Knee Pain While Running
Knee Pain While Running
Knee pain while running is often experienced in one or both knees, and knee related injuries are the most common area injured related to running. To really understand how running affects the knees, we have to know a bit about the structure of the joint.
Anatomy of the Knee
The knee is the largest joint in the body and has an essential role in movement (walking, running, jumping). It joins the thigh with the leg and consists of two articulations:
- Tibiofemoral joint: Between femur and tibia.
- Patellofemoral joint: Between femur and patella/kneecap.
Within them, we can find the menisci (disks made of collagen fibers, designed to protect the bones from rubbing against each other and absorb the shock of each step), ligaments (they stabilize the knee by limiting its movements) and bursae (fluid-filled sacs that function as cushions between tendons/muscles and bones) as the most important structures.
Around them are several muscles, responsible for the movements of the joint. The most important are: quadriceps (anterior, the frontal area of the thigh); hamstrings (which are three muscles: semimembranosus, semitendinosus and biceps femoris) and gastrocnemius (posterior area); tensor fascia lata (lateral, the outside area); adductors (medial, the inner area).
Symptoms of Knee Pain While Running
As the principal symptom will be the pain, it can be felt in the anterior, posterior, medial and/or lateral area of the joint. Also, it can happen at the beginning, the middle and/or the end of the run, lasting after the practice while walking or sitting. More symptoms may be poor stability, swelling, a “pop” or “crack” feeling (crepitus), among others.
Causes of Knee Pain While Running
There are several causes for it, but usually, they are consequences of a biomechanical problem between the hip, the knee, and/or the ankle, even because of wearing the wrong shoes (old shoes, or not adequate for your type of foot).
- Runner’s knee: This is the common name for the “patellofemoral pain syndrome” (PFPS) and the most common cause of knee pain among runners. It’s the irritation of the cartilage under the patella, caused by friction between it and the femoral bone. The pain is localized typically underneath or around the kneecap, and also can be experienced after prolonged sitting.
- Iliotibial band syndrome: It’s the most common cause of lateral knee pain. The iliotibial band is the tendinous portion of the tensor fascia lata muscle, and this syndrome is the irritation of that structure. The pain is localized on the lateral side of the knee. It usually hurts towards the end of the run, progressing to pain while walking and even resting or sitting.
- Jumper’s knee: This is the common name for the “patellar tendinopathy”. The patellar tendon is the one that goes from the patella to the tibia. It’s part of the quadriceps. This injury happens mostly after an abrupt increase of activity or overload. The pain is generally in the inferior pole of the kneecap, in chronic phases the tendon has a progressive degeneration.
- Pes anserine bursitis/tendinopathy: Also known as “goose’s foot”, the pes anserine is a structure made of 3 tendons (one of which is a hamstring: the semitendinosus) attached to the tibia. In this area, there’s also a bursa. The bursa may become inflamed due to repetitive friction, producing bursitis. The tendinopathy happens when the inflammation is in one of the tendons of any of the 3 muscles. The pain is localized in the medial part of the knee, also felt when climbing stairs or stretching those muscles.
- Chondromalacia patella: Also known as CMP, it’s the damage to the articular cartilage under the patella. The difference between this and the PFPS is that the CMP is a chronic phase where the cartilage is damaged, it cannot be reversed, unlike the PFPS that, as an inflammatory disease, can be undone. The symptoms are similar to that of the PFPS, including swelling. The pain worsens when walking downstairs or after sitting for long periods of time. There might be crepitus when bending or straightening the knee.
- Other less common causes are Osgood-Schlatter’s disease (common in children between 10 and 15 years old, the pain is located at the tibial tuberosity -the top of the shin-, usually happens in a period of rapid growth, combined with high sports activity); tendinopathies of other muscles (like gastrocnemius or quadriceps); sprain of any of the ligaments (due to a sudden/unexpected movement); among others.
Physiotherapy Treatment of Knee Pain While Running
Depending on the cause, the treatments of the pain might be:
- Cryotherapy (applying ice to the area, for 15 minutes every 1-2 hours) to reduce swelling and decrease pain. It must be accompanied by protection of the knee, rest to allow the healing process, compression to minimize swelling and increase support and elevation to help reduce the pooling of fluid in the joint (this protocol is known as “P.R.I.C.E.”).
- Activity modification, to maintain aerobic fitness without increasing the injury of the knee, like water running, swimming, bicycle, etc.
- Biomechanical analysis to correct postures, and patterns of movement that may be causing pain.
- Stretching routine of the muscles involved (to reduce their tightness) and/or exercise routine, to strengthen the weak muscles and to improve their stability response.
- Custom Orthotics and/or kinesiology taping, as an adjunctive therapy, to stabilize the joint and help recovery.
- Modalities such as Laser Therapy, Shockwave Therapy, Gua Sha Massage and/or Ultrasound therapy to help the healing process, break up adhesions, and allow for more extensibility in muscles around the knee joint.
- Custom Knee Brace can be useful in supporting the knee while running. We offer a a range of Knee braces from Don Joy and Bledsoe.
- Hobrough, Paul. Running free of Injuries. From pain to personal best. London: Bloomsbury Publishing PLC, 2016.
- Nasin, C. Oh, my aching knees! …an Evidence-Based Guide to the Evaluation and Treatment of Overuse Knee Injuries in College Health (PDF file) available in: https://www.acha.org/documents/Programs_Services/webhandouts_2012/WE4-150_Nasin_C.pdf. University of Rhode Island.