Steve Smith’s Blog

Knee Pain After a Long Run

I saw a recent Facebook post that asked “Is it normal for my knees to hurt after a 10 mile run?” It’s a loaded question that begs a for reasonable answer. While many runners have soreness after a long run I would be nervous about it if I were training for a Marathon. I would be thinking that if it hurts after a 10 miler then how is it going to feel after a 16 miler and will this pain evolve into an injury that will prevent further training. Knowing with reasonable certainty whether or not you have problem that needs to be addressed is important because an ounce of prevention is worth a pound of cures. Let’s take a look at the types of knee pain that are commonly seen in runners, then you can decide for yourself if you need help or if you just need an ice pack and some rest.

The most common problem with knees in long distance runners is along the side of the knee. If you press your index finger into the big bump on the outside of your knee and feel tenderness then you probably are developing illiotibial band syndrome. This is characterized by a gradual onset of pain that worsens as the distance progresses and is worse when going down hills. The pain usually ceases with rest but will return during the next run during the first few miles. It may become progressively worse and can be severely painful. It rarely causes any permanent damage to the knees but may put an end to a running program until it is corrected. Knee straps, and taping are the most common treatments but they are poor alternatives to doing corrective exercises, replacing poor footwear, adding a lift for a short leg, avoiding running on a slope or correcting a poor training program. Shoes that correct for over pronation can also cause the problem so be suspicious if you are training in motion control shoes.

Number two on the hit list is pain at the patellar tendon. This is the tendon that extends down from the kneecap to the bony bump on your shin. Most often the pain is located over the medial (towards the middle) aspect of the tendon. This problem is characterized by pain on the push off phase of your gait and tends to worsen going up and down hills. It becomes more painful as the mileage piles up and although it gets better with rest the onset of pain occurs earlier and earlier on subsequent runs. Rest and ice seem to handle the problem only to have it return during the next run. Eventually the pain will ensue at the slightest hint of running. Knee straps worn below the knee or patellar taping often completely resolve the problem. Overpronation, weak gluteal or medial quad muscles are all contributing factors. If you do a one legged squat and your knee turns in toward your big toe while your arch flattens out then you need biomechanical help in the form of corrective exercises, gait training and possibly more supportive shoes.

Pain above the knee cap that results in swelling spells trouble and probably indicates bursitis. Swelling can take weeks to resolve and will almost certainly put an end to your training program as your gait becomes more compromised. Arthritis is often the underlying cause and you should have an x-ray to rule it out before you resume running.

Clicking, locking, or an inability to straighten or fully flex your knee spells trouble and may indicate a torn meniscus. If you have pain in your knee while getting in and out of your car or when you feel a slight twist in your knee and it does not resolve within a few days you should seek professional help.

Pain on the back of the knee is often caused by a strained calf muscle and deep tissue massage may relieve the pain. If this is the case then you can continue to run but avoid hills and use heel lifts in both shoes until the pain resolves. If massage, ice and anti inflammatories doesn’t help then you may have a cyst on the back of the knee, which often accompanies osteoarthritis. In this case, see a professional and get a diagnosis.

Swelling over the lower medial knee is usually caused by bursitis and can be treated with the usual runners first aid; rest, ice anti inflammatories but you are unlikely to run a marathon with this malady since it is usually caused by torsional stress on the lower leg, which will have to be corrected before you resume running.

I would venture to say that if you are a distance runner then you will eventually have a knee problem of some sort. Get these problems assessed early and get onto the right corrective path. Many runners will offer their opinion on how best to handle your problem. Before you embark on a cure for any problem it is best to find out what problem you are trying to correct. I have seen many heartbreaks over the knee pain that would have been easy to treat if only they would have had early intervention.

A word about rest. Rest is relative to your activity and it means cutting back on the physical stress on your knees. Don’t discount the value of aqua jogging or the use of the elliptical trainer. I have seen many runners complete training programs with these modalities and go on to run their Marathons without any problems. Ignoring a developing knee problem often leads to a disaster when the runner with a competitive spirit insists on completing a Marathon only to disappear afterward and never run again. A wise runner will confront these problems intelligently and go on to run for the rest of a lifetime.

I hope this helps,

Steve Smith

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