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Advice to improve your movement, fitness, and overall health from the world's #1 in orthopedics.

Knee Pain After Running: Causes and Treatments

Learn about different types of knee pain after running, including runner’s knee, and how to treat it.

Advice to improve your movement, fitness, and overall health from the world's #1 in orthopedics.

Running is great for both the body and the mind. It strengthens the heart, lungs, and many muscles throughout the body, plus it relieves stress (runner’s high, anyone?). But running is also a high-impact activity, meaning that it puts your body—particularly your knees—under a great deal of load, often pounding for long durations repeatedly.

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“When you run, you’re essentially hopping from leg to leg, so your knees must absorb and react to high levels of force over and over, often for long periods of time,” says Michelle Kew, MD, a sports medicine surgeon at HSS.

Two components of the knee that are particularly prone to running injuries include:

  • Articular cartilage, which covers the ends of your shin bones, thigh bones and the back of your kneecaps.
  • Tendons, thick bands of tissue that attach the bones to muscles.

Types of Knee Pain Caused by Running

Runner’s knee is a catch-all phrase used to describe several types of pain associated with running. This can include patellofemoral pain syndrome, which essentially means kneecap pain. The pain can be dull or sharp and usually worsens as the intensity of exercise increases. “It’s fairly common in runners who have either ramped up their training quickly or have recently returned to running,” says Dr. Kew. 

“The kneecap is the fulcrum that your knees bends from, so it sees a lot of force when running,” she adds. In addition to the kneecap, the cartilage and tendons underneath and around the knee can get inflamed when overused as well, she says.

Runner’s knee can include:

Patellar Tendonitis (Tendinopathy) Pain below the kneecap, where the tendon connects the bottom of the kneecap to the top of the shin bone, often signifies patellar tendonitis. It’s caused by repetitive stress on the knee, which can lead to inflammation. 

Chondromalacia Patella (CMP) The back of your kneecap, the thigh bone, and the ends of your shin bone are covered with a tissue called articular cartilage. Usually, when the knee bends, the tissue glides across the knee. Sometimes that cartilage begins to wear and the ends of the bones rub together, causing pain in the underside of the kneecap.  

IT Band Syndrome The iliotibial (IT) band is particularly susceptible to inflammation with a repetitive-motion sport like running. This wide strip of tissue runs from just above the hip down the outside of the thigh and attaches just below the knee, and it helps move the leg as it bends and extends. If it’s the IT band, the pain is often felt on the outside of the knee, as the band rubs over the thigh bone.
Other non-runner’s knee pain issues include:

Osteoarthritis causes pain and stiff knees not just after running, but also during everyday activities. The condition develops when the cartilage that normally pads the bones within the joints begin to wear down. Without enough padding, the bones no longer slide easily against each other, causing pain and swelling. OA usually strikes people over 50 years old, and while running doesn’t cause OA, the repetitive stress on the knee from running can trigger a flare up of OA. 

More serious conditions that could lead to knee pain include:

  • Tibial stress fracture 
  • Ligament tears
  • Meniscus tears

How to Care for Knee Pain

Treating knee pain after running usually starts with RICE, which stands for: 

  • Rest
  • Ice
  • Compression
  • Elevation

In addition, nonsteroidal anti-inflammatories (NSAIDs) like ibuprofen and naproxen can help dull pain. 

However, if your pain is consistent after two to three days of RICE treatment, see a doctor. Additionally, you should see a doctor immediately if:

  • Your knee pain is accompanied by a deformed joint.
  • You heard a popping noise when the pain started.
  • You can’t walk or have limited movement.
  • Your knee is significantly swollen, red or warm around the joint.
  • Your knee is intensely painful.
  • You have a fever.

How to Avoid Knee Pain from Running 

Before every run, you should do a warm-up and some dynamic stretches, and after every run you should cool down and do some static stretches. Dr. Kew also stresses that a good strength program is key to avoiding knee pain. “I don’t want you running every day. I want you to run a few days a week, strength train two days a week, then do some sort of cross-training like biking or swimming the other two days.” 

Exercises like squats, leg presses, clamshells, and core exercises will fortify the quads, glutes, and core muscles, which will help to protect your knees. “When the muscles take more of the load, the bones and cartilage will take less,” she says. Sturdy muscles around the knee will both help prevent injuries and help lessen any kind of pain you already have, she adds.

Finally, whenever you can, run on softer terrain—a track or a dirt trail—to minimize the impact on your knee.

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