Knee Pain in Runners: Tendon vs Cartilage vs Joint – Key Differences
Knee pain is one of the most common issues runners face, whether you’re training for your first 5 km or clocking up long-distance mileage. The challenge is that “knee pain” isn’t a diagnosis. Pain can come from different structures within the knee, most commonly the tendons, cartilage, or the joint itself.
Understanding where your pain is coming from matters. Each structure behaves differently, responds to different loads, and requires different management strategies. Treating a cartilage issue like a tendon problem, for example, can delay recovery and worsen symptoms.
This article breaks down the key differences between tendon, cartilage, and joint-related knee pain, the most common injuries runners experience, red flags to watch for, and practical management options.
Understanding the Knee in Running
The knee is a complex joint that absorbs high forces during running. With every step, the knee experiences loads several times your body weight. These loads are shared across:
- Tendons – connect muscle to bone and transmit force
- Cartilage – cushions and distributes load within the joint
- Joint structures – including bone surfaces, synovium, and ligaments
Problems arise when load exceeds the tissue’s capacity to adapt, often due to sudden training changes, poor recovery, biomechanical overload, or weakness elsewhere in the kinetic chain.
Tendon-Related Knee Pain in Runners
What is it?
Tendon pain in runners is usually a form of tendinopathy, a condition involving reduced tendon capacity rather than inflammation alone. The most common knee tendons affected are the patellar tendon and quadriceps tendon.
Common tendon injuries
- Patellar tendinopathy (often called “jumper’s knee”)
- Quadriceps tendinopathy
- Pes anserine tendinopathy (inner knee pain)
Typical symptoms
- Localised pain at a specific point on the tendon
- Pain that warms up during a run but worsens afterwards
- Morning stiffness or pain when starting activity
- Tenderness when pressing on the tendon
Key features that suggest tendon pain
- Pain is very specific and pinpoint
- Pain increases with speed work, hills, or jumping
- Symptoms relate closely to load and intensity
Cartilage-Related Knee Pain in Runners
What is it?
Cartilage injuries involve damage or irritation to the smooth surfaces inside the knee joint. This includes the meniscus and articular cartilage, which help absorb shock and allow smooth movement.
Common cartilage injuries
- Meniscal irritation or tears
- Chondral defects
- Early degenerative cartilage changes
Typical symptoms
- Deep knee pain that’s hard to pinpoint
- Swelling after runs
- Catching, clicking, or locking sensations
- Pain with twisting, squatting, or downhill running
Key features that suggest cartilage pain
- Pain feels inside the joint, not on the surface
- Swelling appears hours after activity
- Symptoms worsen with rotation or compression
Joint-Related Knee Pain in Runners
What is it?
Joint-related pain often involves irritation of the structures that make up the knee joint as a whole, including bone surfaces and the joint lining. This type of pain is common with patellofemoral pain syndrome and early osteoarthritis.
Common joint-related conditions
- Patellofemoral pain syndrome
- Early knee osteoarthritis
- Synovial irritation
Typical symptoms
- Diffuse pain around or behind the kneecap
- Pain during stairs, squatting, or sitting for long periods
- Aching or stiffness after activity
- Occasional swelling
Key features that suggest joint pain
- Pain is widespread rather than localised
- Symptoms relate to knee position and alignment
- Pain worsens with prolonged loading, not just intensity
Key Differences at a Glance (List Format)
Tendon pain
- Localised, pinpoint pain
- Load-sensitive
- Improves with warming up, worse after
- Responds well to progressive strengthening
Cartilage pain
- Deep joint pain
- Swelling and mechanical symptoms
- Worse with twisting and compression
- Requires careful load management
Joint pain
- Diffuse or front-of-knee pain
- Position and alignment sensitive
- Worse with prolonged or repetitive load
- Responds to technique, strength, and volume changes
Red Flags Runners Should Not Ignore
While most knee pain is manageable, certain signs require prompt professional assessment:
- Persistent swelling that does not settle
- Knee locking, giving way, or catching
- Inability to fully straighten or bend the knee
- Sudden severe pain following trauma
- Pain that worsens despite reduced training load
Ignoring these signs can lead to prolonged recovery or further injury.
Management Options for Knee Pain in Runners
Load management
- Reduce volume or intensity, not necessarily complete rest
- Avoid sudden spikes in mileage or speed
- Modify terrain (less downhill or cambered surfaces)
Strength training
- Target quadriceps, hamstrings, glutes, and calves
- Progressive loading is essential, especially for tendon issues
- Single-leg strength work is particularly beneficial
Running technique adjustments
- Cadence increases can reduce knee load
- Avoid overstriding
- Improve hip and trunk control
Recovery strategies
- Adequate sleep and nutrition
- Strategic rest days
- Ice or heat as symptom relief, not a cure
Professional guidance
- Accurate diagnosis guides effective treatment
- Individualised rehab programs improve outcomes
- Early intervention shortens recovery time
Frequently Asked Questions (FAQ)
Should I stop running completely if I have knee pain?
Not always. Many knee conditions improve with modified running, rather than complete rest. Reducing load while addressing strength and mechanics is often more effective.
Is knee pain just part of getting older as a runner?
No. While age-related changes occur, pain usually reflects load exceeding tissue capacity, not age alone. Many runners train pain-free well into later life.
Do scans always show the cause of knee pain?
Not necessarily. Imaging findings don’t always correlate with symptoms. Clinical assessment and movement analysis are just as important.
Are knee braces or straps helpful?
They can provide short-term symptom relief for some runners but should not replace proper load management and strength training.
How long does knee pain take to settle?
Recovery time varies. Tendon issues may take weeks to months, cartilage issues depend on severity, and joint pain often improves with gradual, consistent management.
