The Biomechanics Of Runners Knee
Biomechanical studies also demonstrated that runners with runners knee are much more likely to have weak hip abductor and external rotator muscles, as well as greater internal knee rotation during running.7
These insights spurred researchers to try treating runners knee with hip strength exercises as well as the traditional quadriceps strength exercises. The results were impressive. A 2011 study found that hip strength training was superior to quadriceps strength training alone in a patellofemoral pain rehab program.8
For more on hip strengthening exercises, please read Hip Strength And Running Form.
There are a few snags, though. Some research, such as a 2011 study by researchers at Harvard and the University of Delaware, indicates that improvements in hip strength dont always translate into better running mechanics.9 Direct modification of your running form might be necessary.
Is Running Bad For The Knees
While we discuss knee pain when we run, its important to note that running is NOT bad for your knees. In fact, regular running actually strengthens the knee and protects against arthritis later in life, says Todd Buckingham, lead exercise physiologist at .
Just as lifting weights makes your muscles adapt and become bigger and stronger, running makes your knees and joints stronger by causing the bone and cartilage to adapt and become stronger, he explains.
But this doesnt mean the more you run, the stronger your knees with be. And, it doesnt mean that you should run through knee pain. In fact, you should do the opposite. Stop, treat, and proceed cautiously.
IT Band Syndrome hurts on the outer part of your knee.
What causes it
IT Band Syndrome occurs when the IT Band, which runs along the side of your thigh and glides over your knee, gets tight, creates friction, and begins to swell.
Buckingham says many runners get IT Band Syndrome by running along the same side of the road because most roads slope to allow rainwater to drain.
This causes the outside leg to be lower than the inside leg. Even if it is just a few millimetres, taking thousands of steps with your legs at different lengths will cause the pelvis to tilt to one side and add stress to the iliotibial band, explains Buckingham.
How to fix it
Runners should aim to run on a flat surface such as a paved trail, sidewalk, or track.
Outside Knee Pain: Running With Itbs
Another fairly common source of runner knee pain is iliotibial band syndrome . This injury is especially common among distance runners and it typically causes lateral knee pain when running. ITBS is thought to be the most common source of outer knee pain from running. The pain in knee when running associated with ITBS typically fades quickly once one stops the activity.
So what causes ITBS? Well, the iliotibial band is a thick band of tissue that runs along the outside of the leg from the hip to the top of the shin bone. Its primary function is to control abduction of the thigh.
When one is running, the IT band slides back and forth over a bony structure known as the lateral femoral epicondyle . Too much of this action can cause the band to become inflamed, resulting in painful friction on the lateral part of the knee as one is running.
There are a number of factors that can increase ones likelihood of experiencing this type of runner knee pain, including major foot pronation , running in worn-out shoes, differing leg lengths, tight leg muscles or being bow-legged.
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How Is Iliotibial Band Syndrome Treated
Your healthcare provider might suggest several different treatment strategies to help ease your symptoms. These might include:
- Limiting activities that make your knee pain worse for a while , and returning to these activities slowly
- Icing the outside of your knee
- Taking over-the-counter pain medicines
- Getting corticosteroid shots to decrease inflammation
- Making changes to your activity, like lowering your bicycle seat for cycling or improving your running form
- Practicing special exercises to stretch and strengthen the muscles around your hip and your knee
You may find it helpful to work with a physical therapist as well.
These changes help most people with iliotibial band syndrome. Your healthcare provider might advise surgery if you still have significant symptoms after 6 months of trying these other therapies. Several different surgical choices exist, including one that removes the part of the iliotibial band that moves over the femur. You can discuss all your surgical choices with your healthcare provider.
Causes For Itbs Versus Pfps

No one knows exactly what causes either condition. Most of the risk factors are unclear. Nearly every popular idea such as hip weakness or imbalances is someones unproven pet theory, often to explain a treatment they are selling. The only thing that we know for sure is that the risk of both injuries goes up with training volume, and both are more likely to affect inexperienced runners. Almost everything else is speculation or wishful thinking. But there are a couple of safer bets
One interesting difference is that a slower pace is actually a risk factor for ITBS, while this is likely not a factor for patellofemoral pain.
Just as climbing hills is more likely to aggravate an existing case of patellofemoral pain, its also more likely to cause it, whereas substantial descents are quite an obvious risk factor for ITBS.
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Runners Knee Myth: Its Because Of My Q
Many therapists will blame the usual suspects for a case of PFPS:
- Leg length discrepancy
- Severe pronation
But these issues are unlikely why you have runners knee. Lets keep this simple: there is no research that supports these claims.
PFPS is a more mysterious injury than some others, so I cant criticize clinicians who may blame the usual suspects. But the truth is this: no studies have confirmed these issues as contributing to runners knee.
These biomechanical issues could certainly contribute to runners knee, but nobody knows for certain and its irresponsible to make those claims as definitive.
The Knee Pain Treatment Plan In A Nutshell
To sum up what you need to do in case of knee pain, here are the steps you need to take:
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What Can I Do To Prevent Iliotibial Band Syndrome
In some cases, iliotibial band syndrome is preventable. To help prevent a flare-up, take care to:
- Run on even surfaces.
- Replace your running shoes regularly.
- Ease up on your training.
- If you run on a track, make sure you run in both directions.
- Have an expert check your stance for running and other sporting activities.
- Stretch your outer thigh and hamstrings regularly.
If you’re new to exercise, start slowly and gradually increase your activity.
Ask your healthcare provider or trainer if they have additional advice.
Knee Pain After Running
March 1, 2021Filed Under: KneeTagged With: Arthritis, bursitis, IT band, knee pain, orthopedic surgeon, runners knee, tendonitis
Whether youre a long-time runner or just starting out, having sore muscles after a run is normal. But if you are experiencing knee pain after running, something more serious could be wrong. Board certified orthopedic surgeon Dr. Zach Logan explains common reasons your knee may hurt after running on Livestrong.com.
Runners knee, or patellofemoral syndrome is one of the most common types of knee pain among runners. The pain is located nearly always in the center of the front of the knee, says Dr. Logan. This pain can be a result of the knee cap not tracking properly over the thigh bone or from not getting enough rest between runs. If the muscles around the kneecap are weak or tight, this can also cause runners knee.
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, Dr. Logan says.
Pain below the kneecap is likely due to repetitive stress on your knee from running. 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.
Maintaining strength of the muscles in the front in the thigh is another easy way to help keep the knees functioning well, he adds.
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What Is A Runners Knee
The wide, tough band of fascia known as the iliotibial band plays an important role when running as it helps stabilize the hips and knees. It goes from the top of the pelvis , down the side of the thigh and across the outside of the knee, all the way to the top outside part of the calf bone , below the knee. It also connects the gluteal muscles with a muscle called the tensor fasciae latae. The reciprocal action of these muscles in turn helps stabilize your leg alignment.
However, if the way these muscles interact gets confused, the forces involved become imbalanced and can cause problems. With runners knee, this means there is excessive strain on the thigh bone where it protrudes outward. This is what causes the unpleasant pain on the outside of the knee associated with runners knee.
However, if the way these muscles interact gets confused, the forces involved become imbalanced and can cause problems. With runners knee, this means there is excessive strain on the thigh bone where it protrudes outward. This is what causes the unpleasant pain on the outside of the knee associated with runners knee.
Who Gets Pfp Syndrome
Patellofemoral pain syndrome usually happens in people who do sports that involve a lot of knee bending and straightening, such as running, biking, and skiing. It also can happen to people, particularly young women, who do not do a lot of sports.
PFP syndrome is more common in women and happens most often to teens and young adults.
Tight or weak leg muscles or flat feet can make someone more likely to get PFP syndrome.
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Wear The Right Shoes While Running
One of the most common causes of injuries among runners is wearing the wrong shoes. Your shoes should be designed for running and should be a good fit for your foot type.
In general, the fit of your running shoes should be slightly different from the fit of your everyday casual shoes.
They should provide enough room for your toes to spread out and grab the ground when you run, and also have enough space for your foot to swell as you keep going.
Heres a complete guide to how to tell if your running shoes fit properly that you can check out.
What Are Other Knee Injuries Runners Have

Athletes can also have injuries to the anterior cruciate ligament , posterior cruciate ligament , collateral ligament, meniscus, cartilage and tendons. While these aren’t as common in runners, they’re still serious and require medical attention.
Knee injuries range from minor to serious, so it’s important to take a break from running and see your healthcare provider if pain persists.
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Key Points About Iliotibial Band Syndrome
- Iliotibial band syndrome causes pain on the outside of your knee.
- It often happens in athletes, especially distance runners. But anyone can get it.
- Using incorrect sporting equipment and having a poor running stance may increase your chance of having this condition.
- Most people respond to treatment such as pain medicines, ice, stretching, and strengthening exercises, and limiting the activity for a while.
- Some people may need surgery to treat the condition.
What Is Runners Knee
Patellofemoral Pain Syndrome is a knee injury common among runners, cyclists, hikers, and those who engage in jumping sports like basketball, volleyball, or the jump events in Track & Field.
PFPS is a mysterious injury in that theres no consensus on why it creates knee pain after running. But there are plenty of theories:
- Some claim its because the kneecap does not track well in its groove in the femur
- Others claim that its because the quadriceps is weak and does a poor job of controlling the kneecap during activity
- And some others go on to claim that PFPS occurs because the cartilage of the knee has degenerated. While some research has concluded that there can be some cartilage degeneration accompanying runners knee, its not necessarily the cause.
Many theories abound yet there is no conclusive answer as to what specifically causes PFPS. The best answer is likely a combination of factors, including weakness in the quadriceps and hips , overuse, and inflexibility. Your individual running form may also predispose you to developing this injury.
If we continue diving into the cause of PFPS, its helpful to understand that your knee is a living joint and its stressed virtually all the time . Its very likely that your PFPS isnt a significant, traumatic injury but rather your knee telling you that its tired, potentially inflamed, and overused.
This perspective on runners knee helps explain why most cases respond very well to rest and conservative treatments.
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Use The Stretch To Relieve Outer Knee Pain
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How Common Is Iliotibial Band Syndrome
Experts note that iliotibial band syndrome often affects U.S. Marines during training. More than 20% get iliotibial band syndrome. Frequent runners, especially long-distance runners, are also prone. Iliotibial band syndrome accounts for about 12% of running injuries. More females than males have iliotibial band syndrome.
Knee pain of which iliotibial band syndrome is one of many causes affects as many as 25% of adults.
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Iliotibial Band Friction Syndrome
Iliotibial band friction syndrome causes gradual onset pain on the outside of your knee. It occurs as a result of the Iliotibial band rubbing over the bone on the outer knee.
Symptoms include:
- Pain on the outside of the knee when running.
- Often symptoms develop at a specific point in a run, say after 20 minutes.
- It improves with rest but returns once training resumes.
The ITB is a long tendon running down the outside of your thigh. Various factors such as poor foot biomechanics, weak gluteal muscles, or simply overuse cause it to become inflamed as it rubs on the outside of your knee.
Treatment involves:
Knee Pain And Other Running Injuries
Running injuries can affect anyone, from experienced runners who push themselves hard, to beginners whose muscles are not used to running.
Below are 5 of the most common running injuries. Find out how to spot the symptoms, what causes the injuries, and what to do if you get one, including when to get medical help.
You’ll also find tips on how to avoid becoming injured in the first place, such as choosing the right shoes and warming up properly.
Being injured can dent your motivation, so we have also included tips on how to get yourself up and running again once you have recovered.
Whatever your injury, it’s important to listen to your body. Do not run if you’re in pain, and only start running again when you have recovered sufficiently.
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What Does It Band Syndrome Feel Like
Iliotibial band syndrome is often described as a sharp, burning pain on the outside of the knee. This pain is usually dull and achy at first but can become intense and severe with continued activity. The pain may come and go at first but can become more constant as the condition progresses.
In short, here is how IT band syndrome feels like:
-
Pain on the outside of your knee which may be burning or sharp
-
Pain that worsens when you bend your knee, walk up or down stairs, or stand for long periods of time
-
Stiffness and difficulty moving your knee
-
Swelling, tenderness or warmth around the affected area
-
A dull ache after prolonged sitting or standing
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Hip abductor weakness.
Iliotibial band syndrome is usually worse:
-
When walking up or down stairs
-
After long periods of sitting with your legs bent, such as in a car
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When you exercise, especially if you dont warm up properly first
-
When its cold outside.
Iliotibial band syndrome may worsen as your run progresses and eventually causes you to stop running altogether.
If youre experiencing any of these symptoms, its important to see a doctor or physical therapist to get a proper diagnosis. They will be able to rule out other conditions that may be causing your pain, such as arthritis, bursitis, or patellofemoral pain syndrome.