Runner’s Knee

Posted by Karl McDonald on 19 May 2014

Do you suffer from pain around your knee while running?Is this affecting your enjoyment when you run?
Is this affecting your training volumes and/or intensity?
It may be that you are suffering from some form of “RUNNERS KNEE”

runnersknee1Whilst Runners knee is specific to the diagnosis of Patellofemoral Pain Syndrome (PFPS) runners can suffer from many types of knee pain, none of which come on suddenly with some form of trauma but are more “overuse” types of injuries. In all of these “overuse” injuries pain develops due to an irritation of structures around the knee while you are running.

The most common types of overuse injuries runners can get are….

  • Patellofemoral pain syndrome (PFPS)- where the pain is under or around the kneecap (patella). 
  • -Patella tendonitis (Jumpers knee)- where the pain is located in the tendon underneath the kneecap.
  • -ITBS (iliotibial band friction syndrome)- where the pain is on the outside (lateral) of the knee
  • -Pes anserans bursitis- where the pain is on the inside (medial) of the knee

knee

Sportsmed Physiotherapists will be able to accurately diagnose and explain to you which type of condition that you have.

The key, however, is being able to skillfully identify the CAUSE of your overuse injury. This is where your physiotherapist at YPN will make the difference.

Getting the correct diagnosis and more importantly seeing someone who can identify the actual causes of the pain will influence greatly the correct treatment and the overall outcome.

There is no one  “treatment recipe” that will “fix” your knee pain. The causes are varied and very specific to each individual. Accordingly, the rehabilitation plan also needs to be specific to you. It is important that the causes are treated and not just the symptoms (primarily PAIN) or your pain will return quickly.

Causes of runner's knee

causesofrunnersknee

The exact causes of all the types of knee pain listed above are varied. They are thought to be caused by overuse or over activity and typically occur in runners. There are certain things that have been suggested that may make knee pain more likely. These include:

  • A sudden increase in training frequency or intensity.
  • Hard running surfaces (particularly a sudden change from soft to hard surfaces).
  • Incline and decline running
  • Poorly fitted or inadequate running shoes that do not give your specific foot type the required support.
  • Tightness (of hamstrings, rectus femoris or calves) or weakness problems with muscles in the medial quads (the inner muscles on the front of your thighs).
  • Weakness of abdominal and/ or hip (gluteal) muscles.
  • Foot position- this can include over-pronation of the foot, which can put increased stress on the joints and soft tissues around your knee. If your physiotherapist identifies this as a cause Sportsmed have a preferred podiatrist who is highly trained in this area to ensure you have the right footwear and/or fit you with a customized orthotic.

One, or a combination of these factors can lead to knee pain. 

footposition

What is the treatment?

The key to treating your knee pain is the correct identification of the primary causes and “fixing” them. This can often involve a biomechanical assessment (also known as a muscle balance assessment) used by Sportsmed physiotherapists to identify areas of tightness and or weakness, which are leading to you over loading your knee when running. If you only treat the symptoms (the pain) and these areas of tightness and weakness are not identified and corrected with a tailored rehab programme your pain will soon return. 

It is also important to treat the pain. This may involve, the thing that runners hate, the dreaded “R” word…

Rest. This may mean avoiding any activity, such as running, that may have led to your knee pain. It may not mean stopping running altogether. For example, it may mean changing the surface you are running on or it may mean doing less running sessions and cross training (swimming, cycling, rowing, boxing) other sessions. This depends on many variables and you (your coach) and your physiotherapist are the best people to sit down and make a plan for this.

applyingice

Ice. Applying ice to your area of pain may also help to relieve pain. The cold from the ice is thought to reduce blood flow to the inflamed area. This may limit pain and inflammation. Apply for 15-20 minutes and then re-apply every two hours. This will not “fix” the cause but will help with the symptom (Pain).

Massage. Your Sportsmed physiotherapist can massage the muscles, which have become tight due to overuse to help settle down the pain associated with shin splints. This is important but as stressed many times if the cause of the tightness is not identified and “fixed” the pain will return sooner or later. 

Painkillers such as paracetamol are useful to ease pain. They should not be used to mask pain so that you can continue to run. It is best to take these regularly initially. Anti-inflammatory painkillers are an alternative. There are many types and brands. They relieve pain and may also limit inflammation and swelling. Side effects sometimes occur with anti-inflammatory painkillers. Stomach pain, and bleeding from the stomach are the most serious. Some people with asthma, high blood pressure, kidney failure, and heart failure may not be able to take anti-inflammatory painkillers so you should see your Doctor first.

What is the prognosis (outlook)?

With the correct intervention you can fully recover from your knee pain and achieve your running goals. However, the chances are that they will recur if you do not look at the underlying cause of your shin splints.

Can knee pain in runners be prevented?

runner

Studies and trials have found that no single prevention method has been found to be consistently effective in preventing any of the types of knee pain listed earlier. This is not surprising considering the multi-fact

If you are serious about your running or starting up running then it is advisable to see a sports physiotherapist such as those at Sportsmed. They can identify poteorial nature of the problem and that the causes are very much individual specific.

ntial problem areas before they become an issue and help you structure your training to help progressively load your muscles, hence avoiding the problem. Similarly, if you have early signs of shin splints immediate intervention is the best option. Don’t delay seeking professional help because if you wait until the pain is severe it is likely you will be advised that part of your treatment will involve the dreaded R word!!!