Woman running outdoors in the city

Runner's knee

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Physiotherapist Brad McIntosh discusses what causes runner’s knee and how to prevent and treat this common cause of knee pain.

What is runner’s knee?  

The most common type of knee problem is pain that occurs around the front of the knee or knee cap, also called the patella.  
This pain is often referred to as runner’s knee, which we call a “bucket” diagnosis because it includes several different causes.  
It has other names including patellofemoral pain syndrome (PFPS), anterior knee pain syndrome (AKP), and chondromalacia patellae (softening of the cartilage on the back of the kneecap). 

What causes runner’s knee?

The pain of runner’s knee usually comes on as the load applied to the knee is increased, or the muscles that support the knee have become weak.  
A common time for runner’s knee to develop is when you’re training for a race like a half marathon or marathon.  
Despite the name, it has many other triggers and often affects people who don’t run at all.  Anything that increases load around the knees can bring it on, including walking, stairs, cycling, weight gain, squatting, lunges etc. 

What does runner’s knee feel like? 

If you have pain around the front of your knee and haven’t had a traumatic injury like a fall or bad twist, the chances are you probably have runner’s knee.  It’s very common and according to research, nearly 1 in 4 people will experience this type of knee pain. 
It usually hurts during activities that stress the knee like stairs, squatting, running, jumping, and sitting for extended periods (theatre sign), and feels better with rest, ice and taping or bracing.   
Often, but not always, there may be some grinding and clicking of the kneecap. If there is significant swelling, your knee feels like it’s giving way, or it locks up on you, you may have some other things going on that need to be looked at more closely. 

What are the causes of runner’s knee?

As is often the case, there a number of potential causes or contributors:
  • Biomechanical problems stemming from the hips, pelvis and/or feet
  • Weakness of the supporting muscles, particularly the quadriceps and gluteal muscles
  • A rapid increase of repetitive loading, or a single significant load beyond the capacity of the kneecap joint
  • Inadequate range of motion or flexibility of the hips, knees, hamstrings, ankles, or calf muscles
  • Changes to the cartilage affecting the back of the kneecap
  • Trauma such as fall onto the knee

How do you treat runner’s knee?

There are some things you can use to reduce the pain of runner’s knee, including:
  • Ice
  • Taping or bracing
  • Short periods of rest or reduction of load
  • Cross training
  • Manual therapies such as massage, dry needling and joint mobilisations
Ultimately, the goal is to fix the underlying cause, so a full biomechanical assessment and treatment plan is essential.  This will include a combination of:
  • Stretches of the hips, hamstrings, calves etc.
  • Strengthening exercises, particularly for the quadriceps and buttock muscles
  • Myofascial release of areas such as the iliotibial band (ITB)
  • Movement retraining to fix underlying biomechanical problems
  • Load management and activity planning
  • Footwear changes and occasionally orthotics

How to prevent runner’s knee

A few simple strategies will give you the best chance of avoiding this extremely common problem:
  • Maintain a healthy weight
  • Plan your training well and make sure that increases in load are slow and steady
  • Implement a basic stretching and strengthening regime for the most-common problem areas, including hip mobility, buttock strength and control, quadriceps strength, ankle mobility and hamstring flexibility
  • Get an expert to assess and tweak your running style, but make sure the changes you make are only very subtle
  • Wear appropriate footwear for exercise and activities that stress the knees, and don’t let your running shoes get too old…about 6-12 months or 800km is reasonable

Sydney Physio Solutions was established in 2007 with the aim to provide a high quality service in injury rehabilitation using state-of-the art technology in an innovative environment.

Their team of highly qualified and caring physios, led by founder and Managing Director Brad McIntosh, can do a running analysis and provide advice & assessment for the very best outcome.

~This article first appeared on Sydney Physio Solutions~