A Complete Guide to Runner’s Knee
What Is Runner’s Knee?
If you ask this to any runner that’s dealt with this injury, they’ll say “It’s the annoying thing keeping me from training without pain.” And they’re not wrong. Runner’s knee symptoms tend to be more nagging than truly debilitating. This injury will not typically keep someone from running (at least not initially) but it is painful enough to make it very uncomfortable to continue training at one’s normal frequency or volume. Addressing the pain when you first start to feel symptoms is key to avoid having to cut your training cycle short!
Runner’s knee describes a condition that involves pain behind the patella (kneecap). Most doctors will refer to it as patellofemoral pain syndrome, or PFPS, which can be confusing at times because runner’s knee is commonly used for a wide variety of symptoms surrounding the knee. Runner’s knee tends to be more of an overuse injury that results from excessive strain and stress placed on the patellofemoral joint with higher impact or repetitive activity. Lucky for us runners, our sport is both high impact AND repetitive! So it is no surprise that runner’s knee accounts for a majority of running related injuries every year.
Common Runner’s Knee Symptoms
Because people use the term runner’s knee to describe a number of different injuries, it can be difficult to know if what you are feeling is truly runner’s knee or some other common running injury. Runner’s knee symptoms typically include:
Pain and tenderness around or behind the knee cap, usually dull/achy that can be sharp at times
Pain during or after activity, particularly with activity that involves bending the knee (such as running, go figure!)
Swelling and inflammation in the patellofemoral joint
Pain with prolonged sitting or sustained bending of the knee
Difficulty with squatting, stairs or kneeling
Runner’s knee symptoms can vary in intensity for many runners. The key is getting ahead of the pain and not waiting until you’ve developed a more chronic knee injury. If you’ve been dealing with runner’s knee symptoms for a few weeks now, it may be time to consult with a running medicine health professional to come up with a plan. Seeing someone does not mean you have to completely stop running! It is very possible to continue training with runner’s knee without having to pull out of your next race. You just can’t ignore the pain!
Causes of Runner’s Knee
It would be so easy if there was one simple cause behind runner’s knee but unfortunately that is not the case! Runner’s knee can be attributed to many things but we will focus on just three common causes that I see in the clinic for this blog:
Overuse
As I mentioned before, runner’s knee is an overuse injury. Makes sense considering the nature of our sport. Every runner has a very specific capacity of function, meaning there’s a limit to how much or how intense a runner can train. That capacity can change! A new runner may only be able to handle 10 miles per week while a more experienced runner can handle 50 miles per week with no issue. The problem is when runners try to train beyond their capacity to a prolonged period of time. That’s when injuries occur! A very common training error in runners is increasing volume or intensity too quickly. Working with a training plan or running coach can help to make sure you are gradually progressing your training without increasing risk for overuse injuries.
Muscular Imbalances:
The knee joint is one of the more complex joints in the body, with a large number of muscles and tendons and ligaments all working together to control it. The patellofemoral joint (where the knee cap meets the front of the femur) relies on a balanced pull from the surrounding muscles to move correctly. It is common for runners to experience muscular imbalances in their lower extremity, particularly an imbalance in the hamstrings/glutes and quadriceps. When the quadriceps overpower the hamstrings/glutes, it is common for runners to start to develop runner’s knee symptoms and pain.
Biomechanical Issues:
Biomechanics is a fancy term to describe how the body moves. Running biomechanics are important not only to ensure that a runner is moving as efficiently as possible, but also to prevent incorrect movement patterns that could lead to injury. Taking one wrong step won’t do too much damage but taking thousands of wrong steps over a 5 mile run can quickly become a problem. Common biomechanical issues that lead to runner’s knee are flat arches, overpronation and/or dynamic knee valgus.
Risk Factors for Runner’s Knee
While there is no way to 100% predict if someone will develop runner’s knee, there are a number of risk factors that runners should be aware of:
Age & Gender: younger runners and female runners are more susceptible than male runners
Training Changes: sudden changes in intensity or volume when starting a running plan can put someone at increased risk
Improper Footwear: wearing old shoes or shoes without proper support presents an increased risk for runner’s knee
Previous Injury: the greatest risk factor for a running related injury is a history of running related injuries
Runner’s Knee Prevention
Warm Up & Cool Down
We all know runners are notorious for never warming up and cooling down. But I always tell my runners that it doesn’t need to be a long, drawn out routine in order for it to be effective. Even two minutes of targeted warm up is better than logging off the work laptop and running out the door. Before your next run, try a quick warm up before hitting “Go” on your watch. Some ideas include:
Leg Swings (forward/backwards & sideways)
Standing Fire Hydrants
Hip Circles
Squats
Toe Walks
Step Ups
Once you’ve finished your run, spend a couple minutes cooling down by stretching your legs before getting in the car to drive home. Your body will thank you!
Footwear
Most runners know how important our shoes are for the sport. There are plenty of brands and designs and colors to choose from these days. Stop by your local running store to get properly fitted by a specialist to ensure you get into the right shoe for you!
Running Mechanics
Everyone runs differently! A lot of times there is no need to truly change how you run but if you are dealing with a current running injury, then it is important to know if your running mechanics may be part of the problem. Working with a running gait specialist to analyze your run can be enlightening and shed some light on things you can work on to improve your mechanics and run more efficiently. Not only does that usually mean less running injuries but also improved performance!
Strength Training
For a while, this was a completely overlooked aspect of training for runners. Thank goodness, that narrative is evolving! Strength training for runners now has a lot of research to support it, proving to be extremely beneficial to help reduce injury risk and increase running economy. What does that mean for you? You need to include strength training in your run training plan! Typically 1-2 times per week of strength training for runners is enough for them to see some of the benefits in their running.
Awareness
Simple as it sounds! Awareness of some of the common risk factors and symptoms can help runners recognize early signs of runner’s knee before it becomes a more chronic running injury. If runners deal with the knee pain early, they typically have to take less time off from their training.
Treatment for Runner’s Knee
Relative Rest
You have probably heard of the R.I.C.E method for dealing with injuries. You may even be taking that approach for your runner’s knee symptoms right now! R.I.C.E is no longer the gold standard treatment for injuries. The key is resting from the aggravating activity, which may be running or squatting, for a limited amount of time to let the tissue calm down. But instead of doing nothing as you wait for the pain to go away, you will want to replace it with some other activity. For runners, that looks a lot like cross training. Instead of doing your track workout that week, maybe hop on the elliptical or stationary bike and cranking out a workout there. You still get the benefit of maintaining aerobic fitness without the impact of running.
Running Physical Therapy
Traditional physical therapy may not be the answer for runners. You will want to find a local running physical therapy clinic where they have providers that understand how to best treat running injuries. Most running physical therapists will help to find ways to avoid needing to stop training completely. If you are local to Atlanta, you can schedule a FREE phone consultation with Tempo PT to discuss more about your specific injury!
Strength Training
We talked earlier about the benefits of strength training for runners. It is also a big part of the the treatment for runner’s knee. Strength training is the perfect way to address the muscular imbalances that runners have which started their runner’s knee pain in the first place. On top of compound lifts with weights, there are a number of specific runner’s knee exercises that can be included in the treatment plan.
Gradual Return to Running
This may be the most important factor. Everything else means nothing if you rush back into training and re-injure yourself! Depending on how much you were able to train during your recovery process, you may need to be extremely patient in your return to running. For some, that may mean run/walk intervals while for others it could look like having cross training days to replace your easy runs initially. If you remember, the greatest risk for a running injury is having been previously injured. By being patient in your gradual return to training, you are setting yourself up to avoid developing runner’s knee again!
Conclusion
Runner’s knee can be an extremely frustrating diagnosis for runners to deal with but if addressed early, it is very manageable. If you or someone you know has been dealing with runner’s knee symptoms for some time now, encourage them to find a running physical therapist in order to get an individualized and tailored treatment plan of care. That way they can be back to running without runner’s knee pain slowing them down!
Check out this blog on how to deal with plantar fasciitis as a runner!
