Whether you’re a seasoned marathon runner, an unconditioned collegiate athlete, or a mother of three looking to start-up running, knee pain can often become a hindrance.

Elite and recreational runners are different in terms of endurance and stamina, but both often fall victim to this pain, regardless of physical status.

While multiple underlying factors can cause knee pain, you can take some steps to manage and help eliminate future problems.

Runners are most affected

Within any physical activity or sport, there are often risks of sprained ligaments, strained muscles, broken bones, etc. Since running is a non-contact, low-risk activity, there is usually low cause for concern for any acute injuries.

While runners may not be at high risk of breaking a bone (though stress fractures are frequent) or get a concussion, the constant loads and stresses they take on their knees often become chronic complications.

While running, the lower limbs are continually going through different phases. During these phases, the lower limbs are propelling, loading, and pushing off. This cycle often presents in anterior (front) knee pain in runners. Due to the frequency of this pain occurring in runners, it is aptly named the runner’s knee.

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Why does this pain occur?

Running is an activity performed predominantly within the sagittal plane of movement, meaning there are no lateral or transverse movements within a running program or session.

As stated previously, running involves placing constant loads and stresses on the knee joint throughout the activity, with little to no time for rest before the lower limb is propelled forward and loaded again.

Because of the consistent movement of the lower limbs, associated knee pain is often due to overuse of the knee joint. Other instances of knee pain after running include:

  • Flat feet, causing genu valgum
  • Weakened or tight muscles
  • Lack of stretching before exercise
  • Arthritis
  • Misalignment of patella

Think about the anatomy

Within the knee joint, there are structures loaded and stressed while running. The most important bones are the femur, patella (kneecap), and tibia.

Connecting these bones are the quadriceps and patellar tendons, along with an assortment of ligaments (ACL, LCL, MCL, PCL), muscles (quadriceps, hamstrings) and menisci.

Since knee pain after running is primarily focused in the front of the knee, located just below the kneecap, it is essential to focus on those structures.

The kneecap sits within the patellofemoral groove, on top of a thin layer of cartilage.

It is held in place by the quadriceps tendon, as well as the patellar tendon. These tendons work together along with the hamstring tendons to bend and extend the knee while running.

During these movements, tension builds up on the patella from the constant activation and relaxation of the tendons.

This tension creates a push/pull effect on the patella, as it wears on the cartilage it sits on, causing inflammation and pain.

Know the symptoms…

Common symptoms of runner’s knee include:

  • Dull or achy pain under the patella
  • Pain when going downstairs
  • Clicking or cracking when kneeling or squatting
  • Stiffness
  • Knee swelling

… But do not be fooled

Knee pain during and after running can also be the source of other underlying issues.

While they may share some of the same symptoms as runner’s knee, the location and severity of symptoms can be a crucial factor in determining the cause of knee pain.

Some other potential causes of knee pain include:

  • Patellar fracture
  • Patellar tendinitis- inflammation of the patellar tendon
  • Ligament sprain or tear (pain located on the medial, lateral, anterior or posterior aspect of the knee)
  • Bursitis- inflammation of the bursa in front of the kneecap
  • Chondromalacia-damage to cartilage within knee joint

Take precautions to protect your athlete body

With elite and novice runners alike, it is vital to be proactive and follow specific steps to avoid runner’s knee. These steps include:

  • Running surface- softer, more forgiving surfaces put less stress on the knee joint
  • Footwear- wearing adequately fitted footwear for certain foot alignments
  • Stretch- as with most physical activities, keeping muscles warmed up and loose can help with performance and recovery
  • Mechanics- practice proper running mechanics

Read: 7 Tips to Train Like a Professional Athlete

Take care of the issue like a professional

While runner’s knee can be irritating, it does not have to become a debilitating consequence of running if proper treatments are applied. These treatments include:

Physical therapy

exercises that focus on strength, function, and decreasing pain. These exercises should be low intensity while focusing on activation and range of motion of hamstrings, quadriceps, and calves.

Because the muscles surrounding the hip (IT band, glutes, hip flexor, adductors, etc.) can affect the running mechanics/knee position of an individual, exercises should not just focus on the knee.

Hip mobility and activation are essential factors in decreasing intrinsic stressors on the knee joint.

Taping & bracing

Depending on the severity of symptoms, interventions such as taping and bracing can be introduced to combat signs of runner’s knee.

Standard tape jobs to decrease knee pain include the McConnell technique and Kinesio taping. These methods simulate proper patellar alignment and help reduce pain while running.

In more severe cases, sometimes braces are prescribed to be worn to provide more stability and compression at the knee joint.

A universal brace for runner’s knee is a simple patellar strap. This bracing offers compression to the patellar tendon, while also changing its insertion point.

The brace, in turn, relieves pain and tension while reducing pressure on the tendon.

Orthotics

Orthotics are medically prescribed shoe inserts that effectively correct biomechanical foot issues that occur while walking or running.

These inserts can change the arch and alignment of the foot, which in turn changes the biomechanics of an individual’s running style.

For example, individuals with flat feet tend to have their feet “roll in” while running.

Anatomically, this puts medial stress on the knee joint and can lead to an increase in pain and discomfort. You can use orthotics to change the arch of the foot and improve running performance.

Massage

With most ailments, a good massage is never a bad option for the treatment of pain. In terms of runner’s knee, muscles massaged from the hip down to the toe can be beneficial to alleviate knee pain.

During a massage, muscles and adhesions below the skin surface are kneaded and manipulated to provide a therapeutic effect.

This manipulation increases blood flow to the affected area, improving mobility and flexibility.

However, tightness and discomfort present differently in individuals. Some individuals may need more than massage.

Some may require a muscle release and stretching due to the severity of their tightness.

Prepare, take care, keep going

Half the battle with runner’s knee is preparation.

Footwear, running surface, and proper stretching techniques all play factors in not only the run itself, but how runners feel afterward.

Being mindful of the body and how your body is feeling influences how you manage pain and discomfort.

Understanding how to combat pain, no matter how mild, is a massive step in maintaining performance and confidence with running.

Read: Why You Should Become a Competitive Runner