Why You Need to Take Care of Your Runner’s Knee NOW

When something hurts, and is coming in the way of you and your running goals, you are looking for any kind of solution that could make it go away.

We know how you feel, and that is why so many of our posts provide such specific recommendations on common running injuries like achilles tendinitis, shin splints, and of course runner’s knee.

Have you ever had runner’s knee?

If not, you probably know someone who has.

It’s a nagging, aching pain just underneath your kneecap, and it’s by far the most common running injury, accounting for one out of every six injuries in all runners.1

Runner’s knee, more properly referred to as patellofemoral pain syndrome, can be tough to shake off. Scientific research has uncovered some solid rehab protocols to treat the problem, but even with these, recovery can take a while.

Runner's knee is painful and frustrating, but could you also be doing long term damage and risking arthritis by running on it? We look at the research, and show you how to keep your knees healthy.

Does runner’s knee cause long term damage?

The exact mechanism of injury in patellofemoral pain syndrome is unclear, but it appears to have something to do with the cartilage underneath the kneecap. The involvement of cartilage in an overuse injury is a bit alarming, since cartilage is known for its poor healing ability.

You might be wondering:

Could long-standing cases of runner’s knee lead to chronic knee problems later in life?

A lot of people get knee pain as teenagers or young adults, but knee pain at a young age has been traditionally chalked up as a mostly benign, self-limiting condition. Recent research has begun to question this, however, as a large percentage of people with knee pain at a young age appear to go on to have ongoing knee pain for several years.

Runner’s knee and chronic knee pain

These findings spurred a systematic review of the scientific literature by Martin Thomas and other researchers at Keele University and the University of Central Lancashire in the UK.2

In their 2010 paper, Thomas et al. highlighted seven studies that investigated the potential link between anterior knee pain (much of which was likely patellofemoral pain syndrome) and osteoarthritis of the knee later in life.

While having this many studies to look at seemed promising, most of them were small, low-quality case series whose findings are tenuous at best.

Here’s why:

Many relied on vague definitions of what constituted “anterior knee pain” or included both traumatic knee injuries (like twisting your knee playing basketball) alongside knee injuries that resulted from overuse.

Despite this, Thomas et al. evaluated six low-quality studies to estimate the annual risk of developing knee arthritis after having anterior knee pain.

Two studies with a combined thirty subjects had none go on to develop knee osteoarthritis after five to sixteen years (a zero percent risk), while annual risk in the other studies ranged from 0.9% to 3.4%.

Any relevant data?

One study, however, was of fairly high quality: three medical doctors at Southmead Hospital in the UK published a 2005 paper which interviewed 234 patients undergoing partial joint replacement surgery for knee arthritis about their history of patellofemoral pain syndrome-like problems when they were younger.3

Half the patients were undergoing surgery for arthritis isolated at the patellofemoral joint, while the other half were undergoing a different surgical procedure for arthritis isolated on the inside of the tibia-femur joint (so-called “medial compartment” arthritis).

This second group acted as a control group, since their variant of knee arthritis did not involve the patellofemoral joint, so presumably patellofemoral problems earlier in life didn’t influence their arthritis risk.

The researchers found that 22% of the patients with patellofemoral joint arthritis recalled having anterior knee pain when they were younger, compared with only 6% of the patients with medial compartment arthritis.

However, even this study has its limitations.

It relied on the patients to recall their own injury history stretching back several decades, which has the potential to be very unreliable.

Even though runners have a good memory of their own injury history, you probably have to check your logs to remember the specifics (“was that arch trouble I had back in college in my left or right foot?”). It would have been much better to rely on medically-diagnosed cases of patellofemoral pain syndrome, but the difficulty of assembling a long-term study like that is immense.

Now:

Whether having runner’s knee in adolescence or early adulthood leads to a higher risk of knee osteoarthritis later in life is still an open question.

Some research indicates that there may be an association between the two conditions, but if runner’s knee does increase your risk for arthritis, we do know that the magnitude of that increase isn’t enormous—after all, runners as a whole do not have a higher risk for knee osteoarthritis than the general population, so if the risk was very large, we’d expect to see a difference in that statistic too.4

Additionally, the risk of knee arthritis following injuries common in other sports is far greater. Research in soccer players, for example, pegs the risk of knee arthritis following an ACL tear at over fifty percent!5, 6

Conclusion

If you’re still worried about the connection between runner’s knee and arthritis, the best thing you can do until more research comes out is work to keep your knee healthy.

Some researchers have hypothesized that the same faulty biomechanics that lead to runner’s knee are linked to knee arthritis as well, so the most logical thing to do is adopt a strengthening and stretching plan similar to one you’d use to treat runner’s knee. We actually created a prevention routine for you to keep those knees healthy, and reduce your risk of arthritis.

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Download our Top 5 Runner’s Knee Prevention Exercises for Free.

It’s a PDF with the 5 best exercises to help you prevent runner’s knee.

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References

1. Taunton, J.; Ryan, M.; Clement, D.; McKenzie, D.; Lloyd-Smith, D.; Zumbo, B., A retrospective case-control analysis of 2002 running injuries. British Journal of Sports Medicine 2002, 36, 95-101.
2. Thomas, M. J.; Wood, L.; Selfe, J.; Peat, G., Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review. BMC Musculoskeletal Disorders 2010, 11 (1), 201.
3. Utting, M. R.; Davies, G.; Newman, J. H., Is anterior knee pain a predisposing factor to patellofemoral osteoarthritis? Knee 2005, 12 (5), 362-365.
4. Kujala, U.; Kettunen, J.; Paananen, H.; Aalto, T.; Battié, M. C.; Impivaara, O.; Videman, T.; Sarna, S., Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters. Arthritis & Rheumatism 1995, 38 (4), 539-546.
5. Lohmander, L. S.; Östenberg, A.; Englund, M.; Roos, H., High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis & Rheumatism 2004, 50 (10), 3145-3152.
6. von Porat, A.; Roos, E.; Roos, H., High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Annals of the Rheumatic Diseases 2004, 63 (3), 269-273.

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4 Responses

  1. Thanks a lot for this research-backed article. I have some related questions I’m hoping you can help with:
    1. Does a prevention routine include the same exercises that you should perform to rehab after you already have runner’s knee?
    2. If so, is there a guidance on how long you should perform them for? Is the expectation that one should go back to being 100% pain free?
    3. How much running and to what intensity can one do while recovering from runner’s knee?

    I ask because I developed runner’s knee several months ago and even with a consistent rehab routine, I still have pain in my knee whenever I squat or run.

    1. Hi Rachel, thanks for reaching out. The prevention exercises will help both before for prevention, and help with rehab after you have runners knee, I hope that answers your question. Did you sign up for the bonus we had with this post? It will explain it best there, but we also have this post, which will give you more information, and probably more about how you will recover (and how to get back to running). https://runnersconnect.net/running-injury-prevention/runners-knee-symptoms-causes-and-research-backed-treatment-solutions-for-patellofemoral-pain-syndrome/

      Hope this helps! Best of luck with your recovery!

  2. Thanks for responding, Coach Tina. I appreciate the info. I have got the free guide as I’m subscribed to your newsletter. I’ll check out the other article as well.

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