How to handle running-related knee pain

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I’m training to improve my 10K time, and last week during my long run I started to feel knee pain. Do you have any tips? Should I rest or run? - Rick

You’re wise to be mindful of your knee pain, Rick. In many cases, catching it early and making a few training modifications can assist in efficient recovery and get you back to pain-free training.

First things first. When you experience pain on the run, it’s time to employ an active recovery program to avoid making things worse and creating other issues due to gait compensation. This means cutting the running out of your training temporarily while you allow the knee to heal. Think of this as a recovery phase rather than a loss, as you’re working toward getting back to healthy running. While you’re not running, ice your knee and perform the legs-up-the-wall pose several times per day to reduce swelling and aid in healing.

Release the tension. Many cases of early onset knee soreness are related to muscle tension in and around the joints. The culprit could be the iliotibial band and the muscles in the lateral area of the thigh just above the knee. When these muscles tighten up they can pull the knee out of alignment and cause pain. A great way to assess the situation is to use a foam roller on the iliotibial band and the outer thigh. If it is sensitive, it is tight and could benefit from muscle release using a foam roller, as this video demonstrates.

Schedule a search-and-release massage. This is another way to release muscle tightness. Let a sports massage therapist know about your knee pain and ask them to search for and release areas of tightness. The benefit of this method is you learn from a professional where you need work so you can focus on the same areas with your foam roller at home. Be aware that this isn’t meant to be a relaxing, enjoyable massage - it’s meant to identify tight and weak areas.

Invest in active and passive rest. Avoid working out for a few days to allow any inflammation to subside. Then, perform a cross-training activity that doesn’t aggravate the knee. For some, this means using the elliptical or bike. Others may need to shift to swimming or rowing. Start back with several days of easy-effort activity, and if that goes well, weave in short cross-training intervals once or twice per week to maintain fitness (if your body allows).

As you heal and the pain subsides, use cross-training to gradually come back to running. For example, instead of starting back with 30 minutes of running, start out with 20 to 25 minutes on the elliptical (or your cross-training method of choice) and finish with five to 10 minutes of running. This allows you to slowly return to running to avoid re-injury. Re-introduce running by adding five to 10 minutes at a time, and once you are able to run 30 to 40 minutes easy without pain, you can return to running as your primary mode of exercise. Spend two weeks doing easy-effort runs to build up your running time, and use cross-training modes to train in the harder effort zones to maintain fitness. Then, you can introduce short, hard-effort intervals and long runs back into your regimen.

Ask for help. If you don’t see relief after a week of muscle release and rest, it’s time to get evaluated by a doctor or physical therapist. Check with your local running shop or club for references. Some have relationships with runner-friendly doctors and therapists who can guide you back to running strong.

The most significant steps you can take are to stop running at the onset of pain, to back off and modify your plan, and to seek professional help if needed. Pain doesn’t have to put a permanent end to your running - it can be an opportunity to learn about what your body can tolerate.