Runner's Knee: Symptoms, Causes & Treatments

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

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).

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. But 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.

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 gluteals;
• 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.

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

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

This article first appeared on Sydney Physio Solutions

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.