There is no question that exercise and participation in sport is beneficial to health and well-being. The benefits in terms of cardiovascular health, weight loss/maintenance and mental health are well proven. One of the best forms of exercise that anyone can undertake is running. It is free, easily accessible and can be done at any time of day. There is a common belief that running is bad for your knees and will cause premature wear of the knee leading to arthritis. This is quite simply not true.
However running injuries can occur as a consequence of trauma, increased training or mileage, change in footwear or running technique.
Many knee injuries related to running can be attributed to a specific event such as a twist, trip or fall resulting in internal damage to the knee. Traumatic events like this are likely to cause a problem with either the cartilage shock absorber (meniscus) within the knee or the smooth bearing surface of the joint (articular cartilage).
However there are several common running problems that come on insidiously without a clear history of trauma. By far the most common of these is anterior knee pain, this is pain felt within the knee behind the kneecap and can be very concerning and debilitating. It can be associated with grinding, crepitis and crunching behind the kneecap and there is often a belief that the knee is crumbling away. It is important to realise that noise and grinding from the kneecap joint is very common and not necessarily a sign of internal damage to the joint surface. This condition is often completely resolved with a course of targeted physiotherapy working on the muscle strength and control of the knee (runners will normally only like to run and not do any strength training with weights and this can cause problems with muscle balance and strength around the leg) often combined with local treatment and hands on physio. Occasionally arthroscopic surgery is needed to settle down the cause of the pain.
Other common causes of knee pain in runners are illiotibial band syndrome (ITB) and tendonitis.
ITB syndrome is where an increase in running distance or intensity causes irritation of the outside of the knee from the long band of tissue (illiotibial band) running from the hip to the knee, the treatment of this is again physiotherapy, targeting gluteal strengthening and local treatment, surgery is not needed for this condition.
Tendonitis can affect any of the tendons around the knee but most commonly occurs in the patella tendon or quadraceps tendon in runners. Tendinopathy can usually be treated with strengthening and targeted physiotherapy over the course of around 6 to 12 weeks but occasionally advanced treatments such as shock wave treatment are needed. Rarely surgery is required to cure the problem but this is usually reserved for cases that have failed to respond to any other treatments