Knee Pain from Running: Evidence-Based Treatment Options

As a runner, the last thing you want is constant knee pain hindering your progress. But did you know that knee pain from running can result from various causes, such as overuse injuries, biomechanical issues, and muscle imbalances? In this blog post, we’ll delve into these causes, as well as discuss common knee injuries in runners, and explore evidence-based treatment options. By understanding these factors, you’ll be better equipped to prevent and manage knee pain, allowing you to continue enjoying your runs pain-free.


Key Takeaways

  • Knee pain in runners is caused by overuse injuries, biomechanical issues and muscle imbalances.
  • Treatment for knee pain involves rest, ice, strengthening exercises and manual therapy techniques.
  • Prevention strategies include correct running form, suitable footwear selection and conditioning/cross-training exercises to strengthen muscles around the knee joint.


Understanding Knee Pain in Runners

knee pain from runningKnee pain in runners is often attributed to overuse injuries, biomechanical issues, and muscle imbalances. With its complex structure, the knee is susceptible to a variety of problems, which can lead to pain and discomfort. Addressing these factors with the right training, footwear, and muscle strengthening exercises can help prevent runner’s knee.

The upcoming sections will delve into the causes of most knee injuries and closely examine specific ones, including runner’s knee, iliotibial band syndrome, and patellar tendinitis.


Overuse Injuries

One of the primary reasons for knee pain in runners is overuse injuries, such as Patellofemoral Syndrome or Runner’s Knee. This condition occurs when repetitive stress is placed on the knee joint, leading to inflammation and irritation. Knee stress fractures, a common overuse injury in runners, can be caused by factors such as a rapid increase in activity, running on unfamiliar surfaces, or using improper footwear.

Prepatellar bursitis, another overuse injury, involves inflammation of the bursa located in the anterior region of the patella. Repeated rubbing of the knee region, severe muscle tightness, or any sudden trauma can cause this condition. Besides, incorrect biomechanics or overuse may be responsible too. Preventing overuse injuries requires adherence to a gradual training program, adequate rest, and correction of any muscular imbalances.


Biomechanical Issues

Biomechanical issues, such as improper running form and structural defects, can contribute to knee pain in runners. Poor form, caused by imbalances in the muscles used for running, can disrupt your stride and put additional strain on your knees. This can lead to pain, typically on the inside of the knees or within the kneecap.

In addition to poor form, wearing inappropriate footwear can also lead to knee pain. Insufficient arch support can cause overpronation, resulting in pain on the inner aspects of the knees. Consultation with a physical therapist or running coach for evaluation of your form and guidance on corrective exercises can help resolve biomechanical issues.

Moreover, invest in running shoes with adequate arch support, custom orthotics, or a knee brace to alleviate knee pain caused by improper footwear or issues related to the shin bone.


Muscle Imbalances

Muscle imbalances can impact knee pain in runners by causing unequal force distribution and focal strain on tendons and ligaments. Imbalances between the quadriceps and hamstrings, as well as weaknesses in other muscle groups, such as the lower and middle trapezius and serratus anterior, can result in discomfort, pain, and an increased risk of injuries.

Treatment of knee pain in runners should take into account the extensibility and tone of the quadriceps, hamstrings, and calf muscles. Addressing these imbalances through targeted strengthening exercises and flexibility training can help alleviate knee pain and reduce the risk of injury.


Runner’s Knee: Causes, Symptoms, and Treatment

Runner’s knee, also known as Patellofemoral Pain Syndrome, is a common knee injury in runners characterized by dull pain around the front of the knee.



Runner’s knee is primarily caused by excessive and repetitive strain on the knee joint. This strain can result from factors such as:

  • Overuse
  • Weak thigh muscles
  • Breakdown of cartilage under the kneecap
  • Biomechanical factors, such as imbalances in the muscles used for running

These factors can contribute to the development of runner’s knee.

Incorrect running technique and training errors can place increased stress on the knee joint, leading to runner’s knee. To prevent runner’s knee, reducing the risk of this painful condition is possible by addressing these factors and maintaining proper conditioning.



runners kneeThe primary symptoms of runner’s knee include a dull ache around the anterior of the knee, rubbing, grinding, or clicking of the patella, and aching pain in the front of the knee. Typically, symptoms of patellofemoral pain manifest as a generalized discomfort on the inner front of the knee. This discomfort is often heightened during activities such as running, jumping, climbing, or descending stairs. Prolonged sitting with knees in a bent position can also exacerbate these symptoms.

Additionally, symptoms of runner’s knee may include:

  • Pain around or behind the kneecap
  • Pain when bending or straightening the knee
  • Pain when walking or running downhill
  • Swelling around the knee

Experiencing these symptoms warrants consultation with a healthcare provider for an accurate diagnosis and treatment plan.



Effective treatment for runner’s knee often involves a combination of P.R.I.C.E Principle:

  • Protection (bracing or knee tape)
  • Rest
  • Ice
  • Non-steroidal anti-inflammatory medication
  • Exercise
  • Guidance regarding footwear

Ceasing to run until it’s possible to do so painlessly is an imperative step.

Strengthening exercises, such as clamshells, quadruped mule kick with leg extended, and single-leg bridge, have been demonstrated to be beneficial in strengthening the knee and reducing pain in runners. In addition, manual therapy techniques, such as hands-on cross friction or instrument-assisted techniques, can be employed to address degenerative tendon issues and muscle extensibility imbalances.


Seek out professional help

To enhance treatment effectiveness, it is crucial to undergo a comprehensive biomechanical assessment with your physiotherapist to address any muscle imbalance or biomechanical issues. They may suggest modifications to your activities and target external factors such as muscle imballances that are contributing to your symptoms.


Iliotibial Band Syndrome: Causes, Symptoms, and Treatment

IT Band SyndromeIliotibial Band Syndrome (ITBS) is a knee injury experienced by many runners. It presents with pain and swelling in the lateral knee joint. This section will discuss the causes, symptoms, and treatment options for ITBS, enhancing your understanding of this condition and its management.


The primary causes of iliotibial band syndrome in runners include overuse, weak thigh muscles, and breakdown of cartilage under the kneecap. Repetitive stress on the knee joint, such as that experienced during running, can cause the iliotibial band to become overly tight and irritated, leading to pain and inflammation.

Biomechanical factors, such as weak neuromuscular control of the hip abductor muscles and abnormal hip and knee mechanics, can also contribute to the development of iliotibial band syndrome. Anatomical factors, such as increased prominence of the lateral femoral epicondyle and leg length differences, may also play a role in the development of this condition.



The signs and symptoms of IT Band Syndrome include:

  • Pain on the outside of the knee
  • Popping or clicking sensations
  • Discomfort on the exterior side of the knee
  • Soreness or tenderness on the exterior side of the knee
  • A sensation of clicking, popping, or snapping on the exterior side of the knee

IT Band Syndrome can affect mobility in runners by causing pain and discomfort on the outside of the knee, thereby limiting the range of motion and making it difficult to run or perform other activities that involve knee flexion and extension. Furthermore, IT Band Syndrome can lead to decreased performance and impact various sports and activities, not just running.



Effective treatment for IT Band Syndrome often involves:

  • Resting for at least one week
  • Foam rolling and stretching on a regular basis
  • Strengthening hip muscles
  • Manual therapy techniques, such as trigger point work and myofascial mobilizations, can be beneficial in addressing ITB tensions and lumbar/sacral and pelvic dysfunctions.

Research has demonstrated that strengthening hip abduction muscles is beneficial in the treatment of ITBS, with improvements in pain and function observed. Emphasizing eccentric control on the hip external rotators and the gluteus maximus muscle groups is also essential when treating ITBS, as ITB strain occurs during the deceleration phase of stance.


Patellar Tendinitis: Causes, Symptoms, and Treatment


Patellar tendinitis, also known as jumper’s knee, is another one of the common knee injuries in runners, resulting from the overstressing of the patella tendon. This section will scrutinize the causes, symptoms, and treatment options for knee injuries like patellar tendinitis.



patellar tendonitisPatellar tendinitis is primarily caused by recurrent stress on the patellar tendon and excessive utilization of the tendon due to running beyond what the tendon is prepared for. This strain can result in stress and minor tears in the patellar tendon, leading to inflammation and discomfort. Biomechanical factors, such as imbalances in the muscles used for running and rapid increase in training intensity, can also contribute to the development of patellar tendinitis.

Addressing these factors, maintaining proper conditioning, and ensuring a gradual progression of physical loading can help runners lower the risk of developing patellar tendinitis. Implementing a well-structured training plan and adhering to the recommended maximum progression of frequency, intensity, or duration can also help prevent this condition.



Pain in the inferior pole of the patella is one of the primary symptoms of patellar tendinitis. Other symptoms may include:


  • Repetitive loading of the quadriceps and the patella-patellar tendon complex
  • Pain linked to physical exertion
  • High impact activities such as running or jumping can trigger it

The pain associated with patellar tendinitis may initially be mild and only present during physical activity or after strenuous exercise. However, over time, the pain can increase in intensity and become a sharp pain. Experiencing these symptoms warrants consultation with a healthcare provider for an accurate diagnosis and treatment plan.



Treatment for patellar tendinitis typically involves rest, ice, and strengthening exercises aimed at building up strength and providing relief from pain. Manual therapy, such as cross-friction massage or instrument-assisted mobilization, can be employed to address degenerative tendon issues and muscle extensibility imbalances.

A thorough assessment of technique for the activity causing the symptoms is crucial for a successful return to sport. Emphasizing eccentric control on the quadriceps during high-speed resistance training, as well as incorporating external cues, such as using a metronome, may provide a beneficial motor activation for the quadriceps and help in the treatment of patellar tendinitis.


Prevention Strategies for Knee Pain in Runners

Reducing the risk of knee pain in runners involves implementing key prevention strategies, which include maintaining the correct running form, selecting suitable footwear, and participating in conditioning and cross-training.


This section will delve into these strategies in detail, equipping you with the necessary tools to maintain healthy, pain-free knees, especially when keeping your knees bent for extended periods.


Proper Running Form

Calf cramps while runningPrevention of knee pain and injury risk reduction heavily depend on maintaining the correct running form. Common errors in running form, such as overstriding, gait issues, and inadequate form, can generate increased shearing forces on the patellofemoral joint, leading to pain and potential injury.

To ensure proper running form, focus on the following:

  • Look ahead
  • Keep hands at waist level
  • Relax the hands
  • Maintain good posture
  • Relax the shoulders
  • Keep the arms relaxed and swinging naturally
  • Develop core strength
  • Maintain a consistent cadence

Consulting with a physical therapist or running coach can also help evaluate and improve your running form.


Footwear Selection

Selecting suitable footwear is crucial for runners to avoid knee pain, as it aids in reducing knee pressure. Running shoes should provide:

  • Cushioning
  • Stability
  • Low heel drop
  • Arch support
  • A correct fit

stress fracture treatmentReplacing running shoes every 300 to 500 miles or every 400 to 600 kilometers can also help prevent knee pain. Some recommended brands for running shoes that may help prevent knee pain include:

  • New Balance
  • Hoka One One
  • Mizuno
  • Brooks

Additionally, it may be beneficial to consider utilizing orthotic inserts if necessary.


Conditioning and Cross-Training

deltoid strainImplementing conditioning and cross-training is crucial for runners to avoid knee pain, as these activities promote muscle balance and lessen the chance of overuse injuries. Engaging in a variety of exercises can help strengthen the muscles around the knee joint, thereby improving stability and reducing the impact on the knees while running. Some recommended exercises include:

  • Biking
  • Swimming
  • Strength training
  • Low-impact activities like yoga or Pilates

By incorporating these exercises into your routine, you can strengthen your knees and reduce the risk of knee pain while running.

In order to avoid knee pain, some of the most effective cross-training exercises for runners include aqua jogging, lateral work, and specific knee-strengthening exercises such as step-ups, lunges, and leg curls. Participating in conditioning and cross-training 2-3 times a week can help maintain balanced muscles and reduce the risk of knee pain.



In conclusion, understanding the various causes of knee pain in runners, such as overuse injuries, biomechanical issues, and muscle imbalances, is essential for prevention and effective treatment. By maintaining proper running form, selecting appropriate footwear, and engaging in conditioning and cross-training, you can reduce the risk of knee pain and continue enjoying your runs. It’s also very important to undergo a comprehensive biomechanical assessment with your physiotherapist to address any biomechanical or muscle imbalance issues. They may suggest modifications to your activities and target external factors such as muscle imballances that are contributing to your symptoms.


Frequently Asked Questions

How do I get rid of knee pain from running?

To get rid of knee pain from running, try not running until the pain subsides. Additionally, use cold packs and ibuprofen to reduce inflammation, and incorporate stretching and strengthening exercises into your warmup to help prevent it from occurring again in the future.


Is it OK to keep running with knee pain?

If your knee pain is severe enough to change your gait or cause a limp while running, it is time to rest and let the knee recover. If you experience a gradual onset of knee pain while running, it is okay to continue training as long as the pain is under 5/10. If the pain persists after a week’s rest, see a GP or physiotherapist to determine the cause and how soon you can start running again. It is important to stop running if you have any pain in the knee area.


Does runner’s knee go away?

Runner’s knee can usually be successfully treated by a combination of rest, stretching and strengthening exercises, and some lifestyle changes. With the right treatment plan, it is possible for runner’s knee to go away.


What are the common causes of knee pain in runners?

Knee pain in runners is often caused by overuse injuries, biomechanical issues, and muscle imbalances.


How can I prevent knee pain while running?

To prevent knee pain while running, focus on proper running form, choosing the right shoes, and strengthening muscles through cross-training.



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