Physiotherapist and Cardiff Triathletes coach Patrick Lees on three common knee injuries and how to avoid them.

Triathletes can be susceptible to knee injuries for a number of reasons, but very often running is the cause, mainly because of the high impact nature of the activity.

Those triathletes with a background in a sport other than running, or with limited sporting experience can find they lack the conditioning to cope with the specific demands that triathlon running puts on the body.

This is because running on tired legs is unavoidable when racing or training for triathlon. In addition, triathletes tend to be highly motivated and are likely to overtrain or under-recover.

Therefore fatigue, acute or cumulative, can be a contributing factor to injuries. Also, modern lifestyles that involve a lot of sitting, whether it’s at work or behind the wheel of a car, do not help prepare the body for running. Here are three main areas of concern and what you can do to keep yourself fit and injury free.

Patello-Fempra; Joint Pain

The patello-femoral joint is found around the kneecap. Pain can be caused by imbalances between the quad muscles on the inside and outside of the knee.

Plus, poor hip control allows the Q-angle of the thigh bone to increase, which changes the angle of pull on the kneecap. Heel striking, often a function of over striding, and the subsequent over-pronation that occurs at the foot, compounds the problem.

How to fix it: Bringing the foot strike back underneath the body’s centre of gravity will help reduce the excessive forces travelling through the knee and hip joints and make it easier for the muscles to maintain proper alignment.

Addressing any quad imbalances and strengthening the muscles around the hip is also key to preventing PFJ pain. Deep squats will tick both quad and hip boxes for activation and stability. Keep your feet slightly wider than shoulder-width apart, your core engaged and lower in a controlled manner.

Iliotibial Band ITB Syndrome 

Triathlon coach Patrick Lees Photo copyright Geoff Caddick, Copyright remains with the photographer in perpetuity. If payment is not received within thirty days of invoice no licence will exist for said photographs. Minimum picture usage fees apply, Editiorial use only. Usage of this image dictates that these terms and conditions have been agreed with. Contact Geoff Caddick 07875304612 email

The ITB band runs from the hip down and over the knee. Pain may arise from friction of the IT band sliding over the outside of the femoral condyle, which is slightly above the knee joint. Tight muscles around the hip or along the outside of the leg are often the cause.

Weak muscles around the hip, and quad imbalance are again often major contributing factors.

Bow-legged athletes and those who regularly run on cambers may be more susceptible.

How to fix it: Address any quad imbalance and strengthen the muscles around the hip with deep squats as above. Try stretching the ITB and its connected muscles regularly.

Patellar Tendinopathy

This affects the patella tendon, a strong tendon that connects the knee cap to the shin bone. Pain is often caused by increasing training volume or intensity too quickly which puts excessive repetitive stress on the patella tendon.

How to fix it: After an initial period of rest until the pain subsides, progressive quad strengthening exercises are recommended to gradually allow the patella tendon to adapt to the increasing demands placed upon it.