As the weather warms and the days get longer, I can’t help but notice the increasing number of runners outside. One of the more common problems that runners may experience is a painful knee. This may occur with both new and experienced runners. Often it is associated with increasing mileage by the runner. It is uncommon that the runner has experienced a specific injury.
 
The pain may occur at some distance into the run or may be particularly aggravated by hills. The location of the pain may be very important in diagnosing the problem. There is usually very little swelling in the non-arthritic knees. The history and physical exam are the most important factors in determining the cause of the pain. Early in this process MRIs are rarely necessary. The two most common disorders of the knee that I see in runners are irritation of the iliotibial band and anterior knee pain related to the patella or “kneecap.”

ITB syndrome is a severe pain localized to the outer or lateral aspect of the knee, just above the joint. The iliotibial band is a thick band of tissue extending from the pelvis to just below the knee. As you run the tissue rubs against the lateral aspect of the knee causing friction in the adjacent tissue, which produces local pain. Typically, the pain begins shortly into the run forcing you to stop. In my 24 years of caring for knee problems, I have never operated on this problem. Typically, either an exercise program or formal physical therapy will solve this problem. As with any running problem, you must pay attention to proper shoe wear with or without orthotics. Occasionally, a cortisone injection into the painful location may be needed. ITB stretching and local ice massage is very helpful. This problem is also seen with cyclists.   

Even more commonly seen is anterior knee pain secondary to the patella. The precise nature of why knees hurt is not entirely clear. Many theories have been proposed, but most likely it is multi-factorial. Again, it is rare to operate on the knees because of unpredictable results. Non-operative treatment with or without physical therapy will usually work. The emphasis of this treatment involves both flexibility and strength training of the thigh muscles, hamstrings and quadriceps. Again, do not skimp on shoe wear and if you are running a significant amount of miles. Change you shoes as needed. I often buy two-to-three pairs of running shoes at the same time and alternate their use. Orthotics may be helpful as well.   

Good running shoes, proper stretching and warm-up, and attention to early warning signs are all helpful in having a nice season of running this summer.