Knee Pain While Running? Here’s 5 Keys To Treat Knee Pain After Running According To A PT

With the summer olympic buzz this year, many may feel more enthusiastic to give running a try to get healthier and/or lose weight. Often times with a sudden increase in an activity our bodies are unfamiliar with follows injury and or pain. If you have knee pain while running or knee pain after running and want to get rid of it. Keep Reading to find 5 key steps you should try to alleviate your pain.

1. Cut Back On Volume Of Running

One of the first things you should do if you are experiencing pain with running or after running, is to cut back on the amount of running you are doing. The pain that you are experiencing doesn't mean that running is bad for you, but rather it's a sign that your muscles are not strong enough to tolerate the amount of load being placed on your joints while running. This load placed on your joints increases with the amount of time/distance spent running, increases with increased pace of running, and increases with increased body weight. So you need to cut back on the intensity of your runs as well as the time spent running. Once you have cut back on the volume of your running, you will need to take a deeper look at your muscles to strengthen them to be able to tolerate running to provide proper stability around your joints. During this time period of recovery, if you feel you are missing out on needed cardio you can try cycling or swimming which place very minimal stress on your knee joints.

2. Strengthen Your Hip Muscles

Weak hip muscles may be a potential cause of your knee pain while running and after running. In particular the glute muscles help to keep your knee in proper alignment and stable when running, so if these muscles are weak you may experience pain when running. The glutes are made up of 3 muscles; the glute max, glute medius, and glute minimus. The glute max is the primary muscle that makes up the back side of your hips, while the glute medius and minimus are located on the lateral sides of your hips. When these two lateral muscles are particularly weak they can cause whats called dynamic knee valgus while running. Knee valgus is when the knee caves in towards the other knee. This is also know as "knocked kneed." When the knees cave in there is increased stress placed on the lateral boarders of the bones of the knee joint as you can see from the picture below.  

Due to the knee instability knee valgus causes, the muscles of knee have to adapt in an attempt to provide more stability to the knee. Typically you will see adaptive shortening of the lateral knee muscles and adaptive lengthening of the inner knee muscles. As you can see from the picture above the inner space between the knee bones is wider with knee valgus. So the muscles on the inner knee tend to get weaker, while the muscles on the outer knee than to get overworked and stiffer, causing an imbalance and sometimes even pulling the knee cap out of alignment laterally while running. 

Everyones body responds differently to stress, which is why people with the same diagnosis/injury may experience pain differently in different locations on the knee. Some runners report lateral knee pain, while others inner knee pain, or even front of knee pain. Pain may be dependent on which muscles attempt to take over more to compensate for the weak glute and hip muscles. Regardless of whether you are feeling the pain on your inner or outer knee, if you have knee valgus, you probably have weak glute muscles and would benefit from glute strengthening.

Exercises for knee pain

These exercises are shown in progression from easiest to hardest. Try and incorporate the first  3 exercises into a routine before moving on to the last 3 exercises. Each exercise should be done for 3 sets of 20 reps. Once you can easily do 3 sets of 20 reps without getting tired and/or your muscle burning out you can stop the exercise and move on to the harder level exercises.  You can combine these strength exercise below with some stretching exercises which I will go over later as well.

Straight Leg Raises

Clams

Bridges With Band

Hip Abduction

Single Leg Bridge

Single Leg Squat Step Downs

3. Improve the Flexibility In Your Leg Muscles

Tight and stiff muscles are often a contributing cause to knee pain. When muscles are stiff they are not able to contract properly to produce adequate strength. Stiff muscles also decrease the amount of motion in and around the knee, causing other muscles to overcompensate and work harder. This overcompensation is what typically causes the pain.

A lot of runners may have tight hamstrings and calf muscles, which are the muscles in the back of the knee. When your hamstrings are stiff it may make your quad muscles work hard to contract, leading to pain in the front of the knee. When your calfs muscle are stiff, this can make it more difficult for your knee to actually bend and also contributes to dynamic knee valgus or "knocked knees." Due to the repetitive nature of running, some runners develop stiffness in the muscles in the front of the hip, the hip flexors. The hip flexors consist of three muscles the psoas, rectus femoris, and iliacus. Of these 3 muscles only the rectus femoris crosses both the hip and knee joint. So often times the psoas and iliacus may be weak, causing the rectus femoris to overwork, which can then lead to knee pain. 

Because the muscles at the knee play a roll in hip and ankle movement, its generally a good idea to stretch all the muscles around the knee, hip, and ankle joint, and focus on the areas that feel most stiff. Below you will see pictures of the muscles that are frequently stiff and how to stretch them. Focus on the stretches that are the hardest for you to do. Hold each stretch 3x30 seconds. You can read my article HERE about the importance of stretching and how to stretch properly to become more flexible.

Stretches for Knee Pain

Calf Stretch

Hamstring Stretch With Stretching Strap

Quad Stretch

Hip Flexor Stretch

Watch the video Below to See One Way How to Stretch Your Hip Flexor Properly

4. Foam Roll And Focus On Recovery

The first step to treating knee pain after running is to decrease the amount of running you are doing to give your muscles time to destress and recover. You can further help muscles relax and take stress of the knee joints by using recovery tools. My favorite recovery tools for pain management are foam rollers, massage balls, massage guns, Ice and heating pads

How and When to use Ice for Knee pain

In the initial stages of knee pain, if you get swelling after running using Ice may be beneficial for your pain and swelling. Typically you want to use Ice after your runs or at the end of the day, when you know you will not be moving around much. You can Ice for a 1-2 hours 20mins on 20mins off and repeat. Now a days you don't have to worry about messy Ice melting all over you or your furniture. You can buy gel ice packs at the pharmacy or even amazon. In particular I like this gel Ice pack below specifically made for the knee that you can wrap around the knee and pump to add a compression effect to further decrease swelling. If you have significant knee pain, its recommended you elevate your legs and lay down to further help decrease the swelling while icing. 

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When To Use Heat For knee pain

If you have had knee pain for more than 3 weeks and no swelling is present, than using a heating pad on your knees may be more beneficial. Unlike ice, using heat actually promotes healing and increases blood flow to damaged tissue. Heat can also help relax and loosen up your stiff muscles. Heat can be used anytime really just be careful not to use it on a new injury where you have a lot of swelling, it can make the swelling worse. I love the heating pad below found on amazon. It is made specifically for the knees and has a massage setting, so while you are getting the heat you can further relax with massage. I recommend using heat at 30 min intervals either before a workout or at the end of the day when you are relaxing. When using check your skin often to prevent burns. 

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How To foam Roll For knee pain

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Using foam rollers and massage balls is a form of self massage that uses your own body weight to further relax stiff and tight muscles. To find out more about foam rolling properly to prevent and treat pain you can read my article HERE. When foam rolling, like with stretching, you want to focus on the muscles that are most stiff around the knee joint. Typically foam rolling the quads, hamstrings, and calfs can be beneficial and help treat knee pain. I recommend foam rolling each stiff muscle for 1-2 minutes each session by slowly rolling your body back forth on the foam roll.

Foam Rolling Lateral Quads

Massage Gun For Knee Pain

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Massage guns have recently become a new popular way of self massage life foam rolling. However because the gun is doing the work you can better regulate how deep of a massage you get with the gun than with foam rolling. Massage guns also have adjustable speeds and different attachments to further augment how the massage feels. Its a great way to save money on getting frequent expensive massages as it is just a one time expense.

5. Lose weight

The saying goes, The bigger they come, the harder they fall. And this saying holds true for running. In regards to exercise and running, its simply science. The more weight you carry on your body the more stress and loads are being place on your joints. When running joint forces are several times greater than with walking. So if you are heavier, it would benefit you to try and lose some weight before partaking on a strenuous running routine. Low impact exercises like swimming, cycling, elliptical or simply walking may be a better alternative form of cardio until you have cut down your weight and/or strengthened the muscles around your knees enough to tolerate the loads being placed on them when running. If your BMI is over 30 than I would suggest you try and bring your weight down to protect your joints before starting a serious running routine. You can use a simple BMI calculator to see what your BMI is. BMI is simply an estimation of your body fat percentage and you are considered over weight if the number is over 25.9. However BMI does not take into account muscle mass which may make you heavier even while having less fat on your body. I myself have a BMI of 28 which is why I don't think you should really look too deeply at this number. But if you are significantly over weight with a BMI over 30 it can be used as a reference tool to help guide your weight loss.

Conclusion

There are multitude of reasons why you might have knee pain when running or knee pain after running. And theres no one fix all solution that will help everyones knee pain. But here are the 5 keys that you should consider to help treat and stop your knee pain from running your life...no pun intended 😉.

1. Decrease your volume of running, and slowly ramp back up 
2. Strengthen your hip and quad muscles, particularly your glutes
3. Stretch the muscles around your hips, knees, and ankles
4. Use recovery tools like ice, heating pads, foam rollers, massage balls, and massage guns to help further relax tight muscles
5. Lose weight

If you simply scrolled down to see the answer to your question, please scroll back up to find the specific exercises for knee pain I suggest, specific stretches for knee pain I suggest, and all the recovery tools I suggest using.

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