It’s estimated that eight out of ten runners get injured every year.
And, based on data from physiotherapists, the most frequent injury running patients report is in the knee area.
Sadly, due to the high incidence of knee pain in runners, there’s a deeply ingrained belief that running in itself is terrible for the knees. This couldn’t be further from the truth, based on the research.
What’s more likely is there was a hidden weakness in the general movement of the runner that high volume running merely brought to light.
The movement fault was always present. Running just shoved its existence in your face, and more often than not, it will take the form of knee pain.
Think of running as like a truth serum for poor movement overall. It highlights instabilities sooner than the slower decline of sedentary people who may walk around pain free, but still have the same weakness or vulnerabilities. They will get away with them for longer, but it’s a truth that will out. And they will be sixty-five when it does, with a lot of long term chronic damage already done, and less time to fix it.
The advantage for us as runners is we can discover our poor movement patterns through our knee problems. Then we have the chance to fix them quickly and relatively easily – avoiding long term chronic damage to your knee.
Even better- you can enjoy uninterrupted training and more success by nipping your knee issues in the bud.
And that’s what we’re going to discuss and help you uncover in this article.
Why Knee Injuries Are So Prominent in Runners
The anatomy of the knee is very simple in principle. It’s a simple hinge joint that moves forwards and backwards.
For the knee to work well in this plane of motion, it requires support from the muscles and ligaments around it to maintain the position and direction it was built to move within.
The problems occur when this support system becomes unbalanced. When the muscles on either side of the knee are not equal in strength, the forces on the knee joint increase pressure on one aspect and reduce in another.
Make no mistake – the knee is designed to withstand repetitive running pressure, but not through a twisted or collapsed knee that’s bearing force predominantly through one side, instead of two.
In short, imbalance is usually the cause of pain in the knee, and it’s likely the culprit in yours.
Let’s take a deeper look at the common areas where this can happen.
Bones of the Knee
What can go wrong?
PFPS (patellofemoral pain syndrome) You’ve probably heard of runner’s knee, or patellofemoral pain syndrome.
The cause of this is a tracking problem, where the muscles of the inner thigh are weaker or longer than than stronger or tighter outer thigh muscles – causing the dreaded imbalance.
The outer thigh muscles pull the patella (knee cap) away from the midline groove it sits in on the femur (thigh bone), and starts rubbing the knee cap on the cartilage and bursa underneath, causing inflammation and pain.
How to prevent it
To correct and prevent problems with Runner’s Knee, you need to start a heavy dose of strength training that focuses on the areas that impact how your knee tracks.
Primarily, this is going to involve hip and quadriceps strengthening exercises.
If you’re dealing with Runner’s Knee, here is our full, in-depth guide on diagnosis and treatment options for Runner’s Knee.
Ligaments and Tendons of the Knee
What can go wrong?
MCL Tear -The Medial Collateral Ligament (or MCL) is the most commonly injured ligament in running. It runs from thigh bone to shin bone on the inside of the knee and connects with the cartilage on the joint line.
In running, the most prevalent movement error is the knee collapsing inwards on impact, and to give props to the MCL – its main job is to prevent excessive inwards movement when the muscles have failed and it does it, for most part, beautifully. But repetitive demands on the MCL due to poor movement patterns and a lack of stability can cause injury, inflammation, and a lot of pain.
Patellar Tendonitis. The patellar tendon is a short but very wide tendon that runs from your patella (kneecap) to the top of your tibia. Because of how it helps power for your running stride, the patellar tendon has to absorb a lot of this loading, and as a result, it’s prone to injury in runners. Here is our in-depth guide on diagnosis and treatment of patellar tendon injuries for runners.
How to prevent it
As with your feet, balance is key to prevent the collapse of movement quality that is the likely culprit of your MCL problems.
Maintaining good balance sounds simple in practice, but being able to maintain a stable and neutral knee joint position under the impact of running is an advanced skill. It takes practice and strength to be able to do it effectively and build up enough endurance in the joint to fight the fatigue in the longer runs.
The problem with forging a strong knee position and balance is that it is controlled and influenced by the strength of the hip and the foot/ankle (another opportunity for article link).
Like the foot, the knee is rarely, if ever, the cause of its own problems. So to have a balanced knee, we need to be strong from the pelvis down, and ideally have a strong core to support it all. And so, we balance.
Practice standing on one leg in front of the mirror and use this check list:
Are my hips level?
Do I have a straight line between my hip, knee and ankle?
Can I see the arch of my foot?
If yes to all three- great. Now, progress the exercise and try hopping to see if you can maintain these checkpoints as you take off and land.
Muscles of the Knee
What can go wrong?
I’ll be honest – a lot. There are a plethora of muscular injuries that can occur in the knee of a runner. However, the most common are going to be IT band Syndrome.
IT band syndrome. Pain on the outside of the knee or just above it, though it is not unheard of to get pain further up the ITB , even as far as the top of the femur. Your IT band usually gets sore after a set distance into a run—you’ll feel okay for a mile or two, but the outside of your knee will start to ache, progressing from a dull stiffness to a sharp or burning pain. It will almost feel like there is friction in there.
Here is our in-depth guide to the stretches, preventive exercises, and research-Backed treatments for IT band syndrome.
The common theme with these injuries is overuse or repetitive strain of the muscle involved. Repetitive strain injuries either damage the muscle tissue itself, or repetitively pull on the point of insertion to the bone via the tendon, giving pain and inflammation.
The end result is the same: a whole lot of ouch, and usually a few weeks off.
What causes them? In layman’s terms, biting off more than you can chew.
Training significantly outside your level of running ability, whether in volume or intensity. makes you significantly more vulnerable to strain injuries. What’s worse, these injuries cause muscle weakness and instability that make ligament and bone injuries a lot more likely.
How to prevent it
Make yourself stronger than the demands of your running, and give your body the time and space to recover and adapt to the training you’re doing.
You may be thinking that simply pushing through is the answer. I’m here to tell you it’s not. You can’t train and get fitter if you’re injured. The process of strengthening your muscles to cope with training is a multi-factorial process that goes beyond getting out there and hitting the pavement.
Firstly, keep your muscles healthy.
- Take regular movement breaks if you have a sedentary job.
- Perform at least ten minutes of mobility work (like stretching, foam rolling, and using mobility balls)
- Take hot baths to keep the blood flowing to your muscles on a regular basis.
Second, add resistance training to your running program.
If you can demand more of your body in resistance training without injury, your risk of injury in running will go down significantly. That’s not an opinion -that’s fact.
- If you’re serious about running you should be strength training at least twice a week.
- Practicing running drills, lunges, squats and lifts with weight or bands, in a safe, educated environment, can take your strength capability above the demands required of your body weight in running.
Finally, challenge your stability on a regular basis.
- Take bodyweight movement like lunges, squats, heel raises, and single leg work, and try closing the eyes, or swapping out the stable floor for a wobble cushion or a BOSU Ball. This will help prepare you for unexpected terrain and the onset of fatigue.
Conclusion
There’s a lot that can go wrong with your knee in running but like the foot, the knee is very rarely the cause of its own problems. Each part of our body is connected to another, and the knee is no different.
We may yet have to endure being told at dinner parties that running is terrible for our knees, but you know now that running is not the source of knee pain as much as a magician who performs the great reveal on what is: generally poor movement patterns.
When viewed in this way, your running can be credited as keeping you on your feet for the rest of your life.
