How to fix knee pain from running

Running is on the rise. According to Sport England’s Active People Survey results over 2 million people a week participate in running and, it’s the second most popular activity for people doing 30 minutes’ exercise at a moderate intensity at least once a week.

So why are we a nation that loves to run? There are many reasons. Running is inclusive, cheap and accessible without the need to arrange a court or organise a team. Some people run to lose weight, to get fit, to keep healthy, to beat their personal best time or to have time out to think and once we’ve been for a run we experience runners high with the release of feel good chemicals.

But no matter whether you are a beginner whose muscles are not used to running or a highly experienced runner training for the upcoming London Marathon on 23rd April when you’ll join up to 50,000 other runners as they pound the streets to finish the 26.2 mile run, anyone can be affected by a running injury.

Common knee injuries due to running

The knee is the most commonly injured joint among runners. Damage to the structures inside and outside your knee joint can result in fractures, dislocations, sprains, and tears. Knee components susceptible to running injuries include:

- Articular cartilage - covers the ends of your shin bone, thigh bone and the back of your kneecap (patella).

- Ligaments – there are four ligaments including your anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) in your knee that connect your bones together.

- Menisci - two cartilage discs that act as shock absorbers and help to stabilise your knee.

- Tendons - connect your muscles to your bone.

Runners Knee

Runners knee, also known as patellofemoral pain syndrome (PFPS), is knee pain associated with your patella or kneecap. It is the most common condition for runners. It’s thought to be caused by an imbalance in the muscles that support your knee, and mechanical errors that can cause poor knee tracking.

The main symptom is pain around your knee when you run. The pain can be dull or sharp and severe and usually worsens as the intensity of exercise increases.

Chondromalacia Patella (CMP)

Chondromalacia patella is damage to your articular cartilage. It is a chronic condition that causes your kneecap cartilage to soften and break down resulting in pain and inflammation. It is caused by overuse of the knee, alignment problems, injury or ageing.

Knee pain around the patella typically feels worse when going up or down stairs. It may be brought on by sitting (with the knees bent) for long periods.

Patellar Tendonitis (Tendinopathy)

Patellar tendonitis is generally an overuse and ageing injury that affects your knee. It is the result of your patella tendon being overstressed. A common name for it is jumper's knee.

Patella tendinopathy usually causes pain, stiffness, and loss of strength in your knee.

IT Band Syndrome (ITBS)

Your iliotibial (IT) band is a tendon that connects your knee to your hip. It helps to stabilise your knee.

IT band syndrome (ITBS) can occur due to overuse, overstrain and biomechanical factors. Your IT band tightens and becomes irritated and inflamed. The main symptom is pain on the side of your knee.

ACL and PCL injuries

An ACL or PCL tear is caused by overstretching the knee's ligament. It can occur when a runner stops suddenly, changes direction rapidly, whilst slowing down, landing incorrectly or has a direct collision.

You will feel pain and swelling around your knee. You might hear a popping noise and you may feel your knee give way from under you.

Kneecap Bursitis

Prepatellar bursitis is an inflammation of your bursa (cushioning sacs between bones and soft tissues to reduce friction) in the front of your kneecap. Your bursa can become irritated and swell and then put pressure on your adjacent knee parts.

It can be caused by either repetitive friction on the area, muscle tightness, or from a sudden injury to the knee. 

Kneecap Subluxation

Your kneecap can be pulled to the side of (subluxation), or fully dislocate from, the groove it normally glides over in your knee joint. The supporting tissues can be stretched or torn when this happens. It can be caused by a blow or a sudden change in direction when you put your foot on the ground.

Your kneecap will look out of place and will be accompanied by knee pain, swelling and a popping sensation.

Medial Meniscus Tear

A meniscus tear is a tear to the cartilage in your knee joint causing pain on the inside of your knee.

The most common cause of a meniscus tear is twisting of your knee when your foot is on the ground. It can also occur through direct impact in contact sports and in older athletes through gradual degeneration.

Plica Syndrome

A plica is a fold of the soft inner lining of your knee joint that can be more prominent in some people. Plica syndrome occurs when this lining of your knee joint is irritated and inflamed and causes knee pain.

Activities that repeatedly bend and straighten your knee, such as running can irritate the plica and cause plica syndrome.

Knee Stress Fracture

A stress fracture in the knee can be the result of increasing the amount or intensity of an activity, such as running, too quickly. Unfamiliar surface (path rather than grass), improper equipment (worn or less flexible running shoes) and increased physical stress (a runner increasing their running time) can also cause a knee stress fracture.

A stress fracture will cause you pain in your knee.

When to seek treatment for your knee pain caused by running

Most knee injuries in runners can be resolved by conservative methods such as rest, ice and stretching. If your pain is not severe but lasts for a week or more you should seek medical advice to have your knee checked over. Your GP or a physiotherapist will offer advice about exercises and stretched that will help your recovery.

However, if your pain is severe or your knee is swollen you should see a doctor straight away. They will ask about your symptoms and perform a physical examination of your knee. You may be referred to an orthopaedic surgeon for further investigations or treatment.

Diagnosing your knee condition

Your GP or orthopaedic surgeon may request the following tests to investigate further your knee pain:

- An X-ray or CT scan – to check for a fracture or arthritis.

- An MRI scan – to determine cartilage or soft tissue damage.

- Knee aspiration – to drain off fluid and help in the diagnosis of knee joint disease.

- Knee arthroscopy – your doctor looks inside your knee using a telescope and a tiny camera to see if there is meniscus, cartilage or ligament damage. Knee arthroscopy is minimally invasive surgery and can be used to treat your knee problem at the same time.

Treatment options for knee problems caused by running

Treatment will depend on your specific knee problem and your doctor will be able to advise you on the best course of treatment. Options include:

- Rest

- Ice

- Non-steroidal anti-inflammatory medication

- Exercise to strengthen and stretch your muscles

- Knee tape or brace

- Advice for footwear

- Surgery – some knee pain conditions will need surgery. This may include fractures, ligament tears such as ACL tear, removal of the plica, malalignment of the patella or, damage to the cartilage under your kneecap.A knee arthroscopy can be performed to wash out loose fragments in your joint caused by wear or to trim or repair torn cartilage and ligaments.

Treatment for knee problems caused by running at Berkshire Independent Hospital in Reading

We hope that you enjoy running without injury or knee problems. However, if you do suffer from a knee condition, you can rest assured that Berkshire Independent Hospital offers a local and comprehensive range of service for the diagnosis, treatment and management of knee conditions caused by running.

We also offer first class physiotherapy delivered by senior chartered physiotherapists for knee problems due to running.

For more information or to make an appointment call 0118 902 8114 or contact us.

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Knee pain is common amongst runners. Siam Pukkato / EyeEm/Getty Images

Because running is a repetitive, weight-bearing form of exercise, there is a high risk for injuries, particularly involving the knee. In fact, knee injuries are incredibly common, accounting for up to 50% of all running injuries.

Here are five common injuries that might explain knee pain when running:

Runner's knee, also known as patellofemoral pain syndrome, is the most common cause of knee pain among runners, says Robert Wilder, MD, chair of the Department of Physical Medicine and Rehabilitation at the University of Virginia. 

Where it hurts: Pain manifests around the patella (kneecap), either when active or after sitting with your knees bent for a long time.

What causes it: As we run, the kneecap, the femur, and the tibia all move, putting pressure on the kneecap. When too much load is placed on the kneecap, the tissues can become inflamed and irritated, Wilder says. It can also be caused by tight muscles, poor running form, or a structural issue, like an abnormally high knee cap.

How to treat it: Stop running, apply cold packs, and take a pain reliever like ibuprofen until you are pain-free and ready to run again. Strengthening your knees, hips, feet, and ankles can also help treat and prevent runner's knee. Talk with a physical therapist to find the right treatment plan for you. If your pain does not go away after three or four weeks, Wilder says you should see a doctor.

Iliotibial (IT) band syndrome is another common running injury, especially amongst long-distance runners. It affects the iliotibial band — a layer of connective tissue that runs from the hip to just past the knee, says Steven Mayer, MD, a sports medicine physician at Northwestern Medicine Running Clinic. 

Where it hurts: Pain is located on the outside of the knee. 

What causes it: IT band syndrome is typically caused by overuse and tightness of the iliotibial band. Mayer says runners tend to experience tightness in the IT band because they are frequently moving backward and forwards (as opposed to side to side), which causes friction where the IT band meets the knee, producing inflammation and pain.

How to treat it: Stop running, try foam rolling, and strengthen your core and hips, Mayer says. You can also ice the outside of your knee or take over-the-counter medication for pain. IT band syndrome usually resolves in a few weeks, Mayer says. However, if pain persists see a doctor as IT band syndrome can sometimes become chronic, requiring a month or two of rehabilitation. 

Patellar tendinitis, also known as jumper's knee, is another common running injury. 

Where it hurts: Patellar tendinitis causes pain below the knee in the patellar tendon which connects the kneecap and shin. This tendon is what allows you to fully extend your knee. 

What causes it: Patellar tendinitis is caused by overuse or suddenly increasing running distance or frequency. This places additional stress on the patellar tendon, causing tiny tears that result in pain and inflammation. Having tight quad muscles or hamstrings can also put added strain on the patellar tendon. 

How to treat it: Wilder says the best way to treat patellar tendinitis is by taking a break, icing the affected area, and strengthening and stretching your thigh muscles. Flexibility and strengthening exercises can also stimulate tissue healing, Wilder says. It's also helpful to wear a patella brace to reduce the load on the tendon.

A meniscus tear is an injury in the piece of cartilage that sits between your shinbone and thighbone.

Where it hurts: Each of your knees has two menisci — one on the inside of the knee and one on the outside of the knee. A torn meniscus causes pain and inflammation around the knee which can make it hard to fully extend the joint.

What causes it: Meniscus tears are usually caused by repetitive use of the menisci or by activities that involve twisting, like when you stop suddenly while running or quickly change directions.

How to treat it: Stop running for a short period of time while the injury heals, Mayer says. In milder cases, rest, ice, and medication can help relieve the symptoms so it's safe to run again, even if they don't repair the tear itself. In extreme cases with persistent symptoms, you may need to undergo surgery. 

Knee bursitis is inflammation or irritation of a small fluid-filled sac, called the bursae, located near your knee joint. Mayer says the most common types of knee bursitis in runners are Pes Anserine bursitis, which affects the inside of the knee near the hamstring, or Prepatellar bursitis, which affects the kneecap.

Where it hurts: It causes pain on the kneecap or just below the knee joint towards the inner side. 

What causes it: Knee bursitis occurs when one of the bursae in your knee becomes inflamed because of repeated strain, Wilder says. This is usually because a runner decides to increase their mileage or speed suddenly. 

How to treat it: Ice, rest, and pain medication are all helpful ways to relieve the pain. Mayer says it is sometimes possible to run through the pain as long as the knee is no longer swollen. Other treatment options for more severe cases include physical therapy, corticosteroid injections, or even surgery to remove the bursa. Sometimes, the bursa can become infected and cause a fever, which usually requires antibiotics to treat. See a doctor determine the right treatment plan for you.

Knee pain is common in runners, especially if they increase their mileage or pace suddenly. Most common knee injuries can be treated with rest, ice, and over-the-counter pain medication. However, if pain persists for more than a few weeks, reach out to your doctor as you may require more intensive treatment like physical therapy or surgery.