Inner Knee Pain After Running: Why & What to Do
Inner knee pain after running can be one of the most annoying and persistent pains that most runners have experienced at one time or another. It’s typically one that we battle through until we can’t anymore. In most cases, it’s caused by an issue of muscle imbalance or fascial restriction somewhere in the body. But in rarer instances, it can be from a more serious issue like a meniscus tear or ligament sprain.
Long story short: the best way to find out what’s going on and causing YOUR pain is to visit your local sports physical therapist and get an evaluation. Then you’ll eliminate all the guesswork, stop wasting time, and get back to running without pain. You don't have to accept the "stop running" suggestion that you may be hearing elsewhere.
However, I know you’re reading this because you’re looking for some more information and a possible solution to try on your own first. I totally get it, so let’s explore this topic a little further.
What could be the cause of inner knee pain?
Along the inner knee there are several structures that can contribute to your pain. This is a highly tendinous and ligamentous area, meaning a lot of soft tissues come together and attach on the inside of the knee.
Here are some (but not all) of the most prominent structures located on the inside of the knee:
Pes anserine: the tendinous junction of three muscles ( semitendinosus, gracilis, and sartorius) that cross the inside of the knee and attach directly below. You can get pain from the tendons themselves, the area where they cross over the bone, or from inflammation of the bursa that rests between the tendons and the shin bone. This is called pes anserine bursitis.
Bursae: There are multiple bursae that sit on the inside of the knee to protect and cushion the tendons and bones from rubbing on each other. Think of them as fluid filled sacs. If one is inflamed, you may feel some pain on the inside of the knee.
Adductors: the muscles that attach via tendons on the inside of the knee (some above and some below the knee joint) may be strained or weak, contributing to pain
Medial meniscus: This is the little cushion made of fibrocartilage and collagen that rests between your femur and tibia and helps your knee move without pain. Typically if you acutely injured the meniscus you’ll feel a pop in the inside of the knee at the time of injury, often associated with pain. It’s common to also experience some catching, locking, or clicking in the knee afterwards, sometimes with or without pain. Most meniscus tears don’t happen gradually over time with running, there’s usually a specific moment or mechanism that caused it, such as a sudden twist or jamming of the knee when planting on that leg.
Medial collateral ligament: Though this is another more rare injury for the inside of the knee with runners, it can still happen. Associated with instability and pain on the inside of the knee, there is usually a specific moment in time when you can pinpoint the injury occurred. Usually it’s a hard turn, planting and twisting on the knee, or a blow to the outside of the knee causing it to cave inwards. It often times doesn’t just happen out of nowhere or gradually tear over time.
Patellar ligaments: There are other ligaments that attach to the inside of the knee, providing stability to the kneecap and inside of the knee joint itself. This includes the medial patellofemoral ligament, as well as others that contribute to knee movement.
Bone: Now an issue with the bone is probably the rarest cause of all inner knee pain. But depending on mechanism of injury, always important to rule out. Typically caused by a blow to the inside of the knee directly and results in pain immediately afterwards with walking and weight bearing.
Some other symptoms you may be experiencing
When you experience medial knee pain (pain on the inside of your knee), especially after running, you may also exhibit other symptoms.
Pain and tightness with bending and straightening your knee
Decreased range of motion
Pain under the knee cap, also known as patellofemoral pain syndrome or "runner's knee"
Rubbing, grinding, or clicking
These symptoms don't mean "bad" or "worse", they are all just data and they all play into your overall picture, which will help determine what treatments would work best for you, should you reach out for any running-specific physical therapy.
So, why is there pain?
There’s a lot happening in and around the knee with running - the movement of running is dynamic, adapting to various terrain, elevation and conditions. There are several reasons that you might be experiencing inner knee pain after running, which we’re going to explore a little more.
Here are some of the most common reasons why you might be getting pain in the inner knee after running:
Overtraining or repetitive trauma
Muscle imbalance (weakness)
Strain/muscle tears
Sprain
Bursa inflammation
Fracture
Overtraining or repetitive trauma
This may be the most prevalent cause of inner knee pain after running, which may lead to any of the following factors mentioned in the list (muscle imbalance, strain, sprain, bursa inflammation, or fracture) if ignored. Overtraining occurs when your body, the muscles and joints, don’t get enough rest from the demands of your sport.
Some of the reasons you might experience overtraining? Increasing mileage too quickly, advancing terrain, intensity, time, or duration of your run by too much each week, running on consecutive days, and not incorporating other activities into your workout plan. It’s important to plan rest days, cross training, and strengthening exercises regularly when it comes to your running program. That will help minimize your risk of injury and keep you running pain-free.
Muscle imbalances
Muscle imbalances are probably without a doubt one of the most common source of pain along the inner knee after or during running. If there is a muscle imbalance, aka weakness, present somewhere in the kinetic chain, then running will likely bring it to light. But it doesn’t always happen immediately on your first outing, sometimes these imbalances go unnoticed for a while and you may notice that the knee pain starts gradually after a period of weeks or months.
The most common culprit for imbalances and weakness is the hips, specifically hip abductors and adductors. You can play a guessing game of adding 10+ exercises into your weekly routine to address the hip abductors, adductors, flexors, extensors, external rotators, and internal rotators - or you can go schedule an appointment with your local sports physical therapist to save time, hone in on YOUR specific weakness, and then come up with an efficient game plan to address it. The choice is yours to make.
Strains and Muscle Tears
As mentioned above, there are several muscles and tendons that attach to the medial side of the knee and a strain in one of these muscles, particularly in the pes anserine or adductor group, could be causing some inner knee pain after running.
Right off the bat I want to mention that muscles strains are much more common than muscle tears. A situation involving a muscle tear typically has some swelling and bruising that occurs.
It typically happens more suddenly and a complete tear is associated with a specific movement or moment in time that you can remember feeling a snap or pop in the leg, more specifically along the inner thigh. Partial tears, however, can be a little more difficult to diagnose but may be one reason why you have inner knee pain while running.
Muscle strains can happen more gradually from overuse or quickly from overdoing it in a particular workout. Sometimes it feels like they just come out of nowhere - one day you’re fine and the next day you have pain after running. These are a much more common injury amongst runners and a more likely culprit for pain along the inner knee after or during running.
But the thing is, treatment for most partial tears, muscle strains, and even some complete tears is physical therapy. So save yourself some heartache, time, and discomfort by visiting your local sports physical therapist from the start.
Sprain
Sprains can happen when a ligament, such as the medial collateral ligament or medial patellofemoral ligament, gets stretched. Ligaments connect bone to bone and provide stability to the knee joint.
A sprain also typically involves a specific incident associated with the onset of pain. Usually it’s a fall, slip on wet grass or ice, a blow to the outside of the knee, patellar dislocation (in the case of patellar ligaments), a collision with another person or object, etc.
Sprains very, very rarely happen over time or seemingly out of nowhere. However, if there was trauma or a specific injury to the knee as described above, it is possible that your stretched or tore a ligament in the inner knee.
Start with booking a consultation with an orthopedic specialist or your sports physical therapist to get some additional testing performed.
Bursa Inflammation
There are several bursas along the inner knee, which function to aid in providing cushion and facilitate healthy movement in the tendons and muscles around the knee. When there is some bursa inflammation present, you may experience pain and swelling along the inner knee.
It can be difficult to differentiate between bursal inflammation and a muscle strain in some incidences, so it’s best to leave this part to the pros. Visit an orthopedic specialist or sports physical therapist where they can perform additional testing and palpation to determine if you do have bursal inflammation present.
Many times it’s a strain rather than the bursa causing pain, but it’s always helpful to start treating the correct tissue from the start. This reduces recovery time and gets you back to running sooner without pain on the inner knee.
Fracture
Alright so here’s the thing I want you to really understand - the fracture is the LEAST likely cause of your inner knee pain after running.
A lot of us tend to read the absolute worst outcome and think it applies to our situation. However, a fracture would be rare and usually has a very specific moment in time where you can pinpoint its occurrence.
Usually with a blow to the inner knee, colliding with another object or person, or landing hard during a jump down from a super high surface. Many times there are some precipitating factors as well, such as decreased bone density in cases of osteoporosis or osteopenia.
And I know what you’re thinking - but what about a stress fracture??
Yes, those can happen too. In the case of inner knee during or after running and would usually be located on the medial femoral condyle or the medial tibial plateau. You would most likely experience a sharp pain, point tenderness at the area of the fracture, and may be unable to run due to pain in the inner knee.
If in doubt, meet with your doctor and request imaging for reassurance. Or discuss it with your sports physical therapist if you meet with them regularly.
Hopefully this article was helpful in giving you more information regarding inner knee pain after running! Moral of the story: if in doubt, get it checked out by your local sports physical therapist. By starting intervention early you can be on the mend sooner, speed up recovery times, make sure that your treatment is dialed in to exactly what you need, and be back on the trails (or road) sooner rather than later.
Where to find running-specific physical therapy and performance care in Kennewick
If you’re local to the Tri-Cities area, my clinic is in Kennewick and I’d be happy to work with you. I specialize in working with athletes alike with both injury rehab and recovery care, including manual therapy, dry needling, scraping, cupping, and more.
I love working with runners to help them maintain and increase mileage without pain as well as recover with purpose.
If you’re local to the Kennewick, WA area and want to start with a personalized assessment, call me!
