All hail runners’ knees. They’re the biomechanical wonders helping to power us through miles and miles of training, flexing when we ask them to, propelling us when we require propulsion, moving more quickly when we require speed.
But when they go wrong, our world comes to a literal halt. Luckily, we’re here to help. Together with lead physiotherapist and regional manager of Ascenti, Alan Young, we break down what exactly a twisted knee is and how to recover from the injury, or avoid it happening if you’re lucky enough not to have experienced it.
What happens when you twist your knee and what causes it?
'You can injure your knee in two ways,' says Young. 'Either via a traumatic event or a non-traumatic event.' However, in most cases, a twisted knee is the result of the former. '[A traumatic event] occurs when you’re running on an uneven surface, for example, and your bodyweight turns you in a direction that you weren't intending to go. As a result, you apply a twist to your knee that can injure structures inside the knee.'
Traumatic knee injuries also can be caused via contact with something, often unexpectedly. 'Runners do run into things from time to time, whether it's walls or dogs – as I have done before – and that can lead to What is hip bursitis.'
At particular risk are tears to your meniscus or cartilage that sit between the knee joints. 'If you apply a twisting force it can potentially tear the meniscus, which then causes pain when you’re running and will prevent you from taking part in the sport.'
Non-traumatic knee injuries usually occur because of overuse or running beyond your usual training level. 'So for example, if you’re okay running 5K three or four times a week, but suddenly decide you’re going to add in a few 10K runs, your meniscus or cartilage may not be ready to absorb the extra forces and could potentially tear.'
What does a twisted knee feel like?
Young says a twisted knee can feel like a persistent sharp pain which occurs a day or two after the initial injury, for example, when you stand up from a seated position, it could be a sign of something structural being injured. 'It doesn't necessarily mean it needs help – it could go away on its own after a week or two. But it's a sign that you might need to rest from activity for a while.'
The pain can also be delayed and the symptoms don't arise until you're getting back into running. 'It could feel fine on your first run back, but then similar symptoms start to build up again. It’s most likely not a coincidence and would be a good time to get it looked at by a professional.
'Running on grass is better for your knees as there's more shock absorption when compared to running on road where it's solid concrete, but the benefit of roads is that they are more predictable.'
Despite this, you can get stark changes in terrain on roads – curves, manhole covers, cracks, divots, pot holes. 'The other traumatic knee injury road runners suffer is when you have to jolt to a stop due to a car pulling out unexpectedly. A sudden change of pace puts a lot of stress on the joints, muscles and tendons.'
Is a twisted knee serious?
Twisted knee is a common problem particularly for people who do regular sport where there is a combination of speed and sudden changes in direction. The pain can be mild to severe, and the injury can also cause swelling and immobility.
With the right rest and treatment the vast majority of people make a full recovery from knee injuries.
How do you fix a twisted knee?
'Why you might be getting knee pain from cycling active rest,' says Young. 'If you don't move something, it gets worse and you cause multiple other problems.' Instead, you should to continue to walk, move and do things that your knee’s capable of doing without recreating that sharp pain.'
In order to get that right, Young recommends consulting a physio, as it can be difficult to fully understand how to actively rest.
As with all injuries, you should abide by the ‘RICE’ guidelines following the injury – rest (actively), ice, compression and elevation. In terms of icing, the safest thing to do is apply an ice pack 10 minutes daily. 'Any more than 20 minutes and you start to have the opposite effect of what you want,' says Young.
In the acute phase, compression can be useful, especially if there’s swelling around the knee joint. 'Knee supports can be a bit like a crutch though, and I’d advise not using them unless you've been told to, as you can become dependent on them.'
How long does a twisted knee take to heal?
This will really depend on what part of your knee is injured and how badly it is damaged. Many knee problems will heal within two to four weeks but some may take longer. The best thing to do is to speak to a physiotherapist and follow their advice.
If you go back to running too soon you could inflame the problem or hurt yourself again. Ask your physio about cross training options and how to stay mobile without aggravating your knee.
How to build strength in your knees
To condition your knees to prevent traumatic or non-traumatic injuries, Young’s advice is to build the following two exercises into your Everything you need to know about stress fractures, Updated: 25 October 2022.
Bodyweight squats
'Running on grass is better for your knees as theres more shock absorption – ensure that when you squat your knee is over your second toe. I’d advise you to do squats with your running shoes on so you have a support structure in place in case of biomechanical problems. Performing them in front of a mirror can also help you see if you’re remaining in a straight line. Adding in a balancing element is useful too, so do single-legged squats.'
Bodyweight lunges
'Make sure they’re multi-directional, and not just straight forwards or backwards, as when you’re running you’ll have to turn corners and go over kerbs. Also, add in a hopping element so it’s not always a ‘closed chain’, eg there’s not constant contact with the floor – create open space under your feet by hopping from one lunge position to the next.'
