What is runner’s knee?
Runner’s knee — or, more scientifically, chondromalacia patella — can occur when the cartilage under the kneecap is damaged. It’s one of the most common injuries runners face because cartilage is a natural shock absorber.
According to Becs Gentry, a Peloton Tread Coach and Nike Run Ambassador, there are a few different reasons why these symptoms — including kneecap pain, swelling, or a popping or grinding sensation — show up in the first place.
But runner’s knee is also a catch-all term for any knee pain runners might have, and it doesn’t necessarily have to do with damaged cartilage, says physical therapy physician Kelly Starrett, author, professional athletic trainer, mobility expert. and founder of The Ready State. Instead, Starrett says you should look at knee pain as a kind of signal from your body that it “wants to change” in some aspect of your training, mobility, and preparedness.
What causes runner’s knee?
Unfortunately, pinpointing the exact cause can be difficult, as knee pain is a signal that your body’s overall willingness to run is out of whack.
“There are many reasons why your brain suddenly makes you pay attention to your knee,” says Starrett. “You could have done tons of volume and then sat, you could have been super stressed out in your life, your job and your family. You could be malnourished and your tissue quality doesn’t allow you to be robust and handle the volume that you didn’t warm up. There are just so many things that can happen here.
All of these factors can lead to a lack of mobility in your hip flexors, tight muscles and tendons, delicate muscle tissue, and congestion in the connectivity between your muscles. These physical symptoms can cause pain all the way down to the knee—especially in runners, who tend to have tight quadriceps that connect to the knee (along with the calves and hamstrings). When you feel tightness and limited range of motion, your body sends a signal to your brain that your knee may be in danger, which we interpret as pain.
“Areas of this muscle system can transmit pain absolutely to the knee,” says Starrett.
Other common causes of knee pain while running
Other common knee pain-causing issues Gentry sees come from a poor diet, which builds up toxins and can contribute to inflammation, wearing shoes that don’t provide enough support, and not having enough recovery time. “It’s important to allow the body to rest, adapt and recover before the next run,” she says. “Massages and Epsom salt baths are something I always suggest when runners have sore muscles, as they can both help reduce recovery time and calm the body.”
As for footwear, make sure you’re wearing a shoe that’s designed for your foot type, and replace your shoes about every six months (or sooner, depending on your mileage).
You’re going too hard, too soon
As exciting as it may be to start a new exercise program or modality, it’s always a good idea to scale back initially to give your body time to adjust to your exercise. “You could get runner’s knee if you increase your mileage too early, since going from zero miles to countless miles in a short period of time can cause pain and aggravation for the body,” says Gentry.
To get around this, start humble. And if you’re not sure what that looks like, enlist the help of a professional running coach or use a running schedule app like the Nike Run Club app.
Your technique needs improvement
Another reason for knee pain while running is poor technique, says Gentry. It happens to the best of us, especially when we get tired, but it’s definitely something to actively think about on your runs.
Make sure your hips are not pushed back, your head is in a neutral position, your shoulders are relaxed, your chest is open, and you are swinging your arms back and forth. You should also avoid kicking your butt, as this can put unnecessary stress on muscle groups like your hamstrings, which in turn can pull on other muscles and make your knees worse. You should also try to step on the ground with your metatarsus and be careful not to run with your knees outstretched.
4 ways to prevent running from hurting your knees
While getting rid of the pain is great, there are also some ways to prevent your knees from hurting in the first place. Starrett describes this as “changing the inputs so that the local tissue physiology is improved and the brain recognizes that these positions are safe.”
1. Practice isometric exercises
“The first order of companies trying to see if we can signal the brain that these positions of the knee are safe in motion,” says Starrett. “The easiest way to do this is to get someone to do some isometrics, which are muscle contractions without movement.” The idea is that if you’re mimicking the movements of running over a period of time , your brain learns these are “safe” positions to be in and so pain signals aren’t triggered in the future. It will also help you achieve your full range of motion, which should help with knee pain.
“It makes us very comfortable in those positions and restores our original spectrum at the end,” says Starrett.
Starrett recommends movements for knee pain such as lunges and eventually progressing to raised leg lunges while breathing deeply, flexing your glutes, and holding the position.
“Get into a tall lunge position with your feet straight, both feet pointed straight forward, all toes on the floor,” says Starrett. “You will lower yourself until you feel a tug in your back leg. But more importantly, until you can still push your glutes onto your back leg. Hold this for five to ten big breaths, because if you can’t breathe in a position, that position doesn’t belong to you. And running is all about moving from position to position while breathing heavily.”
2. Practice soft tissue mobilization (foam rolling)
Tension in your soft tissues can cause pain in your knees, so you should do a foam roller (especially on your quads) and focus on areas where you feel pain when compressed by the foam roller or pressure point ball.
“Restricted tissue can cause tension,” says Starrett. “It can change your gait, it can trigger your brain to perceive something that’s going on in the knee. It doesn’t matter what the mechanism is. If I roll you on your quads, it should just feel like pressure. It shouldn’t feel like you’re boarding with water.
3. Train with a running coach
People think running is one of those things you just do, but running right from the start can help keep your knees healthy for years to come. “If you’re unsure about proper running technique, find a coach who can help you analyze your running style and work with you to strengthen it,” says Gentry.
4. Invest in a good pair of running shoes and socks
You wouldn’t show up for swim training without a quality swimsuit, would you? Well, the same goes for running: you need trustworthy gear to get the job done. “The technology in sneakers today is very advanced, and most running shoes are designed to support the human body. So it’s a good idea to go to a running store for a gait analysis,” says Gentry. “In most cases, they can show you shoes that suit your natural running style. Make sure you wear comfortable shoes, though.”
5. Keep a training diary
To make sure you don’t overdo it — especially early on in your running journey — take the time to track your workouts. “Starting a training journal will help you see clearly and outline which days you devote to running, training and resting,” says Gentry. “That way you can balance yourself and not overdo it too soon.”
6. Build your muscular strength
Adding some strength training into the mix can also do wonders for protecting your body –And makes you a better runner. “Building muscle strength is so important. Around every joint there are muscles, tendons and ligaments. Runners need to make sure their whole body is taken care of and strengthened for running, given the impact this has on the body,” says Gentry. “Using bodyweight or weighted exercises and focusing on single leg strength — as well as double leg strength — will help you build your strength and hopefully keep knee injuries at bay.”
We know running with knee pain isn’t ideal, but by making sure you’re wearing the right gear, focusing on your form and engaging in cross-training sessions (weight training is your best friend), resting and eating foods, you fill up should be gone in no time! And never underestimate the power of sundae massages and Epsom salt baths.
Is it okay to keep running on runner’s knee?
Try practicing the above techniques with an emphasis on isometric exercises and soft tissue mobilization. If that doesn’t relieve the pain, you should see a doctor.
Does runner’s knee go away?
If you properly recover from the exertion of running and practice isometric exercises and soft tissue mobilization, runner’s knee should go away. If this is not the case, you should consult your doctor.