Knee Pain In Runners – What Does It Mean?

Knee Pain for runners
Though running is certainly a fantastic way to get fit and strengthen your legs, as many as 80% of runners will become injured at some point each year due to running. It is estimated that around 40% of these injuries involve the knee, and it’s certainly the most common running complaint we see at PEAK.

Those of you who have experience of this know just how frustrating an injury it is the symptoms can be inconsistent meaning you’re never sure whether you will feel it during today’s or tomorrow’s run, and it can totally blow your training plans just when things are really starting to feel good, often just in time for an event. The symptoms associated with knee issues can mean that although you might feel like you can run through the pain, the mechanical difficulties can make the knee feel tricky to move and swing fully during and after a run, eventually making continuing running an impossible task.

Often runners respond slowly to this confusing picture and delay seeking help, which allows the problem to get worse. As a result, this can hugely interrupt your training and make you feel truly miserable.

The million dollar question for many runners would therefore be how do you prevent / stop knee problems in running? If only there was one simple and quick way of doing this, there would certainly be a world of happier runners out there! The truth is there are many things that can contribute to the cause of knee pain from running. This is primarily down to the fact that the action of the knee is dependent not only upon what the foot and ankle are doing when they hit the ground, but also what the pelvis is doing to help co-ordinate all of this from above. As these 3 areas of the body are therefore heavily interrelated, physiotherapists usually need to examine what each area is doing before deciding which segments are responsible for upsetting the apple cart.

Common causes of running-related knee problems include:

• Abnormal foot and ankle motion causing altered alignment of the knee when running
• Poor pelvic alignment and/or core stability e.g. weak gluts, tight hip flexors etc, altering the control and pull on the knee from above
• Poor choice of footwear influencing the way in which the foot hits the ground and the control of the foot, ankle, knee and pelvis during running
• Over-training – sudden increases in mileage, speed or changes in terrain
• Poor self management – e.g. lack of stretches after running, inadequate warm-up, ignoring aches and pains when they first start

Why knee pain if other areas are to blame?

As the knee sits in the middle of the lower limb, caught between the ankle and the pelvis, whatever is going on above or below it can cause it to misbehave. For this reason, knee pain may not be the source / cause of the pain, but a symptom of other areas messing with the dynamics. Most runners however assume that knee pain means that the knee must be the problem area to tackle. The majority of runners with knee problems will have muscle imbalances around their pelvic and thigh areas, and frequently have issues with the way their ankle is moving without even realising this.

By far the most common presentation of running-related knee pains that we see in clinic has got to be lateral knee pain (pain on the outside of the knee) which tends to come on gradually but then suddenly hampers movement of the knee during running. This is often cause by a tightened Iliotibial band (ITB) which then alters the dynamics of the patella (knee cap) causing pain and altered leg swing. ITB issues can be the result of a wayward pelvis and / or the foot and ankle misbehaving in some way. In other words, the ITB and knee are the symptomatic areas, but not necessarily the primary cause of the problem.

This has to be one of the most infuriating knee issues for a runner as often, with a bit of rest and massage, the symptoms settle well only to come back during the next couple of runs, just when you think it’s gone away. This kind of knee problem can continue to be (mis)managed for a while with just rest, stretching and sports massage until the sufferer realises that it’s just not going away, sometimes after several weeks / months battling away with it and after training has been significantly disrupted. Pain around the knee cap, or ‘patello-femoral pain’ can also generally be attributed to problems stemming from above or below the knee where the knee cap is the source of the pain, but other structures are causing the biomechanics to malfunction.

The key points to take away from this are:

Don’t ignore knee pain when running, tempting as it is when it is only mild to keep running through it just because you can for a while, it is usually an indication that something is not working properly in the lower limb and needs correction.

• Delaying the correct management is only going to prolong your agony and interrupt your training for longer
• Don’t jump into buying a sparkly new pair of trainers, just because someone has looked at you on a treadmill in a shop, get an assessment by a professional (physio or podiatrist) so that you know exactly what you need for your body to work well
• Knee problems can often be present because of issues above at the pelvis and / or below at the foot and ankle so these areas should always be assessed by a professional who is experienced in these types of injuries
• Core stability exercises and stretching effectively after running are vital in order to maintain a good balance around the pelvis this helps to keep the lower limbs aligned
• Over-training is asking for trouble, whilst you might feel pleased with yourself for managing more miles that you thought you could do, sudden hikes in mileage when you have biomechanical problems serves only to strain your joints and soft tissues more and more, and you’re likely to develop other compensatory muscle imbalances in the process

It’s a crushing feeling as a runner when you’re just starting to make great progress and an injury strikes. Do yourself and your body a favour, don’t ignore that niggle that you subconsciously know shouldn’t be there, just because you want to keep on running. The smartest way to keep on running is to seek help early and to nip problems in the bud before they take hold and stop you doing what you love for longer. Remember the Kneepflexx from Pflexx Sports helps you build muscle on the move.