Common Causes of Knee Pain
Knee pain runners develop inhibits runners’ ability to improve and later cause chronic knee pain, which can burden daily life. Regardless of experience level, runners may be impacted by structural or non-structural displacements that interfere with improving their performance. This blog will explore how knee pain can develop in runners, how to prevent and treat it, and how physical therapists at Austin Manual Therapy can optimize runners’ running experiences.
Overuse Injuries
It is most common to develop knee pain due to the overuse of the muscles, tendons, and ligaments in the region of the knee. Research has shown that 70-80% of running injuries are due to overuse, and 28% of running injuries occur at the knee. Varied circumstances can cause overuse, whether that is due to lack of rest, wear and tear from varied environmental surfaces (pavements, dirt, gravel, grass, etc.), or excess forces applied to specific placements at the knee. Prolonged stress on a specific location at the knee for an extended time can cause extensive tissue strain.
The major muscles around the knee have a crucial role in movement, stability, and injury prevention. Two major muscle groups have been implemented on the knee, the hamstring, and the quadriceps. The hamstring group is located on the upper back region of the leg, which comprises multiple muscles: semitendinosus, semimembranosus, and biceps femoris. These muscles work together to help the bending of the knee and extension of the hip. The second group is the quadriceps which is located on the upper front region of the leg and is made up of four muscles: vastus medialis, vastus lateralis, vastus intermedius, and rectus femoris. These muscles work together to help the straightening of the knee and support knee alignment. All of these muscles work hand-in-hand to develop efficient movement and strengthen stability when engaged in running. If there is an instance where these muscles are injured or overused the overall functionality is going to decline.
Alignment Issues
The knee is one of the most vital joints of the body that provides us with movement. The function of the knee joint is to provide flexion, extension, rotation, and torque, with proper alignment this will allow for the body to absorb impact on the ground efficiently. The neutral knee alignment is when the patella (knee cap) is aligned between the 2nd and 3rd metatarsal (toe), and the patella is aligned with the middle of the hip.
Once runners are in motion a gait pattern develops, which is made up of two phases: stance and swing. The stance phase is when the foot is placed on the ground which holds the body up. To reach this state there is a movement in the foot from the heels to midstance and push off from the toes. The swing phase is when the foot leaves the ground and pushes the body forward. It is important to have a proper leg alignment, as poor mechanics, like overpronation (when the foot collapses inwards) or inward knee side bending can cause pain. Those who have strong hips, glutes, and core muscles will help maintain the knee in the correct position. While running, the shorter the steps the less impact the knee will face, as well as wearing proper shoes that help with foot misalignments.
Patellofemoral Pain Syndrome (PFPS)
Patellofemoral Pain Syndrome (PFPS), commonly known as runner’s knee, occurs at the front of the knee where the patella (knee cap) meets the femur. It can result from friction at the joint and lack of support from the surrounding muscles.
PFPS is typically caused by structural issues whether that is during movement like running, walking, or standing. The development of this problem can be due to tightness or weakness in muscles, for example, hamstrings, quadriceps, and/or Achilles tendon.
Runners experiencing the following symptoms may have PFPS:
- Popping or clicking sounds while moving
- Persistent pain at the knee cap during exercise
- Numbness and weakness after prolonged knee bending when sitting or standing
How to Prevent Running Knee Pain
Warm Ups and Cool Downs
Why should we warm up? The simple answer is that warming up increases blood flow, and our blood vessels widen which activates the start of increased oxygen flow to working muscles. Gradually moving into your exercises will allow the body to work efficiently by maintaining a lower heart rate as less stress is added to the body. The rule of thumb is, that the more intense the workout the longer the warm-up, and you should ensure to add both static and dynamic stretches. As a runner, the major muscles used are the quadriceps, hamstrings, and gastrocnemius which improves flexibility and reduces strain. Having varied types of warm-ups like dynamic and static stretches helps, especially after a workout to help aid recovery.
Running Form
It is important to note that when running and experiencing pain it is typically due to the alignment of the body and the placement of the feet on the ground. As mentioned earlier in this blog the alignment of your body and running form are heavily dependent on muscle strength and the pattern you are putting your body through.
Poor biomechanics can lead to patellofemoral pain syndrome (runner’s knee) or iliotibial (IT) band syndrome. Proper posture—aligned head, engaged core, and a slight forward lean—reduces knee stress. Foot placement should be beneath the body, avoiding overstriding, which increases impact on the joints. Strengthening stabilizing muscles, such as the gluteus medius, enhances knee alignment and reduces injury risk.
Consistent Active Lifestyle
Keeping your body active is the best way to strengthen it and keep it healthy. The more movement the body has the more blood flow, strengthening and stress reduced the muscles will have. With this comes the maintenance of weight, as people gain weight the more stress and impact will be on the joints of the body. Ensuring a consistent active lifestyle is what is going to help.
Consistent movement supports musculoskeletal health, enhances circulation, and strengthens muscles that stabilize the knee. Excess body weight increases joint stress, exacerbating knee pain. A balanced exercise regimen, including strength training and low-impact activities like swimming or cycling, helps maintain joint integrity. Long-term knee health relies on proper conditioning, weight management, and mindful movement patterns.
How to Treat Running Knee Pain
Strengthening Exercises
Exercises and stretches that target knee stability and flexibility, while reducing pain and preventing future injury.
Stretching:
- Standing Quad Stretch: Lengthens the rectus femoris, alleviating anterior knee strain.
- Standing Hamstring Stretch: Reduces tension in the hamstrings, decreasing stress on the knee joint.
Movement:
- Sitting Leg Raises: Strengthens the quadriceps, supporting patellar alignment.
- Step up with Knee Drive: Enhances glute and hip control, reducing knee stress.
Physical Therapy
At Austin Manual Therapy, all therapists can assess various aspects of your body including, gait motion; looking at how you walk and move, they provide manual therapy, which is hands-on work, and exercises specific to your goals and needs. Not only are the physical therapists at AMTA there to help you in the clinic, but they also set you up for success outside of the clinic with tools like at-home exercise programs and easily available communication via email.
When to see a Physical Therapist
After 1-2 weeks of working through strengthening exercises and using the RICE method, there seems to be little to no improvement in knee pain, it is advised to schedule an appointment with one of our physical therapists. There could be several reasons why your knee is hurting while running or during your daily activities, and physical therapy is designed to help find those problems and solve them.
Conclusion
Knee pain is a common issue when running but there are many ways to prevent long-lasting pain. Overuse injuries, alignment problems, and conditions like PFPS contribute to discomfort and performance. Whether you take actions into your own hands or come see us at Austin Manual Therapy, there will be steps taken to prevent further injury. By taking proactive steps, runners can maintain healthy knees and continue enjoying their sport without long-term setbacks.
FAQs
Is running bad for my knees?
Running itself is not bad for the knees, but improper form, poor alignment, and overuse can lead to pain and injuries over time. Strengthening key muscles like the quadriceps, hamstrings, and glutes can help protect your knees. Proper running form and wearing supportive shoes also reduce the risk of knee pain. Listening to your body and addressing discomfort early can prevent long-term damage.
What kind of shoes should I wear to protect my knees when I run?
Choosing the right running shoes is essential for knee protection and injury prevention. Brands like Hoka, Nike, New Balance, ON, and Asics offer well-cushioned and supportive options tailored for different foot types. A gait analysis at a running store can help determine the best shoe for your foot mechanics. Replacing shoes regularly (every 300–500 miles) also ensures they continue to provide proper support.
What can I do to help my knee pain during a run?
If you experience knee pain while running, stop and assess the discomfort before continuing. Stretching your hamstrings and quadriceps, adjusting your running form, or slowing down to a walk may help alleviate pain. Strengthening exercises and proper warm-ups can reduce knee strain and prevent pain from recurring. If the pain persists, consult a physical therapist for an evaluation and treatment plan.
How long will treatment last?
The duration of treatment for running-related knee pain typically lasts between 6 to 8 weeks, depending on the severity of the injury and adherence to exercises. Consistently performing prescribed strengthening and mobility exercises can speed up recovery. Some cases may require additional time if the pain is persistent or linked to underlying structural issues. Regular follow-ups with a physical therapist ensure proper progress and modifications to the treatment plan as needed.
