Common Running Injuries: The Dreaded Runner’s Knee

Medically reviewed by Dr Bryan Wang ✅

Whether you are a casual runner or an athlete that undergoes strenuous training, you have probably heard of “Runner’s Knee”, also known as Patellofemoral Pain Syndrome, an injury often characterised as dull pain around the front of the knee (patella) and is symptomised by pain, grinding, or clicking sound of the kneecap. 

Despite its commonality among athletes, there is still conflicting discourse surrounding how it should be treated and ways we can prevent it. Through an interview with Dr Bryan Wang of Beacon Orthopaedics, we explore the complexities of this dreaded injury, allowing us to not only gain a deeper understanding of the anatomy behind the anguish but also how we can deal with the injury. 

What exactly is Runner’s Knee?

So, what exactly is Runner’s Knee? In more clinical terms, it could be due to inflammation of the Patella Tendon, which is what we called Patellar Tendonitis. Other times, it could also be due to a muscle imbalance, causing slight pain and inflammation on the surface of the kneecap. We can also get the pain on the outer part of the knee such as in Iliotibial Band Syndrome. 

Essentially, Runner’s Knee is more of a broad term used to describe varying injuries surrounding the knee, accounting for 20 to 40 percent of all knee problems and the most common running injury presenting to a sports medicine clinic.

Causes of Runner’s Knee

“Very often, it is an indication that perhaps the training load is a little bit too intensive and does not allow the soft tissue to recover, or it can be a metaphor of too much too soon for somebody when they develop this sort of pain,” says Dr Bryan. 

Dr Bryan Wang of Beacon Orthopaedics and triathlete Bryce Chong sharing running pointers from good running form to good posture of the knees and midfoot strike, all to prevent common running injuries.

How do I prevent Runner’s Knee?

To prevent furthering the injury, Dr Bryan recommends that when you first start to experience pain, the first thing that should be done is to take a few days of rest or reduce the training mileage and to see whether that helps resolve the pain. According to Dr Bryan, if the pain does not become better then that is likely a sure sign of overtraining. Thus, you should continue giving your body a little bit of time to settle down and put a stop to training for the pain to resolve itself. 

“However, if the pain remains persistent despite rest and taking anti-inflammatory medications, then perhaps it is prudent to see a doctor or an orthopaedic specialist for further assessment because it could indicate something serious.” 

Is it true that wearing the right type of running shoes can help prevent Runner’s Knee? 

“I think with regards to proper footwear it's really important to minimise the risk of injury. We want to make sure that you have a pair of well cushioned shoes,” he said. If you have shoes where the soles have already run thin, it is important to change to a new pair of shoes. 

A less commonly regarded method of preventing the injury is to have different pairs of shoes that you can rotate regularly so that there are varying types of cushioning. Rotating your running shoes can change your body's position and prevent yourself from putting constant stress on a certain part of your body. Having shoes with different cuttings is also an effective way to get your body working in subtly different ways, which can make you less prone to injury. 

“Depending on the biomechanics of the foot as well, depending on the knee action and things like that, you can get specific footwear to help with your running,” further backed up by Dr Bryan. 

Do running surfaces cause Runner’s Knee problems? 

With regards to the running surface itself, generally uneven surfaces and hard surfaces can put increased load on the knee. Trail running, for example, especially going downslope, can sometimes result in the increased joint reaction forces on the knee, which can predispose someone to developing this risk of developing a pain in the knee. 

“So if you do feel like there is an increased pain on the knee where you run on uneven ground, when you do on a lot of down slopes in the trails, perhaps it is good to either reduce the mileage or move your running program back to somewhere on a flat ground and a well-cushioned surface.” 

Can I change my running form to help reduce the risk of Runner’s Knee?

While many running coaches believe that heel-striking is a likely cause of injury, Dr Bryan offers a slightly different opinion, sharing that while heel striking could result in more loading on the spine which could lead to spine issues, it is not established as yet whether heel striking from running directly results in increased knee pain. 

However, he does believe that being able to keep your body upright and not leaning excessively forward will certainly reduce excessive joint reaction force on the knee and can help to reduce overall knee pain. 

Essentially, whether you are a heel striker or a runner who lands on their midfoot or forefoot, weight distribution over your knees are a great determinant on impact and pressure on your knees when you run.

“Good running form is very important on top of proper shoe wear, of course, in terms of minimising the risk of injury to the knees,” advised Dr Bryan, who is also an avid runner having participated in various marathons.

This article is written in collaboration with SportPlus Media.