Knee pain in runners – what causes it and what to do about it

As a physiotherapist I am often asked ‘what is causing my knee pain and what can I do about it?’ A huge proportion of these questions come from runners and some of these running injuries have been picked up training for a half-marathon, marathon or ultra-marathon. The great thing about knee pain in runners is that it gets better with the right treatment and should not stop your training if you catch it early enough. Check out google reviews for lots of inspiring testimonials or go to the testimonials section of the Octopus Clinic website.

For more running/marathon tips you can check out my latest radio interview on running/marathon training tips, check out the marathon training myth busters article, read my top five recovery tips or check out the OC website for loads of advice on running injuries and injury prevention.

Pain at the outer side of the knee

This is most commonly caused by a structure called the ITB. It often consists of a combination of aching and sharp pain, stiffness and sometimes clicking. It is normally worse when running, going downhill or down stairs,

The ITB causes pain when it is overloaded or rubs over the bony bit at the side of the knee. This overloading is often caused when the TFL muscle, into which the ITB inserts, becomes tight as a result of the lateral glut muscles being weak,

Therefore, to treat it properly the most important thing is to train your leg alignment to make sure you reduce the load through the TFL and increase the load through the gluts doing exercises like the ‘wall/ball’ and ‘running man,’ Simply strengthening the gluts doing wall squats or other squats is unlikely to give long term results.

Making changes to running technique is also key – most commonly making sure that you are tipping sightly forward from the hip joints and not running bolt upright, All technique adjustments given should be done very gradually and slowly or you can get injuries elsewhere.

Correct footwear is, as ever, important and insoles can sometimes help.

Massage, joint mobilisations, acupuncture, foam rolling and taping will give short term relief.

 

Pain at the front of the knee

This is most commonly caused by either the patellofemoral joint or the patella tendon. 

The patella is the knee cap and the tendon is the part just below the knee cap. If your tendon is the cause of your problem you will feel it if you poke it but your knee cap joint may not be sore to touch.

The structures of the knee cap that cause pain include the soft tissues surrounding it and also the cartilage that covers its under surface and the surface of the bone below it. If the cartilage has a distinctive pattern of wear and tear it is called chondromalacia patellae.

Patella problems do not respond well to surgery but they do respond well to the right kind of Physiotherapy. The most important thing is to get the knee cap gliding in the notch it is designed for. The way to do this is to strengthen the inner quads (often referred to as the VMO) and the outer gluts (buttock) muscles. However, exercises training these muscles in isolation like clams or knee extensions are unlikely to resolve the problem long term.

What will is retraining the leg to land with the knee turned out so that it is pointing forwards instead of dropping inwards. This will ensure that equal pressure goes through the inner and outer quads and therefore the knee cap will not be pulled out of the notch it is designed to sit in. These exercises include things like mini squats, the wall/ball exercise, running man and landing exercises – all of which are done in standing in front of a mirror to ensure the alignment is correct.

Foot/ankle posture and strength also has a big effect on the knee cap so insoles and foot exercises are often required with knee cap pain.

Massage, joint mobilisations, acupuncture, foam rolling and taping will give short term relief.

 

I will continue my running/marathon series over the next few days on the following topics unless someone gives me a suggestion for another topic first:

  1. Shin splints
  2. Stretching and warming up
  3. Five expert tips for marathon day

Happy running!

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