A powerhouse in running, the calf involves two muscles, Gastrocnemius and Soleus. Both combine together at your Achilles Tendon before inserting into the back of your heel.

Either one of these muscles is susceptible to a strain either from a specific event or due to repetition over time.

For example, If you have recently increased your training volume or intensity, or you have transitioned to hill running, the calf now needs to work even harder than before, which could lead to a muscle strain.

Hamstring Strain

Like the Calf, your Hamstrings do a lot of work during running.

The Hamstrings are a group of three muscles that originate from the back of your hip and insert into either side of the knee, just below the joint line. Weakness and fatigue or a sudden increase in training volume or intensity may contribute to developing a strain.

What Can I Do About It?

Now that you understand what could potentially be causing your knee pain and some warning symptoms to look out for, there are a few things that you can do to potentially alleviate the pain and get back to your normal running routine.

Don’t Stress

Even though it might be one of the hardest things to do when you’re worried about the knee pain you’re feeling while running, it’s important that you try to avoid stressing about it. Stressing out over a potential knee injury you’re sustaining while running or after you’ve run will only build anxiety that won’t do you any good. As the saying goes, it’s best to not make a mountain out of a molehill.

The good news is that most of the pain you feel is likely not due to some severe, underlying damage that will continue to permanently wear away your tissues with every step.

Even if you have had a scan, such as an X-Ray or MRI, recently or in the past, they often don’t tell the full story about what is going on. Instead, a little bit more information needs to be acquired before the root cause of the pain can truly be determined. There’s no use in overreacting or stressing out about what you don’t know when it could be something minor that is causing you some knee discomfort or slight knee pain while running.

As a general rule of thumb, pain that is at an annoying, but tolerable level shouldn’t be feared and will likely just require a few little tweaks to get you feeling better. If the pain in your knee is severe, causes you to limp, or doesn’t ease with rest, seek out a healthcare professional.

Actively Work Towards Staying In Shape

It goes without saying that there are plenty of different ways you can avoid causing undue knee discomfort or incur knee pain while running, but perhaps one of the best ways to potentially avoid getting some knee pain while running is to actively work towards staying in shape. Many individuals can suffer from routine ailments, discomfort, or annoying pain when they start working out or getting in shape for the first time in a long time.

Due to the body’s discomfort with physical activity, some pain or discomfort can arise from the onset of routine exercise. To avoid this common pain, you should always seek to actively stay in shape. When your overall health and fitness level are in good condition, you’ll avoid many potential injuries or annoying pain ticks before they even begin. Staying in shape year-round is something we should all aspire to do.

Stretch Pre-Workout and Post-Workout

The next thing you can actively do to potentially decrease the knee pain you experience while running is to perform some pre-workout and post-workout stretches. Once you’ve done a light warmup and have gotten your blood pumping a little bit more, you should consider performing some stretches that will help you increase flexibility and tension that has built up since your previous workout.

Pre-workout stretches and post-workout stretches are a great way for you to increase flexibility, alleviate tension, and align many of the dynamic muscles that are used while you’re actively running. Stretching can also be good for the soul in that it helps you relieve some of the mental stress that has been built up and allow you to center yourself to focus on the upcoming run.

Include Strength Training Into Your Weekly Routine

If you’ve been someone who actively does cardio all of the time and only picks up a dumbbell or barbell sparingly, then perhaps you should consider incorporating some strength exercises and weight training. The next way you can potentially decrease your knee pain while running is to incorporate some level of strength training into your weekly routine. There are a number of benefits to including strength training in your weekly program.

Adding strength training to your routine will improve the health and strength of your muscles, tendons, and bones. It can also help to prevent those frustrating injuries.

The main muscle groups you should focus on are the ones that work the hardest during running: the Glutes, Hamstrings, Calves, and Quads, as well as some hip adductor/abductor exercises.

Incorporate dynamic, standing exercises at least 2 days per week into your routine.

And don’t worry, including strength training likely won’t make you bulk up, instead, it is likely to improve your overall performance. If you’re nervous about adding some exercises and strength training into your routine, our physical therapists can help educate you on some great strengthening exercises you can do to build and strengthen your muscles.

Change Your Running Style

Changing how you run is typically easier said than done, especially if you have been running for many years. Sometimes it can take an outside perspective on what your running style looks like and the potential ways to correct it. In those cases, one of our physical therapists might be able to help you identify ways to improve your running style and showcase how your current running style is contributing to the pain that you’re feeling.

There is quite a debate about the “optimal” running style, but ultimately everyone runs slightly differently.

Research shows that taking shorter, quicker steps decreases the amount of force going through your hips and knees.

Some things that are worth trying to change or potentially improve your running style are:

• Changing to a more midfoot/forefront strike if you are a heel striker
• Increasing your cadence (steps per minute) by 10%
• Decreasing your step length and not overstriding
• Trying to land with “soft feet”
• Decreasing the amount of time your foot is touching the ground
• Having an upright, but slightly forward-leaning trunk
• Having a relaxed arm swing where your hands don’t cross in front of you

Now, this may seem overwhelming at the start, but by changing just 1 or 2, you will likely change other components. It can be difficult changing your running style when you’ve been performing the same running style for years. Often, it’s like anything else in life, it takes a bit of practice to gradually change your running style over time.

Changing Footwear

Your shoes can make a big difference to your pain level during your run. It’s important to remember that your body responds to some of the tools and accessories you use when you’re performing physical activity. This can also certainly apply to the types of workout accessories, shoes, or footwear that you use when you’re running.

It can be difficult to get a true idea of “which shoe is best”, as there is an incredible amount of bias with footwear manufacturers who claim to have the best footwear and running shoe every season.

Shoes have a broad range of features based on the surface you’re running, how much cushioning you want, how much “drop” you want, and how much control you get.

Focus on finding a shoe that is comfortable during running, and if possible, try a few different pairs to see what you like. Don’t be afraid to ask for some assistance when you’re at the store to find the perfect shoe that fits. Many problems can arise when individuals pick the perfect shoe but it doesn’t fit appropriately. When looking for footwear that you can use while running, you want to make sure that you try a few different pairs to identify what feels comfortable, what fits, and what type of running shoe will match the surfaces and run routine you perform.

Remember, shoes are only part of the equation. If you are having knee pain, you may want to focus on changing your running technique first, before opening the wallet to buy a new pair of shoes. No amount of workout footwear will help you drastically change your running style or help you get your running form into shape, so you should focus on that before deciding to spend potentially hundreds of dollars on new running shoes.

Modify Your Training

So, you’ve changed your running technique, bought different shoes, and added strength training to your weekly program, but are still having issues with that nagging knee pain.

One thing you may want to adjust is your running program. Oftentimes, there is no need for you to completely stop running (unless your pain is severe). Some ways you can modify your running program without needing to completely stop can include the frequency of which you run (how many times per week), the intensity of your run (your pace and heart rate), or the length of your run (miles or time).

It is also okay to have rest days in between runs or break up your runs to include walking phases (i.e.-. Run 2 miles, walk 1 mile). One of the most important things to remember is that part of a strong exercise routine is the time in which you rest and recover. As we’ve highlighted earlier, one of the biggest causes of knee injuries and knee pain while running occurs when individuals overuse or overexercise. Don’t be afraid to take some time off between the days you run to give your body some time to heal up and get ready for the next bout of jogging.

Another thing that you can do when attempting to modify your training is to identify if there is a certain point or location in which you normally start to feel pain on your run. This will require some trial and error, but if you start to feel pain at a specific mile or time, make note of it.

Seek Out a Physical Therapist For Your Knee Pain

Finally, if your knee is still giving you issues, and you have tried all the above – consider reaching out to a healthcare professional or licensed physical therapist to give you an individual evaluation.

Physical Therapists are often well trained to evaluate the entire body and will be able to work with you to address the issues that could be contributing to your knee pain. Schedule an appointment today at a nearby physical therapy clinic to see how our physical therapists may help you avoid knee pain while running.

 

1. “Bursitis: Types, Symptoms, Treatment & Faqs.” Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/10918-bursitis#:~:text=There%20are%20more%20than%20150,called%20miner’s%20or%20barfly’s%20elbow).
2. “Strength Training: Get Stronger, Leaner, Healthier.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 15 May 2021, https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/strength-training/art-20046670.
3. Heiderscheit, Bryan C, et al. “Effects of Step Rate Manipulation on Joint Mechanics during Running.” Medicine and Science in Sports and Exercise, U.S. National Library of Medicine, Feb. 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022995/.
4. Berryman, Nicolas, et al. “Strength Training for Middle- and Long-Distance Performance: A Meta-Analysis.” Human Kinetics, Human Kinetics, 1 Jan. 2018, https://journals.humankinetics.com/view/journals/ijspp/13/1/article-p57.xml.