Runner’s Knee Injuries: Treatment and Causes

Do you feel a dull, aching pain or even a sharp pain in your knee when you’re running? Is it painful or swollen after you run?

Many people will rest their knee until the pain settles down and go straight back to running. This can end up worsening the problem, as the issue causing it won’t usually go away on its own. On the other hand, ongoing knee pain may cause people to stop running completely. Luckily, most of the conditions that lead to runner’s knee can be treated easily – as long as you have the correct diagnosis.

What is runner’s knee?

Any pain around the front the knee can be described as ‘runner’s knee’, but it’s not just runners who suffer: it can be brought on by any activity that repeatedly stresses your knee – from walking, cycling or football to skiing and walking.

Runner’s knee is particularly common in middle age. An early diagnosis from sports medicine experts or orthopaedic specialists can usually resolve the issues without the need for surgery. 

What are the causes of runner’s knee?

The knee joint forms a hinge between your thigh bone (femur) and your shin bone (tibia). The bones are coated with a smooth layer of cartilage, and the inside of the joint is cushioned by two semi-circular pads known as the menisci. Protecting the front of your knee is a disc of bone called the patella – or kneecap.

The whole joint is held together by thick cords called ligaments, and muscles which are connected by stretchy tendons.

Any of these structures can be damaged as a result of repetitive strain, misalignment or an injury.

Some of the most common causes of runner’s knee include:

Tight or unbalanced muscles

The large quadriceps muscle in front of your thigh, the hamstring in the back and the calf muscles do most of the work when you’re running. When they build in mass, they can get shorter and pull on the tendons that connect them to the bones and other muscles. It can particularly cause pain around the patella.

Patellar tracking disorder: weak or unbalanced muscles in your leg can pull your kneecap out of alignment. This causes the tendon and other soft tissue that attaches it to the shin bone (patella tendon) to rub across the joint, causing pain and inflammation.

Connective tissue problems

Iliotibial (IT) band syndrome: the IT band is the tissue that connects your hip, your knee and your shin bone along the outside of your leg. It helps you to bend and straighten your leg and rotate your hip. It also stabilises your knee. Your IT band can get tight due to overuse – particularly flexing and extending of your knee, making it especially common in runners and cyclists. A tight IT band pulls on the outside of your knee joint, causing pain.

Cartilage damage

Injury (especially sudden twisting movements or an impact) can cause the smooth layers of cartilage on your bones, or the rubbery meniscus to tear.

Cartilage can also be damaged through wear and tear, particularly as a result of sports which involve a lot of jumping.

Chrondomalacia

The cartilage lining the back of the kneecap (patella) deteriorates, causing friction when the patella moves across the joint. It can be caused by overuse in younger athletes or arthritis in older people.

Arthritis

Osteoarthritis (bone degeneration) and rheumatoid arthritis can cause friction and damage to your knee joint.

Foot problems

Overpronation (when your foot rolls down and inwards as you step), fallen arches (flat feet) or hypermobililty (loose ligaments in your feet) can all lead to knee problems. If your footfall is unbalanced, your lower leg bones can shift position, putting stress on the bones and soft tissue of your knee joint.

What are the symptoms of runner’s knee?

Runner’s knee is usually felt as a dull, aching pain around or behind the kneecap, especially where it meets the lower part of the thigh bone (femur). It also cause a sharp pain that pulls you up. It can occur during exercise, or can appear afterwards. Some conditions will also result in grinding or popping sensations, particularly if there is cartilage damage.

How is runner’s knee treated?

The first thing you can do, if you have pain in your knee, is to rest it and take anti-inflammatories. Icing the joint can help to reduce the swelling, and heat can help with the pain.

Once the pain has settled down, you can try introducing stretches into your routine. Most physiotherapists recommend stretching every day. There are many stretching exercises for runner’s knee – you particularly need to focus on your hamstrings, quads, calves and IT band.

If your symptoms persist, it’s best to consult a physiotherapist or a specialist for a diagnosis. You may need an MRI scan or an ultrasound scan to assess the damage.

Depending on the diagnosis, you will usually be referred to a physiotherapist who will recommend strengthening and stretching exercises. For more serious issues, you may need surgery.

Other common causes of knee pain:

There are various conditions that can lead to knee pain, which are not strictly ‘runner’s knee’. I would advise that any ongoing pain in your joints needs to be examined and properly diagnosed before you carry on running, or even give up altogether. Some of the most common knee problems that are treated by the Capital Orthopaedics team are caused by:

Ligament damage

Pain in your knee can be caused by a partial of total tear of one of the four fibrous ligaments that connect the bones in your knee. It is usually accompanied by a feeling of instability. While it is not strictly a ‘runner’s knee’ condition, it can be worsened by running.

Tendon damage

Any of the tendons connecting the muscles of your leg to your knee joint can be stretched by overuse, tight muscles or injury.

Bone misalignment

If any of the bones from your ankle to your hip are out of alignment (often due to stretched tendons or ligaments), it can cause problems in your joints due to excess pressure at certain points.

How can I prevent injury from running?

Stretch, stretch, stretch! I would suggest stretching your leg muscles at least once a day. Also, warm up your muscles before you start running. This could be a brisk walk or very gentle jog on the spot.

It is important to ensure that you have the best fit of shoes for running, even if you don’t think of yourself as a ‘serious’ runner. Most running shops will provide advice, and many running shoe specialists will do a ‘gait analysis’ – to see the way that your foot lands when you run.

Posture is also important. Holding your core tight while you run can help to keep your body in alignment and prevent joint injuries. Again, some running shops will look at your running form and advise you on altering your posture.

It is worth consulting a podiatrist to see if you have foot problems, such as overpronation, fallen arches or hypermobility. A podiatrist can provide you with special shoe inserts (orthotics) to support your feet while you’re running, which can help prevent knee pain.

I cannot emphasise more strongly that the sooner you deal with knee issues, the better. Early diagnosis can help you treat your condition conservatively – and, if the problem requires surgery, it is better to resolve it as quickly as possible, before it becomes more serious.

Simon Moyes is an internationally renowned orthopaedic surgeon and leader in the field of arthroscopic (keyhole) surgery. His Capital Orthopaedics team works from The Cromwell Hospital in London, with its state-of-the-art diagnostic and surgical equipment, and top sports medicine professionals.