Have you recently started to notice that your knees are sore after your runs?

Are you unsure if you should continue to run or rest?

Is the pain starting to worsen or failing to settle despite a period of rest?

Knee pain during or after running is a very common complaint in clinic. It often starts as a mild niggle only to worsen over time and eventually restricts activity levels. Those suffering with such symptoms will often trial a period of rest but on return to running pain soon re-occurs and in some circumstances the discomfort can start to linger with daily activities. It is difficult to know how best to manage this by yourself but there are some very common causative factors that can account for such symptoms and being aware of these may help you recover:

1: STRENGTH

The most common mistake I see in runners is that they do no strength training, or those that do are doing exercises that are just not hard enough or specific enough to the stresses imposed when running. You must, must, must do strength exercises to ensure your joints are protected from the heavy loads imposed on them as you run. Every time you land on 1 foot your joints and soft tissues have to control your full body weight as it lands on the floor as well as coping with the ground reaction force. This is then multiplied by however many steps you take through your run. When speed or hill sessions are introduced the efforts can be even higher so you need a robust system to cope with this.

Two of the most common running injuries affecting the knees are iliotibial band friction syndrome and patellofemoral pain:

 Patellofemoral pain is a condition that causes pain around the front of the knee; around or behind the knee cap. It is linked to poor control of the pelvis, and poor movement patterns through the lower limb. Suboptimal strength through the muscles that support this joint are also commonly seen. Combine all these factors together and the joint is placed under a stress that it simply can not cope with. The cartilage struggles to absorb all the forces it is subjected to and so this is imposed on the bone behind it. Bone is a living tissue with nerve endings and when these nerve endings are stimulated beyond ‘normal levels’ they will transmit warning signs to the brain. It is these signs that are perceived as pain. This is a clever and natural protection mechanism. It doesn’t always mean that damage has been imposed but that there is a perceived risk of damage on the associated area.

Iliotibial band friction syndrome is linked to similar mechanisms but in this case there is thought to be a increase in friction or compression around the outside of the knee where the iliotibial band passes over the lateral femoral condyle. There is a bursa here which is a fluid filled sac designed to act as a cushion between the 2 surfaces. When subjected to abnormal forces the same warning signs occur.

Both these injuries are categorised as an ‘overuse injury’ and addressing how well that joint is supported by the muscles around it will be an essential part of recovery.

4 OF MY FAVOURITE RUNNING EXERCISES FOR YOU:

2: LOAD MANAGEMENT/ TRAINING PROGRAMME

How much training we do and therefore how much stress we put on our body is an important balancing act to avoid injury. Another common mistake I see in the less experienced runner is simply running too much too soon. Whether this is the amount of times run in a week, the intensity of those runs or the distance covered, a sudden peak in loads subjected to your knees can cause pain and injury.

Your musculoskeletal system needs time to adapt. A training plan is essential and this must take into account your baseline strength and cardiovascular fitness, previous injuries and other commitments in your life. With a good training programme you will avoid overloading your body, allow for effective rest periods and thus get the most out of each training session.

3: RUNNING FORM

This is big topic of debate within the physiotherapy world as well as the running community.

Is there a ‘right’ way to run?

Research has shown that we can alter the forces subjected to the knee by changing where our feet land relative to our body. Cues to change trunk position and exercises to increase step width (to avoid a crossover pattern) have all been effective in improving knee pain. However, implementing these changes is often difficult. It takes time for the alterations to take effect and can be hard work on the muscle groups subjected to the new stresses. As a result, it is important that a detailed assessment is performed, all variables are accounted for and the runner is guided through the change in running form if further injury is to be avoided.

4: FOOTWEAR

The structure of your shoe breaks down when you run so your trainers need replacing. This can vary according to the individual but as a rough rule, a new pair is recommended after every 500miles. For some individuals the type of shoe they are wearing can also play a role in the development of knee pain but personally I often think too much emphasis is placed on this and its effect on injury and performance.

So where should you start and what factors should you take into consideration?

Shopping for trainers can be quite confusing. Every brand promises to make your run faster or cure your injuries and let’s face it: some simply look better than others! A few helpful tips from me:

1: There is not 1 perfect trainer for runners. We all move differently and have different strengths and weaknesses. As a result, what works for 1 runner may not work for another. Be sure to go with what is COMFORTABLE and try not to be sucked into all the promises that advertising campaigns state.

2: Fashion trainers are NOT running trainers. Yes, I have seen people running in all sorts! Be sure to get yourself a running trainer. Asics, Brookes, Saucony etc are examples of some well- known brands. They may be expensive but you get what you pay for. Years of research go into designing these shoes for athletes.

3: If injured ensure you initially get a detailed assessment from a healthcare professional first before rushing out to get new shoes and making quick fixes. Though this may help temporarily it is likely that there are factors, (like those stated above) that play a part in the injury. Addressing these first will be the key to the best long- term management of any musculoskeletal condition.

5: BONE STRESS

Every so often a stress reaction or stress fracture will appear in clinic and these are very important to be aware of. If pain starts to become constant or difficult to ease, if it is present when resting or sleeping and if it is sore when you hop on the spot then be sure to see someone about this. Though stress fractures are less common around the knee, stress reactions to the patella (knee- cap) can occur and in some cases stress fractures can refer pain to the knee. Causes can be linked to diet, body mass or hormonal links, training loads and training techniques.

BE AWARE THAT A STRESS FRACTURE MAY NOT SHOW ON X RAY. AN MRI OR CT IS OFTEN NEEDED.

Unfortunately, a period of rest and offload is essential for recovery and the time required will depend on the severity of the fracture. Managed well and you should return to running stronger and better prepared for the miles ahead!

SO IN SUMMARY……….

  • You must, must, must do strength  exercises to protect your joints from the loads imposed on them by running.
  • Consider a training programme to avoid peaks in load.
  • Do not ignore pain that persists when you are resting or sleeping.
Davina Sherwood
Specialist Musculoskeletal Physiotherapist