Knee pain after running: a guide to why you get it and how to treat it

Posted by for Strong Women

If Instagram is anything to go by, we’re all runners now. But what we aren’t sharing in those 5k challenge photos is the post run pain. Here’s how to treat those sore knees before your next nomination.

I like to think that I’m pretty sporty. Not a description that 15-year-old me, who stood at the back of every P.E lesson, ever expected to hear. But here I am, eight years on and getting agitated at the fact that I can’t hit the gym. To make matters worse, right now I can’t really do any at-home lower body focused workouts, because my knees feel like they belong to an 80-year-old.

It all started when I decided to get out for a run. I’m not a running novice but my jogging habit is seasonal at best, so I hadn’t been out since September. Two light 5ks later and suddenly I could barely move from my bed to my desk. 

Turns out, I’m not alone. My flatmate moaned about having sore knees, as did other members of the Strong Women team, and friends who I’ve seen sharing their Run 5, Donate 5 challenge on Instagram stories were suddenly messaging me for advice.

So I turned to the expert, Lyndsay Hirst, physiotherapist at Your Pilates Physio, to explain why we’re all suffering with knee pain now that quarantine has made runners of us all.

WHY DO MY KNEES HURT AFTER RUNNING?

This depends on where the pain is, explains Lyndsay. “If you’re suffering with bilateral pain, so both knees are suffering, the usual culprit for that is weakness in the quad muscle,” she explains. Things get more complicated when it’s one knee that’s taking more of the strain: “That’s more likely to be a biomechanical issue. With the knee being between the ankle and the hip, it’s hugely influenced by both of those joints.”

Is running causing your knee pain?

This explains a lot for me. At the beginning of the year I had tendinitis in my right ankle so badly that I was on crutches, and now my right knee is the one feeling fiery. But for many, it’s hip pain that is usually the cause: “99%, if not 100%, of my patients with knee problems after running have biomechanical problems with the hip,” Lyndsay says. “What we’ll find is that they have weakness in their glute muscles, and in particular in their gluteus medius muscle. The glute meds job is to externally rotate the femur [thigh bone]. If the glute med is weak, then as you’re running the femur will internally rotate instead, causing an inward twisting of the knee.”

But, back to tooting my own trumpet, I’m strong! Or I thought I was. I trained legs at least twice a week, lifting heavy. So why are these ailments suddenly being blamed on muscle weaknesses? Maybe I’m just not as strong as I thought I was? “Well, resistance based exercises don’t really mimic the action of the muscle during running,” Lyndsay says. “The firing patterns of the muscles are different to how you would train them on a leg press or hamstring curl machine. Even if it’s just a 5k, which might not sound like a huge amount, it’s something new to your body. You’re asking your muscles to perform a completely different activity to what they used to do.”

HOW DO I TREAT KNEE PAIN AFTER RUNNING?

I’m a ferocious googler when it comes to any sort of ailment, and my research told me that foam rolling my quad muscles and hips can ease up any tightness or weaknesses, helping to reduce strain in my knees. So far, it’s been working like a charm for me. But, best to check with the expert. “Discomfort or pain in the IT band [the outer thigh] can be caused by all of these muscle imbalances,” says Lyndsay. “Foam rolling is a soft tissue release technique that can reduce the tension in the muscular structure, but I would never suggest doing that in isolation. You need to make sure you’re ironing out the muscle imbalance in the first place.”

So, how do we do that? Activating glutes before running, with clams, bridges and other waking-up moves will stop other muscles taking over and causing pain. But general strength training is essential, too. “Quad loading exercises like squats or single leg knee dips are great, but if it’s those glutes that need work then we really need to focus on form. For example, in those knee dips push the knee out over the toe in order to get the glute muscle functioning.”

Running injuries be helped by getting used to the impact

But we also need to get our joints used to that impact, as well. That’s where Lyndsay recommends plyometric work, such as box jumps, to create the type of contraction that your muscle needs in order in order to survive the run.

Rest is also important. If you’re really suffering, take at least a week off from running, Lyndsay says, then gradually make your way back in by following a Couch to 5K programme, for example. “But do those strength training exercises daily,” she urges.

WHEN IS KNEE PAIN SERIOUS?

“You can get ligament damage or meniscal tears in the knees, but just from a pounding the streets, you wouldn’t usually get that sort of injury,” Lyndsay reassures. You’ll know the difference: proper damage will force you to stop running, rather than just ache a little, may swell and be hot and angry. If that’s you, contact a doctor or practitioner. 

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Images: Getty / Unsplash

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