Runner’s Knee: What It Is and How to Fix It
By Alison Staples
Editor’s Note: The below information is not intended as medical advice, nor should it replace the recommendation of a physician. If you think you might have a problem with Runner’s Knee or any injury, ask a doctor before proceeding with any exercise or physical therapy regimen.
It’s a familiar feeling for many runners: that sharp pain on the outside of your knee or a nagging dull pain in the front of your knee that seems to pop up when you’ve reached your heaviest mileage of training or even during a race. You might feel it most when walking downstairs, or if you've sat for too long. First, you googled it. Then you talked to your other runner friends about it. Finally, you (hopefully) went to the doctor about it and (dun, dun, dun) it’s official: you have “Runner’s Knee”.
Runner’s knee refers to either one of two overuse injuries—iliotibial (IT) band syndrome or patellofemoral syndrome.
IT band syndrome presents as sharp pain located at the side of the knee and is mainly caused by inflammation of the IT band.
Patellofemoral syndrome presents as pain at the front, under, or around the kneecap often caused by abnormal tracking of the kneecap.
In either case, it's annoying, it’s irritating and it can be debilitating for runners.
What Causes Runner’s Knee?
Simply put, you’re “doing the most.” Whether it’s 20-mile training runs, sprint hill repeats, 800s or run streaks, you’re probably just on “The Gram” living your best run life. What you (probably) aren’t doing, though, is stretching and strengthening. Plus, are you even running in the right shoes, sis?
In order to protect your knees (and the muscles and ligaments that support them) from injury, your training regimen should include more than just running.
The Knee’s Anatomy
The IT band is a thick band of connective tissue that runs along the lateral (outside) part of your thigh. Its job is to stabilize the outside of the knee as it bends and straightens (running, jumping, going up and down stairs, etc). It originates at the iliac crest (butt bone) and inserts/attaches to the outside of your tibia (shin bone). As the knee bends and extends, the IT band crosses the bony prominence to the outside of the knee on your shin bone.
Normally, you don’t feel this happening but when the IT band gets too tight, there is an increase in friction and irritation, mostly felt on the outside of your knee (where the IT band attaches). Because of where the IT band starts and ends, Runner’s Knee is not really a knee injury, per se. It’s more indicative of muscular weakness or imbalance in the hip stabilizing muscles and quads.
The Runner’s Knee Fix
The first thing to do is to make sure you’re running in properly fitted shoes. Shoes not tailored specifically for your running needs can cause problems at the foot and ankle. The leg is a long chain and issues at the foot and ankle will almost always turn into knee pain.
Second, you’ll want to work to strengthen your quads and glutes, specifically your gluteus medius (side butt muscles). Your gluteus medius is responsible for moving your hip away from your body, but also maintaining your body weight on one leg when the other leg is in the air as in running or walking. A Weak glut medius muscle can lead to knee pain because that’s where the IT Band approximately starts. Got it now? It’s all one big chain.
To strengthen this muscle, do any resisted exercise that forces your hips away from your body! Some examples of strengthening exercises include:
Squats - Traditional squats
Lateral squats - Start with feet shoulder width apart, squat, take a step to the side with either right or left leg, bring that same leg back in to the middle making sure feet come together at end of move. Alternate sides.
Sidestepping - Start with feet shoulder width apart, squat, then take a side step while remaining squatted. Take about 10 steps in one direction, bringing your feet together on each step. Repeat in opposite direction. For more challenge, add resistance bands.
Lunges - Traditional front lunges
Side-lying hip abduction - Lying on your side, keep the top leg straight and bring it straight up in the air. Keep toes pointed forward in the same direction as your head.
Note: DO NOT USE the abductor/adductor machine at the gym while recovering from this injury. The motion is not functional because you are sitting down. You’re putting yourself at risk for more injury and strain.
Other Ways to Alleviate Runner’s Knee
Foam roll your lateral quads (from the middle move slightly over towards the outside and roll there).
Run with your legs further apart. Running with your legs closer together creates a more narrow alignment, increasing tension on the ITB.
Ice the outside of the knee for 20 minutes per day.
Load up on turmeric to cut down on inflammation.
Stop training on hills until the problem goes away. Hill training exaggerates knee flexion and extension.
REST! You may need to stop running altogether for a few days/weeks to allow your body to heal and recover.
Focus on the above strengthening exercises and stretching until you are able to make a gradual return and you’ll be back in no time.
Have you experienced Runner’s Knee or similar symptoms? How long did your recovery take? Share with us in the comments below.
Follow Alison’s journey on Instagram @alioop_0_o_runs.
Alison is a Physical Therapist Assistant, specializing in neurophysiology. Picking up running after she turned 30, Alison is a RRCA certified long distance run coach, and coaches for Charm City Run, and Team in Training with the Leukemia and Lymphoma Society. When she's not running, she can be found at Trader Joe's, hanging out by the free coffee.