Imagine you’re in the middle of a run.
You’re feeling great, your lungs are burning, and you know that you’re just about the hit your stride.
But instead of finding the sweet spot, you realize that a dull ache has begun in your knee. It surrounds your kneecap – otherwise known as the patella – and no matter how you adjust your foot strike the pain just will not go away.
If this sounds familiar, then you already know what you’re up against: Runner’s Knee. The more generalized name for this affliction is Patellofemoral Pain Syndrome, so-named because it is the result of strain on the knee joint when it is in a bent position and this joint is located where the patella meats the femur. A few unlucky people suffer from Runner’s Knee due to the natural structure of their knee, but it is, for the most part, a sports-related injury.
It is a repetitive-motion injury much like Tennis Elbow and got it’s common main in the same way, which is to say that it affects one group of athletes far more than it affects any others. There are an array of treatment options, most of them available either over the counter or free of charge once the ailment has been diagnosed. Most medical professionals recommend using several treatments at the same time in order to speed up the rate of recovery. Even so, it can still take up to six weeks before those suffering from Runner’s Knee can consider a return to their usual routine. The first step in recovery, however, is knowing how to receive a diagnosis. Treatment methods will vary depending on the severity of the issue and the demographics of the patient, as will preventative measures that runners can take in the future.
Runner’s Knee: Diagnosis
There are only two ways that athletes can receive a Runner’s Knee diagnosis. The first is a routine physical examination by a medical professional, which is usually performed after the provider asks the patient a series of questions regarding their medical history and activity levels. A basic physical examination is often enough for a diagnosis but, on occasion, a provider will want to take a closer look before they make the call. In these cases, the provider will send the patient for an X-Ray and use the resulting images to make their determination.
Once the actual diagnosis has been made patients will be introduced to a variety of treatment options. There are few to no invasive treatment options since Runner’s Knee is often a case of overuse or weak muscles around the affected area. This is good news for runners who don’t want to deal with the pain of surgery and recovery. Unfortunately, on the flip side, there is no “magic bullet cure” and every treatment option, even when used together, is only part of a long road to recovery. That road begins when a health care provider uses a set of criteria to determine which treatment option or options work best for each individual patient.
Runner’s Knee Treatment Choice Factors
Age
Nobody likes to admit that age has serious effects on their body, but athletes don’t have the luxury of denying this fact. Age affects our ability to heal from wounds, process strain from exercise and, in some people, sets firm limits in what they can and can’t do. Doctors have to take age into consideration when they set a treatment schedule for a patient because an athlete in their sixties is not likely to recover as quickly or as easily as an athlete in their early twenties.
Activity Level
One of the most common treatments for Runner’s Knee is to let the muscles around the knee rest. This is not as easily done if the patient has a job that requires them to be on their feet, is required to compete in upcoming competitions, or generally has a higher activity level than average. Patients on the opposite end of the spectrum – typically athletes who develop Runner’s Knee as beginning runners after a relatively sedentary lifestyle – might be required to attend more physical therapy so that the muscles around their knees can be strengthened. For these runners, the issue is less a matter of overuse and more a matter of weak knee muscles that can’t keep up with the workload they are put under.
Weight
A patient’s weight is a particularly tricky issue. The medical community has a track record of blaming a patient’s weight for issues they may be facing without digging deeper. In the case of Runner’s Knee, however, attention to a patient’s weight is necessary. An athlete may or may not be overweight for their frame but may still be putting more weight on their knees than the muscles can handle. In some cases, this can be remedied by weight loss but in other cases, the muscles will need to be strength trained to prevent another case of Runner’s Knee later on. Treatments are broken down into two general categories which are injury maintenance and muscle treatment.
Runner’s Knee Treatment Options
Once a person is diagnosed with Runner’s Knee and their health care provider goes over their treatment factors, the patient moves on to the treatment phase. There is, unfortunately, no quick cure for Runner’s Knee. Most of the treatment options take time to work, but the good news is that many of them can be combined to encourage a more rapid and thorough healing process. Some of these options may be discounted by a health care professional, and patients should always check with their provider before they attempt or alter a treatment plan on their own. The most common treatment options are outlined below, beginning with injury maintenance and moving into long-term relapse control and avoidance.
Cold Packs
Runner’s Knee is incredibly uncomfortable and this is largely due to the way the muscles around the knee swell and become tender after they are overloaded. Cold packs help reduce swelling which, in turn, will make the muscles less tender. Muscles also tend to heal faster when they are not chronically inflamed. It is not as simple as keeping an ice pack on the affected area 24/7, unfortunately. Most medical professionals will detail the frequency and duration of ice pack exposure that is most beneficial to the muscles. They can also help a patient incorporate this cooling schedule with other treatment options like physical therapy and anti-inflammatory drugs.
Elevating the Leg
Anyone who has suffered a sprain – or watched a show in which someone has sprained their ankle – will know that the area needs to be elevated. This is to reduce blood flow to the damaged tissue which is another way to help reduce swelling. When an injured area is elevated after the initial injury, it has the same general effect as an ice pack. Swelling and discomfort are reduced so that healing can take a more prominent role, so long as the area is not elevated too long or too often. Blood flow is necessary for an area to heal for a number of reasons, so it is important to get the correct ratio of blood flow to swelling reduction.
Compression Knee Wrap
A lot of benefits have been attributed to knee sleeves and the jury is still out on some of them. But there is one benefit to compression sleeves and wraps that is absolutely earned and it is the benefit of stability. Compressing the muscles of an injured knee help to stabilize them which is most helpful if the injury occurred due to a lack of strength in the affected area. Outside pressure lends strength to the muscles until additional training and targeted therapy can increase their inherent strength to a level that will allow for healing and prevent future injuries.
Anti-Inflammatory Drugs
Most anti-inflammatory drugs are better known by their brand names such as Tylenol, Aleve, Advil, etcetera. Their generic names are a little less well-known like acetaminophen, naproxen sodium, and ibuprofen. So long as the milligram dosage as the same, patients will get the same benefits from a brand name as they will from generic anti-inflammatory medications. This method, more-so than most others on the list, is one that should not be undertaken without medical supervision. Safe drug intake levels can vary depending on pre-existing medical conditions, age, diet, and several other factors that should be weighed before a consistent or continuous medication regimen is undertaken.
Stretching and Physical Therapy
One of the most common training treatments prescribed for Runner’s Knee is physical therapy. Most physical therapy treatments focus on stretching the muscles around the knees and their supporting muscles so that cramps, knots, or tension do not lead to additional injury or prolong the current case of Runner’s Knee. Athletes are often encouraged to continue the stretches well past their final day in physical therapy so that they can keep their muscles limber. Some of these exercises can even include changing the way a patient walks so that their knees are in better alignment.
Strength Training
A common cause of Runner’s Knee, aside from overuse, is a weakness in the muscles of the knees and the surrounding area. Once a patient has been cleared to continue exercise, many doctors will advise that the athlete take up strength training specifically targeted on the knees, core, and legs. Some specific exercises include fire hydrants, clamshells, and donkey kicks. Others can include lunges and squats, though athletes must be careful not to re-injure their knees or to over-train their legs without focusing on their core or knees.
Arch Support
Rare instances of Runner’s Knee are due to neither muscle weakness or overuse but by genetic bad luck. Some people’s knees do not align properly and, over time, this misalignment can lead to extreme knee pain and the hallmark swelling that comes with Runner’s Knee. Some of these cases can be corrected with specific arch support inserts in the person’s shoes in much the same way that plantar fasciitis can be addressed with custom shoe inserts. It is best to get such inserts from a podiatrist, but there are some drugstore versions that may provide relief for those without access to or the desire to see a podiatrist.
Surgery
The most uncommon treatment for Runner’s Knee is turned to only when all other treatments fail. It is most often used for people who have permanently damaged the tissue of their knees or whose knee alignments lend themselves to repeated cases of Runner’s Knee. In these extreme instances, removing the damaged tissue or manually realigning the knee is the only method by which the patient can gain relief. The majority of people who suffer Runner’s Knee will be able to rid themselves of the affliction without having to go under the knife.
Prevention
Once an athlete has shaken off their Runner’s Knee, the final step is to avoid a relapse. Just as with treating Runner’s Knee, there are a few ways to avoid a repeat injury. Unlike treatment, however, there is little to no need for an outside prescription and all of them can be combined to create a winning cocktail of improved skill, strength, and endurance.
Stretching
Anyone who suffers from Runner’s Knee will be very familiar with knee and leg stretches before they can declare themselves free of the issue. Most of these stretches can and should be carried over into their daily fitness routines. A good warm-up involves more than static stretches, of course. But a combination of movement and static stretches will get the muscles ready for the stress they are about to endure which will help the athlete avoid further injury.
Increase Activity Gradually
Once the pain of Runner’s Knee subsides, it can be tempting to dive right back into the level of exercise an athlete left off with. The muscles will be weak, however, no matter how much physical therapy they have been through. Medical professionals recommend that anyone who recovers from Runner’s Knee return to their usual fitness routine slowly. Athletes must pay attention not only to their knees but to the muscles around them as well so that any sort of strain or discomfort can be accounted for and dealt with before it develops into another case of Runner’s Knee.
Improve Running Form
Most of the damage that leads to Runner’s Knee occurs when a runner lands on their bent knee mid-stride. It’s nearly impossible to avoid this sort of strain but there are a few things that runners can do to improve their form so that the stress is better handled. One such adjustment is to lean forward slightly when running and to avoid fully locking their knees at any given point. These changes might sound easy but will affect the gait and cadence of any runner, and making the appropriate adjustments will be easiest with a running coach or buddy to help the athlete keep an eye on their form.
Proper Equipment
Misalignment and improper shock absorption are both issues that can lead to Runner’s Knee and, to a degree, they are issues that can be limited by the use of proper equipment. Runners should make sure that the soles of their shoes are not unevenly worn and their insoles are properly supporting the shape of their feet. Those who need additional knee support should invest in compression wraps or knee sleeves in addition to strength training the weaker areas if possible. These steps are not guaranteed to avoid all future cases of Runner’s Knee but they will greatly reduce the risk of relapse.
Runner’s Knee is uncomfortable but, in nearly every case, it can be treated and relapses can be prevented. Most runners will need to combine treatments and prevention measures to safeguard the health and safety of their knees. But these steps are a small price to pay for the ability to keep on your feet and keep moving.
Sources:
- Scoi, Should You Ice or Heat an Injury
- Hopkins Medicine, Patellofemoral Pain Syndrome
- Health, Runner’s Knee
- Orthoinfo, Patellofemoral Pain Syndrome
- Runners World, What’s the Best Solution for Runner’s Knee
- Physioworks, Patellofemoral Pain Syndrome
- Box Life Magazine, Knee Wraps vs Knee Sleeves
- Cleveland Clinic, NSAIDs
- Cleveland Clinic, 6 Best Fixes for Pain and Swelling