CSA Physio Blog

Ask the expert: Runners Knee

Posted on: September 26th, 2018 by Stephanie Dumont

Runners Knee?  What??

I’m a physiotherapist, and I recently started training for a half marathon. My training was going well until I felt a sharp pain on the outside of my left knee during a long run. I don’t remember hurting it. The pain came on suddenly. Now it only seems to hurt at the beginning of a run, subsides after 20 minutes, but starts to hurt again when I am done. Is this an injury? Should I keep running if I feel pain?  If this sounds like your story, let me shed some light on things.

What’s going on then?

Runner’s Knee

This is a very common occurrence for both beginner and veteran runners. Running injuries can be classified into two groups: traumatic and progressive. Traumatic injuries are usually caused by a specific event, such as rolling your ankle or twisting your knee. This causes acute inflammation and localized pain. Based on the symptoms described above though, it sounds like this is a progressive or overuse injury. This type of injury tends to develop slowly and is is most likely due to overuse. The result is chronic inflammation and pain that comes and goes. Progressive injuries are caused by:

  • Training errors- doing too much too soon.
  • Biomechanical abnormalities- such as flat feet or bowed legs.
  • Muscle imbalances- such as weak gluteal muscles or tight quadriceps.

Frequent Causes of Runners Knee

IT Band Syndrome (ITBS): Irritation of the ilio-tibial band, a thick band of connective tissue that runs along the outside of the leg that attaches just below the knee on the outer aspect.

Patella Femoral Pain Syndrome (PFPS): Abnormal tracking of the patella (kneecap), which occurs when the kneecap starts to move slightly to the outside, causing rubbing and pain under the patella. This is the most common running injury.

In the early stages of an overuse injury you are often able to run through the pain. Why? When you start running, the injured tissue warms up and blood flow increases to the site, which makes the pain subside. As soon as you stop moving, the pain returns since the inflammation moves to the painful site. At this stage, you can probably get away with “running though it” for a few days, even a few weeks. The danger over time is the chronic inflammation and pain will slowly worsen – until you can’t run anymore. At this point, your body might compensate by overusing other areas (e.g., hip or foot) which can lead to further injury and imbalance.

How to treat Runners Knee

Typically, an overuse injury takes 4-6 weeks to settle down, depending on severity. First, focus on controlling pain and inflammation. This can be done at home by icing the tender area for 10-15 minutes several times per day to help reduce swelling. Modifying your training plan to rest the injured area is also important. Non-weight bearing activities are the best way to maintain fitness while resting from running. Cycling, swimming, pool running, rowing machine and core stability exercises are all good providing they don’t aggravate your condition. Next, seek help from a health professional such as a physiotherapist to help determine the cause of your knee pain. They will assess for any specific joint issues, muscle imbalances and weakness, and provide a specific treatment plan.

Interventions could include stretching tight muscles, mobilizing stiff joints, dry needling or IMS, targeted exercises to strengthen weak muscles, patellar taping, and advice on correct running shoes.

Once the pain and inflammation have settled, a progressive walk-run program can be re-introduced. It is important not to increase your running mileage by more than 10% per week to allow your body to fully adapt to the stresses you are putting on it. It is also not advised to do two hard workouts two days in a row (e.g., running hills and a long run the next day). If you are smart with your training, you will prevent an injury from becoming a recurring problem.

Now get things fixed up and get back out there!


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