Still got that nagging knee injury? ASICS physio Sarah Connors discusses concerns, causes and treatment.

Most knee injuries in runners are biomechanical overload. We don’t tend to get acute knee injuries like torn ligaments unless like me you have fallen while skiing and ruptured your ACL. Any previous injury like this or cartilage injury can predispose the knee to further wear and tear. If you have had any of these injuries it’s extra important to look after you knee keep it strong and even think about maybe taking some Glucosamine with Chondroitin to help keep the articular cartilage strong and healthy.


So let’s hope your knees are all healthy then what can make them sore at this point of the year? One thing that springs to mind is mud, have you spent the last few weeks slogging through the mud in trail shoes? Its way harder work on the legs, the quads the hips and the core. Trial shoes are normally lower in heel drop so this can change your mechanics, normally more stress on calf/Achilles though than knees. I’ve seen loads of anterior knee pain in athletes following hard muddy cross country races where the quads and hips end up battered and tight, they normally then carry on training and develop pain around the kneecap. This is usually from tight quads and hip flexors pulling on the patella so it rubs on the femur or stresses the tendon just below the knee. Make sure you recover properly after these hard races, foam roller and stretch the quads and revisit your core exercises.


Another potential cause of knee pain is ramping up the miles, running into fatigue causes the pelvis to drop hips to tighten, gluts switch off and your TFL, (tensor fascia lata) to overwork pulling on the ITB causing pain and friction on the outside of the knee. Make sure you don’t increase mileage too quickly. If you’ve been ill have an easy week, don’t jump straight back in where you were. It’s very easy to overcook things if you’re looking at a spring marathon especially with so many bugs around. It’s better to get there in one piece with consistent training than try and rush it. It doesn’t matter if you’ve missed a long run, it’s better to get there injury free.


Overload of the knee can come from one end of the leg or the other. We’ve talked about the pelvis and gluts. The other cause is the foot turning in and not controlling the lower leg, old shoes, wrong shoes etc. Hopefully you should all be running in the correct shoes now but always worth checking.


Couple of tests to look at;


Stand on one leg in front of a mirror and bend the knee. Where does the knee go? Does it stay in good alignment or does it drift inwards and the pelvis shift out? If so this indicates poor glut control.


Look at one leg bridge. Lying on back knees bent. Lift the pelvis then try and lift one leg. Can you keep the pelvis level? Are the gluts strong. Same position, lift one leg in the air and lift the pelvis x20, can you repeat this 3x.


These are great tests to keep revisiting to see if you’ve lost a bit of strength in one leg, one leg may be a bit weaker and been overworking so you need to give it some TLC. Also add some one leg work, calf raises and mini one leg dips aiming to keep good control. Then add some squats and lunges which will all help to keep the knee strong and stable.


I went over on my ankle Monday very unusual for me with my cankles! However I’ve realised that my foot was very stiff, quads very tight and leg generally weak from all the muddy runs with the dog. I’ve even started to get a bit of tendonitis of my oblique’s from using my core to stabilise that leg so much, old injury coming back to haunt me! Just shows you have to keep on top of the body. I’ve had 2 days off, loads of stretching and core and am starting to feel good again.


Pain on the inside of the knee can come from tight adductors the muscles that come from the groin and the medial hamstrings. These form a tendon that wraps around the inside of the knee. Adding adductor stretches and foam rolling the inside of the leg can help. Sometimes you just need a good massage to release all these tight muscles.


If the ITB is tight as mentioned above this can pull the knee cap out of line causing pain on the inside of the patella. These injuries can be quite frustrating as you can’t quite find the area of pain. If releasing all the tight muscles yourself doesn’t help and the pain continues then this is time to get some help. See a running experienced physio that can look at your mechanics and find out where the pulling is coming from. Remember with all running injuries the first thing that needs to be identified is the cause. If they just try and treat the pain ask why, what is causing it.


There are other less common issues, pain in the back of the knee can be hamstring tendonitis or pain in the popliteus.


If you’ve twisted the knee and get a sharp acute pain then you may have damaged the cartilage (meniscus), the knee may feel weak and give way and you won’t like squatting. This can be an acute injury or can gradually wear so it then doesn’t take much for the knee to go. Less common in younger runners. Unfortunately these don’t fix themselves and you’ll need a referral for an MRI initially then maybe a surgeon.


Hopefully this has covered most of the common and less common knee injuries. 

written by

Holly Rush

ASICS UK Frontrunner Community Manager from Bradford on Avon

Age group: 40-45

Club: Avon Valley Runners

Coach: Alan Storey

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