Has knee pain stopped your running?

If you have answered yes to the above question then this blog post is for you! Today we will focus on a very specific yet common issue that is the problem of knee pain whilst running. This blog post explains why this occurs and gives you the advice and tools to prevent knee pain during exercise.

I think it is fair to say that running and taking part in challenges such as Tough Mudder or Run’a’muc have seen a steady rise in participants over the past few years.


I’m sure this era of challenging events has encouraged folk who have been previously inactive to start getting their groove on and take to the streets with enthusiasm and guile in order to beat their friends’ Strava* times.

I’m certainly not a gambling man, with the exception of Cheltenham, when communication lines with my Dad peak every year, but I would bet a few quid that there are a lot of people out there who are very peed off right now due to knee pain coming on whilst running.

Hence the reason for this blog post – to enlighten readers about the actual act of running, and how to be physically ready prior to starting a running regime in order to significantly reduce the risk of such sports injuries occurring. Sorry readers, I will not be delving into the mental preparation prior to starting a running regime, just the physical one!

* a website where people post their latest runs/cycles and can compete with the wider community on how fast they ran from paddy the farmers pub to Finn’s Corner.

“Running is a method of terrestrial locomotion allowing humans and animals to move rapidly by foot or a series of jumps”.

We can all see how continuous jumping would cause forces or stresses through our legs and probably for this reason, people often say that running is ‘bad for the knees’.   The knee joint and soft tissue surrounding it absorbs these impacts. It is estimated that the body absorbs 2.5-3 times its body weight in force with each running stride. To put that in perspective, an 80kg runner would need to absorb around 100,000kg of force per mile! It is this accumulation of impact and stress on the body that we call ‘Load’.

100,000kg per mile sounds like a lot doesn’t it?! Our bodies are more than capable of managing this load if we gradually and progressively train our muscles and tendons to adapt and cope with the loads placed upon them. I stress the importance of gradual adaption because if we ignore the simple rules then our muscles, tendons and joints can become ‘overloaded’, resulting in pain and ‘why me’ syndrome! Many of you will have heard of the ‘Couch to 5k’ programme, based entirely on this gradual progression of load principle.

An example of a common running injury would be pain to the front of the knee on the tendon below the knee cap, the patella tendon. If overloaded, it becomes painful and gets termed a reactive patellar tendinopathy. Same can be said for the Achilles tendon also.

There are a few things that may increase your risk of developing a running injury, these include:

  1. having a previous injury.
  2. being overweight.
  3. being a new runner.

If any of these apply to you, be cautious building up your distance and intensity, we’ll chat more on this later in the blog!

In terms of tendon overload, for example the Patella tendon and Achilles tendon mentioned above, think of tendon loading in the form of a fight, a boxing fight between Ground Force Frederick and The Tendon Tornado! When you start a running programme, Ground Force punches and pounds into Tendon Tornado with every stride and run around the park. As a runner, and also the manager of The Tendon Tornado, you want to ensure your fighter is at his/her physical best. The Tendon Tornado is both male and female you see!

This means habits such as smoking should not be tolerated by the Tornado’s management/training crew. Smoking is a significant risk factor for poor tendon healing and it also effects the fighter’s aerobic fitness of course. Obesity is also a big no-no in the training camp. Men with a waist girth greater than 83cm appear to be at a greater risk of patellar tendinopathy according to a study in 2007. This higher risk is partly because weighing more means more forces from Frederick pounding on your tendons. Being overweight and a novice runner is not a red light to run, quite the opposite, its green all the way. However, be clever. Have a look at the ‘couch to 5k’ programme and use this as a guide for starting your running fitness plan.

Every boxer knows the importance of training pre-fight in order to be at their best. Well the exact same is true here too. Before embarking on a running programme it is a good idea to test your strength and use a wise and well-planned approach to your first encounter with Ground Force.   If you can do this, you will be able to match the opponent pound for pound. I will get onto how to prepare for these bouts in my next blog, for now, we should talk a little more about tendons and how they can be overloaded or knocked out in the first round.

Their role in the body is to transmit the force of muscle contraction to bone, seeing as they connect all muscles onto their bony attachments. Tendons look like a bunch of spaghetti under a microscope. The spaghetti represents an extremely strong structure called type 1 collagen fibres, and it is also worth noting that 50% of tendon make-up is water.   They are continuously undergoing a process of remodelling, just like our bones. They are being broken down and built up all the time, therefore you won’t have the same tendon in your shoulder that you had when you were seven. This process of change is influenced by what we do day to day. If we sit on our backsides and avoid exercise like the plague, this lifestyle will ‘underload’ our tendons causing insufficient stimulus to stimulate development of healthy tendon. An important fact for people who get inspired to take up running , but have had no previous exercise background, pushing the odds in favour of Ground Force Frederick for sure. We mentioned earlier how smoking negatively effects tendon healing, this is because it causes a reduction in type 1 collagen production.

If the above inspired runner does take to running at an over exuberant rate, he will also run the risk of overloading his tendons. Let’s use the patellar tendon in this example. If he overloads the tendon, he will most likely feel some soreness in the front of the knee the next day after the run, the area may swell or may not, may be painful to touch or not, but will most likely settle after a few days, provided the runner lays off the running. If the runner decides to throw caution to the wind and continue to run at the same intensity, be it too many kilometres, or too high speed, he will overload the tendon again making it even more difficult for the tendon to repair. This can become a vicious cycle, or in this case a vicious run, in such a way that if the runner continues to abuse his tendons and continues to run once the symptoms have settled, the tendon can enter a state of disrepair. This presents itself with pain coming on with movement, be it running, or walking up the stairs until the damage is repaired. Under the microscope this looks like boiled spaghetti, as type 1 turns to type 3 collagen, and loses its parallel arrangement. At this point, Ground Force Fredrick is dominating the fight, and The Tendon Tornado would really benefit from a change in tactics and a particular rehabilitation programme. You will have to wait until next week for part two of this blog to discuss this and also advice on how to structure your running training and strength training to reduce risk of injury and ensure gradual, consistent progress.

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