Runners Knee .

With a runners knee, symptoms are experienced on the outside of the knee due to irritation of a tendon, namely the tractus iliotibialis. In addition to pain, there may also be stiffness. Thus, we speak of a tendon injury. It is often the result of increased daily or weekly strain on the body. From the pelvis (spina iliaca anterior superior) springs the tensor fascia latae muscle, which passes into the tractus iliotibialis and attaches to the outside of the lower leg. The iliotibial tract provides stability to the outside of the knee. Sometimes complaints arise at the tendon structure at the level of the knee (often sports related). Some studies suggest that the tendon structure cannot experience friction due to fibers that stop it (Kaplan Fibers). Other studies suggest that it can. Patients frequently speak of a "chafing" sensation anyway in which pain is also experienced. Pain is usually experienced on the outside of the knee when bending and stretching during, for example, running. Pain in this case is an alarm bell from your body indicating that the tendon structure does not actually like the strain at that moment. You often see this when the intensity or frequency of training has been increased in a short period of time.

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Sample Case Study:

You recently started running with the goal of running a marathon. You have been exercising all your life, so you notice that running comes easily to you conditionally. Recently, you started feeling some pain on the outside of your knee after running. The pain quickly subsides, so you decide to continue your workouts and build up your training miles. So suddenly you are running 20km a week in a very short period of time. The pain is at first only present after training, but also moves to during training and at rest. Running goes less and less smoothly and you are held back by a painful knee. Running goes less and you are balking. This "case study," is a typical example of wanting to build up your body load too quickly. Often fitness is not the problem but your tendons are not used to the load, so they protest and you start experiencing pain.

These factors increase the risk of developing a runners knee: 
  • Occurs more often in women than men, presumably related to a different pelvic position and how this affects the hip and knee.
  • People with O or X-legs have an increased risk because this requires the tendon to withstand greater forces. 
  • High-intensity, high-impact sports; running,fast walking, hiking, etc.

When a person continues to walk with tendon problems for a long time without dealing with them adequately, the structure of the tendon can change. This is because the tendon does its best to recover after activities but does not get around to it. The moment you deal with tendon problems adequately, recovery will occur over time. We do know that recovery from this type of injury can take a long time. This is because tendon tissue normally requires relatively little oxygen (up to 7.5 times less than a muscle). This makes recovery from this type of complaint take much longer compared to recovery from a muscle-related complaint. Characteristics for runners knee complaints are: 

  • Pain on outer side of knee 
  • Walking downhill or walking on narrow paths can trigger the symptoms. 
  • Stiffness when starting to move (after sitting for some time or morning stiffness).

Pain symptoms can be experienced with higher intensity activities such as running and jumping. We can classify runners knee symptoms into different stages. This gives us an idea of the severity of the symptoms. 

Stages of a runners knee 
  • Stage 1; there is pain and/or stiffness after exercise
  • Stage 2; there is pain during warm-up. These disappear when you warm up properly. 
  • Stage 3; pain is present throughout the sporting activity.
  • Stage 4; pain is present even more than 24 hours after exercise as well as during daily activities. 


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Treatment and rehabilitation. 
  • Balance and recovery: When a tendon is overused, a proper ratio of load to rest is important for recovery to take place. Loading is ultimately necessary to get the tendon back in good shape. 

  • First stage of recovery:  In the first phase, pain may still be present. The earlier symptoms are recognized, the less irritation will be developed in the tendon. 
    • Training through a pain score: The load stimulus can be gently built up over time, constantly stimulating further recovery. We accept some discomfort with a pain score up to a maximum of 4 on a scale from 0 (nothing) to 10 (extreme pain). 
    • No complete rest. Did you know that complete rest is definitely not the way out for this type of complaint? Research has shown that a tendon of people who take complete rest shows the same characteristics as the tendon of someone who keeps overloading it. Reducing the intensity is sometimes enough to continue training with a runners knee. 
    Rehabilitating together

    At Fysio Fitaal we help you get back on the track, field or in the gym as soon as possible! Thus, together with you we look at the cause through a movement examination. Besides a movement research we use a running analysis to map the efficiency of your running pattern. Together we work step-by-step towards a pain-free and healthy situation in order to pick up sports again with enthusiasm. 

    Do you recognize yourself in these complaints and are you looking for a (sports) physio? Send an email to

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