Outside of knee pain when running: How to get relief
Runners know what I mean when I say there’s nothing more irritating than getting a few miles into your long run and feeling that sharp pain in the outside of the knee. It usually comes on gradually through the run - you start strong, feeling confident, and then the pain strikes (and of course it won’t go away). It derails your entire run and frustrates you beyond belief.
As a physical therapist who specializes in working with runners at my practice, Game Changer Physical Therapy in Kennewick, WA, lateral (or outside) knee pain is a common complaint. I’ve helped many runners recover from outside knee pain and get back to logging the miles in preparation for their nest race.
In this blog post, I’m going to explain some of the potential causes of lateral knee pain when running, how you can relieve pain, and when to get professional help.
Causes of Outside Knee Pain While Running
Lateral knee pain is a very common area for runners to experience pain during or after a run. You’ll typically feel pain while running that might be relieved when walking. The pain is usually worse when running downhill or going up and down stairs. While there are many potential causes of this pain, I’ll list a few of the most common reasons:
Iliotibial Band (IT band) Syndrome: Irritation of the fascial band that runs on the outside of the thigh from the hip to the knee. Most commonly related to muscle weakness in the hips and glutes, resulting in increased friction and pain on the knee.
Muscle imbalance or weakness: The most common areas of weakness in most runners are in the hips and glutes, but may also be related to weakness in the hamstrings or quadriceps. This creates imbalances in the muscle groups and can lead to strain and pain on the outside of the knee.
Hamstring strain: The hamstrings attach down just below the knee and one of the muscles, biceps femoris, attaches to the outside of the knee just below the joint.
Joint stiffness: Decreased mobility (or as we call it in PT “hypomobility”) in the knee joint, also known as the tibiofemoral joint, or the proximal tibiofibular joint - a physical therapist can tell you if things aren’t moving as well as they should. Spoiler alert: it may be stiffness in your ankle.
Nerve pain: This is a typical referral pattern for the lateral femoral cutaneous nerve and also the common fibular nerve.
Referral from the hip: Joint stiffness, muscle weakness, or impingement can refer pain from the hip down into the knee. It’s important to make sure your physical therapist includes hip mobility in your assessment for knee pain.
Improper training plan: Some of the most common errors in training include,
Running too many miles especially in a short amount of time
Ramping up mileage or intensity too quickly
Running too many days in a row (or two-a-days) - yep, I said it
Not taking rest or recovery days as scheduled
No (or minimal) strength training in weekly routine
Forgetting to monitor nutrition and hydration
Training equipment: I don’t like to blame equipment, because in most cases, it’s your training not your shoe. With that being said, if you are a runner then I highly recommend that you get fitted with a good pair of running shoes at your local shoe store (Runners Soul in Kennewick, WA is the best!) and replace them as recommended. Yes, it’s expensive, but so is dealing with an injury.
Why Does Running Cause Outside Knee Pain?
Well to put it simply, running is a unique sport. Unlike baseball where you’ll get a few hundred reps of throwing or batting in on a busy tournament weekend, with running you get thousands of steps on each run. And guess what - if you do anything thousands of times, you can bet your bottom dollar that it’s going to bring any imbalances or old injuries to the surface.
It’s also going to serve as a reminder about your training plan and your equipment. Have you replaced your running shoes lately? Or better yet,, have you been fitted with the right shoe for your movement patterns running style?
And before you go down that rabbit hole, no, not every runner needs to be running in zero drop or minimal drop shoes. Despite what some popular podcasts recommend, you don’t have to be running in barefoot shoes to be “doing it right.” In fact, running in these shoes when your body isn’t ready for it can actually cause an injury. But that’s another conversation for another time.
How to Prevent and Relieve Lateral Knee Pain
Prevention is key, but you probably arrived at this blog post because the outside of your knee started hurting on your long runs over the last couple weeks and you’re trying to figure out how to stop it.
My top recommendation is always going to be to make an appointment with your local sports physical therapist and get an evaluation to determine the specific cause of your knee pain. However, I know that’s on your to-do list and you’re currently looking for some immediate relief.
Let me share some of my top tips for prevention and relief of lateral knee pain.
Take a look at your strength training plan
Make sure your strength routine targets the hips, hamstrings, glutes, and quadriceps on a weekly basis. A simple and effective 20-30 minutes per session on 2-3 days per week can be enough to prevent injury.
Try adding in some goblet squats, side lunges, reverse lunges, step-ups, side plank clamshells, glute bridges (or hip thrusters), and romanian deadlifts into your routine.
Remember to include foam rolling and stretching in your routine
You gotta do it. If you’re going to be running consistently and performing thousands of reps, then you absolutely have to take care of yourself. Foam rolling, using your percussive massage device (ex. Theragun, Hyperice), and stretching need to be programmed into your routine on a weekly basis. I suggest 2-3 times per week for 10 minutes each time for starters.
When using foam rolling and massage devices, target the quadriceps, hamstrings, glutes, calves, adductors, and feet for 30-60 seconds per area. Make sure to do both sides.
Warm-up and cool-down every time (yes, actually)
Develop a routine that will help activate muscles through your hips and legs, get the joints used to moving, and ease the body in and out of your run. This means faster recovery, less pain, and better performance - a triple win!
Get fitted properly for a pair of shoes
One of the most essential pieces of equipment for runners. You can expect to drop nearly $200 on a pair of quality running shoes, but they generally last you between 250-500 miles and help to cushion the joints and keep you moving. Most local running stores will take nearly an hour with you to get you in the right shoe. Runners Soul in Kennewick, WA does a superb job. Shoe models are constantly changing, so don’t just get in the habit of ordering the same pair online or worse - ordering the same shoe as your friend without getting fitted.
Restructure your training plan
You’ll probably be dealing with this injury over and over again unless something changes. Double check your progression with running mileage (no more than 10-20% per week) and intensity. Are you running on back to back days? Could you try taking a day off to strength train or cross train between runs? Are you allowing yourself one rest day during the week for physical recovery? It’s important to make sure that your program targets strength training and includes a proper ramp of mileage (with cut back weeks) in order to prevent injury.
Schedule an evaluation with a physical therapist who specializes in runners
You want to make sure you’re working with someone who gets it. Someone who doesn’t give you the same ol’ “take two weeks off and see how it goes” advice. It’s important to make sure you’re working with a physical therapist who understands the demands of your sport and your personal goals as a runner.
Immediate Ideas for Relief of Lateral Knee Pain
If you’re struggling with the pain, you’ve made an appointment with your local sports physical therapist, and you just need some solutions to get you by until your visit, I’ve got you covered!
Here are some things you can do in the meantime to alleviate pain in the outside knee:
Aim to under do it - cut back your mileage, take days off in between runs, try intervals (like 30-60 seconds) of running with walking to reduce irritation. You may need to mix in some other exercises in the meantime, like walking, cycling, swimming, or strength training to keep your fitness level up, but decrease irritation on the outside of the knee
Ice after exercise - Apply an ice pack (with a covering) to the lateral knee over the area of pain for 15-20 minutes at a time. You can do this 2-3 times if needed after a run, but a word of caution, don’t just leave the ice pack on your knee all day long. You want to decrease excessive swelling and inflammation but also want to make sure that it’s getting good circulation for tissue healing
Get a knee sleeve - not necessarily the one with hard bracing on the outside, but getting one with general compression can help with reducing pain around the inside and outside of the knee.
Use Kinesiotape or Rock Tape - Ask your physical therapist for recommendations on how to tape.
When to See a Sports Physical Therapist
It’s important to pay attention to how you’re feeling after each run. If the pain continues after 1-2 weeks, increases in intensity or duration, or the knee is constantly swelling, feeling weak, or unstable, then it’s time to get some help.
Consult with a physical therapist to figure out a recovery and rehab plan that is specific to your needs. You can use ChatGPT all you want to try and DIY a solution, but there’s no replacement for a hands-on evaluation and assessment from a sports physical therapist.
Where to find a sports physical therapist who can help you recovery from a knee injury (and one who understands the needs of an athlete)
If you are looking for physical therapy in Kennewick, my clinic, Game Changer Physical Therapy serves the Tri-Cities area and I’d love to help you. I specialize in working with athletes and active adults and am committed to helping you not only feel better but address whatever we need in order to decrease your risk for future injuries.
You can get started at any time by booking a free discovery call or submitting a contact form.