Knee pain after running: Common causes and how to manage it

While knee pain is definitely a common thing among runners, it’s a mistake to think that it’s all running’s fault. Although research shows that it is one of the main sites for a running-related injury, numerous studies also suggest that non-runners have it worse. According to one, ‘a more sedentary lifestyle’ is more strongly associated with knee osteoarthritisthan the life of the recreational runner.

A round-up of 17 different studies in the Orthopaedic Journal of Sports Medicine in 2023 concluded that running ‘may be protective against generalized knee pain.’ Another piece of scientific research from 2021 stated that: ‘Increasing evidence indicates that exercise training can improve pain, stiffness, joint dysfunction and muscle weakness in patients with knee osteoarthritis.’

However, if you do have a knee injury, it may well hurt more after running. There could be a few different causes. We spoke to sports doctor Jordan Metzl for the lowdown on four of the most likely causes of knee pain following a run. Below he tells us the symptoms and most importantly, the best ways to fix them.

What everyone's reading

Why do my knees hurt after running?

Why do you run? Because it feels good. Because it relieves stress. I get that, because running is also important to me.

I'm a 32-time marathoner who knows how frustrating it is to be injured. It’s the reason why I became a sports doctor. Ripping my anterior cruciate ligament playing football when I was in medical school was devastating – but it was also the single most important event to influence my work. It's what drives me to help my patients. Almost every day I treat runners with sore knees. Many freak out. Can I still run? Will I have to switch to swimming? Thankfully, most knee problems won't keep you off the road for long.

We have great strategies to diagnose and fix many common knee problems that affect runners. This is what you should know about the most frequent running-related knee injuries.

Runner's knee

Where does it hurt?

Runner’s knee feels like a pain located below your kneecap that worsens after running and when going up or down stairs.It is the most common condition affecting runners of all ages and is most frequently seen in runners under the age of 50.

What's going on?

When the patella (kneecap) moves out of alignment during running and doesn’t track properly in the trochlea, the ridge inside the upper leg bone, the femur, causes the cartilage under the patella to become irritated. This is known as your quads – looser muscles mean less loading force on the patella, or runner's knee.

How to treat it

You don’t usually have to stop running altogether – cutting back your weekly mileage is often enough to ease the pressure.
Focus on strength training that supports the knee without making pain worse. Building up the muscles around the kneecap is key to reducing discomfort. Begin with simple moves such as straight-leg raises, progress to bodyweight squats once they feel comfortable, and eventually add in more dynamic options like plyometric squats. Take an anti-inflammatory.
Consider arch supports (orthotics) and more supportive shoes. Foot mechanics, particularly pronation, play a role in runner's knee.
Apply ice for 15 minutes twice per day to reduce symptoms.
Read our full guide to treating runners knee.
Foam roll your quads – looser muscles mean less loading force on the patella.
If the pain continues, see a doctor to get a more definitive diagnosis.

Preventing runner’s knee

Do strength training.
Highly cushioned shoes.
Use a patellar tendon strap to help to reduce pain.
Shorten your stride to help to take pressure off your knees. Aim to do 170-180 foot strikes per minute.

Read our full guide to treating runner's knee

Patellar tendinitis

Where is the pain?

Patellar tendinitis shows up as pain just beneath the kneecap, where it meets the top of the shin. The discomfort tends to be more pronounced while running and while using stairs. The culprit is the patellar tendon – the strong band of tissue linking the kneecap (patella) to the shin bone (tibia).

What’s happening to my knee?

The force placed on the knee during running can sometimes put too much strain on the patellar tendon.

The best treatments

Cross-train, Best Garmin deals.
Unlike runner's knee, you will not diminish the effects of patellar tendonitis by running. I warn my patients about messing with an irritated tendon!
Apply ice for 15 minutes five times a day.
Apply ice for 15 minutes five times a day.
If it doesn't improve, see a doctor.

Preventing patellar tendinitis

Do strength training.
Stretch your quads and hamstrings.
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your quads – looser muscles mean less loading force on the patella

Iliotibial band syndrome

Where is the pain?

IT band syndrome is felt as pain on the outer side of the knee. It often kicks in a few minutes into a run and usually eases off once you stop.

What’s happening to my knee?

You’ll be in no doubt if you experience this one. The iliotibial band (ITB) is a strip of connective tissue that runs all the way from the hip down to the knee, meeting both joints. When it becomes tight, the friction against the thigh bone (femur) can trigger sharp pain often described by runners as feeling like a screwdriver digging into the outside of the knee. This irritation can also inflame the bursa, a fluid-filled sac that cushions the ITB from the bone, leading to even more discomfort.

The best treatments

While a mild form of ITB syndrome is manageable on a run, you should keep an eye on the pain and watch out if it is worsening. In our office, we advise our patients to stop exercising if the pain is affecting their running form.
See a doctor or physical therapist to get a proper diagnosis.
Reduce your mileage and do some cross training.
Foam roll Runners World, Part of the Hearst UK Wellbeing Network.
If you overpronate, You’ll be in no doubt if you experience this one. The.
What is overpronation. Squats are essential in building hip and glute strength and are one of the best ways to get rid of ITB pain.
See a doctor if pain persists for possible X-rays, medication or injections.

Preventing IT band syndrome

Apply ice for 15 minutes twice per day to reduce symptoms core muscles – this is key.
If it doesnt improve, see a doctor.
Reasons why your feet can go numb while you run, quicker stride. The best knee-strengthening exercises for runners.

How to spot and fix IT band syndrome

Knee osteoarthritis

Where is the pain?

It’s worth noting that there is no evidence that running itself causes osteoarthritis. The symptoms of knee osteoarthritis (OA) – pain, swelling and stiffness – tend to show up not just when you run but also in everyday activities. OA gets more prevalent in old age, particularly in the over 60s, and can be caused by genetics, past injuries, or simply chance.

What’s happening to my knee?

The wearing out of hyaline cartilage (the lining of the joint) causes bone to grind on bone.

The best treatments

Contrary to popular belief, movement acts as an anti-inflammatory. Unless you're limping badly, keep moving. Activity keeps joints lubricated.
Apply ice to the knee area regularly and you may take anti-inflammatory medication like ibuprofen.
See a doctor. Getting a proper evaluation including a physical examination and an X-ray is important to grade the OA in your knee and to help make a plan moving forward. If your doctor says 'maybe it's time to give up running', find another doctor.
Highly cushioned shoes or motion-control shoes might help with the pain, depending on the amount and location of OA in your knee. This is diagnosed by X-ray.
Depending on your foot and running mechanics, running on a softer or harder surface might help to make things more comfortable.
Lubricant injections (viscosupplements) and platelet-rich plasma (PRP) are helpful in reducing OA symptoms.
Strength train, especially your lower body. Strong muscles, including glutes, quads and hips, can all help to offload the knee and improve symptoms.