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Understanding and Managing Knee Pain When Running

Writer's picture: Claire__CoreLDNClaire__CoreLDN

By: Claire Mills, Physiotherapist and founder of Core LDN

First published: 23rd January 2025

How to recover from an injury pre and post race with the support of physiotherapy and Pilates

Running is one of the most accessible and effective forms of exercise, offering numerous physical and mental health benefits. But for many runners, knee pain can become a frustrating barrier, potentially limiting their ability to stay active or continue training. Whether you're a seasoned marathoner or just starting out, knee pain when running can occur for a variety of reasons. Fortunately, with the right approach and understanding, you can manage or even eliminate knee pain, allowing you to enjoy running without discomfort.


Common Causes of Knee Pain in Runners


Knee pain in runners often manifests in different ways. It might be a dull ache, sharp pain, or a sensation of stiffness. While the exact cause of knee pain can vary, there are several common conditions that physiotherapists encounter when treating runners:


  1. Patellofemoral Pain Syndrome (Runner’s Knee) One of the most common causes of knee pain in runners is patellofemoral pain syndrome, often referred to as “runner’s knee.” This condition occurs when the cartilage under the kneecap (patella) becomes irritated, leading to pain around or behind the knee. The pain is usually felt during activities that involve bending the knee, like running, squatting, or walking downstairs.

  2. Iliotibial Band Syndrome (ITBS) The iliotibial band is a thick band of tissue that runs along the outside of your thigh from the hip to the shin. When it becomes tight or inflamed, it can cause pain on the outside of the knee. ITBS is particularly common among runners who increase their mileage too quickly or run on uneven surfaces.

  3. Patellar Tendonitis (Jumper’s Knee) Patellar tendonitis occurs when the tendon connecting the kneecap to the shinbone becomes irritated or inflamed, often due to repetitive stress. This condition is common in sports like running, where repetitive loading of the knee joint occurs.

  4. Osteoarthritis While osteoarthritis is more common as we age, runners can develop knee osteoarthritis due to overuse, improper biomechanics, or past injuries. Osteoarthritis can cause the cartilage in the knee joint to break down, leading to pain, stiffness, and swelling.

  5. Meniscus Tears The meniscus is cartilage in the knee that acts as a cushion between the thigh bone and the shin bone. A tear in the meniscus can occur due to twisting motions, sudden changes in direction, or excessive wear and tear over time. Meniscus injuries can lead to pain, swelling, and difficulty moving the knee.


Factors Contributing to Knee Pain While Running


While these conditions are common causes of knee pain, there are other factors that may contribute to your discomfort:


  • Running Form and Technique Poor running mechanics, such as overstriding, poor posture, or improper alignment, can put additional stress on the knee joint. Over time, these small deviations can lead to pain and injury.

  • Overtraining Increasing your running distance or intensity too quickly without allowing your body time to adapt can result in overuse injuries, including knee pain.

  • Weak Muscles and Imbalances Weakness in the muscles surrounding the knee, particularly the quadriceps, hamstrings, and glutes, can contribute to knee pain. Muscular imbalances can affect how forces are distributed across the knee joint.

  • Improper Footwear Wearing shoes that don’t provide proper support or that are worn out can alter your biomechanics and lead to knee pain. If your feet pronate (roll inward) or supinate (roll outward) excessively, it can increase strain on your knees while running.

  • Running Surface Running on hard surfaces like concrete, or uneven terrain, can increase the impact on your knees, potentially leading to pain and injury.


Strategies for Preventing and Managing Knee Pain


The good news is that knee pain doesn’t have to stop you from running. With the right approach, you can prevent or manage knee pain effectively. Here are some strategies that can help:


  1. Strengthening Exercises Strengthening the muscles around the knee can provide better support and reduce the strain on the joint. Focus on exercises for the quadriceps, hamstrings, hip abductors, and glutes. Single-leg squats, lunges, step-ups, and bridges are excellent choices.

  2. Improve Running Form Work on your running technique by focusing on shorter strides, a more upright posture, and keeping your knees aligned with your toes. A running coach or physiotherapist can provide feedback and help with adjustments.

  3. Gradual Increase in Mileage Avoid increasing your mileage or intensity too quickly. Follow the 10% rule—don’t increase your weekly mileage by more than 10% to reduce the risk of overuse injuries.

  4. Footwear and Orthotics Make sure you're wearing the right shoes for your foot type. Visit a running store or a physiotherapist to get a gait analysis and choose the best footwear. In some cases, custom orthotics may be recommended to address issues like overpronation.

  5. Stretching and Foam Rolling Tight muscles, particularly in the hamstrings, quads, calves, and IT band, can contribute to knee pain. Incorporating regular stretching and foam rolling into your routine can help release tension and improve flexibility.

  6. Cross-Training To reduce the repetitive stress of running, incorporate cross-training activities like swimming, cycling, or strength training. These exercises can help maintain cardiovascular fitness and muscle strength while giving your knees a break.

  7. Rest and Recovery Don’t underestimate the importance of rest. If you experience knee pain, allow time for recovery. Ice, elevation, and compression can help manage swelling and discomfort. If pain persists, seek advice from a physiotherapist to rule out any serious underlying issues.


When to See a Physiotherapist


If knee pain persists despite trying these strategies or if it's severe, it’s important to seek professional help. A physiotherapist can assess your condition, identify the root cause of your pain, and develop a personalized treatment plan. This might include hands-on therapy, specific exercises, posture correction, and even advice on modifying your running form to prevent future injuries.


About Core LDN


Aimed at revolutionising the fitness and rehabilitation landscape, Core LDN firmly believe

that a one size fits all approach simply doesn't apply to wellness. At the heart of Core LDN's philosophy is a team of expert physiotherapists dedicated to treating and rehabilitating all injuries. Through a fusion of exercise rehabilitation in specialised CORE classes, clients can experience the benefits of Physiotherapy-led Pilates. Whether in recovery mode, navigating pre/postnatal stages, or striving towards specific fitness objectives, individuals can harness the power of personalised Pilates sessions.


To find out more about Core LDN, book a physiotherapy initial appointment or Core LDN Pilates intro visit www.coreldn.com


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