Ultrarunning: Knee Injuries to Watch Out for in Ultras

March 27, 2012

This article is part of Endurance Planet’s ultrarunning article series. If you have questions, comments or feedback about “Knee Injuries to Watch Out for in Ultras”, please leave it below in the comments section…

Statistics on reported knee injuries for runners appears to be quite varied. Some say as high as 60 to 70 percent, while others figure a third of all running injuries happen at the knees. These numbers apply to runners in general but it wouldn’t be hard to imagine how the greater challenges of ultramarathons could increase the chances of knee injuries occurring.

As disparate as these numbers are, they do seem to underline the same thing – knees are a much vulnerable part of your legs. They are fairly complex and sensitive structures after all, and being crucial joints, they also get much abused by the act of running. The hilly courses that would usually be part of a trail ultra can be especially unkind to your knees.

Two common knee injuries

The two knee injuries that are said to typically plague runners are: 1) patellofemoral pain syndrome or runner’s knee, and 2) iliotibial band syndrome.

Runner’s knee is actually a general term that can refer to several conditions. The usual description is that the kneecap (patella) is rubbing the wrong way against the end of the thighbone (femur) on which it rests. There is no single cause for this occurrence. It could be damaged tendons, worn out shock absorbing cartilage, or misaligned kneecaps. High-arched feet or conversely flat feet can lead to excessive twisting movement of this joint. Uneven leg muscle development, particularly weak quadriceps can also be a factor. Whatever the cause, the pain is commonly located at the front of the knees.

Meanwhile in iliotibial band syndrome, the pain is usually felt on the outside edge of the knees. The iliotibial band is a connective structure of tissue and muscle that runs along the whole outer side of your thigh, starting from the hip all the way to the knee. As you bend and straighten your knees, the lower end of this band moves over a knob at the lower end of the thighbone. If the band is inflamed or swollen, this normal motion is going to result in pain.

How to avoid them

Start with making sure you have the right shoes that compensate either for a high or a low arch. Then work on your stride movements. The basic technique of leaning forward and avoiding a heel strike can actually do a lot to reducing the force that travels from the foot all the way up your body. That means less shock for your knees to absorb. Also keeping your feet and legs aligned and facing the direction you are running (rather than splayed out to the side) will reduce the possible twisting motion and force that hits your knees with every foot strike. Your knees are designed to hinge forward so try to keep them within that kind of movement as much as possible. Since the way your foot is built and the way you stride is highly relevant, the right footwear and running form, can help you avoid unnecessary wear and tear on the tendons, ligaments, and cartilage around your kneecaps as well as the iliotibial band.

Stretching of course is also a helpful practice. Some doctors say there are more injured runners during spring because (as they speculate) such enthusiasts are so eager to start running in the warmer weather they forget to stretch. Stretching your hamstrings and doing leg lifts while lying down are some example warm ups that would be good for preventing runner’s knee.

As always let pain be your guide and adjust the volume and intensity of your training accordingly. The dangers of doing too much too soon can never be overstated.


Do you have questions about common knee injuries, or what you’ve read so far? Do you have any ultrarunning pointers of your own to add? Please leave your feedback, comments and questions below, and we promise we’ll respond.

Comments (2)

  • Andy DuBois says:

    Think that advising stretching before running without clarifying dynamic stretching NOT static stretching since static is more likely to increase your risk of injury and decrease economy would be useful.

  • Shane Warne says:

    Thanks for sharing this one. I'm pretty much satisfied to know this view of knee injuries. Thanks mate. 🙂

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