Understanding Runners Knee

Any activities that involve significant knee bending, whether that’s running, walking or biking, can lead to pain around or behind your kneecap, particularly when you bend your knee or you walk downhill or downstairs. Some people find that the pain associated with runner’s knee alternatively flares up when they sit for an extended period of time with bent knees, and unlike some other sporting injuries, the onset of pain tends to be gradual. The condition, also known as patello-femoral joint syndrome, may be accompanied by swelling and a grinding sensation in your kneecap. While there are a variety of causes of runner’s knee, most cases heal without medical intervention. However, there are a number of steps you can take to enhance the healing process.

Causes of runner’s knee

The condition is common among people who put a lot of hours into training each week, as continuous knee bending irritates the nerves supplying your kneecap, and over-stretching your tendons can also lead to knee pain. It is particularly a problem if you suddenly increase your training or incorporate a lot more uphill training than you are used to. A fall onto your knees can also trigger runner’s knee. However, if your kneecap is out of balance, this irritates your femoral groove in which it sits, causing pain. This misalignment can occur for a number of reasons and one or a combination of the following may contribute to runner’s knee:

• Tight quadriceps can cause your patella to sit higher than it should be in the femoral groove; similarly, tight calves, hamstrings or hip adductors can also adversely affect the position of the kneecap.

• Weak leg muscles, especially the quadriceps, can also cause your kneecap to misalign.

• If your feet have high arches, there isn’t sufficient shock absorption, which stresses your kneecap; alternatively, worn cartilage also diminishes shock absorption.

Possible hip instability, which means physical stress isn’t evenly distributed so your kneecaps take more weight than they are designed to, leads to joint damage and pain.

• Women may be at greater risk of knee injury owing to their wider pelvis.

If you over-pronate, where your foot moves excessively inwards when you move, this places extra stress on your ligaments, muscles and tendons, which in turn stresses your kneecap. If you regularly run on a surface that has a camber, this affects your knee joint’s tracking, as does using running shoes that are well worn.

Diagnosing runner’s knee

Your doctor or sports physio may be able to diagnose runner’s knee following a physical examination and taking a medical history from you. However, to confirm your diagnosis and exclude other possible causes of knee pain, you may require an X-ray, an MRI scan or a CT scan. It’s essential that you seek professional advice to receive the correct diagnosis, as this will determine the most appropriate treatment for you, allowing you a swifter recovery.

Speeding recovery from runner’s knee

The following protective measures not only aid recovery, but increase your chances of keeping healthy in the future, by preventing further damage to your joints:

While you may be reluctant to take time out of training, it’s vital that you keep the weight off your knee as much as you can. Use ice on your knee for up to 30 minutes every few hours, keeping this up till your knee pain subsides. Compression offers your knee more support and an elastic bandage is ideal for this. When sitting or lying, keep your knee raised to reduce swelling.

Use anti-inflammatory medication, such as aspirin or ibuprofen, to relieve pain and lessen swelling. However, as these drugs increase the risk of stomach ulcers and bleeding, they are only intended for use in the short-term, so if pain and swelling persist for more than a week, see your doctor for advice.
If weakened thigh or hip muscles are probably the cause of your runner’s knee, ask your trainer, doctor or physiotherapist about exercises to strengthen your muscles; straight leg lifts are usually helpful for this, but it is best to seek specialist advice.

If your shoes indicate excessive wear on the inside and your inside sole makes contact with the ground when stood up, you most likely over-pronate and research suggests you would benefit from orthotic inserts to correct this.
Surgery may be needed to remove damaged cartilage or reposition your kneecap, but this is only the case when runner’s knee is severe and other measures have proven unsuccessful.

Exercising after runner’s knee

Besides using correct footwear and orthotics if you experience pronation, there are a couple of other points you should bear in mind when you return to exercise. Firstly, limit downhill running and activities where your knee is bent until you have made a full recovery, as resuming normal activities too soon can hinder your rehabilitation. If you feel that your kneecap is not in a good position despite taking precautions, strapping your knee or wearing a suitable support may additionally help. Even after you have recovered from runner’s knee, particularly if you are prone to tight muscles, make sure you always stretch out all muscle groups prior to strenuous exercise to avoid kneecap misalignment and recurrent problems with runner’s knee. However, always ensure that your body is warm before you stretch out, as otherwise you risk soft tissue injuries, which is why active stretches are preferable to static stretches.

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