What’s causing pain on the inside of my knee?

Louise says: I get a niggling pain on the inside of my left knee when running. It’s nothing too painful, just an awareness that something’s a bit amiss. I’ve been told by other runners that it’s tendonitis but would appreciate advice on treatment, support and rest.

Mr David Sweetnam, consultant orthopaedic surgeon (Knee Unit at The Wellington Hospital):

If it’s on the inner aspect of the knee and you’re over 40, we could worry about possible cartilage problems, which involves sharp twinging discomfort that comes and goes and affects your running. That would be cause for concern, but the likelihood is that you’ve got a bit of hamstring irritation. This is a condition called pes anserine bursitis, which is where the tendons from the hamstring come around the inner aspect of the knee and they insert just below it. This pain is normally a function of not stretching quite enough to make sure those hamstrings aren’t tugging, but like all issues my advice would be if you’ve maxed out on stretching, you’ve done your conditioning and you’ve done all your gluteal and core stability, then it probably is worth having it looked at by a professional. It could be a little bit of inflammation of that tendon, but Voltarol cream locally is worth a try just to see if it settles down. If it doesn’t, you should see a local physio, or ultimately get a referral to a sport medicine doctor to get it investigated with a scan.

Emily Drakes, acting clinical lead physiotherapist (London Bridge Hospital):

This one’s difficult because there are a few things it could be. If it’s just niggly and not something that interfering with the running, I wouldn’t necessarily say you need a rest from running, but it is a good thing to pick it up early if it is something brewing so it doesn’t become an injury.

If it’s tendonitis-like pain, there are two kinds – you can get an acute onset of pain usually related to a big change in activity, for example if you’ve suddenly done a big run or started doing a big CrossFit class, you might find it comes on quite suddenly. If it’s more of a chronic tendonitis, you don’t get that acute bit and it’s just grumbly, so it’s a gradual onset of a pain and then it can get worse.

Tendonitis tends to be worse in the mornings. People describe that it hurts when they wake up, but when they’re leaving the house or by the time they get to the station it’s settled down. It’s often worse with activity - the tendon is part of the muscle so it’s bothered when you’re doing things. Tendons are very sensitive to load so if you do something too soon, even if it’s something very small, even just changing your shoes slightly or running on trail instead of on the pavement, something like that could be setting it off. It’s normally better with a bit of rest, rehab and anti-inflammatories.