Running Knee Injuries: Know Your Enemy!

Apr 1, 2013   //   by James Dunne   //   Strength And Rehab For Endurance Athletes  //  4 Comments

Two Very Common Runners Knee Injuries

There are of course numerous different potential causes for knee pain. However in the running population, the two most common varieties we see are:

Both of these conditions have a nasty habit of starting off slightly niggly then developing into a full-blown chronic injury if not assessed and rehabilitated appropriately.

This time of year, during spring marathon season, we see a great deal of runners coming to us with one or the other of these knee injuries. It happens every year. Their stories are usually very similar, involving an increase in weekly running milage and long run duration in preparation for a late-spring marathon.

This increased running volume and frequency often exacerbates existing flaws in running form, leading to injuries such as these, which had previously been avoided in times of lower run volume.

Of course, it’s not just increased running volume that can pick on technique flaws and biomechanical dysfunctions, to the point of injury. Some runners will find that adding hill running workouts or speed work into the program before they are ready, can also exacerbate muscular imbalances leading to these conditions.

Diagnose Your Knee Pain

Read the following descriptions and note which symptoms and locations seem similar to your pain. This will provide a good guide to the nature of your injury.

Most guides will cite location of the pain around your knee as being the most obvious differentialting factor between these two injuries. With ITBS more typically presenting as lateral knee pain, and PFPS being more anterior in location, originating from the knee cap area.

However, there are various other factors you can take into consideration in identifying your injury.

It’s really important for me to preface this with saying that an online self-diagnosis is in no way an appropriate substitute for seeking the advice and proper assessment of your injury from an experienced sports injury professional. If you’re taking your injury seriously enough to have read this far, you should definitely go and see a Physiotherapist or similar.

That said, Paul Ingraham at SaveYourself.ca has constructed this useful table comparing the common symptoms for these two common running related knee complaints:

Iliotibial Band Syndrome Patellofemoral Pain Syndrome
The epicentre of the pain is on the side of the knee. Symptoms may occur nearly anywhere around the entire knee, particularly in severe cases, but the worst spot has to be on the side of the knee. The epicentre of the pain is somewhere under or around the kneecap. As with ITBS, symptoms may occur nearly anywhere, but it will usually be mainly on the front of the knee.
There is a spot on the side of your knee, right around the most sticky-outy bump, that is sensitive to poking pressure, but your kneecap is not particularly sensitive when pushed firmly straight into the knee. It’s not very comfortable pushing your kneecap straight into your knee, but there is no particularly sensitive spot on the side of your knee.
Pain tends to be worse when descending stairs or hills, and is either not painful at all or noticeably less painful when ascending. Pain tends to be worse when ascending stairs or hills, but may be painful both ascending and descending.
Pain first started while going downhill. Pain first started while going uphill.
Both PFPS and ITBS can start over the course of a few hours or a day, but ITBS almost always does. The pain can start relatively quickly. Your pain grew relatively slowly, over months or years.
Doing a deep knee bend does not especially hurt. Doing a deep knee bend definitely hurts.
Pain is not particularly affected by sitting, although it might get worse after sitting for quite a while (longer than an hour). Pain is clearly aggravated by sitting with knees bent. When you get up, it hurts more than it did when you sat down.
You do not have any obvious structural problems in the legs. You are a little knock-kneed, have flat feet, or kneecaps that seem to be kind of at a funny angle.
Symptoms tend to be quite consistent and predictable, with only minimal changes in the intensity of the epicentre over time, and almost no change in the exact location of the hottest spot. PFPS may also have consistent symptoms, in which case you can’t really check either side for this point. However, if you experience seemingly mysterious fluctuations in intensity or location — if you find that the problem is just not very predictable — this is a strong indicator that you have PFPS, not ITBS, so you should check this side.

Original source: The Runner’s Knee Diagnostic Stand-Off

If Your Symptoms Don’t Fit This Pattern

If you have knee pain symptoms that don’t fit into the descriptions above, such as:

  • Locking, Instability or Giving Way of The Knee
  • General Swelling Of The Knee
  • Altered Sensation, Pins & Needles, Numbness
  • Other Unlisted Symptoms…

It’s likely you have a different knee injury, not falling under the banner of PFPS or ITBS. You should certainly seek a professional opinion.

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MORE INFO

We’ve teamed up with specialist physios to provide this comprehensive and progressive exercise program to prevent running knee pain.

Knee pain affects a huge number of runners. This specialised program provides a structured approach to addressing the underlying biomechanical causes.

Rehabilitation Phases:

  • Muscle Activation
  • Movement Pattern Correction
  • Functional Strength Development

Additional Bonus Material:

  • Knee Pain Specific Stretch Routine

Knee Rehabilitation Exercises

Anatomically speaking, the knee is stuck in a pretty unfortunate position! It requires good alignment to be able to operate without dysfunction, injury and pain – yet it’s located between two very mobile structures: the hip and ankle/foot.

When working with an injured knee we often find that control at the hip and/or foot and ankle is compromised, disrupting the alignment and loading of the knee as we run.

A progressive rehab program is needed to engage and strengthen the right muscle groups to provide control as we develop correct movement patterns, to put the knee in a better position as we run.

Not only do we need to strengthen the correct muscles to look after the knee, and improve control as we move. It’s important to work to remove any muscular imbalances, stretching over active muscles as we strengthen their weaker counterparts.

SOME EXERCISES TO GET STARTED:

Single Leg Squat

A simple but effective exercise to work on single leg stability…

Active & Static Hip Flexor / Quad Stretch

Tight quads and hip flexors are a common factor in both ITBS and PFPS. Here’s a great stretch…

Hip Thrust

This is great for strengthening those Glutes. Keep your core tight, and squeeze your butt as you come to the top…

About The Author

James has an academic background in Sport Rehabilitation and a special interest in Applied Biomechanics. He currently coaches a large number of Runners and Triathletes across all levels of ability and performance. He's grown a strong reputation for enabling athletes to improve their running performance and overcome running injuries through improving their Running Technique and developing Running Specific Strength.

 

4 Comments

  • [...] Do you know the difference between Paleofemoral Pain Syndrome and Iliotybial Band Syndrome? Here’s a good primer on each. [...]

  • Mmm I have different pains in my knees and fit both ITB and PFPS but physio!! Physio prescribed lots of glute strength work and stretching.

  • Interesting you put this on Twitter today… I am suffering from what is probably ITBS right now but it has been quite an acute arrival of the pain! My left knee has always been bad and regularly niggles but my right knee has recently become painful. I have been very slowly introducing change to my programme and was at 9 weeks which has included glute work throughout… The main symptom however which is not listed below is clicking / popping of the knee – both during squats and non-weight bearing movement! I am off to see the physio tomorrow but would be interested if you have come across this symptom with ITBS before or whether it is always due to other damage such as meniscus tear?

  • Hi James,

    I’m curious. I have been out of running for about 4 weeks with pain that slowly started in the back of my knee then disappeared and moved to the inside (anterior) side of my knee. The pain is not under or around the kneecap but located on the anterior side of the knee. All the symptoms are exact to IB issues but with the location of pain being anterior. I have iced, rested, and foam rolled my legs, but it’s pretty slow going with returning.

    Donnie

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