Knee Pain in Runners: Understanding, Prevention, and Treatment

Knee pain is one of the most common complaints among runners, affecting both recreational joggers and competitive athletes. Whether you're training for a marathon or simply enjoy running for fitness, understanding the causes, prevention strategies, and treatment options for knee pain is essential to maintaining a pain-free running experience.

Common Causes of Knee Pain in Runners

1. Runner’s Knee (Patellofemoral Pain Syndrome) Runner’s knee, or patellofemoral pain syndrome (PFPS), is one of the most frequent sources of knee pain. It manifests as pain around or behind the kneecap, particularly during activities such as running, squatting, or ascending stairs. Research suggests that PFPS results from an imbalance in the forces controlling the knee, causing abnormal tracking of the patella (kneecap) on the femur (thigh bone) .

2. Iliotibial Band Syndrome (ITBS) ITBS occurs when the iliotibial band, a thick band of fascia running along the outside of the thigh, becomes tight or inflamed. This friction can lead to pain on the outer side of the knee, particularly during longer runs or downhill running. Studies indicate that ITBS is associated with biomechanical factors like hip abductor weakness and poor running mechanics .

3. Tendinopathies Tendinopathies, such as patellar or quadriceps tendinopathy, result from repetitive stress on the tendons around the knee. Patellar tendinopathy, often referred to as "jumper’s knee," is especially common in athletes who engage in repetitive jumping or running activities. These conditions are usually due to overuse, and proper load management is crucial for prevention and recovery .

Prevention Strategies for Knee Pain

Preventing knee pain in runners often revolves around optimizing biomechanics and managing training loads. Here are key strategies that can help:

1. Strength Training Weakness in the quadriceps, hamstrings, glutes, and hip stabilizers can lead to poor knee alignment and increase the risk of injury. A study by Willy and Davis (2011) found that runners with PFPS benefited from hip-strengthening exercises, which corrected faulty movement patterns and reduced knee pain .

2. Gradual Progression in Training Rapid increases in mileage or intensity can overwhelm the body’s ability to recover, leading to overuse injuries like tendinopathy or ITBS. Following the 10% rule—gradually increasing running volume by no more than 10% per week—helps prevent sudden spikes in load that contribute to knee pain .

3. Improving Running Form Poor running mechanics, such as overstriding or excessive inward collapse of the knees (valgus), can increase stress on the knee joint. Research suggests that adopting a shorter, more efficient stride and maintaining proper knee alignment can help reduce injury risk .

4. Proper Footwear Wearing appropriate running shoes that match your foot type and gait can provide the support needed to prevent excess strain on the knees. Consulting a professional to assess your running biomechanics and recommend the right footwear can make a significant difference.

Treatment for Knee Pain in Runners

If knee pain develops, early intervention is key to preventing further injury and allowing for a safe return to running. Treatment options may include:

1. Rest and Load Management Taking a break from running and modifying activities that aggravate the knee is often the first step in treatment. A physiotherapist can guide runners through a graded return-to-sport program to ensure a safe recovery.

2. Manual Therapy and Dry Needling Techniques such as joint mobilizations and soft tissue release, combined with dry needling, can alleviate pain and improve flexibility in tight or inflamed tissues around the knee. Studies show that manual therapy, when combined with exercise, leads to better outcomes in patients with knee pain .

3. Exercise Prescription Tailored rehabilitation exercises are essential for strengthening the muscles around the knee and improving hip and core stability. These exercises help address the underlying biomechanical issues that contributed to the knee pain, ensuring a more durable recovery .

4. Gait Re-Training For runners with faulty biomechanics, physiotherapists may recommend gait retraining. Research suggests that modifying running patterns, such as increasing cadence (steps per minute) or altering foot strike, can significantly reduce knee loading and pain .

When to Seek Professional Help

While some knee pain may resolve with rest and self-care, persistent or worsening symptoms should be evaluated by a physiotherapist. Early assessment allows for a targeted treatment plan, preventing further injury and ensuring a quicker return to running.

At Movement Revival, we specialize in treating running-related injuries, including knee pain. Our team offers personalized rehabilitation programs, combining manual therapy, dry needling, and strength training to get you back on track. Whether you’re struggling with patellofemoral pain, ITBS, or tendinopathy, we can help.

Book your assessment today to regain your stride and run pain-free!

References:

1. Bolgla, L. A., & Boling, M. C. (2011). An update for the conservative management of patellofemoral pain syndrome: a systematic review of the literature from 2000 to 2010. International Journal of Sports Physical Therapy, 6(2), 112.

2. Fairclough, J., et al. (2007). The role of the iliotibial band in patellofemoral pain syndrome. Journal of Anatomy, 210(1), 27-30.

3. Khaund, R., & Flynn, S. H. (2005). Iliotibial band syndrome: a common source of knee pain. American Family Physician, 71(8), 1545-1550.

4. Zwerver, J., et al. (2011). Patellar tendinopathy: a review of the literature. Journal of Orthopaedic & Sports Physical Therapy, 41(10), 780-788.

5. Willy, R. W., & Davis, I. S. (2011). The effect of a hip-strengthening program on mechanics during running and during a single-leg squat. Journal of Orthopaedic & Sports Physical Therapy, 41(9), 625-632.

6. Nielsen, R. O., et al. (2012). Training errors and running related injuries: a systematic review. International Journal of Sports Physical Therapy, 7(1), 58.

7. Noehren, B., et al. (2012). Hip and knee kinematics during running: a longitudinal study of changes associated with iliotibial band syndrome. Clinical Biomechanics, 27(4), 365-371.

8. Crossley, K. M., et al. (2002). A randomized controlled trial of exercise and patellar taping for anterior knee pain. American Journal of Sports Medicine, 30(6), 857-865.

9. Rathleff, M. S., et al. (2014). Exercise therapy, patient education, and patellar taping compared with patient education alone in treating adolescents with patellofemoral pain: a cluster randomized controlled trial. British Journal of Sports Medicine, 48(10), 805-812.

10. Crowell, H. P., & Davis, I. S. (2011). Gait retraining to reduce lower extremity loading in runners. Clinical Biomechanics, 26(1), 78-83.