It’s not just aching calves and tight hamstrings that plague runners — sore knees are also common among runners of all fitness levels. Between 40 and 60 percent of runners experience patellofemoral pain syndrome, or iliotibial band syndrome, at some point in their running careers, according to studies published in the Journal of Sports Health and the Journal of Athletic Training. In fact, "runner’s knee" (as both of these issues are more commonly called) can be so common that many people don’t even realise they have it and just think that knee pain is an inevitable part of running. So if you get knee pain during or after a run, this blog article will help you to understand what type of knee pain you may have, what causes the pain and give you some solutions to overcoming it.
An Overview of Patellofemoral Pain Syndrome
Patellofemoral pain syndrome (PFPS), is a condition that results in pain around or under the kneecap. The pain is often worse when running, going up and down stairs, or sitting for long periods of time. PFPS is caused by the misalignment of the kneecap and can be aggravated by weak muscles around the hip, particularly the gluteus medius.
Weakness in this muscle tends to laterally drop the hip and subsequently internally rotate the femur and forces your knee to bear more weight than it should. Exercises like squatting with a resistance band will help strengthen the gluteus medius and bring your pelvis back into alignment, which may alleviate knee pain while running. We'll talk more about that later.
What Is Iliotibial Band Syndrome and How Is It Caused?
ITB syndrome is caused by the overuse of the knee joint, as well as tightness in the hips and weak gluteal muscles. Pain is experienced on the outside of the knee where the illiotibial band attaches into the knee, as the tension of the band frictions over the lateral condyle. The combination of key muscles being tight while others being weak tends to lead to instability at both the hip and knee joint, which then causes the overload and friction. Studies have shown that runners who have weak gluteal muscles are more likely to experience pain in their knees while running. This is because the gluteal muscles play such a critical role in stabilising the hip joint.
You don't need to be a runner to experience runner's knee, in fact the non-active population suffer from this condition just as much fitness fanatics and weekend warriors. Often however the symptoms and causes can be quiet similar, as previously mentioned hip instability often is a factor along with other issues such as a lack of lower leg stability, shoe type, age and posture.
The Importance of Strength Training
When it comes to runner’s knee, pain in the knees while running, or any type of knee pain while running, there are a few key things that are important to understand. The first is that runner’s knee is often caused by weak and unstable hip and core muscles. The second is that if you believe your hips are strong then you need to look south at your lower legs, instability and weakness there can also underpin sore knees. And finally, optimal joint alignment and movement mechanics are key to preventing knee pain while running.
Strength and sound mechanics allow for optimal force transfer allowing the loads associated with these forces to be shared evenly across multiple joints, NOT just your knees. The good news is there are several ways to improve your hip stability and increase strength of these muscles. By doing so you’ll decrease pain in your hips, legs, and knees while also increasing performance.
An Overview of Hip Instability
The gluteus medius is a large muscle that attaches to the side of the hip. It is responsible for stabilising the hip and keeping the leg from collapsing inward when running. When this muscle is weak, it can cause the hip to drop and the knee to collapse inward, leading to pain on the outside of the knee (runner’s knee). Additionally, tightness in the hips can also lead to pain in the knees as it can cause instability in the joint.
It’s important to remember that, while there are many factors that can lead to pain in your knee, it is most often due to an imbalance in how much you use your legs when running. For example, if you rely more on your right leg than your left when running, then it may be putting more stress on one side of your hip and leading to pain on that side of your knee.
Alternatively, if you are naturally tight through your hip flexors then you will A) struggle to get your hip into an optimal position to generate force and B) you become more susceptible to overuse injuries through your hip flexors.
How Can I Fix My Hip Muscle Imbalance?
If any of the above is sounding familiar fear not, there is hope! By focusing on exercises that are unilateral (single leg) you can address the muscle imbalances between left and right.
Furthermore, there are also exercises that help to correct faulty neuromuscular patterns. For example, if you recognise that your hip flexors are tight/over active while your glutes are neurally inhibited or lazy then you can do exercises that improve the order and timing of how they fire.
All in all, by doing these exercises (ie. single leg squats off a box) you can help to re-teach your brain how to activate your glutes and loosen up tight hip flexors while also strengthening your glutes to fight against future imbalances. Not only will you have stronger muscles around your hip, but you’ll have better control over them too.
Here are 3 hip exercises that we use in clinic that delivers every time with our clients.
This Glute circuit is actually three exercises in one. It's a great combination that will bring your Glute Med and Gluteus Max to life and ready for more challenging movements. 2 rounds of 12 reps on each of the three movements is a good beginners rep range.
These last two movements to a great job at challenging your hip in a position that's specific to any gait pattern, whether that's walking, running or lunging it doesn't matter. Challenging your hip strength in movement patterns that are specific to your needs is critical if you want to remain pain free long term.
This last exercise builds on the previous and helps to teach you how to load the hip rather than just the knee. Be sure to listen to the instructions on all three videos to gain a sound understanding of what we are trying to achieve.
Knee pain from running is extremely common, but fear not as it's almost always treatable as so often knee pain is a cause and effect of neuromuscular dysfunction either at the hips or lower leg.
Perform these three exercises 3-4 times a week for 3-4 weeks and reduce your running volume to half during this time.
If you still get knee pain during or after a run, then make an appointment to come and see us in clinic, We will be able to identify your underlying problems and get you back out there running in no time.