Running and Knee Pain
The knee is the most commonly injured area in runners, with prevalence up to 30% in runners (women more than men, sorry gals).
Runners like to run, despite pain, but they are more than willing to invest in whatever remedy may be the magic fix: tape, braces, rollers, shoes, cupping, massages...you know the drill.
Any and all of those remedies may provide some relief, but the problem with these types of solutions is that we're never actually getting to the root of the problem.
Let's try and figure out WHY you may be getting knee pain with running, not just how to manage it.
Do you need to see a doctor?
Well, for the run-of-the-mill knee pain (my knee hurts during or after I run vs at odd, random times), you can see your primary care doctor who will refer you to PT and/or an Orthopedic surgeons.
Surgeons prescribe meds, offer injections, and perform surgery. Do you think you need any of those interventions?
The role of a Physical Therapist in this situation is to diagnose your running mechanics, and to find any weaknesses or mobility deficits.
Try PT first!
Let's dig into some mechanics.
The knee gets into trouble because it's trapped between the ankle and the hip. That means it's subject to forces from the bottom AND the top. It's a vulnerable spot, which explains the high prevalence.
However...the knee itself is usually not the problem.
When you come to see me for a running analysis I look at a few key elements:
- Your mobility, specifically in your big toe, hip, and torso rotation. Lack of mobility here can set you up for faulty running form.
- Static strength, meaning a baseline "can you resist me" test of your quads, hamstrings, glutes, and core telling me how well your muscles are performing.
- Functional movements - can you do a single leg squat holding good alignment? This gives me an idea if you are well set to absorb the impact of running.
- Video analysis of you running. I don't know what you're doing out there until I watch you run! You may have all the strength but could be falling apart on your runs because of some sub-optimal strategy.
Here is a quick video that will guide you through some of the mobility, strength, and functional movement tests:
How did you do?
If you picked up on some obvious deficits, you know exactly what your homework is.
Why are women more likely to get knee pain?
Women tend to be more quad dominant, lacking balanced hamstring and hip strength to keep them stable in something like a single-leg squat. This is not an over-generalization, this is well documented.
Women also have a slightly different bone structure and alignment from their hips to ankles, which, unfortunately, sets them up for less-than-ideal stabilization strategies.
Remember an orthopedic surgeon's xrays and MRI scans only show the anatomy of your knee at a particular place in time.
This can be valuable information if you suspect some kind of tear, but without a clear injury mechanism (ie you fell during your run), it's more than likely you're dealing with some kind of overuse injury.
Having a PT watch you move and analyzing your kinetic chain while you run gives us the best information to see exactly what might be going wrong and where, which therefore guides the most efficient treatment plan.
Look for a PT who specializes in running analysis. I perform these regularly and would love to help you get the right information you need to clear up your pain!
Now what about the shoes, braces, stretches, tape, etc??
All of these things have their place in your symptom management, but they will only serve as a bandaid until you get to the root of your problems.
Some quick advice/opinions:
- Pick the shoes that are the most comfortable. If an orthotist or PT says you need inserts then get them, but only after they've done a complete running analysis. Someone only analyzing your feet when running is missing what's going on elsewhere in the kinetic chain. You need to see big picture before spending that kind of $$.
- Foam roll and warm up your joints before you run, stretch after. (Video on post-run stretching linked here).
- Strengthen. Period. Hips/glutes, core, hamstrings and quads. (see video above!)
- Braces are generally bulky and uncomfortable, and inhibit your running form. I'm not a fan, and they haven't been proven to work. If a basic compression sleeve (like this one) feels good to you that's fine, but know that external braces are not doing much for you. Your internal strength provides significantly more stability.
- Kinesiotape. There is somewhat of an unknown effect (possibly placebo? research unclear so far) that makes people feel better with tape on. Tape won't hurt you, it's cheap and pretty easy to apply. It won't hinder your running form. If you like it, go for it. If you don't, it's not going to be the thing that makes or breaks you. My favorite brand is linked below.
What's one quick thing you can do right now to start improving your stride and reducing your knee pain?
Dr. Bryan Heidersheit, PhD, DPT is a leading researcher in the world of runner's rehab. The bulk of his research lately has been focused on reducing stride length and increasing step rate.
If you are struggling with knee (or hip or ankle) pain with your running, try downloading metronome (free apps available! I use pro metronome) and work on increasing your step rate. 180 bpm appears to be the ideal, but start around 170 if this is new for you.
It will feel strange at first, but you will also quickly notice the difference in your form. Your core will turn on and your hips will stabilize. This is a great tool I've used with my runners that limits the amount of cues I need to tell them to focus on while running.
Reducing stride length has been shown to greatly reduce the biomechanical risk factors for injury. In Dr. Heidersheit's research they found and over 50% reduction in symptoms by implementing this.
My last bit of advice to you: don't be a hero.
PT's exist for you. I LOVE treating runners. Runners are passionate about their sport and will do anything to keep going, which is why so many of you run through pain. It doesn't not have to be this way. You don't have to try and figure it out on your own.
Be good to your body, get the help you need, and move forward with confidence!!
You're likely to find increased performance and speed as a side effect...
May happy miles to you, my friend! See you out there.