Knee Pain After Running? Here’s What Your Body Is Trying to Tell You

If you feel knee pain after running, it could be a sign you might have muscle imbalances or alignment issues.
Image Credit: Nikada/E+/GettyImages

It's completely normal to feel a little bit of muscle soreness after running, especially if you're pounding pavement for long periods of time. However, if you experience knee pain after running, it could be a sign that something more serious is up.

The good news is that most knee issues from running can be treated to keep you on your feet. Here are common reasons you could be feeling knee pain after running, and what you can do to find relief (and prevent injury).

1. Your Kneecap Is Tracking Poorly

The type of knee pain that's most common among runners is the result of runner's knee, also known as patellofemoral pain syndrome. Runner's knee can be caused by a number of factors, including overuse, muscle imbalances, alignment issues and repeated stress on the knee joint, according to the American Academy of Orthopaedic Surgeons (AAOS).

Patellofemoral pain syndrome is "nearly always in the center of the front of the knee," says Zachariah Logan, MD, a board-certified orthopedic surgeon at Texas Orthopedics.

For example, you can get runner's knee if you rack up too many miles at once or run every day and don't allow your body to properly recover. Or, your patella (or kneecap) may be tracking poorly in the groove it sits in within your thigh bone. This results in a potentially painful force on the bony joint where your thigh and kneecap meet.

Weak quadriceps muscles and weak or poorly engaged glutes and hip rotator muscles can also cause issues with tracking, according to the AAOS.

Fix It

Dr. Logan recommends icing the kneecap to help relieve pain. "Tight hamstrings and calf muscles both cross the knee joint in the back. Runners are pretty notorious for having tight hamstrings, so focusing on flexibility can help with knee pain," he says.

Lauren Lobart Frison, DPT, OMPT, a certified sports and conditioning specialist (CSCS) and owner of APEX Physical Therapy, recommends strength training to build the muscles around the knee, including your quads and glute medius and maximus specifically. Exercises that strengthen these muscles can help keep the patella in place.

She also suggests stretching tight hamstrings and calves, which can put added pressure on the knee. Doing a dynamic warm-up and jogging before your run can also help your muscles and joints prepare for the demands of running.

Here are some exercises to help strengthen the quads and glutes:

Move 1: Step Down

  1. On an exercise step or stair, start by standing with one foot on the step and the other foot lifted off the ground and to the side.
  2. Slowly hinge your hips back to lower the lifted foot down and to the side of the step, gently touching your heel to the floor.
  3. Push off of your front foot on the step to stand back up and return to the starting position.
  4. Alternate sides for your desired number of reps.

Move 2: Side Step

  1. Loop a mini resistance band above your knees and keep your feet shoulder-width apart.
  2. Keeping your chest proud and a slight bend in the knees, take a step to the right with your right foot so that your stance is well outside of shoulder-width.
  3. Pause here, then step with your left foot to the right.
  4. Continue stepping out with your right foot, followed by your left.
  5. Complete your reps, then repeat in the other direction.

Move 3: Hip Thrust

  1. Place a loaded barbell parallel to a bench on the floor. Sit down on the floor with your back alongside the bench and slide your legs under the barbell. (You can do this without weights, too.)
  2. Grasp the barbell at each side and bend your knees and keep your feet flat and shoulder-width apart on the floor.
  3. Keeping your torso rigid, exhale as you raise the barbell by lifting your hips off the ground until they are fully extended.
  4. Hold this position for two counts, squeezing your glutes.
  5. Inhale as you lower the barbell by flexing your hips. Don't allow the barbell to touch the floor.
  6. Repeat.

2. Your Knees Are Under More Stress Than They Can Handle

Pain below your kneecap and above your shin is generally due to repetitive stress on your knee while running. That's because the force placed on the knee while running may strain the patellar tendon, which connects the shin bone to the kneecap.

Over time, that stress could result in patellar tendonitis. "Physiologically, this is the inflammatory cells in your body becoming overactive in a certain area." Dr. Logan explains.

Although it's less common, knee bursitis can also be caused by excess pressure on the knees while running, Dr. Logan says. Bursa are small, fluid-filled sacs located near joints, and the ones around the knee can cause pain when inflamed.

"In the case of runners, this would most likely be pes anserine bursitis, which is on the inside of the knee, but further down between the shinbone and three tendons of the hamstring muscle at the inside of the knee," Dr. Logan says.

Fix It

If you're experiencing pain and tenderness below the kneecap and at the top of your shin, try using ice and anti-inflammatory meds until it subsides.

Frison says avoiding running completely is sometimes necessary but not always. "If you have pain with running or after running, you are likely irritating the tissues, and it will make recovery longer," she explains.

That said, completely avoiding running and then returning full throttle isn't ideal either. "We generally recommend doing what you can. Try to run on flat ground — inclines can exacerbate this condition — and only do what you can tolerate with minimal pain. This may mean changing the surface, pace and distance of your runs," she says.

If you want to avoid putting pressure on your knees and aren't able to run without significant pain, Frison recommends using the elliptical, which doesn't require as much extreme knee bending as biking, to keep up with your cardio without running. This kind of cross-training — in addition to other exercises, such as strength training and swimming — help limit overuse, Frison says.

Be sure to build up endurance gradually, too. Dr. Logan recommends not increasing distance or intensity by more than 10 percent per week. This slow-and-steady increase will help your body adapt to your training without risking overload and injury.

Here are some stretches that Frison recommends to help take stress off the knee and prevent pain:

Move 1: Lying Shin Stretch

  1. Lie on your side with the knee of the lower leg bent and your foot behind your back.
  2. Reach behind with your top arm and grab your foot to pull it as close as you can to your back.
  3. Hold for 15 to 20 seconds.
  4. Perform 10 reps, then switch legs.

Move 2: Figure-Four Stretch

  1. Lie face-up with your left ankle crossed over your right quad with your knee bent.
  2. Hold the back of your right leg and gently pull it toward your chest.
  3. When you feel a comfortable stretch, hold the position.
  4. Perform 12 reps, then switch sides.

3. You Might Have Iliotibial Band Syndrome

If you feel pain outside your kneecap, chances are you have iliotibial (IT) band syndrome. The IT band is a stretch of fibers that runs from your hip to the knee on the outer side of the leg and is supported by the bursa to function smoothly, Dr. Logan explains.

Repeatedly bending and extending your knee while running can irritate the IT band and the tissues around it, causing pain and swelling known as IT band syndrome, according to Cedars Sinai. In addition to pain on the outside part of your knee, IT band syndrome can cause clicking, popping and snapping, per the Hospital for Special Surgery.

"Hip abduction is required for any activity that involves one of your feet being off the ground. Your hip abductors keep your pelvis relatively level when walking or running when the opposite side foot comes off the ground. The IT band helps with this, which helps explain why it gets tight," Dr. Logan says.

"For the IT band to be stretched, your knee has to cross the midline of your body," he explains. "This rarely occurs during straight-line running, so all it gets to do is contract over and over."

"I also notice more pain myself when my shoes have too many miles on them. Spend the money to get fitted for the right shoe for your foot shape, and keep track of your miles," he says. When you feel like your running shoes are worn out, toss them and get a new pair to prevent injury and pain.

Having weak muscles, particularly the glutes, also increases your chances of getting IT band syndrome. "Runners are notorious for having tight ITB structures, so focusing on the gluteal muscles and ITB stretching and strengthening is a good insurance policy," Dr. Logan says.

"Maintaining strength of the muscles in the front in the thigh is another easy way to help keep the knees functioning well," he adds. This is especially important as the pain from IT band syndrome is the result of friction on the lower outer edge of the thighbone.

Related Reading

Fix It

If you suspect you have IT band syndrome, you should take a break from running and do some glute-strengthening exercises until the pain subsides. Stretching your quads and hamstrings can also help, as can foam rolling the sides of your thighs regularly to loosen your muscles and ease tension, Frison says. Try these exercises:

Move 1: Side-Lying Hip Abduction

  1. Lie on one side on an exercise mat and stack your top leg directly above your bottom leg with your hips facing forward. Bend your bottom leg and straighten your top leg. Make sure you support your head with your arm or a pillow.
  2. On an inhale, lift your top leg 45 degrees off the ground, or as much as you are able to lift it.
  3. Slowly lower your leg back down on an exhale.
  4. Complete 10 reps before switching legs.
  5. Repeat for 3 sets.

Move 3: Weighted Step-Up

  1. Stand in front of an exercise step, box or sturdy piece of furniture with a dumbbell or kettlebell in each hand by your sides.
  2. Step up with your right foot, pressing through the heel to straighten your right leg. Bring your left foot to align with your right foot on the step.
  3. Bend your right knee and step down with your left foot. Bring your right foot to meet your left foot on the ground.
  4. Repeat this for your desired number of reps, then switch to leading with your left foot and repeat.

4. You Skip Your Warm-Up and Cooldown

While it's tempting to just jump into a run, especially if you're short on time, you need to prepare your body for this rigorous cardio workout. Frison recommends always warming up and cooling down before and after you run.

A warm-up increases the flow of oxygen and blood throughout the body to prepare your muscles for exercise. On the other hand, a cooldown helps your body temperature and heart rate return to normal, and might help stave off muscle soreness, per the American Council on Exercise (ACE).

Skipping a warm-up and cooldown can lead to greater strain on your knees and slow down recovery from running injuries, Frison says.

Fix It

Spend at least a few minutes warming up your muscles and joints before running. Here are some dynamic stretches Frison recommends to do just that:

Move 1: Single-Leg Deadlift

  1. Stand on your left leg with your left knee slightly bent and touch your right toes slightly behind your left foot on the floor for balance.
  2. Slowly send your hips back and kick your right foot back behind you. Hinge forward until your torso is parallel to the floor and your right hand is on the inside of your left foot. Keep your left foot on the ground and slightly bend the left knee to stabilize yourself.
  3. Return to start position.
  4. Repeat for 30 seconds, then switch legs.

Move 2: Bent-Knee Forward Swing

  1. With your hands on a wall or another sturdy object for support, like a table or chair, stand with your feet hip-distance apart and shift your weight to your left leg.
  2. Bend your right knee to a 90-degree angle, and drive it up toward your chest.
  3. Then, swing the leg straight out behind you before bringing it back down to the starting position.
  4. Perform 12 reps, then switch legs.

Cool down with walking and stretches like seated figure four and lateral lunge. This post-run routine only takes three minutes.

5. You Could Be Experiencing Osteoarthritis

If you notice pain, swelling and stiffness in your knee, not just after running but during everyday activities — and especially after waking up — and you're over 50, you may have osteoarthritis, according to the Arthritis Foundation.

Osteoarthritis, one of the most common forms of arthritis, happens as joints degenerate with age or with a history of injury to the area. Cartilage typically facilitates smooth joint movement, but as the cartilage becomes damaged with OA, repetitive movement can lead to inflammation and pain. Osteoarthritis is more common with age and can happen in the knee whether you run or not, Dr. Logan says.

Fix It

While there is no cure for osteoarthritis, physical therapy and anti-inflammatory medications can help the pain subside, and regular exercise can keep pain at bay, Dr. Logan says.

Talk to a health care professional about your symptoms and the best course of action for you. Some people may need to find alternate forms of physical activity, while others can continue running.

references