Can Runners Knee Be Cured? Yes, here’s now.
If you're a runner, chances are you've experienced some form of knee pain.
And chances are you’ve heard things like “rest, take a few weeks off, stretch and foam roll” to help you get on the other side of it.
What if I told you that not only are these runners knee myths but these myths can actually impede your recovery when it comes to runners knee?
This blog post will break down everything you need to know about this condition, including what causes it, how to heal it, and most importantly, how to prevent it from coming back so you can keep running strong well into your 80s.
Most Common Types of Knee Pain for Runners
Before diving into the specifics of runner’s knee, it’s important to understand that knee pain comes in various forms. Here are the five most common types of knee pain that affect runners:
Patellar Tendonitis (Runner's Knee)
Pain is felt in the front of the knee, right below the kneecap, in the patellar tendon. This pain is often worse after a workout than during, which can make it really confusing when you’re experiencing it because it felt okay during the run but after whooaaa. This is not uncommon at all!
IT Band pain
Inner Knee Pain
Hamstring irritation or tendonitis
The important thing to know is that all of these types of knee pain can improve through a targeted strength and mobility plan. And, for most runners, you’re able to continue running while you rehab it!
A Closer Look at Runner’s Knee
Now that you understand the most common types of knee pain, let’s take a deeper dive into patellar tendonitis—runner’s knee—and explore what causes it, how to treat it, and most importantly, how to prevent it.
What Causes Runner's Knee?
Patellar tendonitis is caused by an imbalance between the load placed on the tendon (from activities like running and strength training plus how much recovery you’re getting between training sessions) and the turnover rate of cells within the tendon. Tendons are made up of collagen fibers, which regularly regenerate. When the amount of stress placed on the tendon exceeds its ability to repair and renew, your tendon will start to show symptoms of tendonitis (pain).
Research studies show that, when a tendon has tendonitis, there are changes in the collagen matrix, bloodflow and nerve innervation of the tendon. The good news is that all of this can change back - even if you’d had tendonitis for years.
How Exactly Does Runner’s Knee Heal?
In order for tendonitis to heal, the balance between cell turnover inside your tendons and your training plan has to be restored.
This can be accomplished through two options:
Training Adjustments
No, this doesn’t mean giving up running entirely. In fact, in my 9 years as a physical therapist I’ve only told a runner to stop running for more than 2 weeks a handful of times.
Adjustments to your overall training plan, running form, mileage, elevation, etc can often make a large enough different to where you’re able to continue running while the area heals.
Tendon Healing Exercises
Your tendons are composed of collagen fibers that adapt, change and remodel based on what type of movements and resistance they encounter day-to-day and week-to-week.
Resistance training causes changes in your tendons that promote a healing response to make your tendons healthier, more resilient and less uscceptibel to injury. Check out my illustration below for all you visual learners!
The collagen fibers in your tendon undergo cellular changes based on how much (or how little) activity they are doing.
For example, if you start strength training regularly, your tendons begin to increase the amount of cell turnover they have. They also make some other cool changes like this:
Changes in elasticity (which can impact running performance)
Changes in tensile strength (which can impact your injury risk)
Changes in cellular composition (which can affect tendonitis)
The great thing is - we can use this info for good!
Research shows that strengthening your tendons can not only eliminate pain but also reduce your risk of future irritation (and improve your running performance).
They key to healing tendonitis is to tap into your body’s ability to change your tendons on a cellular level through resistance training.
Practical Examples:
To give you an idea of what these concepts look like when applied to real runners like you - here are two examples from recent clients that I’ve worked with.
Client A : Had runners knee for 2 years and was unable to run due to pain. They were nervous it meant they’d never be able to run again!
Training Adjustments
We created a custom return to running plan for them that specified how much to run and when so that they could begin running with less knee pain.
Tendon Healing Exercises
We focused on hip and knee strengthening, since research shows this to improve knee pain more effectively than knee strengthening alone. As their pain improved, their weekly mileage increased to where they were able to enter their goal training plan (marathon build).
Client B: Had runners knee that was fine with daily activity but unable to run, squat or hike downhill without pain. This made them nervous they might not be able to continue running or strength training due to their knees!
Training adjustments
We made adjustments to their running elevation to allow them to begin running without knee pain.
Tendon Healing Exercises
Their custom strength and mobility plan focused on exercises that increased tendon cell turnover. These exercises were completed 3x/week. They currently no longer have daily pain or pain with running and hiking. We are now working on restoring their ability to squat without knee pain, too!
How Long Does It Take to Heal?
Recovery from patellar tendonitis can take anywhere from three months to a year, depending on the severity of the condition, how long you’ve had it, and what your goals are.
For example, Client A and I worked together for 18 months to reach their goal of completing a competitive marathon.
Client B and I worked together for 3 months to get them back to running 5Ks pain-free.
The key takeaway here is that patience and consistency are crucial for healing.
Many people experience tendon pain for months or even years and assume it’s something they just have to live with. What I find most often is that these people purely weren’t given the science-backed tools they needed to heal!
Your tendons, just like the rest of your body, are adaptable and able to heal with the right guidance and support!
Common Questions About Runner’s Knee
Does Runner’s Knee Go Away on Its Own?
The pain from runner’s knee may decrease with rest, injections, or removing activities that irritate the tendon. However, this is only a temporary solution. Without addressing the underlying cause through resistance training, the pain is likely to return once you resume normal activities because the root issue has not been addressed.
Is Rest Effective for Runner’s Knee?
While rest can reduce pain in the short term, long-term rest can actually weaken your tendons. After just three weeks of inactivity, the collagen fibers in your tendons begin to undergo negative changes, making it more likely that you’ll experience pain when you return to running. This is why a strategic plan that includes resistance training is essential for true recovery.
What About Injections?
Injections can reduce pain temporarily, but studies have shown that people who rely on injections often have worse outcomes than those who incorporate resistance training. Furthermore, long-term use of injections can degrade tendon health.
How to Prevent Runner’s Knee
Research shows there are ways to improve the health of your tendons, making them less susceptible to the imbalance that causes tendonitis.
This involves a 3-prong approach:
Resistance training 1-2x/week to improve and maintain tendon health
Balancing your training and recovery to prevent a tendonitis reaction from beginning in the first place
Understanding the concept of allostatic load (how your body cannot tell the different between life stress and training stress)
I break this down in detail in this article.
I hope this helps you better understand runner's knee!
For more information on working with me one-on-one to receive a plan to heal runner’s knee for good, you can find the details here.
