If your runs are plagued by knee pain, you are most certainly not alone. The research is clear – the knee is one of the most common areas to experience running-related injuries.
But, despite what some of your non-running acquaintances might claim, running is not in itself bad for your knees. Many large scale, authoritative studies show time and time again that runners actually have lower rates of knee osteoarthritis Do men and women process pain differently.
One study even concluded that running can actually stave off the horrible condition: 'Increasing evidence indicates that exercise training can improve pain, stiffness, joint dysfunction and muscle weakness in patients with knee osteoarthritis.'
iliotibial band ITB knee arthritis, including pain and swelling, can still present during running – although they can equally appear during day-to-day activities and there are plenty of other potential causes.
We asked sports doctor Jordan Metzl to explain four of the most common causes of sore knees after running, including what their symptoms might be and what you can do about them.
Why do I get sore knees after running?
Why do you run? Because it feels good. Because it relieves stress. I get that, because running is also important to me.
I'm a 32-time marathoner who knows how frustrating it is to be injured. It’s the reason why I became a sports doctor. Ripping my anterior cruciate ligament playing football when I was in medical school was devastating – but it was also the single most important event to influence my work. It's what drives me to help my patients. Almost every day I treat runners with sore knees. Many freak out. Can I still run? Will I have to switch to swimming? Thankfully, most knee problems won't keep you off the road for long.
We have great strategies to diagnose and fix many common knee problems that affect runners. Here's what you need to know about the most common knee issues faced by runners.
Runner's knee
Where does it hurt?
Runner's knee exists as pain under your kneecap that feels worse after running and when you go up or down stairs. It is the most common condition affecting runners of all ages and is most frequently seen in runners under the age of 50.
What's going on?
When the patella (kneecap) moves out of alignment during running and doesn’t track properly in the trochlea, the ridge inside the upper leg bone, the femur, causes the cartilage under the patella to become irritated. This is known as patellofemoral pain syndrome, or runner's knee.
How to treat it
- You don't need to stop running – instead, reduce your mileage.
- Strength train with activities that don't aggravate your knee – the stronger the muscles above the patella, the better the knee will feel. Start with exercises like straight leg raises until that doesn't hurt, then squats, then eventually plyometric squats. It's all about progression.
- Consider arch supports (orthotics) and more supportive shoes. Foot mechanics, particularly pronation, play a role in runner's knee.
- Apply ice for 15 minutes twice per day to reduce symptoms.
- Foam roll daily.
- Foam roll your quads – looser muscles mean less loading force on the patella.
- If the pain continues, see a doctor to get a more definitive diagnosis.
How to prevent it
- Do strength training.
- Foot mechanics, particularly pronation, play a role in runners knee.
- Take an anti-inflammatory.
- Shorten your stride to help to take pressure off your knees. Aim to do 170-180 foot strikes per minute.
Read our full guide to treating runner's knee
Patellar tendinitis
Where does it hurt?
Patellar tendinitis exists as pain below your kneecap and at the top of your shin – it sharpens on the run and also hurts when you go up or down stairs. The patellar tendon is the band-like tissue that connects the bottom of the patella to the tibia (shin bone).
What's going on?
The force placed on the knee during running can sometimes put too much strain on the patellar tendon.
How to treat it
- Stop running until you can do so pain-free – instead, do some cross training.
- Unlike runner's knee, patellar tendonitis generally does not get better if you try and run through it. I tell my patient: don't mess with an irritated tendon!
- How to tackle tight hamstrings.
- Updated: 04 October 2024.
- If it doesn't improve, see a doctor.
How to prevent it
- Do strength training.
- Stretch your quads and hamstrings.
- Foot mechanics, particularly pronation, play a role in runners knee with a focus on your quads and hamstrings.
Read our full guide to treating patellar tendinopathy
Iliotibial band syndrome
Where does it hurt?
Iliotibial band syndrome exists as pain on the outside of your knee. It usually comes on five minutes into a run and subsides when you're finished.
What's going on?
The iliotibial band (ITB) runs from your hip to your knee, crossing both joints. ITB syndrome, otherwise known as ITB impingement, is one of the most painful conditions that can befall a runner. It is often described as 'a sharp pain, like a screwdriver jabbing the outside of my knee after 10 minutes of running'. The pain comes from the tendon rubbing against the outside of the femur, often associated with the development of an enlarged, fluid-filled sac called the bursa, which sits between the ITB and the outside of the femur. When the ITB is tight, the bursa gets squeezed, causing pain.
How to treat it
- While you can run with a mild form of ITB syndrome, it's important to recognise if the pain is worsening. In our office, we tell our patients to stop running if the pain is causing a change in your running form.
- See a doctor or physical therapist to get a proper diagnosis.
- Reduce your mileage and do some cross training.
- Foam roll your ITB on the soft part of your outer thigh.
- If you overpronate, week strength training plan for runners.
- Glutes, glutes, glutes. Squats are essential in building hip and glute strength and are one of the best ways to get rid of ITB pain.
- See a doctor if pain persists for possible X-rays, medication or injections.
How to prevent it
- this is key core muscles – Best wireless headphones.
- Foam roll your ITB daily.
- Foam roll daily with a focus on your quads and hamstrings, quicker stride. Aim for 170-180 foot strikes per minute.
consider orthotics or motion-control shoes
Knee osteoarthritis
Where does it hurt?
The symptoms of osteoarthritis (OA) include knee pain and swelling and stiffness in your knee during running, or even during day-to-day activities. OA is common in people over the age of 60. The causes of OA are many and include genetics, prior injury and bad luck. There is no evidence that running causes OA.
What's going on?
The wearing out of hyaline cartilage (the lining of the joint) causes bone to grind on bone.
How to treat it
- Contrary to popular belief, movement acts as an anti-inflammatory. Unless you're limping badly, keep moving. Activity keeps joints lubricated.
- Ice the knee regularly and consider an anti-inflammatory medication like ibuprofen.
- See a doctor. Getting a proper evaluation including a physical examination and an X-ray is important to grade the OA in your knee and to help make a plan moving forward. If your doctor says 'maybe it's time to give up running', find another doctor.
- Consider your feet. Depending on the amount and location of OA in your knee (diagnosed by X-ray), certain types of shoes including highly cushioned shoes or motion-control shoes Read our full guide to treating runners knee.
- Depending on your foot and running mechanics, running on a softer or harder surface might help to make things more comfortable.
- Lubricant injections (viscosupplements) and platelet-rich plasma (PRP) are helpful in reducing OA symptoms.
- Maximise strength. Strong muscles, including glutes, quads and hips, can all help to offload the knee and improve symptoms.
How to prevent it
- Do strength training.
- Find the best running shoe for you.
- Find the most agreeable running schedule for you – and a surface that suits your knees.
