Pain in the Knee: How it Presents — and How You Can Avoid it

May 13, 2015

Lisa Reinke, a physical therapist with Bellin Health Sports Medicine, writes about common knee injuries:

The knee, it should come as no surprise, is a common trouble spot for runners.

Look no further than a 2002 study, which identified the knee as the most common area where runners experience pain. Published in the British Journal of Sports Medicine, the study found that the knee accounted for a whopping 42 percent of running-related injuries — more than double the 17 percent of foot and ankle injuries, which came in second.

Of the top 10 reported injuries in the same study, patellofemoral pain syndrome came in at No. 1, affecting 21 percent of runners. IT band syndrome, also a knee injury, affected 11 percent, and knee meniscal injuries and patellar tendonitis (both knee injuries) also cracked the top 10.

Because the knee is such a common injury location, we are dedicating this blog post to defining the top knee injuries in runners. They are:

Patellofemoral Pain Syndrome – “Runner’s Knee”

What is runner’s knee?

Patellofemoral pain syndrome (otherwise known as “runner’s knee”) is pain behind the kneecap. 

What causes runner’s knee?

Runner’s knee commonly occurs with overuse. The kneecap is attached to a large group of muscles in the thigh called the quadriceps, and it glides through a groove in the end of the thigh bone. With repeated bending and straightening of the knee, runners can irritate the inside surface of the kneecap if it does not move correctly in this groove. Pain can occur from the way the hips, knees, ankles or feet are aligned and/or how they move. 

What are the symptoms?

The main symptom of runner’s knee is pain behind the kneecap. You may have pain when you walk, run or sit for a long period of time. The pain is generally worse when running downhill or going down stairs. The knee may swell at times. You may feel or hear snapping, popping or grinding in the knee.

What is the treatment?

Initial treatment of runner’s knee focuses on rest and ice to decrease your pain. If symptoms do not resolve within seven days, consult with our running experts to discuss possible changes to your training, or the potential need for a consult with a sports medicine physician or referral for physical therapy.

Illiotibial (“IT”) Band Syndrome

What is IT band syndrome?

Illiotibial band (or IT band) syndrome refers to inflammation and pain on the outer side of the knee. The IT band is a layer of connective tissue that starts as part of a muscle in the hip and travels down to the outer side of the knee, attaching to the upper shin bone.

What causes IT band syndrome?

IT band syndrome occurs with improper movement at the knee, causing stress and inflammation at the outer side of the knee. This most often occurs in running. This condition can result from tight muscles in the hip, pelvis or leg, and/or weakness of the hip muscles affecting knee position during running.

What are the symptoms?

The main symptom of IT band syndrome is pain on the outer side of the knee.

What is the treatment?

Initial treatment of IT band syndrome focuses on rest and ice to decrease your pain. 

If your symptoms do not resolve within seven days, consult with our running experts to discuss possible changes to your training, or the potential need for a consult with a sports medicine physician or referral for physical therapy.

Knee Meniscal (Cartilage) Tear

What is a meniscal tear?

The meniscus is a piece of cartilage in the middle of the knee that acts as a shock absorber during weight bearing and guides the movements of the knee. The meniscus is a tough, rubbery tissue. A meniscus tear is a fraying or tearing of this tissue.

What causes a meniscal tear?

A meniscus tear commonly occurs when the knee is forcefully twisted during a weight-bearing activity.

What are the symptoms?

Common symptoms include pain in the knee joint, immediate swelling, not being able to fully bend or straighten the knee, or the knee locking or getting stuck in one position.

What is the treatment?

Early treatment would focus on ice applied to the affected area and rest. 

If your symptoms do not resolve within seven days, consult with our running experts to discuss possible changes to your training, or the potential need for a consult with a sports medicine physician or referral for physical therapy.

Patellar Tendonitis – “Jumper’s Knee”

What is jumper’s knee?

Patellar tendonitis, also called jumper’s knee, is inflammation or swelling in the band of tissue (the patellar tendon) that connects the kneecap (patella) to the shin bone (tibia).

What causes “jumper’s knee”?

The most common activity causing patellar tendonitis is too much jumping. Other repetitive activities such as running, walking or biking can also cause patellar tendonitis as all of these activities can cause repeated stress to the tendon, causing inflammation or swelling. This inflammation and pain can occur from the way the hips, knees, ankles or feet are aligned and/or how they move. 

What are the symptoms?

Common symptoms include pain and tenderness around the patellar tendon, swelling in the knee joint or swelling at the patellar tendon, pain with running or jumping, and pain with bending or straightening the leg.

What is the treatment?

Initial treatment of patellar tendonitis focuses on rest and ice to decrease pain. 

If your symptoms do not resolve within seven days, consult with our running experts to discuss possible changes to your training, or the potential need for a consult with a sports medicine physician or referral for physical therapy.

How do I keep my knees healthy?

Proper Training Program

Proper training is the key to avoiding knee injuries. Most knee injuries occur with overuse or overtraining, so it is important to follow a training plan that slowly and appropriately builds time and mileage. Utilizing the Bellin Run calendar for your training is a good start. Contact Nate Vandervest, Bellin’s certified running coach, to get an individualized plan for the Bellin Run or another event.

Strength Training

Strength training — specifically the glutes, hips and quad muscles — is also a great way to reduce your risk of knee pain. It is important to learn the proper exercises and form from a personal trainer, strength coach, athletic trainer or physical therapist if you do not already have a background in strength training. 

Complete a runner’s gait assessment

A runner’s gait assessment can identify if you have excessive knee movement during running, if your running form is placing your knee in positions of increased stress or if you have weaknesses or flexibility restrictions that are commonly associated with knee pain. The only way to truly know if you are at risk of getting knee pain with your walking or running is to examine and evaluate the way you move.

In the end, it does not matter exactly where your knee hurts if it is limiting you in daily activities and/or walking and running. It is a good idea to consult your physician or a running specialist if your knee pain limits you for more than one week without a decrease in pain.

At Bellin Health Sports Medicine, our physical therapy team will help to treat the knee pain diagnosis specific to you and get you back to your training as quickly and safely as possible. I hope you don’t find yourself among the many runners with knee pain — but if you do, our team is ready to help!

I wish you continued happiness and health in your training— enjoy every step of your health journey!

Lisa Reinke is a physical therapist with Bellin Sports Medicine who specializes in the treatment of running-related injuries and gait assessments for the injured runner or walker. Lisa has participated in several road races, bike rides and triathlons. You may email Lisa with any questions regarding running or walking injuries: Lisa.Reinke@bellin.org.

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