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How to prevent and treat knee pain when running?


Knee pain and injury is a common ailment among runners. There are many possible causes, from biomechanical defects to training conditions. Generally speaking, the knee joint is one of the most stressed joints in running, which calls for an adapted prevention strategy, whatever the type of running practised. What causes knee pain when running? How can we effectively prevent and treat this pain?

What is windshield wiper syndrome?


In common parlance, "windshield wiper syndrome" refers to iliotibial band syndrome, a knee pain rightly considered the bête noire of runners.


Located on the outside of the knee, this condition corresponds to damage to the iliotibial band, a tendinous tissue located on the outer side of the thigh. Highly solicited during running, this tendinous band extends from the top of the thigh to the outside of the knee.


According to a recent systematic review, ice-wiper syndrome is :


  • The fifth most common running-related injury, all body areas combined

  • The second most common knee injury in runners, after patellofemoral syndrome

A study published in 2024 of 255 runners on Reunion Island showed that 54.9% of them had already suffered from this injury, confirming the importance of preventing and treating patellofemoral syndrome in running. According to the above-mentioned review, patellofemoral syndrome (also known as patellar syndrome) is by far the most frequent injury among runners in all areas, accounting for around 17% of all injuries. Hence the importance of a comprehensive prevention strategy, whatever the runner's level, to avoid knee injuries.


What causes knee pain when running?


The high prevalence of knee injuries in running is explained by the high level of stress placed on this joint when we run. The slightest "at-risk" parameter, such as a change in training conditions or an intrinsic weakness in the runner, can trigger more or less severe pain.


When Knee pain is not caused by trauma, it can be explained by various factors. We distinguish between intrinsic factors, which are physical causes linked to the anatomy of each runner, and extrinsic factors, which correspond to running conditions.

Among the intrinsic factors that promote knee pain, we find mainly :


  • excessive internal rotation of the knee

  • genu varum (outward deviation of the knee)

  • Misalignment of the patella

  • excessive adduction of the hip

  • bony prominence leading to rubbing of the iliotibial band

  • excessive pronation of the foot (foot turned inwards)

According to the study already mentioned on trail running in Reunion, young age and being a woman favor the occurrence of windshield wiper syndrome. Finally, we must not neglect excess weight, which can place excessive strain on the knees and promote disorders.


In terms of extrinsic factors , the runner whose knee is painful can look at:


  • His training load (perhaps excessive, or increased too suddenly)

  • The surface on which he runs (asphalt, athletics track, uneven terrain)

  • A sudden change in altitude in his training

  • A recent change of shoes, for example having different cushioning

  • An increase in downhill running, which puts more pressure on the knees

  • Furthermore, insufficient or inappropriate practice of muscle strengthening of the lower limb can also promote knee injuries.


Most of these factors are modifiable, which allows you to return to running in optimal conditions and without pain. As for physical factors, it is not always possible to correct them, however the runner can adapt his technique to minimize the risk of injury.


How to prevent and treat knee pain related to running?

Primary prevention of knee pain while running is based on knowledge of the risk factors, allowing their management and correction. For example, we know that iliotibial band syndrome is more common in people with genu varum, in women, in young and/or inexperienced runners, and in those with insufficient muscle strengthening. Thus, each of these points can be worked on by the runner himself, ideally under the supervision of a health professional such as a physiotherapist, as part of active rehabilitation .


Physiotherapy plays a key role in both the prevention and treatment of knee injuries. Indeed, thanks to muscle strengthening exercises (internal rotators, quadriceps) supplemented by an improvement in his motor pattern (hip rotation, foot drop), the runner learns to better distribute the loads supported by the knee during the effort, which reduces the risk of injury. Several studies have also shown the role of strengthening the trunk (sheathing) in the treatment of patellofemoral pain syndrome; very satisfactory, the results were measured in terms of reduction in pain, stability and joint function, and finally muscle strengthening.


In the event that the architecture of the foot is involved in the pain syndrome, a consultation with a podiatrist may be indicated, leading to the creation of suitable orthopedic insoles .


Finally, it is up to each runner to monitor their training conditions to adapt them if necessary: ​​for example, if the onset of pain coincides with wearing new running shoes, it is better to change them or return to the old pair. In the same way, it may be a good idea to change the route if a significant difference in altitude or a significant number of descents seems to match your pain.

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