Knee injuries are the most common running injury. They make up about a third of injuries from running yet many athletes are “muddling through” knee pain from running without addressing underlying root causes, setting themselves up for potentially longer term damage.
Thankfully there are easy ways to prevent or cure knee injuries from running.
Many treatment options exist and – spoiler alert – improvements in running form is one that is proven to help. This post is based on contemporary research and leans heavily on this scientific review of current literature on treatment options.
Types of knee pain
The three most common types of knee injuries are patellofemoral pain syndrome (PFPS) a.k.a. “Runners knee”, iliotibial band friction syndrome (ITBFS) a.k.a. “IT band syndrome” , and patellar tendinopathy (PT).
- Out of these Patellofemoral pain syndrome, commonly known as “runners knee” is the most common. If you gradually feel the onset of knee pain under load at the front of the knee , around the kneecap you may experience this.
- Iliotibial band friction syndrome (ITBFS of often “ITB” or “IT-Band” syndrome) is also common among runners and describes pain at the outside of the knee. The knee typically presents itself as the knee extends during loading and push off, when tested when moving from 90 to 30 degrees or when walking stairs up or down. The cause for this pain is still debated among researchers but most believe it is related due to friction and compression the strong, thick IT band causes with surrounding bones, tendons and tissue.
- Patellar tendinitis causes pain just below the kneecap after running or when landing from a jump,when going up and down stairs or when squatting. Patellar tendonitis is caused by tiny tears in the tendon, which happen if too much stress is placed on the tendon too soon, before it can strengthen. The body aims to repair the tears, causing inflammation and weakening of the tendon.
All three conditions are often caused by training errors – such as increasing volume or intensity too much too soon, instead of a gradual build up. (1)
Other causes include muscular imbalances and insufficient muscle strength at the knee, hip or quadriceps, lack of flexibility and poor running form.
How to fix knee pain from running?
For any acute pain, that does not go away after a day or two of rest see a physiotherapist or doctor! It is the most prudent choice for an individualized in-depth assessment and treatment plan. This article is a summary of relevant research but we are not doctors and this is not medical advice for your specific situation!
Short term fixes: Rest, Ice, Taping, Anti-inflammatories
To take off the edge of immediate pain
- rest,
- icing,
- anti-inflammatories,
- and taping
can all be effective.
Mid-term fixes: Massage, myofascial release
Once the immediate pain is taken care of then massage, myofascial release and dry needling can bring relief and relax and prepare your muscles for recovery and strengthening.
For Patellar tendonitis shockwave therapy is sometimes used with mixed results, whereas infrapatellar strapping show more consistently improvements of the condition.
Long-term fixes: Running form, Strength training and flexibility
Adressing knee pain with running form
Interestingly enough for all three conditions the same improvements in running form are effective to improve knee pain:
- Increasing your cadence gradually by 5-10% will decrease impact forces.
- Avoiding overstriding and landing closer to your body (with a more vertical shank angle) and moving towards more of a mid-foot or for-foot strike will also take impact forces off your knee.
If you are unsure about your running form our analysis at Movaia.com will visualize your run form and show potential for improvement.
There is also a strength and flexibility component to fixing knee pain from running.
Exercises for patellofemoral pain syndrome (PFPS) a.ka. “Runner’s knee”.
For PFPS these exercises are a great, evidence based starting point. For all stretches try to hold stretches 60-90 seconds and repeat them 4 times.
Flexibility:
- Hip flexor stretch
- Quadriceps stretch
- Hamstring stretch (with the help of a towel or brand if flexibility does not allow you to grab your toes)
Strengthening: Progress through these exercise
Phase 1
- Side plank
- Fire hydrant
- Lateral step down from a box
- Straight way leg raise
- Side Leg raises
Phase 2 (as pain subsidies to less than 3/ 10 and strength increases)
- Single leg squats
- Split squats
- Step ups
- Side lunges
- Luges
Phase 3 (Plyometric)
- Double leg squat jumps;
- Double leg box jumps up/down;
- Single leg hop downs;
- Single leg forward hops.
Exercises for iliotibial band friction syndrome (ITBFS) a.k.a. “IT band syndrome”
For IT- band issues try these exercises:
Phase 1:
- Clamshells;
- Mule kicks
- Single-leg bridge;
- Side-step with band proximal to knees.
Phase 2 (as pain subsidies to less than 3/ 10 and strength increases)
- Standing on one leg next to a wall while pressing the bent, lifted leg into the wall
- Hip hikes
- Single leg squats
- Single leg deadlifts
Phase 3 (May coincide with restarting a running routine)
- Bilateral lands off of step followed by sitting back in a chair. Focuson a soft-landing. The chair element will cue hip activation. Progress to single-leg landing;
- Single leg lateral hops while focusing on pelvic and hip control. Progress to single-leg hops in multiple directions.
Exercises for patellar tendonitis (PT)
For Patellar tendonitis start your strength regimen with isometric exercises in Phase 1:
Phase 1
- Flex your knee slightly with foot flat on the ground and hold for 5 sets of 45 seconds Repeat 2-3 times a day. The other foot hovers just above the ground.
Phase 2
- Use a leg press or squats to perform 15 reps, extending for 3 seconds and contracting for 3 seconds. Slowly progress towards a 90 degree bend over time and progress from one to up to 6 daily sets.
- Once comfortable doing the exercise with both legs progress to single leg variants.
Phase 3
- Progress through the jumps below. Perform 15-20 reps and increase to up to 6 daily sets.
- Double leg jumps
- Single leg jumps
- Single leg jumps in all directions.
After a break due to a knee injury from running increase training volume only gradually. Loosing weight can also help to lower the risk of injuries for higher weight runners. Surgery is a final option for knee injuries but only needed in rare cases if no improvement is seen after multiple treatments and many months of no improvement.
As always prevention is better than cure: Increase your training volume and intensity slowly, be mindful of your running form and maintain strength with regular exercises – with this you maximize your chances to avoid knee injuries from running altogether.
Become a more injury resistant runner
Check your running form with a Movaia run form analysis today and lower your risk for knee injuries!
Sources & further reading
James, Stan L. MD. Running Injuries to the Knee. Journal of the American Academy of Orthopaedic Surgeons 3(6):p 309-318, November 1995.
Mellinger S, Neurohr GA. Evidence based treatment options for common knee injuries in runners. Ann Transl Med. 2019 Oct;7(Suppl 7):S249. doi: 10.21037/atm.2019.04.08. PMID: 31728373; PMCID: PMC6829001.
Patellofemoral pain symdrome, Mayo clinic website,
Willy RW, Davis IS. The effect of a hip-strengthening program on mechanics during running and during a single-leg squat. J Orthop Sports Phys Ther. 2011 Sep;41(9):625-32. doi: 10.2519/jospt.2011.3470. Epub 2011 Jul 12. PMID: 21765220.
Heiderscheit BC, Chumanov ES, Michalski MP, Wille CM, Ryan MB. Effects of step rate manipulation on joint mechanics during running. Med Sci Sports Exerc. 2011 Feb;43(2):296-302. doi: 10.1249/MSS.0b013e3181ebedf4. PMID: 20581720; PMCID: PMC3022995.
Jocelyn F. Hafer, Allison M. Brown, Polly deMille, Howard J. Hillstrom & Carol Ewing Garber (2015) The effect of a cadence retraining protocol on running biomechanics and efficiency: a pilot study, Journal of Sports Sciences, 33:7, 724-731, DOI: 10.1080/02640414.2014.962573
Nunes, Guilherme & Oliveira, Jênifer & Iacob, George-Sebastian & Signori, Luis & Diel, Ane & Schreiner, Rafaela & Solner, Matheus. (2023). Effectiveness Of Interventions Aimed At Changing Movement Patterns In People With Patellofemoral Pain: A Systematic Review With Network Meta-Analysis. Journal of Orthopaedic & Sports Physical Therapy. 10.2519/jospt.2023.11956.