Knee Pain in Distance Runners

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Distance running for fitness has increased enormously in popularity and participation over the years. At the same time, more organizations are holding races. With this emphasis on competition, runners must intensify their training runs by running greater distances. Runners preparing for a marathon commonly run 70 miles a week or more. Accompanying this increased training is a greater risk of overuse injury. Most of these problems affect the lower extremity, particularly the knee1. Regular running also helps to keep our muscles, joints and bones strong and healthy. As well as these physical benefits, running is great for our emotional wellbeing, too. It helps to destress, boost our mood, provide mental clarity and build confidence.

Injury is a key barrier in many runners, accounting for a 19.4% to 79.3% lower extremity injury rate. With over 40 million people in the United States running regularly, this percentage can represent a significant number of runners with injuries. Nearly half of those 40 million runners experience some type of pain or injury annually. The knee is the most common area of injury in runners, the knee joint is affected by three main injury types including patellofemoral pain syndrome (PFPS), iliotibial band friction syndrome (ITBFS), and patellar tendinopathy (PT)2,3.

PFPS is the most common musculoskeletal overuse injury in active adults. With a prevalence reported up to 19–30% of female runners, and 13–25% of male runners. PFPS is the most prevalent running-related injury. PFPS is characterized by a gradual onset of anterior or retro patellar knee pain typically experienced under loading and compressive forces. Activities involving significant quadriceps demand with knee flexion such as running, squatting, hopping, stair climbing, and even prolonged sitting can onset symptoms.

ITBFS is another one of the commonly diagnosed injuries in runners. This syndrome is characterized by pain during loading of the lower extremity over the lateral aspect of the knee, with pain over the lateral knee when the knee moves from flexion into extension.

PT is most notably characterized by pain at the attachment of the patellar tendon at the   inferior pole of the patella. PT is activity dependent and usually only symptomatic in high energy activities such as running and jumping2,3.

The knee is the most common site of overuse injury in runners, of the various types of knee injuries, anterior knee pain (AKP) occurs most frequently. Although the exact mechanism of anterior knee pain is unknown, a combination of genetic, environmental, and training factors are possible components of its etiology. In an earlier study, it is found that Q angle, knee muscular strength, and several training and gait variables discriminated between runners with patellofemoral pain and noninjured runners. More specifically, the injured runners had a greater Q angle, were weaker in knee extension and knee flexion, ran fewer miles per week, and exerted greater vertical propulsive peak forces and smaller braking peak forces relative to the noninjured control group4.

Maintaining good form is essential, as is wearing the correct trainers for your feet. It’s important to listen to your body, and learn the difference between pushing yourself to succeed in training, and pushing over your limit and sustaining an injury. Running injuries also include cuts, scrapes, bruises, pulled muscles and broken bones, all potentially caused by pushing yourself so far that you have an accident.

Rest and recovery should be important factors in your training plan, along with strength and conditioning exercises.



  1. Grana, W. A., & Coniglione, T. C. (1985). Knee Disorders in Runners. The Physician and Sports medicine.
  2. van Gent RN, Siem D, van Middelkoop M, et al. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med 2007; 41:469-80; discussion 480.
  3. Taunton JE, Ryan MB, Clement DB, et al. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med 2002; 36:95-101.
  4. MICHAEL J. DUFFEY, DAVID F. MARTIN, D. WAYNE CANNON, TIMOTHY CRAVEN, and STEPHEN P. MESSIER. Etiologic factors associated with anterior knee pain in distance runners.