What is Runner’s knee ?

Runner’s knee is a term used as an umbrella term to describe a cluster of symptoms of knee pain that is frequently encountered in running athletes. Other terms that have been used to describe this condition are “anterior knee pain”, “chondromalacia patella”, or “patellofemoral pain syndrome (PFPS).” Runner’s knee involves the kneecap, quadriceps tendon, knee cap (patellar) tendon, and the associated soft tissues that are critical to extension of the knee. 

 

Who gets Runner’s Knee?

While classically associated with long-distance running, any activity that places significant stresses on the front of the knee joint  can result in “runner’s knee”. This includes repetitive jumping sports like basketball or volleyball, as well as skiing, cycling, and soccer. 

 

Symptoms

Runner’s knee symptoms are associated with activity-related pain in the front of the knee and around the kneecap. While the pain develops during athletic activity, it can often be most pronounced afterwards during a period of rest. Pain is also felt after sitting for a long period of time with the knees bent. For the same reason, marathon runners will often complain of greater difficulty running downhill rather than uphill. Kneeling, squatting, or direct pressure on the front of the knees may be uncomfortable as well.

 

Causes

The kneecap and its cartilage is subject to very high forces with daily activities, and any injury to the cartilage or factors which result in increased pressure between it and the thigh bone (“femur”) can increase the risk of “Runner’s Knee”. These include:

  • overuse
  • trauma to the kneecap
  • misalignment of the kneecap
  • complete or partial dislocation of the kneecap
  • flat feet
  • weak or tight thigh muscles
  • inadequate stretching before exercise
  • arthritis
  • a fractured kneecap
  • plica syndrome or synovial plica syndrome, in which the lining of the joint becomes thickened and inflamed

 

Diagnosis

Usually, the diagnosis of “runner’s knee” can be made in athletes based on the history and physical examination of the knee by your Physiotherapist. The exam will evaluate the stability of the kneecap as well as alignment of the leg. Signs of tenderness under the kneecap and/or instability will be assessed. Strength and tone of the quadriceps and hamstrings will also be determined. Flexibility of the feet and loss of the arch should also be noted as this will predispose to kneecap problems. X-rays, MRI, and CT scans can all be useful adjuncts depending on the examination findings and symptoms. 

Treatment

The first line of treatment for “runner’s knee” is typically nonoperative. Recommendations include:

  1. RICE protocol ( Rest, Ice, Compression, Elevation) and anti-inflammatory medications can certainly help to relieve the pain in the front of the knee. (always consult your GP or pharmacist to check these are suitable)
  2. Avoid running down hills or down steep slopes or stairs that increase pressure on the kneecap.
  3. In certain cases, taping of the kneecap or use of stabilizing braces for the kneecap can help. These are particularly useful in the setting of instability of the kneecap.
  4. When the knee is more managable, a course of rehabilitation for improving the range of motion and strengthening of the identified weak structures.

 

Exercises and Prevention

While certain predisposing factors such as kneecap and leg alignment are not in the control of an athlete, other preventative measures can be taken to minimize the risk of “runner’s knee”. Runner’s Knee Exercises include ( Our exercise program you can find Below)

 

  •  Quadriceps strengthening – a strong quadriceps and, specifically, the internal head of the muscle will improve the tracking of the kneecap and help to minimize aggravation of the condition.
  • Keep your weight down – the patellofemoral joint experiences forces that are 8 to 10 times our body weight, such that even small reductions in weight can significantly reduce the forces on the kneecap. Ten pounds of weight loss can be as much as 80 to 100 pounds less force of the kneecap when climbing or descending stairs.
  • Stretch before running or jumping activities – Strains of the knee cap tendon( patellar tendon, or other soft tissues that stabilize the knee cap can cause significant lateral knee pain. Warming up and stretching both before and after exercise can help to prevent injuries.
  • Wear proper shoes and orthotics – Flat feet (“pronated” feet) can predispose to knee cap maltracking problems and knee pain. Appropriate shoe wear and insoles can help with that after a thorough assessment by the respective professional.
  • Plan for a good running surface – Running on a flat surface without steep, downhill slopes can help to prevent significant stress on the knee cap. Even, padded surfaces and good running shoes can help as well.

 

If you have any questions or want to discuss any barriers or injury issues that may be stopping you from running, training or reaching your full potential, get in touch at bookings@physio-flex.co.uk or on 01506237770 to speak to one of the Physioflex Team

We can’t guarantee full recovery for all problems as this is just not possible for chronic conditions. Our job, in that situation, is to help you to understand and manage your condition to maximise your function, recovery and pain management.
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Caroline Bennett
On Behalf of PhysioFlex (West Lothian) Ltd