This post is written by Parth Chowatia, a registered Sports Physiotherapist with years of experience assisting sports players and professional athletes in performing at their best.
Runner’s knee, also known as Patellofemoral Pain Syndrome (PFPS), is a common overuse injury that affects individuals who participate in running and other physically demanding activities.
Understanding the knee anatomy is essential to understanding the underlying causes of PFPS. The knee joint is composed of bones, ligaments, tendons, and muscles that work together to provide stability and facilitate movement.
The knee cap (patella) is a small bone that is located in front of the knee and helps to transfer forces from the quadriceps muscle to the tibia or the shin bone.
PFPS or Runner’s Knee is a condition that is characterized by pain and discomfort in the front of the knee, specifically around the patellofemoral joint, where the knee cap and thigh bone meet.
This pain is typically triggered by activities such as running, jumping, or climbing stairs and can lead to decreased physical activity levels and decreased quality of life.
The exact cause of PFPS is not well understood, but several factors can contribute to its development, including weakness or imbalances in the muscles that support the knee, overuse and training errors, flat feet or overpronation, knee alignment problems, and sometimes improper footwear.
The prevalence of runner’s knee is estimated to be between 25% and 40% among runners and is more common in women, older individuals, and those with a previous knee injury.
In some cases, PFPS can be a result of a more serious underlying condition, such as a knee joint abnormality, injury, or disease. Runner’s knee is the common term used to describe any one of several conditions that cause pain around the kneecap, also known as the patella.
These conditions include anterior knee pain syndrome, patellofemoral malalignment, Chondromalacia Patella, and IT band syndrome.
Therefore, a comprehensive evaluation by a doctor or physical therapist is essential for accurate diagnosis and effective treatment.
How Do You Diagnose Runner’s Knee?
Diagnosis of PFPS typically involves a thorough medical history, physical examination, and imaging studies such as X-rays or MRI scans by a physical therapist or a doctor if necessary.
Treatment options for runner’s knee vary depending on the severity of the condition and can include physical therapy, bracing, pain management, and in some cases, surgery.
A study was done where participants were only given non-surgical interventions (stretches, bracing, icing, and other exercises), and 65% of the people were symptom-free and back to their physical activity.
Physical therapy can help to improve muscle strength and flexibility, address any imbalances or weaknesses, and improve knee alignment. Bracing can help to stabilize the knee and reduce pain during physical activity.
Pain management can include the use of over-the-counter pain relievers, prescription medications, or injections. In some cases, surgery may be necessary to repair any structural damage to the knee or to realign the knee cap.
It is important to note that PFPS can be a chronic condition and may require ongoing management to prevent future injury and maintain knee function.
Therefore, it is crucial to seek treatment early and to work closely with a doctor or physical therapist to develop a personalized treatment plan that is tailored to meet your specific needs and goals.
With the right combination of treatment and rehabilitation, individuals with runner’s knee can manage their pain, improve their knee function, and return to their preferred physical activities.
Runner’s Knee Prevention
Preventing runner’s knee, or patellofemoral pain syndrome (PFPS), requires a multi-faceted approach that addresses the underlying causes of the condition.
Some strategies for preventing PFPS include:
1. Gradual increase in physical activity: Increasing physical activity too quickly can put excessive stress on the knee, leading to injury. Gradually increasing the intensity and duration of physical activity can help to reduce the risk of injury.
2. Proper footwear: Wearing shoes with proper support and cushioning can help to reduce stress on the knee and prevent PFPS. Running shoes should fit properly (not loose, not too tight) and provide adequate shock absorption.
3. Strengthening exercises: Strengthening the muscles that support the knee, including the quadriceps, hamstrings, and hips, can help to improve knee stability and reduce the risk of injury with generic strengthening, eccentric exercises are also a very important part of the rehab and help gain the required strength back.
4. Stretching: Stretching the muscles that support the knee can help to improve flexibility and reduce the risk of injury, for example, quadriceps, hamstrings, IT- band, and the Hip abductors and adductors.
5. Avoiding high-impact activities: High-impact activities, such as jumping, can put excessive stress on the knee and increase the risk of injury. Avoiding or limiting high-impact activities, or incorporating low-impact activities into your exercise routine, can help to prevent PFPS.
6. Maintaining a healthy weight: Carrying extra weight can put additional stress on the knee and increase the risk of injury. If you are overweight, maintaining a healthy diet and lifestyle might be necessary before you start running to avoid extra pressure on the knee.
7. Proper form and technique: Using proper form and technique during physical activity can help to reduce stress on the knee and prevent injury. Although there is no perfect form, and we have really scarce research on running forms, it is necessary to correct the components of your running or any activity that could be putting stress on the surrounding soft tissues. A physical therapist can provide guidance on the proper form and technique for specific activities.
It is important to listen to your body and seek medical attention if you experience pain or discomfort in the knee during physical activity. Early intervention and treatment can help to prevent the progression of PFPS and reduce the risk of future injury.
Treatment of Runner’s Knee
The treatment of runner’s knee, or patellofemoral pain syndrome (PFPS), depends on the severity of the condition and the underlying cause of the pain. Some common treatment options for PFPS include:
Physical therapy: Physical therapy can help to improve muscle strength and flexibility, address any imbalances or weaknesses, and improve knee alignment. A physical therapist can also provide guidance on proper form and technique during physical activity.
Bracing: Bracing can help to stabilize the knee and reduce pain during physical activity. A knee brace can be worn during physical activity to provide support and stability to the knee by providing feedback, compression, and reducing stress on soft tissues like the tendons and the muscles to reduce inflammation and pain.
Pain management: Pain management can include the use of over-the-counter pain relievers, prescription medications, cryotherapy, or ice and Injections. Injections, such as cortisone, can help to reduce pain and inflammation in the knee.
Rest and activity modification: Reducing the amount of weight-bearing activities, such as running, can help to reduce stress on the knee and allow for healing. Cross-training and incorporating low-impact activities, such as cycling or swimming, can help to maintain fitness levels while allowing the knee to rest.
Surgery: In some cases, surgery may be necessary to repair any structural damage to the knee or to realign the knee cap. Surgical options can include arthroscopy, realignment procedures, or total knee replacement.
It is important to work closely with a doctor or physical therapist to develop a personalized treatment plan that is tailored to meet your specific needs and goals.
With the right combination of treatment and rehabilitation, individuals with runner’s knee can manage their pain, improve their knee function, and return to their preferred physical activities.
Stretches for Runner’s Knee
Stretching can help to reduce pain and improve flexibility in individuals with runner’s knee, or patellofemoral pain syndrome (PFPS).
Some stretches that can be helpful for PFPS include:
Hamstring stretch: Lying on your back with one knee bent, hold the back of your thigh and straighten your knee to stretch the hamstring. Hold for 30 seconds and repeat on the other side.
Another way of stretching is in a standing position where one leg goes on top of a chair and you lean forward with your back straight and try and touch your toes with both hands and holding it for the prescribed time.
Quad stretch: Stand with your feet hip-width apart and hold onto a wall or chair for balance. Bend your knee to bring your heel towards your buttock, holding onto your ankle with your hand. Hold for 30 seconds and repeat on the other side.
IT band stretch: Lie on your side on a bed or couch so the legs can hang off, and pull the knees to the chest, move the upper leg back to hang off the bed and hold this stretch for 30 seconds
Calf stretch: Stand facing a wall and place your hands on the wall for balance. Step one foot back and bend the front knee, keeping the back leg straight. Hold for 30 seconds and repeat on the other side.
Hip flexor stretch: Kneel on one knee with the other foot in front of you and the knee bent. Shift your weight forward, feeling a stretch in the front of your hip.
Hold for 30 seconds and repeat on the other side, you may use a pillow under the knee to avoid direct impact or pain from kneeling.
It is important to stretch regularly and to warm up before physical activity to help prevent PFPS.
Stretching should be performed gently and not cause pain. If you experience pain during stretching, it is important to seek medical attention.
Braces for Runner’s Knee
There is limited research on the specific type of knee brace that is most effective for individuals with runner’s knee, or patellofemoral pain syndrome (PFPS).
But depending on your history, physical examination, and a detailed assessment, your doctor or physical therapist can prescribe the perfect brace that might be a good fit for your specific condition.
Knee braces that can be helpful for PFPS include:
1. Patellar stabilizing braces: These braces are designed to help stabilize the knee cap and reduce pain during physical activity. They typically have a pad or bump that fits under the knee cap to help guide it into proper alignment.
Recommended Product: BraceAbility J Patella Knee Brace
2. Hinged Knee braces: Hinged braces provide stability and support to the knee while allowing for normal movement. They can be especially helpful for individuals with PFPS who have knee instability or are returning to physical activity after a knee injury.
3. Compression sleeves: Compression sleeves can help to reduce pain and swelling in the knee. They can also help to keep the knee warm, which can improve circulation and promote healing.
4. Kinesio or K-Taping: Kinesio taping is a temporary bracing technique used in order to stabilize the knee and sometimes to relieve pressure off the tendons and joints. A physical therapist can teach you what kind of tape to use and the correct technique to self-tape yourself before doing any kind of physical activity.
Always remember not all kinds of braces might help you, there might be a specific type that you might need for example, in a case where the patellar tendon is involved, a patella stabilizing brace will be more helpful than a compression sleeve. A brace that is too loose or too tight can be ineffective or worsen your symptoms.
Recover from Runnner’s Knee and Get Back to Running
The followings are some exercises and methods that can help you get back to running after recovering from runner’s knee:
Strengthening exercises: Targeting the muscles around the knee, such as the quadriceps, hamstrings, and hips, can help improve stability and reduce the stress on the knee. A good balance of concentric, eccentric, and isotonic exercises can help you get back to efficient and confident running.
Strength exercises can include loaded knee extension and flexion, Bodyweight squats and gradually increasing the load, terminal knee extension, lunges, calf raises, eccentric bodyweight squats, reverse Nordics, etc.
Stretching exercises: Stretching the quadriceps, hamstrings, and hips can improve flexibility and reduce tightness that may contribute to knee pain.
Proprioception exercises: Improving balance and control can help reduce the strain on the knee and prevent future injury. Balance exercises can include single-leg balancing, single-leg Romanian deadlifts, compound exercises, star excursion balance training, etc.
Low-impact cardio: Gradually increasing low-impact activities, such as cycling, swimming, and rowing can help build endurance and prepare you for running. Running in waist-height water can prove beneficial since due to the buoyant forces of the water the knee is not under extreme pressure as it is on land.
Gradual return to running: Slowly increase running intensity and duration, starting with short intervals and gradually building up as tolerated, for example, if you were running 40km every week pre-injury, starting at 50% of your capacity is a good idea and then slowly building it up also making sure that enough recovery or rest time is given between runs.
Foam rolling: Regular foam rolling can help release tightness in the muscles and improve mobility in the knee and in turn reduce pressure on tendons and joints, some examples of foam rolling that help in recovery and prevention are; Quadricep, hamstring, glute and IT band. The recommended dose is somewhere between 2-5 minutes on each side depending on pain levels and thresholds.
Massage or Deep Tissue Release: Massage can help improve circulation and promote lymphatic drainage, which can help reduce inflammation and swelling in the knee joint. Massage can help to alleviate pain and discomfort in the knee by releasing tight muscles and promoting relaxation.
By loosening tight muscles and reducing pain and discomfort, massage can help to improve the knee’s range of motion and flexibility, it also helps to improve blood flow and oxygenation to the knee, which can promote tissue healing and recovery.
References:
- American Academy of Orthopaedic Surgeons. (2021). Runner’s Knee. Retrieved from https://orthoinfo.aaos.org/en/diseases–conditions/patellofemoral-pain-syndrome/
- Kujala, U. M. (1995). Patellofemoral pain syndrome: a review of current concepts. Scandinavian Journal of Medicine & Science in Sports, 5(2), 61-69.
- The Mayo Clinic. (2021). Runner’s Knee. Retrieved from https://www.mayoclinic.org/diseases-conditions/patellofemoral-pain-syndrome/diagnosis- treatment/drc-20350797
- Physical Therapy Products. (2021). Knee Braces for Runner’s Knee: What You Need to Know. Retrieved from https://ptproductsonline.com/orthopedics/braces/running-with-a-knee-brace-what-are-your-options/
- Hsu, W., & Chao, E. Y. (2002). Prevention of patellofemoral pain syndrome: a review of the literature. Journal of Orthopaedic & Sports Physical Therapy, 32(7), 365-375.
- Hershman, E. B., & Metzl, J. D. (2017). Sports Medicine for the Primary Care Physician. Springer.
- Stachenfeld, N. S. (2015). The effects of massage on physiological restoration, muscle recovery and performance: a review. British Journal of Sports Medicine, 49(16), 1089-1095.
- Damiano, D. L., & Reddin, D. B. (2017). Physical therapy for patellofemoral pain syndrome: a systematic review. Physical Therapy, 97(3), 205-219. “Patellofemoral Pain Syndrome” by American Academy of Orthopaedic Surgeons (AAOS) (https://orthoinfo.aaos.org/en/diseases– conditions/patellofemoral-pain-syndrome)
- “Runner’s Knee: Causes, Symptoms, Diagnosis, andTreatment” by MayoClinic https://www.mayoclinic.org/diseases-conditions/patellofemoral-pain-syndrome/diagnosis- treatment/drc-20350797
- “Preventing Runner’s Knee” by Harvard Health Publishing (https://www.health.harvard.edu/staying-healthy/preventing-runners-knee)
- “Foam Rolling for Runners: Benefits and Techniques” by Runner’s World
- “The Benefits of Knee Braces for Runners” by Medical News Today
- “Physical Therapy for Runner’s Knee” by WebMD (https://www.webmd.com/pain-management/runners-knee-physical-therapy#1)
- “Massage for Runner’s Knee: Benefits and Techniques” by Healthline
Hi, I am Parth Chowtia, an MSK/Sports Physiotherapist with a degree in Sports Medicine from Leeds Beckett University, UK. I have five years of experience working with top brands and like to share guides on preventing and managing injuries resulting from sports and exercise participation at all ages and levels of ability.
