There are two major causes of knee pain from running. Here’s how to treat your pain, and prevent it from occurring again in the future.
The two major causes of knee pain from running
If you’ve spent any time on the trail, you’ve likely already suffered knee pain from running. This common condition affects a large number of runners, with women affected disproportionately. However, most knee pain from running is due to two treatable causes:
- Patellofemoral pain syndrome, also called “runner’s knee” or PFPS, that is felt inside the knee around the kneecap
- Iliotibial band syndrome, or IT band syndrome, that is felt on the outer knee along the side
In this post, we’ll discuss the common causes of patellofemoral pain syndrome and IT band syndrome, along with methods for treating and relieving your pain. Another major concern, especially for older adults, is whether you should run with osteoarthritis. We’ll also discuss that later in this post. The following video gives a brief overview of the many causes and treatments for knee pain conditions.
What causes inside knee pain from running?
Patellofemoral pain syndrome, or runner’s knee, is an unfortunately common condition. It accounts for up to 20% of all running injuries, and it affects women disproportionately.
As the NHS explains, runner’s knee often feels like:
“During your run, you may develop pain at the front of the knee, around the knee or behind the kneecap. The pain may be dull or it could be sharp and severe.”
This pain will likely increase when you run uphill, downhill, or walk downstairs. It also probably hurts more whenever you bend your knee–whether that’s while sitting or doing deep knee bends. Finally, inside knee pain from running typically develops gradually since runner’s knee is often caused by strength imbalances. Active.com explains:
“Strength and mobility imbalances will have a greater effect on the body over increased mileage, resulting in issues like runner’s knee. The dilemma is you often won’t know you have these imbalances until your knee starts to nag you. At this point, it becomes important to back off and identify where the injury originated.”
Common causes of runner’s knee
The most common causes of runner’s knee include:
- Increased mileage
- A knee injury
- No or little cross-training
- Training issues, such as running on hard surfaces or with an running form
- Malalignment in any of the leg bones
- Weak or unbalanced hamstrings muscles
- Weak hip or inner quadriceps muscles
- Foot issues, such as hypermobility, overpronation, or flat feet
How to relieve inside knee pain from running
It’s likely that your runner’s knee was caused by either a mechanical problem or a training issue. For both causes of knee pain from running, take some time off first. Continuing to run on the knee could cause more pain down the line. Instead, take some time to rest and figure out what was causing your pain in the first place.
If you’ve recently hit the trail hard and increased your mileage, your knee pain from running is probably due to training issues. Rest comes first. Runner’s World explains:
“At the first sign of pain, cut back your mileage. The sooner you lessen the knee’s workload, the faster healing of runner’s knee begins. Avoid knee-bending activities, canted surfaces, and downward stairs and slopes until the pain subsides. As you rebuild mileage, use a smaller stride on hills.”
From there, find ways to alter your training to prevent runner’s knee in the future. This may include:
- Finding a softer surface to run on
- Icing your knee after any running or walking
- Keeping your mileage increases to less than 10% per week
- Performing quadricep strengthening exercises (Runner’s Connect has some great suggestions)
- Regularly stretching your hamstrings and calves (Fitness recommends some here)
- Foam rolling to loosen up calves and quads
- Wearing knee support in the form of a brace (use one with a hole in the front for the knee cap)
- Working in some cross-training, like swimming or biking
If these alterations don’t help, it’s time to do a bit more work. Visit a running shop to find the right shoes for your foot and gait style. Ask them about orthotics you could use as well. Finally, visit a pain doctor to rule out other causes of pain. They can also refer you to a physical therapist.
If your knee pain is caused by a mechanical problem–such as weak muscles or malalignment–working with a physical therapist is going to be your best option. Continue icing and following your physical therapist’s advice for cross-training. This will give your knee the most amount of time to heal properly.
What causes outer knee pain from running?
The easiest way to tell the difference between patellofemoral pain syndrome and IT band syndrome is where the knee pain from running occurs. You’ll feel patellofemoral pain syndrome around the kneecap. IT band syndrome, on the other hand, is most clearly felt on the outer side of the knee, where the IT band lies. As PainScience.com explains, the symptoms associated with IT band syndrome include:
- Pain that tends to be worse when descending stairs or hills, but not during ascent
- Pain that isn’t affected by sitting or deep bends in the knee
- Symptoms that are consistent and predictable over time, with no change in the location of pain
- Swelling and pain on the outside of the knee
- Pain relief when you stop running
- Occasional popping or snapping sensations
Common causes of IT band syndrome
IT band syndrome is caused by a tight IT band that rubs against the bone, causing inflammation in the band itself. As Runner’s World explains, this can be caused by:
“[A]ny activity that causes the leg to turn inward repeatedly. This can include wearing worn-out shoes, running downhill or on banked surfaces, running too many track workouts in the same direction, or simply running too many miles.”
How to alleviate outer knee pain from running
The initial suggestions for outer knee pain from running are similar to that of runner’s knee. The first step? Rest. Runner’s World goes on to explain:
“Once you notice ITB pain, the best way to get rid of it for good is to rest immediately. That means fewer miles, or no running at all. In the majority of runners, resting immediately will prevent pain from returning. If you don’t give yourself a break from running, ITBS can become chronic.”
From there, it’s cross-training, finding a softer track to run on, and getting into some better shoes. This should all be combined with more concentrated stretching and strengthening exercises to reduce tension in the IT band and strengthen your hips. Cool Running has some iliotibial band stretches here. If these don’t help, contact your pain doctor for a diagnosis and then a physical therapist for more focused stretching exercises.
Should I run with knee osteoarthritis?
To run or not to run? That is the question, especially if you suffer from knee osteoarthritis. Conventional wisdom has long been that high-impact activities such as running only compound the pain and damage of osteoarthritis. Joints are asked to absorb a jarring shock, often on hard surfaces, which has been thought to lead to an increase in osteoarthritis overall. Whether hard surface or trail running, which asks the knees to remain stable over uneven terrain, running can be a real pain for the knees.
But what if running was not only not harmful but could also help prevent osteoarthritis? New research indicates that conventional wisdom banning running may actually be wrong.
Research on running to prevent knee osteoarthritis
While it is true that those with severe arthritis may not be able to participate in high-impact exercise, activities like running may prevent the development of arthritis in the first place. Research presented at the annual meeting of the American College of Rheumatology (ACR) explained that data collected from 2,683 participants found that those who ran at any age were less likely to have knee pain later on. Grace Hsiao-Wei Lo, MD, MSc of Baylor College of Medicine and a lead author of the study pointed out that while running might not be for everyone, the benefits for those trying to prevent arthritis pain before it starts may want to lace up their trainers:
“This does not address the question of whether or not running is harmful to people who have pre-existing knee OA. However, in people who do not have knee OA, there is no reason to restrict participation in habitual running at any time in life from the perspective that it does not appear to be harmful to the knee joint.”
Even if your run resembles fast walking more than a professional runner’s stride, this can be excellent prevention for knee osteoarthritis. And forget about the conventional wisdom that says only 10,000 steps a day has benefit.
Manage knee osteoarthritis with lower-impact walking
A study funded by grants from the National Institutes of Health (NIH) and published in the American College of Rheumatology (ACR) journal, Arthritis Care & Research, found that 6,000 daily steps (or more) was enough to keep those with osteoarthritis (OA) in the knee from functional limitations due to their RA. Osteoarthritis affects approximately 27 million people in the U.S., and in the knee joint it can seriously disrupt simple daily activities like climbing stairs or standing up from a seated position.
Daniel White, PT, ScD, from Sargent College at Boston University in Massachusetts, noted that this recommendation is just 60% of the commonly accepted goal of 10,000 steps a day but can yield benefits:
“Walking [slowly or at a quicker pace] is an inexpensive activity and despite the common popular goal of walking 10,000 steps per day, our study finds only 6,000 steps are necessary to realize benefits. We encourage those with or at risk of knee OA to walk at least 3,000 or more steps each day, and ultimately progress to 6,000 steps daily to minimize the risk of developing difficulty with mobility.”
If the overall goal is increased fitness that supports decreased symptoms of rheumatoid arthritis, then incorporating running (or fast walking) into a treatment plan starts with a conversation with your doctor.
How to prevent knee pain from running
If you’re ready to start running, but want to stop knee pain before it starts, there are some easy ways to reduce your risk. To ease into a program of running, slow and steady truly wins the race. Try these simple steps:
- Invest in supportive, well-fitting running shoes: Your old sneakers will not work. Footwear with proper support is crucial. Talk to your local highly-recommended running store for help.
- Choose an even surface on which to run: Trail running can be a wonderful experience, but to start with, find a well-marked and even surface to run on. This will put less stress on the knee and get your body used to the actions of the run.
- Stretch before running: It is important to stretch thoroughly before a run, even if it is only going to last for five minutes. Focus on the legs, including the IT band that runs on the outside of the hip. Don’t bounce into the stretch. Go to your edge and then breathe there for several breaths. Let the body loosen itself up, and don’t push.
- Utilize a training program for your fitness level: Start where you are for the best results. This may mean you start walking and work towards a run.
- Cross train in another low-impact sport (e.g. swimming or yoga): This gives overworked joints a rest and prevents further injury from overuse or repetitive motion.
- Add time or distance, not both: If you feel like you can progress in your runs, run at the same pace for a longer period of time, or increase your speed. This will give you the challenge you need without taxing your body too much.
- Listen to your body: If you experience sharp or stabbing knee pain from running anywhere, slow down or stop. Pushing too far, too fast can only end in more knee pain from running. Learn your limits and only extend them safely.
How to relieve knee pain from running
No matter what type of knee pain from running issue you suffer from, remember these simple steps to manage or relieve it.
- Rest first, don’t push your body
- Incorporate stretching and strengthening exercises into your routine
- Talk to professionals for help retraining your gait or getting the right shoes
- Work with a physical therapist to correct underlying issues
- Talk to a pain doctor to get a correct diagnosis and additional treatment options
If you suffer from ongoing and severe knee pain from running, it may also be due to other conditions, like a sprain, tear, or bursitis. If you experience this type of pain, or any sudden onset of symptoms, tingling, throbbing, numbness, extreme swelling, clicking, or locking, talk to a doctor to rule out other causes. Click the button below to find a pain doctor in your area who can help.