Runners constantly challenge their bodies on a daily basis. Unfortunately with these challenges come uncomfortable aches and pains as well as a risk of injury. Depending on the amount you train, present weakness in the body, and biomechanics, some runners have a higher risk of pain and injury than others. The most common complaint from runners is usually knee pain. As much as you hear how bad running is for the knees, this statement is actually a myth. Running does not necessarily ruin your knees—it is the other factors that create the damage. Whether you are just starting out or have been a long-term runner with knee issues, it is important to evaluate what really causes ‘runner’s knee’ and how you can prevent this condition.
Patellofemoral Pain Syndrome
This is the proper term for ‘runner’s knee’ since it consists of pain and stiffness around the patella (knee cap). There are many structural components to the knee joint itself that may contribute to runner’s knee. Tendons, ligaments, menisci, and cartilage are just some of the many structures found inside this joint. Damage or overuse to any of these parts can lead to pain around the kneecap. Basically when any area around the joint becomes inflamed enough to hit the nerve endings, pain will develop. This is common in many athletes who are involved in sports that require running, jumping, pivoting, and squatting. Non-athletes who have had any knee injuries in the past that developed a loss of cartilage in the underside of the kneecap are also at risk for developing this condition.
Causes & Symptoms
Repeated stress on the knee joint from vigorous activities is the most common cause of patellofemoral pain syndrome. It can also be caused by sudden changes in activity where the knee is not accustomed to such as altering the frequency or length of training or changes in footwear or running surfaces. Problems or imbalances in other areas of the body such as in the hips or ankles can also cause runner’s knee. Malalignment from the hips to the knees, such as women with wider hips, can create pressure in the kneecap over its groove where it attaches to the joint. This results in significant irritation in the muscles and tendons surrounding the knee creating pain.
Muscle imbalances are often to blame for knee pain in runners. Weakness in the hip and core muscles causes more pressure and overuse in the knee joint. This weakness mixed with tightness in the quad or hamstring muscles will lead to significant pulling where the quad tendon connects below the knee, which is called the patellar tendon. The inflammation that results from this tightness and pulling, compresses on the kneecap, impinging on the nerve endings. This is why it is important to incorporate hip and core exercises on a regular basis, not just direct knee strengthening.
Treatment & Prevention
The first step to curing pain from runner’s knee is to take time off of the aggravating activities. This will help decrease any developing inflammation in the area. During this time off, it is important to incorporate other anti-inflammatory techniques such as icing. Physical therapy will help with the use of other modalities such as electrical stimulation, dry needling, ultrasound, and manual therapy techniques. To avoid losing fitness during this time, low impact cross training is helpful such as swimming, cycling, and walking.
As mentioned above, weakness in the hip and core muscles can contribute to increased pressure in the knee joint. Addressing this weakness is the next step in rehabilitating runner’s knee. Hip exercises such as standing 4-way kicks with a resistance band and floor clamshells and bridges are great pain-free exercises. Once the pain and inflammation are under control, direct knee strengthening such as step-ups, squats, and lunges can be incorporated. Quad sets are an effective exercise to isolate the quad muscle during any stage in the rehab. Sit with a towel rolled under the knee and extend your leg, contracting the quad muscle as you push down on the towel with the back of the knee. Hold the extension for 5 to 10 seconds and repeat 10 to 20 times.
Once the pain and inflammation is no longer present and a strengthening program has been incorporated for a few weeks, running can gradually begin. The most important part of returning to running after experiencing knee issues is to slowly ease into increased mileage and intensity. The rule of thumb is to increase by only 5-10% each week and monitor your symptoms. Any sign of pain or stiffness in the knee can eventually lead back to the same issue if ignored. Runners tend to train through pain hoping it will go away on its own but in reality many of the aches we push through can turn into conditions that will leave us out of the sport for more time than we would like.