Runner’s knee is irritating at best, debilitating at worst. Learn how to stop the pain in its tracks before it takes you out of the game.
Ugh, feeling the onset of a dull, aching throb in your knee? It’s time to listen to your body before “slightly sore” turns into “completely sidelined”. Runner’s knee is the arguably the most common injury among pavement pounders, but how you respond to it is critical.
We’ve compiled a list of the most frequently asked questions regarding runner’s knee to equip you with the information necessary for putting your pain to rest.
Click on a question below to get quick answers or read your way through to learn everything you need to know about one of the biggest foes for runners.
- What is runner’s knee?
- How does runner’s knee happen?
- How do I heal runner’s knee?
- Can I run with runner’s knee?
- Does runner’s knee cause permanent damage?
- How do I prevent runner’s knee?
- Key Takeaways
What is runner’s knee?
Runner’s knee is a broad term describing pain experienced in the front of the knee and around the patella (kneecap). The pain and stiffness vary, but it can become so intense that it makes even the simplest daily activities like getting out of bed or climbing up stairs feel excruciating.
Types of Runner’s Knee
There are a few different types of runner’s knee that could be troubling you. The easiest way to identify your condition is by isolating the area of your knee that hurts the worst.
- Patellofemoral Pain Syndrome (PFPS): With PFPS, pain occurs in the fat pad beneath the patella, the synovial tissue lining the knee joint, and surrounding tendons. This is the most common form of runner’s knee, usually felt in front, around, and beneath the kneecap. PFPS runner’s knee tends to be sorer when going upstairs, but this pain usually grows relatively slowly and can worsen over months and years. You might notice that it’s aggravated by sitting with your knees bent, but that it tends to hurt worse when you stand up.
- Iliotibial Band Syndrome (ITBS): The iliotibial (IT) band is a huge, tendon-like structure running from your hips down your thigh and to your knee. When the IT band becomes irritated or fatigued, it can cause pain on the side of the knee, leading to ITBS. ITBS feels worse when descending and the pain usually comes on more abruptly than PFPS. You don’t experience any particular sensitivity when your kneecap is pushed firmly into the knee, but you have a really sensitive sore spot on the side of the knee (right around that sticky-outy bump called the lateral epicondyle).
- Chondromalacia Patella: In some cases of patellofemoral pain, this condition might also be present. The articular cartilage on the underside of the kneecap begins to soften and break down, leading to damage in the structure.
There are no nerve endings in articular cartilage—meaning you won’t feel the pain there directly—but it can cause inflammation of the synovium and pain in the bone.
Be sure to jot down the knee symptoms that apply to you and where the epicenter of your pain is located. It’s always best to get a professional diagnosis before determining your course of treatment so you know exactly what you’re working with.
Keep in mind that numbness and tingling are not symptoms of runner’s knee, in which case you should definitely go get yourself checked out.
How does runner’s knee happen?
At the most basic level, runner’s knee occurs when nerves sense pain in the soft tissues and bone around the kneecap. No one knows the exact definition of runner’s knee, leaving us to only speculate on a few safe bets. One thing we know for sure is that risk of runner’s knee increases with training volume.
To understand how runner’s knee happens, we need to take a quick peek at the human anatomy. Unlike most bones in your body, the kneecap is pretty funny, floating freely as you move back and forth.
Your patella rests in a cozy little home called the trochlear groove, sliding up and down within the “track” as you sit and stand, flex and bend. Articular cartilage is a slippery substance lining the trochlear groove and patella, helping your bones glide together nice and smoothly when in motion.
The synovium tissue—a thin lining covering the surface of the joint—also aids in movement thanks to the lubricating fluid it produces. On top of that, a small fat pad rests behind the patella, cushioning it and acting like a shock absorber.
Anatomy considered, it seems like humans are just born to run. But even though running is biologically and anatomically programmed within us, our finely-tuned machines start to wear down over time.
Overuse from vigorous exercise can take its toll on your delicate structure due to repeated stress. A sudden change in activity, frequency, intensity, or duration of knee-related exercises can lead to patellafemoral syndrome.
Common Runner’s Knee Causes
- Walking, jogging, and running
- Climbing stairs
- Jumping and squatting
- Sports such as soccer and basketball
Essentially any exercise that involves repetitively bending and flexing your knee could lead to irritation in the surrounding soft tissue. You might also be experiencing issues attributed to improper technique, misuse of sports equipment, new footwear, or changes in the pavement.
You don’t even need to be an athlete to get runner’s knee—despite its lovely nickname coming from plaguing runners the worst. Those who sit for a living could also develop PFPS by fatiguing their constantly bent knee.
Aside from constant stress, runner’s knee could also be caused by patellar malalignment or poor tracking of the kneecap. Your patella gets pushed out to one side of the trochlear groove when your knee is bent, rubbing against your thigh bone, creating pressure, and irritating soft tissue.
Think of the patella as a train riding along the tracks of the trochlear grove. Some abnormal mechanics up or down track cause the train to go askew, placing strain on the side of the kneecap and causing pain. There are a few different factors that contribute to patellar malalignment which could be giving you grief:
- Flat feet. If you have foot pain when running in addition to a troublesome knee, flat feet might be the source of your woes. Those without arches tend to overpronate when they run, causing their feet to roll outwards, legs to twist inward, and knees to move unnaturally and uncomfortably.
- Misaligned hips and ankles. Those whose bones aren’t stacked quite right might have problems with a kneecap that shifts too far left or right, or too high up in the trochlear groove (a condition called patella alta).
- Muscular weakness or imbalances. Particularly in the quadriceps and hip muscles, a muscular imbalance might cause abnormal tracking of the patella. If you have sore leg muscles in addition to knee pain, it might be time to switch from running to strength training.
Regardless of whatever caused your runner’s knee, the symptoms are pretty consistent across the board: dull, aching pain around your knee that intensifies with activity, but also after sitting for a long period of time with your knee bent.
You also might be familiar with that less-than-pleasant cracking and popping when climbing stairs or standing up after sitting for a while. Don’t worry—it’s not a sign of age—it’s just gas built up in the synovial tissue releasing itself.
If your knee goes snap, crackle, pop too often, you should get it evaluated. It could be a sign of a meniscus tear or arthritis, both of which are way more serious than runner’s knee.
How do I heal runner’s knee?
Now that you have a better idea about which type of runner’s knee you have and are able to pinpoint the source of your pain, you can begin to turn your focus on how to heal it—so you can finally get off the sideline and back on your running routine.
Runner’s Knee Treatment: Home Remedies
Runner’s knee can be a major frustration, especially if it strikes while training for your next marathon. Don’t be too deterred; many of these cases can be easily cleared up and treated with some simple home remedies.
- RICE method. Almost every athlete knows about the “Rest, Ice, Compression, Elevation” healing method. Avoid putting weight on your painful knee when possible and rest your knee raised higher than your heart with cold packs for 20 minutes at a time, several times per day.
Compression is good for preventing additional swelling and it offers a little extra support during your runner’s knee recovery period. Just be sure the bandage isn’t too tight and not causing any additional pain.
- Foam rollers. If your runner’s knee pain is caused by your IT band, stretching it out by rolling on a foam roller might provide some relief. However, it’s important to make sure the stretching doesn’t irritate your knee any further.
- Tape. Both rigid athletic tape and flexible kinesiology tape has been shown effective at alleviating soreness caused by PFPS.
- Brace. If tape doesn’t provide enough structure and support, you might consider upgrading to cho-pat straps, neoprene sleeves, and other similar knee braces and can help improve your patella’s tracking.
- Medication. Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce swelling and alleviate some of the pain caused by runner’s knee. Most NSAIDs such as ibuprofen and naproxen are available over-the-counter at a low price, but you should be mindful of their consumption.
Runner’s Knee Treatment: Medical Treatment
Sometimes, at-home runner’s knee treatments aren’t effective at healing your injury, requiring you to step up to a more aggressive strategy. Bear in mind you’re not alone; health care providers say PFPS is pretty common—accounting for as many as 17% of all visits—and that runner’s knee can be cured.
- Gait analysis. If it’s within your budget, you can have your gait professionally analyzed at a physical therapy office by running on a treadmill equipped with a high-speed camera. Doing so would help you detect and correct any abnormalities that are putting strain on the patella.
- Custom orthotics. Visiting a podiatrist can help you score a pair of custom orthotics molded to the exact shape of your unique feet. Correcting collapsed arches with orthotics might relieve some of the stress placed on your patella. Motion control shoes can also help with pronation.
- Cortisone shot. Cortisone is a synthetic steroid provides a quick solution for reducing inflammation and relieving pain caused by runner’s knee. They’re an attractive option because they’re fast, effective, typically covered by insurance, and results can last six weeks to six months.
Be skeptical of this runner’s knee treatment method, though. It might be good for short-term intervention, but it doesn’t actually correct your biomechanics, muscle imbalance, or whatever else the issue might be.
Furthermore, repeated cortisone shots are corrosive; multiple injections will attack the joint’s soft tissue, break down the collagen framework, wear way cartilage, and weaken tendons to the point of being worse than before.
If you want to treat runner’s knee with cortisone, do so in moderation—once per year max.
Can I run with runner’s knee?
In short, no, you should give your knee a break to let it heal—or at least consider dialling back the duration and intensity of your runs. But that doesn’t mean you’re entirely out of the game.
Exercise seems to fire up your pain, so it makes sense to think that the solution is to stop working out. Don’t make this assumption—it could be counterproductive. While you should stop doing whatever activity is causing your pain, you don’t need to derail your entire training.
Low impact exercises such as biking or swimming can keep you from sacrificing your workouts altogether, while also helping you strengthen the muscles necessary for healing. If you’re really feeling the itch to run, take to an unpaved trail or softer terrain that will be a little more forgiving with every footfall.
If your pain is so severe that it keeps you from working out altogether, it’s time to go see a professional physician or physical therapist who can tell you exactly what’s going on. They might call for some lab tests or imaging, but they can offer specific exercises and treatments to get you back on your feet and feeling better.
Runner’s Knee Recovery Time
Runner’s knee recovery time varies from person to person. Unfortunately, pesky knee pains can linger in the unlucky ones, making runner’s knee notorious for sticking around for months on end.
Generally speaking, you shouldn’t run through the pain. When you first return to running you might feel some stiffness in the joint but as long as it continues to get better—not worse—you’re probably okay to keep going.
It’s difficult to predict how much time you’ll need off from runner’s knee due to the complex biomechanics involved. Most treatment plans suggest four to six weeks of non-aggravating activities coupled with strength training, but depending on the cause, you could be looking at a lot more or less.
A reputable doctor or physical therapist will be able to estimate your runner’s knee recovery period. As with most medical conditions, the faster you get treated, the faster you’ll recover. If you catch runner’s knee early on you might only need a few days of rest—so don’t overdo it.
Ignoring your PFPS can lead to a whirlwind of trouble. You won’t lose much fitness over a few weeks’ breaks, so invest in your future running health by taking a little RNR now.
Does runner’s knee cause permanent damage?
Did someone warn you once upon a time that running will destroy your knees? It might sound pretty scoff-worthy, but it turns out that there is a teensy bit of truth to this glorified myth.
Granted, it’s really rare, but runner’s knee can end up causing permanent damage to the cartilage. This only happens if your condition is left untreated, so if we haven’t stressed it enough, give your knee adequate time to heal before jumping back into training mode.
Runner’s Knee Surgery
If you don’t take your patellofemoral pain seriously, you could end up in the operating room. When your problem snowballs into something so large that you can’t even roll out of bed without wincing, a surgeon might be able to help.
Surgery for runner’s knee is rarely recommended, but if you and your doctor determine it’s the right thing to do (after a very lengthy, thought-out conversation), there is a procedure known as “lateral release”.
The surgeon would cut the lateral patellofemoral ligament in order to decrease the outward pull of the patella in an effort to improve tracking along the trochlear groove. Runner’s knee surgery isn’t game-ending, but you’ll likely be non-weight bearing for an extended amount of time.
Our advice? Stay away from cortisone, stay away from surgery. Just stay off your knee for a little while and let it regain its strength.
How do I prevent runner’s knee?
You’ve heard it before: prevention is better than cure. Before you have to consult Dr. Google on the best runner’s knee treatment, take active measures to prevent PFPS from popping up in the first place.
It’s worth mentioning that runner’s knee is more common in women and young adults (likely due to the shape of the pelvis and the angle at which the quad muscle and knee align). If you’re in either of these two camps, learning how to prevent runner’s knee is doubly important.
Correcting your form and strengthening your supportive muscles are the best ways to prevent runner’s knee. Not only does cross-training help stave off injury, but it also makes you a well-rounded athlete and will make your stride all the more explosive.
Runner’s Knee Exercises
You might have runner’s knee due to weak pelvic muscles which allow your femur to rotate inward during the weight-bearing cycle of your gait, putting pressure on your patella.
By making your pelvic muscles stronger, you can train your body to hold your femur in the proper position while you run, allowing your knee to heal.
In order to prevent runner’s knee, add these exercises to your training routine.
- Side leg lift
- Fire hydrant
- Glute bridge
- Bird dog
- Hip abduction
- Leg swing
- Foam roll
- Low lunge
- Hip-flexor stretch
- Lateral hip stretch
- Straight leg raise
- Single leg squat
- Side lunge
Essentially any stretch or exercise that targets your core, low back, hips, quads, and lower body balance will help prevent not only runner’s knee but all different injuries related to pounding pavement.
These activities can also help heal the problem by correcting your biomechanics and perfecting your running form, thereby reducing pressure on your patella and alleviating your pain.
You might not think much of these low impact exercises, but you need to take your physical therapy seriously on your road to recovery. Research shows that out of 199 participants, 78.9 percent felt a decrease in knee pain after performing knee and hip strengthening exercises three times a week for six weeks of rehab.
Consistency is key here. Add these to your training program by taking them onto your warm up or cool down routine, or add 10 extra minutes to your time in the gym in order to prevent runner’s knee from striking.
If you’re on the road to recovery, treat your knee gingerly and listen to what your body is telling you. Always balance strength training with stretching to gain and maintain flexibility and minimize any pull on your patella.
Runner’s knee is quite a headache, plaguing not just pavement pounders, but anyone who constantly bends and flexes their knee.
Extreme treatments in the form of steroid shots or surgery are possible, but this can all be avoided by giving your knee joints a little TLC.
Take note of your body mechanics, check in with your form, make sure your feet are set up for success, and if all else fails, give it a little break.
With proper prevention and treatment, runner’s knee will turn into just another challenge you’re able to conquer.