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Running related knee pain is common. Many runners will have experienced pain and injury related to their running activity. As it is an high impact and endurance exercise most running related injuries are related to over use, and overload of a specific structure. Therefore training methods, such as the inclusion of strength and conditioning as well as variety of paces and terrain can be helpful. Training structure, such as daily, weekly and monthly volume of running, and the rate of increases of distance or speed, are also an important to be done carefully to reduce the risk of injury through training error. Ensuring adequate rest and recovery, and maintaining a health body with good sleep, nutrition and hydration is another key element to keep you injury free.
Many people will experience pain behind the knee after running or while running. If you experience pain at the back of the knee, it can be difficult to understand what is injured and therefore how best to treat the injury to recover and resume the training that you love. Age, sex, health, strength, flexibility and running styles are just some of the contributing factors of inside knee pain running. These can also be helpful in the diagnosis of the cause of pain at the back of the knee, as there can be a greater incidence of some conditions related to these factors.
Hamstring tendinopathy occur at the top of the hamstring near your seat bone or behind your knee. This can cause pain on the inside or outside of the back of the knee, depending on which one of the 3 hamstring are affected. Pain is usually very localised to the hamstring tendon and it will be painful to pinch the tendon. The tendon might feel thicker than the one on your other leg, this is local to the tendon and there will not be any other swelling. Commonly it will feel stiff to straighten you knee, especially first thing in the morning and after rest. Activity that overly uses the hamstring may result in pain that can be delayed by hours or felt the next day. You can read more about this injury: Hamstring Tendonitis.
The meniscus are two thick cartilage disks in knee. They help with knee stability of the knee joint, but are also important for absorbing some of the energy from impact. Therefore with running the meniscus will take a lot of load. Pain from the meniscus can be a dull diffuse ache with slight swelling generally seen at the knee. It can often feel difficult to pinpoint the location of pain. So you might feel it is generally at the back of the knee. Or in more severe cases it can be intense or sharper pain with a lot of swelling and the knee might feel unstable or lock. You can read more about injury to the meniscus in our related article: Posterior Horn Medial Meniscus Tear.
A Baker’s cyst is excess fluid in the synovial membrane of the knee which bulges out of the back of the knee. It will feel sore at the back of the knee and you will be able to feel a large lump, but it isn’t normally hot or feel inflamed. This will make it hard to bend or straighten your knee fully and you might feel that your knee is blocked in these movement. Usually a Baker’s cyst will worsen and enlarge with exercise, especially impact exercise, and it will improve with rest and elevation of the leg. You can read more about this in our related article: Baker’s Cyst.
Osteoarthritis is a broad term that can cover several specific injuries that are related to ageing and wear and tear to a joint. This includes, degenerative ligament injury, meniscus injury, and cartilage softening and reduction, to name a few. It will usually develop gradually over time and symptoms can be specific but can also feel generally around the knee. There will be swelling of the joint and both swelling and pain can worsen with too much exercise. However, strengthening the joint can be very helpful long term. Stiffness will be present but can improve with some mobility exercises.
Running styles that can overload the back of the knee are those that land on a straight knee, excessive knee flexion in the swing phase, and high angle of knee flexion during mid-stance. These run form elements will overload different structures in the knee and this can lead to injury.
Landing on a straight knee reduces the amount of impact that can be absorbed by the muscles around the knee, so the joint will take more load. This is a common running style seen with individuals who have pain at the back of the knee related to running.
Excessive knee flexion in the phase of running where the foot is off the ground will put more load onto the structures at the back of the knee such as the hamstring tendons. This excessive load can lead to injury, especially if combined with sudden increases of running volume or a change of running speed.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.