Runner’s Knee Causes, Treatment, and Prevention

Audio Transcript

Sinead: Hi everyone and welcome to this episode of the Runners Connect podcast. Today, we have a great question from John about runner’s knee.

John says, “I’ve been experiencing pain around the top of my knee and have had to take several days off running. Is this runner’s knee or is that pain on the inside of the knee?

If it is runner’s knee, what causes it and how can I treat it?”

Sinead: First off John, I’m so sorry you’re experiencing this pain. Just so you know, it is runner’s knee. What you describe sounds exactly like patellofemoral pain syndrome, which is runner’s knee.

I had this injury for five years in a row and couldn’t figure out why I kept getting it without fail, every single year.

Finally, I realized why and I’ll get into that today. I haven’t had it in a few years, so hopefully I can help you out and help you to prevent it in the future.

First off, patellofemoral pain syndrome or runner’s knee, is one of the most common injuries among runners.

It accounts for about 19% of injuries, according to recent studies, and like you said, it’s characterized by this kind of dull pain behind or around the top of the kneecap.

Typically, this area gets aggravated when you do motions like squatting, running, running especially downhill, descending stairs and any sort of prolonged sitting.

This is when you tend to get some aggravation in that area.

John, I’m sure you’re well aware of this already. You can also have pain when resisting leg extension and even a little bit of tenderness when you push down on the kneecap itself.

That’s what patellofemoral pain syndrome is. It’s what we all know it to be as runner’s knee. It is important to distinguish this from patella tendonitis, which is entirely different.

It’s a pain that manifests itself in the tendon that connects the kneecap to your sheen, the patellar tendon, so it’s more on the inside of your knee.

This is where you need to be careful in distinguishing the two as there are very different treatments for the two.

As for the causes of runner’s knee, obviously this affects so many runners and so there’s got to be some underlying reason for this.

A lot of the research done around patellofemoral pain syndrome has shown that people with poor quadriceps and calf flexibility as well as general weakness in the quadriceps, in the hips, tend to lead to this injury.

While the quadriceps do come into play here, a lot of the time it is a weakness in the hip abductors and external rotators.

As runners, we tend not to use certain muscles of our hips so much, because we are moving pretty much purely across the frontal plane.

We don’t have any sort of lateral movement usually and so we don’t tend to work all of the muscles in our hips.

This usually prompts some weakness in the hip abductors and external rotators, like I said.

A lot of research done in the last decade or so has uncovered that the true culprit behind knee injuries and runners is hit mechanics.

That seems a little bit counterintuitive, but it is a chain reaction injury; the runner’s knee. When you have weakness in your hips, it can prompt pain elsewhere and this is where it usually manifests in the knee.

This is because weakness in these areas, the hip abductors and external rotators, causes the knee to collapse toward the center of your body when you run.

John, this is most likely the cause of your knee injury.

As for treatment and prevention, it’s usually all about strengthening those weak spots in your hips.

A lot of good programs will include close chain functional exercises like squats and balance training.

We have a program here at Runners Connect and you can check it out by just googling “Runners Connect – runners knee prevention routine.”

There are some great exercises in there that will help you to increase your stability and also increase your strength in your hip muscles.

If you’re interested in that program, be sure to check it out. It’s great for preventing this injury and preventing it from happening again down the line.

As for actual treatment of this injury, for most runners, stretching and foam rolling is a must.

It can help to loosen up your tight calves and quads and your hip flexor muscles. Definitely be sure when you have a knee injury to foam roll your hip flexor muscles.

At Runners Connect we have videos on this. You have to have a master’s subscription to see these, but there are some great foam rolling techniques in there, especially for treating injuries like runner’s knee.

It’s also just important to ice.

Every runner probably knows the rise where its recovery ice compression elevation and these are all very important to runner’s knee.

Just make sure that you ice the area pretty regularly. You want to do it for 15 minutes on, 15 minutes off and do that twice, two to three times while you’re just sitting at your computer or just lounging.

You want to make sure that you continue icing the area so you can get blood flow to the area.

Be sure to see a physical therapist. I am giving you as much as I can to help you here. A physical therapist is going to help you way more by actually seeing the problem, and helping to get you back into alignment, if you are out of alignment and even give you some exercises to help expedite the recovery.

Just to conclude, for treatment you want to start doing some conservative hip and quadriceps strength exercises and these are all included in our runner’s knee recovery program.

If you include exercises for the abductors, external rotators, quadriceps and even farther down the line, your lower leg muscles, you want to do some mini squats on a step, do some single leg squats, and some glute bridges.

All of these things are going to help increase your stability and increase your strength in these weak areas of your hips.

You also want to continue icing after each run and then even a little bit more throughout the day, if you can.

If you’ve got time to just sit there and ice your knee for 15 minutes on and 15 minutes off, that will really help to facilitate recovery.

Also, make sure that you are stretching your quadriceps and calves and foam rolling these areas as well.

I will say that patellafemoral pain syndrome is pretty notorious for sticking around for weeks and even months, so you have to be cautious with this injury in general.

You don’t want to run through the pain, but sometimes as you are recovering the knee, it may continue to feel a bit stiff at the beginning of a run, but will get better as you go.

As long as you’re being conscious of this, as long as it’s getting better and not worse as you progress into your run, you are probably okay to keep going.

At the end of the day, a good doctor or physical therapist can give you a decent estimate of how long it will take you to recover, to get back to running.

Just make sure that you see a professional and they can give you different activities to keep your fitness up, while you are taking time off.

Aqua jogging, biking and using the elliptical are all great options for cross training that don’t tend to aggravate the knee.

Make sure you see a professional; they’ll be able to help you out a little bit more than I can.

I hope what I’ve said has helped you John, and hopefully it’s helped other listeners that have either dealt with the runner’s knee in the past, or are looking to prevent it in the future, as most of us probably are.

Thanks again John. That was a great question.

If you have a question you would like to submit for an upcoming episode, you can do so at runnersconnect.net/daily.

Again, anything to do with running, nutrition, racing or anything in between. We’d love to hear from you and want to help in any way we can.

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