Rod Cedaro knee painText by Rod Cedaro (M. App. Sc.) Consultant Sports Physiologist

ACC Accredited Level III Triathlon Coach

The three disciplines of triathlon place different demands on triathletes: Technically speaking, swimming is the most demanding, from a time efficiency perspective cycling is the most costly, while running, physically, is the most demanding on the body. With this in mind I thought we’d focus on the duress the running places through probably the most susceptible joint in the body – the knee.

First up, you need to identify what “sort” of knee pain your experiencing before you can hope to remedy it.

Here following is a quick checklist of problems and some suggested ways of alleviating them.


a. Your knee “aches.” Q: Does your knee feel stiff through the front and/or medial (inner) side of your kneecap? Is it worse after sitting or kneeling? Does it hurt more walking down steps? Does the pain go away after you warm up? If you’ve answered “yes” to most of these questions chances are your suffering “Patellofemoral pain”, see 1 below for suggested cure.

b. The outside section of your knee aches.

Q: Are you doing track sessions and or putting in some big training volume – during your long training sessions the knee aches and then the pain dissipates shortly thereafter.

You’re probably suffering from “Iliotibial band syndrome” (ITBS), see 2 below.

c. The front of your knee aches and it seems to get worse the more you run Q: Is the pain in the front of the knee just below patella (kneecap)? Have you recently added more training volume in on the run? If you’ve answered yes to these questions, you’re probably suffering from “Patellar tendinitis”, see 3 below.

d. You’ve been running a lot of late and you’ve got knee pain that seems to be “under” knee cap. Q: Is your knee swollen? Have you run a lot of kms in the same shoes?

If this is the case, you may have Osteoarthritis, see 4 below.

Some suggested cures:

1. Patellofemoral pain is often caused by alignment problems which in turn can damage the articulating surface of the kneecap (what is slides on), cause excessive pronation and/or muscle/tendon weakness or tightness. Often times you can “run through” this sort of pain, but you’re going to need to back off volume, hills and intensity. Some strength training, wearing a knee brace, taping your arches or wearing an orthotic, and replacing worn shoes or wearing motion-control shoes can help to realign your knee and alleviate this problem.

2. (ITBS) occurs when the IT band, which runs from the hip down and across the knee becomes tight and inflamed. Athletes that over-pronation and/or are bow-legged often suffer from this problem. If you get on to it quickly you can recover in one to four weeks. Take anti-inflammatories one to two hours before you run, stretch your ITB’s pre and post run and ice the distal part of your ITB post-run. In the short term you may need to decrease of your training volume and intensity and stay out of the hills. If you’re doing track sessions mix them up – do half the session clockwise and the other half anti-clockwise. If the problem persists you may need taping or or orthotics.

3. Patellar tendinitis is an inflammation of one patella tendon. Tendinitis occurs when tissue breakdown outpaces re-growth. It is often caused by a sudden increase in training volume, adding in more hill work and/or quality work. If you try to “run through” this sort of an injury it’ll only get worse. It is an “overuse” injury in the true sense of the term. You need to give you knee time to recover. If treated early, it can heal in a few weeks. Focus on your swimming and cycling while the knee is healing, take some anti-inflammatories (under doctor’s direction), ice the knee, try wearing a patella strap to lift the knee cap, stretch and strengthen your quads – straight leg lifts with the leg fully extended and the foot weighted can be helpful here.

Rod Cedaro osteoarthritus4 Osteoarthritis occurs from wear and tear of cartilage. It can flare up on a run or even when you’re out for a leisurely walk depending on how bad it is and how old you are. The good news is, if you keep your run training to a moderate level you should be okay. Simply manipulate your training volume/intensity around the symptoms. Change your running shoes over regularly – you’ll generally get about 400-700km out of a pair of shoes max – if you’re suffering from osteoarthritis turn your shoes over after 400km max. Make sure you’ve got a good strength training program that focuses on the supportive muscles of the knee joint to lessen the load on it (i.e. Hamstrings, quads, shins, and gluteals). You might also consider a knee brace and taking nutritional supplements of chondroitin and glucosamine.

Speaking of chondroitin and glucosamine – normally I don’t recommend supplements, but I must say from having read the research and personal experience glucosamine and chondroitin appear to be the real deal. A recent internet poll on the popular Runner’s World website found that 79.8 percent of those that have used this supplement reported that their symptoms had either “somewhat improved” or “greatly improved” after taking glucosamine and/or chondroitin. Less than one percent reported that “things got worse” after taking the supplements. Glucosamine and chondroitin both occur naturally in the body. Most commercial glucosamine comes from the exo-skeleton of shellfish, and most commercial chondroitin from cow or shark cartilage. Both have relatively low rates of absorption from the intestines, and yet both are said to promote healing of the articular cartilage in joints. It’s the wearing away of this cartilage that causes the pain and inflammation of osteoarthritis. It is the trauma of running over extended periods of time that wears away on these articulating surfaces and the knees and hips of older athletes are particularly at risk simply because of the volume of training that has been done. Having said that, there are no actual studies that conclusively show that running “causes” (or for that matter, doesn’t cause) osteoarthritis.

The problem: All existing studies are cross-sectional in nature. As such they can only provide a snapshot of a given group of runners at a given time. They don’t account for injured runners who might have stopped running before the study was conducted and why they stopped. What is needed is a comprehensive prospective study – looking at the same athletes over extended periods of time – such research is more likely to prove/disprove the running-osteoarthritis connection.

The medical literature in support of glucosamine/chondroitin is however cautiously positive. Although some scepticism persists as many of these studies have been funded by supplement manufacturers with vested interests. A recent meta-analysis of studies (i.e. Where the results of a number of studies are tallied and reviewed) demonstrated on the whole positive outcomes. The paper concluded that glucosamine and chondroitin were “effective” treating several outcomes measures of osteoarthritis. While several other meta-analyses studies have reached similar conclusions, most in the scientific community believe that the jury is still out.

Personal experience on both myself and some of the older runners and triathletes I work with, would suggest it is money well spent!