Runners knee is one of the most common problems that affects runners today as it encompasses around 25% of all running injuries. Runners knee is also known as anterior knee pain, which differentiates it from things like iliotibial band syndrome. It has the tendency to affect adolescents at slightly higher rates and women about twice as often as it does men. It should be noted that treating runners knee is important because 70-90% of people that have it tend to have recurrent or chronic symptoms.

How Does Runners Knee Feel?

People that suffer from runners knee typically complain of pain and tenderness around and behind the kneecap. It has the tendency to affect people during weight-bearing activities and with things that require the knee to bend repeatedly. People often complain of pain with walking, running, squatting, kneeling and going up or down stairs. Classically, people will report pain after prolonged sitting with the knee bent, and this is known as a movie sign.

Will Runners Knee Heal By Itself?

It is possible to help decrease the pain associated with runner’s knee by avoiding things that have the tendency to cause pain. The problem is that there usually biomechanical problems that are causing the knee to get inflamed. Once a person resumes activities that were causing pain, there is a high likelihood that runner’s knee will return in less it is appropriately dealt with.

What Causes Runners Knee?

The underside of the kneecap is shaped like a “V” and should specifically sit in a  V-shaped groove on the femur. Runner’s knee occurs when forces cause the kneecap to not slide in the groove properly.

The outside part of your quadriceps muscle has the tendency to be stronger and overpowers the inside part of the muscle. If you can imagine unevenly pulling up on a blanket with both hands where your right hand comes up to your shoulder level in your left hand only comes up to your waist, the blanket would obviously be lopsided. When the lateral part of the thigh overpowers the inner area of the thigh, the patella does not ride correctly in the groove.

A secondary factor that explains why women have the tendency to be affected more often than men comes down to a difference between the sexes on the structure of the knee. There is a greater angle at the knee due to the fact that women’s hips are generally wider than men’s. Younger girls even have the tendency to be “knock-kneed”. This extra angle in the knee has the propensity to make the patella ride further to the outside on the knee and out of its V-shaped groove when the quadriceps are contracted.

What to do for runner’s knee pain

The first thing to do is to make sure that you actually have runner’s knee. There are a host of different issues that can affect the knee in runners to include iliotibial band syndrome, patellar tendinitis, meniscus tears and ligament problems. You want to make sure that you are treating the right thing so it would be prudent to go to a trusted healthcare provider that has a specialty in sports medicine, like a Certified Chiropractic Sports Physician. A thorough history and a proper examination will help to pinpoint the right diagnosis. If the knee pain becomes more frequent or intense, it makes you use over-the-counter pain medication or if it affects your ability to run, it would be a good idea to get yourself checked out. The best part is that often you can be helped without being told to cut back on your running.

Again, runner’s knee is a multifactorial problem that will respond better when it is treated earlier and will be less likely to become recurrent or chronic if treated appropriately.

Corrective Exercises for Runner’s Knee

Often, corrective exercises are going to be the best thing in order to help someone get rid of patellofemoral pain and prevent it from coming back. People that have runner’s knee usually have specific weaknesses in the gluteal muscles and the quadriceps muscles, which need to be rehabbed properly. There can also be issues with flexibility in the quadriceps hamstring and calf as well as poor movement patterns of the hip and knee. These exercises should be able to be performed in a pain free manner as to not aggravate the condition. Poor hip and knee control can cause internal rotation of the hip and pronation of the foot which will increase the angle at the knee leading to a worsening of the anterior knee pain. Exercises to strengthen ankle and foot may be beneficial as well. It is important to have a proper assessment in order to determine which muscles actually have deficits.

What are my Treatment Options?

There are number of conservative treatments that are available for runner’s knee. Surgery is not really something that should be considered for most people with anterior knee pain. When someone is in the initial stages of trying to recover and they are in a lot of pain, kinesio taping is something that can be extremely effective at allowing the person to continue to run. Kinesio tape can be left on for several days and it will help to improve the position of the patella during activities like running. It is water resistance and can stand up to bathing and even swimming. Kinesio tape can be used while the person is starting to work on strengthening specific areas of the quadriceps. There are some specialized braces that can be worn which can accomplish similar goals to the tape. In my experience, the Kinesiotape does work much better but there is not as much training needed to put on the brace. Mind you this is not a common cheap neoprene type of brace, but a specialized brace that could run around $80

Foot orthotics can be helpful for people that have excessive amounts of foot pronation. Foot pronation can increase the internal rotation of the hip and therefore change the biomechanics at the knee in order to increase anterior knee pain.

Chiropractic adjustments to the foot and ankle can be extremely helpful for people that have a restriction in those joints. Patients who have decreased motion of the patella due to long-standing anterior knee complaints can benefit from the use of Graston Technique.

Activity modification can be helpful, but that does not mean that a runner needs to stop running. Runners with runner’s knee might want to think about doing cross training include activities like swimming, kettle bell swings, etc. Activities that can possibly contribute to runner’s knee might include changing the running surface, working on up or downhill running and increases in running mileage.

Article Featured in Toledo Roadrunners Club Footprints – Volume 45, Issue 12 (December 2019)