Runner’s Knee Pain? The Answer May Lie in Your Butt and Ankles

If you’re a runner and putting in lots of miles, you may have come across nagging knee pain. You may have even kept running through the pain, thinking it comes with the sport. Truth is, cross-training is the answer to relieving what’s known as runner’s knee.

“Pain on the inside of the knee is likely arthritis, but if the pain is on the lateral or outside portion of the knee, that could be IT-Band syndrome,” said physician Jonathan Buchanan, MD, CAQ-SM, Avera Orthopedics.

Buchanan said the IT band is a tight group of tissues – clinical name: iliotibial band – that runs from your tensor fascia lata (in the pelvis) to your shin. This band is a secondary stabilizer for our bodies.

Runners who “only” run and don’t get enough cross-training exercise can develop lateral knee pain.

“This syndrome can lead to distinct pain in the knee, especially after a run,” he said. Good habits – when it comes to logging your miles and preparing your whole body – can keep the pain at bay.

“It’s a matter of working down from the glutes and up from the feet. It’s a process that will help get the pain out of your runs.”

How Glutes Help Keep Knees Pain-Free

Runners often have what’s called, in a humorous fashion, “runner’s butt” which is usually non-existent or flat. The gluteus maximus – the official name of the muscles that make up this part of our bodies – differs from one athlete to another. If you compare a runner’s posterior to those that football or soccer players have, the differences are obvious.

“For runners, walkers and bikers it’s all linear movement,” said Buchanan. “A runner’s butt is flatter when you compare it to someone who plays soccer or other sprint-based sports.”

The muscles of the lower body, specifically the quadriceps and hamstrings, are put to use with each stride, be it a race or a stress-relieving outing. These muscles are repeatedly worked, meter after meter, mile after mile.

“The necessity for changes in direction, to avoid a tackle or to move laterally leads to the bigger backside,” Buchanan said. “Building all the muscles that support the knee is important.”

Experienced runners with a good stride still get tired when their stride is letting the knee slip outward. If it’s no longer over the toes – you need to adjust. “You can see that happen if you run on a treadmill with a mirror,” Buchanan said. “Training the glutes and hips is important to avoiding this condition.”

Read More: Is Your Running Form Causing Injuries?

Cross Train to Avoid Pain

Runners need to cross-train more, and they can do so by trying things like:

• Sports with lots of lateral movement, like basketball, soccer, Ultimate Frisbee and football
• Strength training with a focus on hip and lower-body workouts
• Plyometric exercises that focus on jumping and landing, which can build muscles that’ll make stability more natural

When runners do more than log miles, they make their pelvis more stable – and lessen knee pain. Stronger hips – the key starting point for that IT band group – can help.

“So for marathon-running record-setters, another five or six miles helps less than an intense game of Ultimate Frisbee,” he added.

Yet many runners feel like running more miles equals being a stronger runner.

“It’s hard to get them to do the squats and lunges or work with weights because they fear getting bulky, adding muscle weight and slowing down,” he added.

Runners with Stronger Ankles Go Farther, Faster

Buchanan practices what he preaches as an avid barefoot runner for many years. He also recommends getting stronger in the feet and ankles. If either end of the leg is too weak the pain will surface in the knee, in many cases.

He also alluded to studies that show runners who develop the muscles in feet and ankles can also reduce possible knee pain. “Eversion and inversion isometric exercises – where you basically roll your foot and work the ankle’s muscles – are easy to do lying down, in your office chair – anywhere,” Buchanan said. “There’s really no ‘ankle machine’ at the gym, but these simple exercises can help you bolster your ankles.”

When Cross Training Doesn’t Work

While cross-training and getting those parts of your body stronger may be a solution, in some cases other approaches are needed. This could include steroid injections for knee pain.

“I would encourage any runner who has knee pain to discuss injection options with their orthopedic provider,” Buchanan said. “There are options that can help the deteriorating tissue and keep you moving.”

Learn more about your treatment options for knee pain and other injuries and make an appointment to talk with a specialist.