Runner's Knee: Symptoms, Causes, and Research-Backed Solutions for Patellofemoral Pain Syndrome
If you're reading this article about treating knee pain, you're probably suffering from some symptoms of runner's knee and are looking for a solution to the problem so you can start running again.
If so, then you are in the right place.
We will help you determine if you have this nasty injury; what causes it; We'll give you tips on how to prevent runner's knee in the future. We will also tell you what types of treatment exist: from conservative to aggressive.
What is runner's knee injury?
Patelloforemoral pain syndrome, also called runner's knee, is the most common running injury (16.5% of injuries among runners), according to one recent study.
The injury is characterized by a dull pain localized “behind” or near the top of the kneecap.
Typical pain-increasing movements include squats, running (especially downhill), going down stairs, and sitting for long periods of time.
This injury makes the training process difficult and may well force you to change your plans for preparing for competitions.
If you have patellofeoral pain syndrome (PFPS), you will also likely experience pain when resisting knee extension and possibly when pressing on the kneecap itself.
It is important not to confuse PFPS with patellar tendinitis, which is a completely different injury that requires completely different treatment. Patellar tendinitis occurs as pain in the tendon that connects the kneecap to the tibia.
Patellofemoral pain syndrome is more common in women, although why this is so is not entirely clear.
The most popular theory that women are more susceptible to knee injuries because they have wider hips has been debunked. Other theories regarding differences in leg length and pronation are also unhelpful.
Patellofemoral pain syndrome gets its name from the anatomy of the knee: the pain is caused by the kneecap rubbing against the femur as it slides up and down as you bend and straighten your knee.
What causes runner's knee?
Historically, research into PFPS has focused on factors influencing patella motion, particularly how the quadriceps muscle controls the movement of the patella in the femoral groove.
Indeed, scientific research has shown that lack of flexibility in the quadriceps and calf muscles, poor high jumping ability (which is highly dependent on quadriceps strength), and quadriceps weakness in general are risk factors for the development of PFPS.
The blame has often been attributed to the vastus medialis muscle, which appears to contract slightly differently in people with PFPS. And runners who performed exercises that engaged this muscle often recovered!
However, recent research has demonstrated that this was likely due to an increase in overall quadriceps strength rather than activation of a specific thigh muscle. And unfortunately, many runners don't find relief from doing strength exercises for the quads alone.
Differential diagnosis of knee pain
A huge number of websites, magazines, Instagram posts, thoughts from sports fans - all this has created confusion regarding “runner's knee”.
Sports doctors call this pathology of the iliotibial tract (ITB syndrome). The pain is localized along the outer edge of the knee (we will look at the clinic in more detail below). It is this pathology that occurs most often in track and field athletes.
In addition, patellofemoral syndrome now falls under the category of “runner's knee.” In this case, pain occurs inside the joint behind the patella.
It would seem - what difference does it make: after running, does the knee hurt on the outside of the joint or on the inside? This is the same anatomical structure!
But the causes of these two symptoms are diametrically opposed: ITB syndrome is partly associated with tension in the anterior thigh muscles, and patellofemoral syndrome is partly associated with their weakness . This means that corrective exercises + treatment will be completely different for them! Let's take a closer look at each of them.
How to treat runner's knee?
Fortunately, research over the past 10 years has identified another mechanism that contributes to the development of knee injuries in runners: hip mechanics.
It turns out that although the kneecap appears to “shift” to the outside of the leg during squats and running, it is actually due to rotation of the femur.
This explains why many runners (especially women) with PFPS have weakness in the hip abductor and external rotator muscles. This appears to contribute to changes in biomechanics during running. Due to muscle weakness, the knee rolls inward toward the midline of the body while running.
Some studies have focused directly on changes in biomechanics in runners with PFPS. The researchers used a treadmill and camera system to analyze running strides in real time. Unfortunately, this is not an option that is widely available to most runners.
Fortunately, some preliminary research has shown that hip stabilization exercises and techniques are quite effective. In particular, it has been proven that a successful training program must include exercises for the hip abductors, external rotators, and quadriceps.
Many programs that have shown good results also contain hip flexor/extensor strength exercises, “functional” closed chain movements such as squats, and balance exercises.
Stress fractures
This is a small fracture in the bone that causes pain and discomfort. Often in runners it occurs in the foot or lower leg. The pain intensifies with continued exercise and subsides with rest. Rest is important here, as continued exertion can cause a more serious injury.
Prevention and treatment:
⁃ Consultation with a traumatologist
⁃ Selection of drug treatment
⁃ Correct physical activity, excluding shock
How can I reduce the amount of time I have to stop running if I have runner's knee?
For most runners, regular strength training will eventually provide relief from knee pain.
But, as always, there are other treatments that can either provide temporary relief or act as an adjunct to a strength training program.
Stretching and deep massage with a special roller can be an excellent addition to strength training, as they help relax tight calf muscles and quadriceps.
Often, if you continue to run with an injury, your muscles become tense and stiff, but massage with a special foam roller and stretching exercises for the quadriceps can help you relax them. Just don't do stretching exercises if they irritate your knee.
The use of an elastic bandage or flexible kinesiology tape has been shown to provide some relief to athletes with knee pain.
Some studies have also shown that a knee brace (brace, neoprene sleeve, etc.) may also provide some relief.
Moreover, the mere presence of a tape, bandage or bandage that provides some tactile feedback already provides relief. Thus, a loose, incorrectly applied bandage helps just as much as a tightly and correctly applied bandage!
Another option is a product called NuNee. This is an innovative product designed specifically for people with runner's knee. NuNee was invented by 2-time Ironman winner Mike Emmerling as a result of his own 5-year battle with this injury. Research shows that if you relieve the pressure, you can relieve pain. NuNee does just that. By relieving pressure on your kneecap, NuNee can provide immediate pain relief from runner's knee.
Custom orthotics may speed up the rate of your recovery, but at least one study suggests they don't have a significant impact after a few weeks of use. Anecdotally, many runners experience significant relief when using custom orthotics, so you may want to try them if first-line therapy isn't working for you.
But given little, if any, evidence that factors below the knee (i.e., feet and ankles) play a role in the development of PFPS, regular or even custom orthotics should not be your first choice when treating pallotemoferal pain.
Conservative treatment plan
1. Exercises to strengthen the following muscles:
- Hip abductors - lifting the leg up while lying on your side or abducting the leg to the side using a rubber band.
- External rotator muscles of the thigh – clam exercise in the side lying position or external rotation of the foot using a rubber band.
- Quadriceps – straight leg lift while lying on the floor (the second leg is bent at the knee).
To start, perform 15 repetitions of each exercise once a day. As your strength increases, you can move up to doing 2 or even 3 sets of 15 reps. All exercises must be performed SLOWLY!
2. Exercises to strengthen the leg muscles in general and improve balance:
- Maintaining balance, perhaps on an unstable surface (bosu ball), initially for 30 seconds or 1 minute and gradually increasing this period of time to whatever you prefer.
- Partial range squats on a step, starting with 1 set of 15 reps and gradually increasing the amount of work to 2 or 3 sets.
- Glute bridge - hold the position for 10 seconds, do 10-12 repetitions in total, and gradually work your way up to holding the pose for 2 minutes.
3. Apply ice after each run.
4. Exercises to stretch the quadriceps and calf muscles.
5. Deep massage of the quadriceps and calf muscles with a special roller.
6. Taping the knee joint with either a regular elastic bandage or flexible kinesiology tape.
Prevention
As with any other injury, the best treatment for iliotibial tract syndrome is prevention.
This can help:
- Correctly designed training schedule, with a smooth increase in loads
- Correct running technique
- Choosing the right sports shoes
- High-quality warm-up and cool-down after the main workout.
- Strengthening all muscle groups involved in leg movement
A little theory and exercise to prevent the development of iliotibial tract syndrome:
- Anterior quadriceps stretch
There are several options you can use to stretch your quadriceps. One of the most effective is a lunge with the knee of the back leg on the floor, the front leg at a right angle. Next, the shin of the hind leg is grabbed with the same hand and pulled upward until a feeling of tension appears. This position must be held for 40 seconds or longer.
- Calf muscle stretch
Starting position: from the front position, you need to push your hands against the wall, and lunge forward with one leg. The knee of the hind leg, the calf muscle of which will be stretched, is straight. Next, tilt forward and down. Fixation – at least 40 seconds.
- Soleus stretch
For stretching, a low stand (step, step) is used. Place your foot on the stand and use your hands to lower it down. Fixation – at least 40 seconds. In this position, the muscle is stretched.
Aggressive Treatment Methods
These options are often more expensive or difficult to access and should only be used if the knee does not improve despite several weeks of exercise, rest, and other rehabilitation treatments.
1. Analysis of a running stride in a physical therapy room using a treadmill and a high-speed camera to detect and correct poor running technique.
2. Custom orthotics can change your running stride and reduce stress on your knees, but they also may not help at all.
Damage to the hamstrings (hamstring syndrome)
Hamstrings are the muscles of the back of the thigh. Sudden movements and changes in direction quite often lead to injury and sprain. It is important to choose the right load so as not to completely tear them, stretching and gradual strengthening with running, sudden stops and changing directions.
Prevention and treatment:
— Strengthening the posterior muscle groups of the thigh in combination with stretching
— Physiotherapy
— Drug treatment
— Manual techniques