Inner knee pain or “medial knee pain” from running is a bit of a black box. Unlike many running injuries where all the research points to one clear thing, this one has a few possible causes. In this article we’ll break it all down and fill in this frustrating gap. While there are many causes of medial knee pain, like most running injuries, small changes in training load combined with the correct strengthening exercises will usually free a runner from pain. Today we’ll explain what might cause inner knee pain from running, and then we’ll show you the best exercises to help you get rid of it!
(Pain in this general area is fairly common in runners)
What causes inner knee pain?
The common causes:
- General training load. Most likely, inner knee pain is simply the result of training a bit more than your body is ready for. Maybe you did more miles, more hills, ran faster, or slept less than your body expected. As a result of feeling overwhelmed, the body sends a pain signal to the brain to try and slow you down so the tissue can recover.
- Pes anserine bursitis. This is a slightly less common cause of inner knee pain, but it’s still worth mentioning. Bursa are fluid filled sacs that cushion different tissues. Sometimes the repetitive load of running can irritate (“-itis”) one particular bursa sac located 2-3 inches below the knee joint. Here the tendons at the end of the hamstring muscle attach to the shinbone in a shape that resembles a goose’s foot, “pes anserinus” in Latin.
(diagram of the Pes Anserinus from Wikipedia)
Uncommon Causes: the following issues are unlikely to be the cause of your inner knee pain, but it’s a good idea to know them in case you need to get checked out by a orthopedic expert.
- MCL or Meniscus strains & tears. If you’ve been running steadily and started to develop pain, it’s highly unlikely you’ve torn your meniscus or Medial Collateral Ligament. If, however, you rapidly pivoted or twisted your knee and felt sudden pain, it’s possible you’ve strained one of these structures and should definitely get an MRI to rule it out.
- Medial tibiofemoral arthritis. Runners get arthritis at lower rates than the general population (study) but if you are an older runner or a former elite runner it’s worth getting in touch with an orthopedist to rule out any kind of arthritis.
How to fix inner knee pain
If you’ve got pain from running, generally there are two things you should do: modify your training load and gradually increase strength in the relevant muscles with resistance exercises. If you’ve got bursitis, it might be worth taking some time off to let it calm down, but simply reducing your pace or substituting a few workouts with easy runs might be enough to get your knee to relax if it’s just a little overloaded.
When the pain settles down, these 3 exercises can build the strength you need. Stronger tissues have a higher tolerance to training. If you commit to regular strengthening, you’ll be able to keep inner knee pain away, hopefully for good!
Exercise 1: Split Squats
Why it works: Squats fix everything, especially when it comes to knees. Focusing on one leg at a time will allow you to identify and fix any difference in strength between your quads. Exercises like this are currently the best thing science has to offer for those with inner knee pain (summary of research).
Exercise 2: Eccentric Hamstring Bridges
Why it works: because inner knee pain from running often involves the pes anserine and the hamstring attaches to the pes anserine, strengthening the hamstring is critical to improve your knee’s ability to handle running training. The hamstring responds best to eccentric exercises (ones that provide resistance as the muscle gets longer) and this is the best eccentric hamstring exercise you can do without equipment!
Exercise 3: Single Leg Bridges
Why it works: the world’s experts on knee pain recommend including glute exercises as well as quad exercises whenever knee pain is present (consensus statement). This exercise is a great way to build strong glutes and strong glutes are always a good thing.
You can try this routine, along with a few other key exercises, in the Recover Athletics app. The Recover App helps runners fix aches and pains and prevent injury. A year’s subscription costs less than one trip to physical therapist and we have an unlimited free trial. Give the app a try today!
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