Runner's knee issues

July 13, 2020 9:42 PM

Last year I started running, but had to stop after 3 months due to pain along the circumference of my right kneecap. I recently started again, and after a week and a half the same pain reappeared. What do I need to do to keep my knees healthy and continue running?

When the pain started last year, I had built up to running three miles about five times a week. The running surface was asphalt. My shoes were about 1.5 years old with little mileage. My pace is a slow 11 minutes/mile, with no pushing of speed. My weight is below average for my height. I'm a cis-male in my mid-fifties. When the pain retuned after restarting running I had ran 2 miles each time five times over a week and a half.

Using the top of my right kneecap as 12 o'clock, the inside 3 o'clock, the bottom 6 o'clock, and the outside 9 o'clock, the pain while running was at 4 o'clock. After running, the pain would persist, following the circumference of my kneecap it would move to between 6 o'clock and 10 o'clock. I'd give the pain level about 4 out of 10 at most.

Last year, the pain persisted a few weeks after stopping running, including some pain walking stairs. For my recent attempt to restart running, it took a few days for the pain to fade. I haven't seen a doctor about the knee pain.

Before running, I'd do a basic set of stretches, including one I did decades ago that seemed to help prevent knee issues while running: extend one leg fully straight and reach down towards my ankle. Which I believe is stretching my IT bands, which are extraordinarily tight (actually, I'm extraordinarily tight everywhere; it's just my body's nature. I gave up doing yoga as it was too easy to inadvertently injure myself).

What can I do to continue to run without knee pain?

posted by Sock, Sock, Sock, Sock, Sock, Goose! to Health & Fitness (15 answers total)

Maybe your knee muscles need to be strengthened? Try to do some balance work, like standing on one foot on a bosu ball while you brush your teeth.
posted by pairofshades at 10:05 PM on July 13, 2020

I think I have figured out that my runners knee is basically due to muscle imbalances (weak core, hips and glutes, overactive quads). If I don't keep up a minimum routine of strength training, it starts to act up, but if I do, it's manageable and not too bad. For me, I lift weights (barbell - deadlift, squat, bench, and row) and do planks/dead bugs/bird dogs. I feel those exercises provide the most benefits for my efforts, but I think there are lots of strength training routines you can do that might help, if you search around online. Good luck, it's a frustrating thing!
posted by carlypennylane at 10:37 PM on July 13, 2020 [1 favorite]

Oh! Also, if you look up coach Jay Johnson's strength and mobility (SAM) routine, that might be a good place to start for rehab type exercises with no equipment needed. Hope this helps!
posted by carlypennylane at 10:39 PM on July 13, 2020 [1 favorite]

Stretch stretch stretch. My knee pain was always tight muscles so it’s worth a shot. 20 min of a gentle yoga routine a day
posted by christiehawk at 10:47 PM on July 13, 2020

Research from Canada has found that strengthening hips is key for addressing knee pain in runners. Link includes a description of the recommended exercises as well as a video.
posted by lulu68 at 12:19 AM on July 14, 2020 [4 favorites]

Pain on the outside and bottom of the knee cap is often related to IT bands. First, don't stretch before you run. Cold stretching prior to exercise isn't that great. Instead, start off slowly, maybe even walking for five minutes, and then go into your run. Stretch after your run. There's lots of IT band stretching on the internet; if you've found one that works, keep doing that.

Seconding everyone else about the strength work. A simple routine incorporating squats and lunges, done properly, made a big difference to my knees and ankles.
posted by Faff at 12:23 AM on July 14, 2020 [4 favorites]

It's hard to self-diagnose knee pain from running, especially over the internet.

I'm a big, big believer in strength training and foam rolling, but you have to know which strength training exercises to do, because some will fix it like magic and others will make it worse. And which is which changes based on what/where the exact problem is. Foam rolling is similar, to a lesser degree. The only solutions which might be somewhat general-purpose are stress reducers like hot baths, but I'm sure even those are contraindicated for some specific problems, and they usually don't disrupt the underlying causal chain.

Sports massage and sports physiotherapists are the way to go here. I emphasize sports medicine because many regular docs/massage therapists don't understand a goal of getting back to a particular activity. See an expert, have them work on it, have them explain their hypothesis and solution to you, get them to give you exercises to do at home. Setting expectations for yourself is important: hope that the first professional fixes it, but be prepared to see two or three and to spend a month or two figuring this thing out, and remember that in the long run you have to become the expert on your body.
posted by daveliepmann at 1:51 AM on July 14, 2020 [3 favorites]

You might also want to check in with a doctor to see if you have some arthritis. The fact that it persisted for a while after you stopped running and that you had pain on stairs could indicate that.
posted by pangolin party at 3:56 AM on July 14, 2020

Yes, strength training. When I've had similar knee pain with running, the solution was strengthening my hips, glutes and core. If you can, I'd strongly encourage you to see a physical therapist. They can give you some exercises and ideally analyze your running form to pinpoint any weaknesses or imbalances.

The form analysis was also key for me - it turned out that the injured knee was buckling inward on every step, but neither I nor anyone around me noticed until we had it on slow-motion video.
posted by fiddler at 4:06 AM on July 14, 2020 [1 favorite]

I had similar pain when running in my 20s. Two weird tricks that worked as short-term fixes: pushups and stairs. Until I was able to build up strength and develop a stretch that worked for me, I ran on a local track and either did a couple up-and-down on the bleacher stairs, or a blast of 20 push-ups. See if either or both of those work - for me, they "re-set" the pain for another lap around the track.

Long-term, I found a stretch that killed the pain as long as I did it regularly before I ran. In bare feet and standing behind a couch, roll one foot over so the tops of your toes are on the floor - kinda making a "fist". Holding on to the couch, bend your knees to squat. Point your ass back and stretch the front-outside of your shin. Switch to the other foot. If you have a yoga mat or you're on carpet, transfer your body weight to the couch via your upper body, and roll over both feet at once. It will probably hurt at first (don't try it on hard floors). Again, hold on to the back of the couch and squat with your butt wayyy back.
This stretches out the tibialis anterior.
posted by notsnot at 5:19 AM on July 14, 2020

>3 months
>three miles about five times a week
>cis-male in my mid-fifties

That's a quick build-up. As others have said, strength and flexibility training will help, a lot. But, realistically, in your mid-fifties, you need to have a non-running day between runs when starting out and probably for a long time. Like, don't do back to back days until you've been running for at least a year.
posted by TORunner at 5:33 AM on July 14, 2020 [2 favorites]

I had knee pain from cycling. I went to see my physiotherapist and she was able to figure out what I needed to do, mainly targeted exercises for specific muscles to fix it. I would expect you might only need one or two sessions and maybe some minimal equipment, like a resistance band. I have always found it to be beneficial to go to physio for fairly minor injuries or problems, because then I get specific advice from an expert.
posted by ice-cream forever at 5:39 AM on July 14, 2020

I had similar problems to you after suddenly increasing my mileage in training for a race. I ended up seeing a sports physio, and they had me do a lot of core and strength exercises. It took three visits to the physio to get a good program in place, which I use to this day.

Taping (done correctly - a physio can show you how) can really help relieve some of the stressors (but it's not a cure).
posted by KirkpatrickMac at 5:57 AM on July 14, 2020

How did you choose your shoes? If it was just a matter of 'these seem OK', then whenever's practical, get yourself to a running shop and have them help you choose shoes that suit your gait. So much knee pain from running is resolved by getting the right shoes. They'll watch you run (either on a treadmill, or around the shop, or on the pavement outside) and watch how much your feet roll inwards as you run, and help pick out a suitable shoe that will keep you better aligned and put less stress on your knees.

But yes, also strength and conditioning for the rest of your body.
posted by penguin pie at 12:35 PM on July 14, 2020

I too am a runner and had pain around the kneecaps. My knee issues were because of muscle imbalances and general weakness in my hip girdle (the muscles around which helps absorb impact) + a tight IT band (caused by said muscle imbalances). Definitely look up MYRTL workout - it's a handful of super straightforward exercises (takes like 10 minutes, I do them after my runs) designed for runners specifically to strengthen their hip girdles. It helped me IMMENSELY. That + foam rolling my IT bands on the regular = no more knee pain for me.
posted by thebots at 6:24 PM on July 14, 2020 [2 favorites]