What causes runners’ knee or, as I like to call it, simply pain in your knee while running? Well there could be a lot of factors, but I think the first thing to understand is that runners’ knee is not a “real” diagnosis, and it also doesn’t mean that you have to stop running. Too often the advice people get with this is, “rest, then when you feel better get back to running.” Well the problem with this is that you aren’t actually addressing the cause of the pain you are feeling, yeah it may feel better when you rest, but if the underlying issue is still there it will come back when you return to running, and that most certainly is not the goal.
When people come into the office complaining of pain in their knee with running, they are often surprised that one of the last things we want to talk about is their knee. I like to start with their training history, and often I like to go back about a year.
- What was their training volume like for the last year
- What did their training consist of (running, cycling, strength training)
- What have they been training for (marathons, triathlons, obstacle course races, water polo?)
- What are their training goals over the next 12 months
These questions often will give us a good idea of how someone is approaching their training, and one thing that will surprise many people is that knee pain while running, whether it is in the front of the knee, top or on the outside (later knee, or IT band), is usually caused by a training error, not anything physically “wrong” with the person.
What do I mean by this? Well in the simplest form, what I mean is that whatever load you are putting on that tissue while training, is more that it is ready for. Maybe this means there is a strength deficit above or below the knee. Maybe it means you are doing too much work at too high of an intensity, or maybe you are doing too much work on hills too suddenly. These are all possible answers and things we can easily tweak and change to allow you to keep running and training while your knee stops yelling at you.
The other possible explanation is maybe there is nothing wrong with your training, maybe you have plenty of strength above and below the painful area, but maybe there is a form or technique issue with your running that is putting too much unnecessary stress on one area or another. The most common example of this (and something I too will do often), is running with your stance too narrow. To be honest, these are my favorite causes of knee pain, because they are so easy to fix, and people feel so much better so quickly that they think you are a genius, and who doesn’t want to be thought of as a genius.
Do you have knee pain when you run, or has knee pain kept you from running? Let’s figure out why!