Knee Pain When Running: What Could it Be?

Identifying Your Knee Niggle

There are of course numerous different potential causes for knee pain when running. However amongst runners, the two of the most common types of knee pain we see are:

• Patellofemoral Pain Syndrome (PFPS) 
• Iliotibial Band Syndrome (ITBS)

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 huge number 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 biomechanical flaws in running form, leading to injuries such as these, which had previously been avoided in times of lower running volume and training load.

Of course, it's not just increased running volume that can pick on technique flaws and movement 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.

Self-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 the location of the pain around your knee as being the most obvious differentiating 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.

That said, Paul Ingraham at Painscience.com has constructed this useful table comparing the symptoms of both patellofemoral pain syndrome (runner's knee), and ITB syndrome:

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 (but not limited to):

• Locking, instability or giving-way of the knee
• General swelling of the knee
• Altered sensation, pins & needles, numbness

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.

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 specific rehab program is needed to engage and strengthen the right muscle groups to develop neuromuscular control as we learn correct movement patterns, to put the knee in a better position as we run. Here's a great functional exercises to strengthen muscles around the knee, and work on single leg stability.

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 Runner's Knee Exercises to Get You 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...

I hope this quick guide helps give you an idea of what could be causing your knee pain.

If you have any questions, please feel free to let me know in the comments below...