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Slowing Down Runner's Knee

As a Chiropractor and Sports Medicine doc, I want to be as specific as possible in my diagnosis so that I can target and treat the offending problem to quickly return patients to their healthy lives.  It is for this reason that I hate the term “Runner's Knee”.  It is a catch-all term for pain.....that runners the knee.  Brilliant.  There can be many causes of knee pain in the running population, and in other areas of society as well.  To lump them all together under one umbrella complicates the matter and confuses the patient.  

“Why do I have Runner's Knee?  I don't even run!”

“I did XYZ for my Runner's Knee based on an article in a running magazine, and it didn't help.  What am I doing wrong?!”

“My Runner's Knee hurts on top of the kneecap, and my wife's Runner's Knee is on the bottom.  How is this possible?!”

In this post I'm going to talk a little about different types of knee pain that can arise from running, and what you can do to alleviate it.  There are not going to be any vague terms, and I will provide specific recipes to provide relief to each.

First, it is important to understand the origin of your knee pain.  Was there a twist, a direct hit, or is there a history of arthritis or prior injury/surgery?  If not, your knee pain is likely not being caused by the knee at all, but rather the foot/ankle or the hip/pelvis.  In my post regarding knee pain among cyclists, I stressed the importance of a bike fit.  This does not apply directly to non-cyclists, but there is equipment to consider--shoes.  Regardless of activity or activity level, make sure that you have footwear that fits, and that is properly-suited to what you will be doing.  I always suggest to any runner that walks into my office with pain, that they visit a running specialty store for an evaluation and fitting.  Get this out of the way before the pain starts.  In other words,

  1. Before you start running

  2. Before you significantly increase mileage

  3. After you have worn your shoes for approximately 350 miles of foot travel

The following will address knee pain by relating its location to the kneecap:

Above & Below:  Typically pain above the kneecap is due to tight or overactive quadriceps muscles.  Tight muscles can be massaged, foam rolled, and stretched to reduce the stress on the tendon attaching the quad to the kneecap, and therefore alleviating pain.  Overactive quads are typically due to weak hamstrings.  The balance of pull between quad (front of thigh) and hamstrings (back of thigh) is most effective when the strength is distributed 60-40 respectively.  If this is off, and the hamstrings are weaker, then the quad will be too strong and put too much pull onto the quad tendon that attaches to the kneecap.  The difference between tight and overactive is often difficult to discern on your own, so I would start with the roll, a stretch method [5 min/leg, 3 sets of 30 seconds respectively], and if that doesn't create relief, then visit a sports medicine professional.  

Inside & Outside:  Pain in these areas is often due to a pulling of the kneecap laterally (outside) by the connective tissue attached to the end of the iliotibial band or IT band.  You cannot stretch the IT band, so do not try.  It is an extremely strong, dense band of connective tissue that runs from the gluteus medius and tensor fasciae latae (TFL) muscles on the pelvis and runs along the outside of the thigh to just below the knee.  If the glute med and TFL muscles are tight, they will pull on the IT band which then pulls the kneecap laterally.  This pulling can create pain on both the outside and the inside of the kneecap.  

The muscles of the outside hip can be rolled and stretched just like the quads in our previous example.  The lateral quad can also be rolled along the IT band to break up any adhesions that may have formed between the muscles of the lateral thigh and the IT band.  The hip muscles become are tight if they are overused, or if there is not an adequate movement at the sacroiliac (SI) joints.  For this scenario, a chiropractor can determine the movement of the joints, and address any problems.  Too much pronation or inward rolling of the foot can also cause tightness in these muscles.  This should hopefully be addressed by the shoes that you got fitted to your feet and gait.  Kinesio tape is also helpful for keeping the kneecap where it belongs so that it may travel in its preferred tract on the knee.

Behind:  Pain behind the knee is usually due to a degenerative disease known as chondromalacia patella.  This is a condition where the cartilage that covers the backside of the kneecap becomes worn and tattered.  There is often grinding and some discomfort.  Stretch and roll the quads in the same manner as you would for Above & Below kneecap pain, and it will take some of the stress off of the kneecap, not pulling it into the knee joint so hard.     

The stress on the knees from running can be reduced by shortening your stride.  Refer to my earlier post on changing (or not changing) running stride to learn more about this. 

Needless to say, there are many other knee injuries and ailments that can occur with runners and with all populations.  These are simply the most common overuse injuries seen in runners, and athletes of all sports and of all levels.  If you are experiencing knee pain, and these above methods have not worked for you, please contact an experienced sports medicine professional.  Also, if you are experiencing pain that is more severe than you would assume for an overuse injury, please consult a professional.


If you have any questions regarding the material covered in this post, or on your specific knee pain, please do not hesitate to contact ESSM via email at or by phone at Evergreen Spine & Sports Medicine 303-670-8902

Originally posted on March 18, 2016

Original author: Alan Staughton, DC

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