Why Do My Knees Hurt When I Run?

Avid running is associated with several different types of knee pain. All are commonly referred to as "runner's knee". The two most common types of runner's knee are patellofermoral pain syndrome (PFPS) and iliotibial band syndrome (ITBS). These two types of repetitive use and impact injuries commonly affect people who cover a lot of ground, such as triathletes, runners, hikers and people who walk a great deal. In this article, we discuss the various types of runner's knee and provide sound advice to help you avoid, identify and treat these conditions. Read on to learn more.

How Does Runner's Knee Start?

There are a number of activities that frequently precipitate runner's knee. Among them are:

1
Excessive or repetitive use: If you perform a great deal of high stress exercise, such as squats and/or lunges, the tissue surrounding the kneecap can become irritated. Bending your knees repeatedly for any reason can result in a repetitive use injury.
2
Knee impact: If you fall on your knees or take a blow to the knee, the injury can cause runner's knee symptoms.
3
Poorly aligned leg bones: If the bones and joints from your ankles to your hip are misaligned, pressure on the knees is likely to be uneven. This can cause uneven wear and tear, resulting in pain.
4
Foot problems: All manner of foot problems can cause uneven wear and tear and pain in the ankle, knee and hip joints.
5
Weakness or lack of balance in the thigh muscles: Your kneecaps are held in position by the quadriceps, which are the large anterior thigh muscles. Excessive tightness or weakness in one or both quadriceps can cause your kneecaps to shift around.
6
Damaged cartilage: Injury and/or repetitive use can cause the cartilage that pads the kneecaps to break down. When this happens, you have bone grinding against bone and this is naturally painful.

Any of these circumstances can cause knee damage, most commonly ITBS or PFPS. here are the differences between these two common types of runner's knee:

ITBS

ITBS pain usually manifests as pain on the inner or outer sides of the knees. The pain is caused by inflammation of the iliotibial band, which is a very large structure that runs along the sides of the thighs and knees.

PFPS

PFPS manifests as pain under and around your kneecap. This condition can be brought on by walking, cycling, hiking or running; however, excessive sitting, squatting or keeping the knee flexed, can also cause it.

Symptoms To Watch For

Runner's knee of all types are mainly characterized by pain. With PFPS the pain is most notable on, around or under the knee cap. ITBS, manifests as pain on the outer side of the knee
PFPS may cause a grinding sound and sensation in the kneecaps. You may also hear and feel popping. In some cases, inflammation may cause slight swelling
With both PFPS and ITBS, bending your knees as you rise from a chair kneel, squat, walk or run can cause pain

One way to determine whether you have PFPS or ITBS is to think about the way you work out. If you tend to run or walk uphill, your pain is likely to be caused by PFPS. If you tend to run or walk downhill, suspect ITBS.

Symptoms You May See With Other Types Of Knee Problems

In addition to PFPS and ITBS, there are many other ways to injure your knees and experience pain when running. If you experience any of these symptoms, you can be fairly sure that your problem is caused by a knee condition other than these top two.

Meniscal cartilage problems are usually the cause of instability, clunking or locking of the knee joint.
Extreme swelling is not a common symptom of PFPS or ITBS. You may see some slight inflammation and swelling with PFPS, but extreme swelling and pain indicate some other cause.
A specific precipitating event is not associated with PFPS or ITBS. These two conditions develop gradually. Sudden pain indicates traumatic injury.
Neither of the top two runner's knee problems are associated with throbbing pain or any pain in the bend of the knee. Pain on the back of your knee is sure to have a different cause.
Numbness and tingling are serious symptoms that warrant a doctor's attention. They are not symptoms of PFPS or ITBS.

How Does Your Doctor Diagnose Knee Pain?

Any time you have a sports related injury, a good doctor will begin diagnosis with a thorough exam. He or she may also call for tests, such as x-rays, that will allow a better look at the insides of your knee joints.

How Do You Take Care Of Runner's Knee?

Time heals all things, and that includes knees. One of the main components of recovery from knee damage is time. You must have the patience to rest and care for your knee until all symptoms are resolved and you have regained strength. Working out or running on injured knees will only make your problems worse.

Rest: Don't run, cycle or perform exercises like squats and lunges while your knee is recovering. If you must stand, walk or squat for work, talk with your doctor about getting an excuse until your knee is healed. With your doctor's backup, you may be able to work out alternatives with your employer.
Ice: Apply an ice pack to your injured knee(s) for twenty or thirty minutes, every three or four hours for several days. Continue this therapy until your pain is resolved.
Compression: Use an Ace bandage or a stretchy knee brace to support and protect your injured knee.
Elevate: Whenever you are sitting down or lying down, use a pillow to support your leg and hold it higher than your heart. This encourages good blood circulation to help resolve inflammation.

There are similarities in caring for all types of knee injury. As with most exercise related injuries, rest, ice, compression and elevation (RICE) can help reduce pain and swelling and encourage healing. Remember that knee pain can become chronic if you don't give ample time and attention to recovery.

Talk with your doctor about using over-the-counter pain relievers, such as naproxen or ibuprofen. These mild drugs help relieve inflammation, swelling and pain. Be sure not to overdo use of pain medications because excessive use can cause ulcers and may thin your blood dangerously. Follow packaging directions (or your doctor's instructions) carefully.

If you and your doctor are not able to resolve your problem through these techniques, your doctor may refer you to an orthopedic surgeon. Surgery for runner's knee may involve replacing damaged cartilage and/or correcting the kneecap's position.

What Can You Do To Avoid Developing Runner's Knee?

The precise causes of both ITBS and PFPS are unclear, but exercising common sense in caring for your feet and legs can help you avoid these and many other foot and leg problems associated with running and other athletic activities.

Follow these tips to avoid running related injury:

1
Don't overdo it. Excessive training and inadequate rest are the perfect combination for causing running related injuries. Set realistic running and exercise goals for yourself, and always give yourself ample time to rest and recover between workouts.
2
Focus on the strength of your thigh muscles. Be sure to add exercises to your regular routine to keep these muscles strong so that they will keep your kneecaps securely in place while you run. Remember to stretch your quadriceps as well as strengthening them.
3
Wear supportive footwear that is in good condition. Don't skimp on running or exercise shoes. Your feet are the foundation of your body, and it pays to wear shoes that absorb impact well and provide correct alignment and support. When your shoes start to wear out, replace them.
4
Add shoe inserts for custom support. In addition to purchasing high quality shoes, work with your doctor or podiatrist to identify any additional support you may need. Use over-the-counter or custom shoe inserts to get just the right amount of arch support, heel stability and ball-of-foot cushioning.
5
Avoid running on hard surfaces. Whenever possible, run on a properly prepared track or on well-manicured grass. Concrete sidewalks and other hard surfaces create a lot of impact on your joints and can cause joint injury. Rocky, unkempt areas present dangerously uneven surfaces which may lead to serious traumatic injuries.
6
Take care of yourself. Eat right and participate in regular, overall exercise to maintain general health and fitness.
7
Maintain a healthy weight. Excess weight causes excess stress on your feet and your joints, as well as on your heart.
8
Always warm up. Running or performing strenuous exercise with "cold" muscles, tendons and ligaments will surely lead to injury. Take a few minutes to perform a warm up routine before you begin your run.
9
Cool down. Take time to cool down at the end of your run or workout. This helps realign your body to avoid injury. One very good cool down routine is the yoga Sun Salutation series.
10
Increase your workout gradually. Sudden additions of challenging exercise can stress your body. Adding or greatly increasing reps of exercises such as lunges or squats can especially stress your knees. Add challenges gradually to give your body time to adjust.
11
Use support. If your knees bother you when you work out or run (or even if they don't) knee braces can help protect them and prevent injury.
12
Seek professional help. If you are experiencing pain in your knees and consistent application of RICE for a significant period of time (2 weeks) does not help, see your doctor. Be willing to participate in physical therapy to get your knees back in shape.

How Long Does It Take To Recover From Runner's Knee?

There is no cut-and-dried estimate for recovery time. Your rate of recovery depends a great deal on your physical fitness and your ability to follow your recovery plan.

This can mean making adjustments to your exercise routine. You want to rest your knee and stay in shape. This means you will need to change your routine and focus on low and no impact forms of exercise. Some good examples include swimming and yoga.

The importance of taking your time cannot be stressed enough. You should not return to your regular workout until you are fully pain free. You must be able to completely straighten and bend your knee without feeling any pain.

Likewise, walking, jogging, sprinting and jumping should be pain free. If you feel any pain when performing any type of exercise, it means you need to slow down and focus on healing your knee.

Author

Rehan Iqbal

Rehan is a content creator with a focus on plantar fasciitis and gait issues. His knowledge in this field is considerable and he has helped many people understand and overcome these conditions. In his free time, he enjoys outdoor activities like running and hiking.

View all posts