What to do about Runners Knee
Running is a great form of exercise. It involves minimal kit, can be done anywhere and participation is free. However, a common problem amongst runners is knee pain. One of the most common causes is a condition called patellofemoral pain syndrome (PFPS), or Runner’s knee. Here we’ll discuss how you know if you have it, and what you can do about it.
This condition is known as Runner’s knee because of it’s prevalence with runners, but it can be caused by any sport or activity which increases the load on the knees, such as cycling, skiing or hill walking.
The knee cap (patella) sits in a groove on top of the thigh bone (femur) and forms your patellofemoral joint. The knee cap moves mostly up and down in this groove, but can tilt, rotate and has some side to side movement as well. The position and mechanics of this can be easily effected by weakness or tightness of surrounding muscles and soft tissues. Patellofemoral pain simply means pain around the area between the patella and the femur.
How do I know if I have Runner’s knee?
The most common feature of this condition is pain at the front of your knee, under and around your knee cap. Patient’s usually report dull aching pain which may have come on gradually with running.
Pain will be worse with any activity which increases the load through the joint, such as walking up and down stairs or hills, squats and kneeling down. You may also pain in the knee when you are sitting for a long time.
If in doubt, go and see a physiotherapist as they can differentiate between other knee conditions such as tendinitis, iliotibial band syndrome, arthritis, ligament or cartilage problems.
What can I do about it?
One cause of this condition may be due to your training schedule. The distance or frequency that you are running may need to be modified. Our previous blog about reducing the risk of running injuries is worth a read as this may be all that you need to work on in order to help your knee recover.
Step 1: Reduce the load
The first thing to do when you experience knee pain when running is to STOP. The symptoms are unlikely to change without reducing the load on the knee. Think about a scab trying to heal - if you keep picking at it, it won’t have chance. Sometimes it is possible to continue running with this, but shorter distances. If this is the case for you, make sure you are only running whilst the knee is pain free and stop when it becomes painful - this will just continue to aggravate the area.
Knee brace
You may want to consider the use of a knee brace to reduce the load. Alternatively, your physiotherapist can provide taping techniques for your knee. Both these options change the forces going through the knee and may allow you to continue running with less pain.
There are loads of knee braces out there but we tend to find the neoprene supports with the open patella ring are best for this condition. Bracoo KS10 Knee Support is a great one.
If you cannot find a way to run without pain (try less distance, slower speed, softer ground, less frequency of running, taping or bracing) then STOP RUNNING to allow the knee to rest. This may be a few days, or it may be you need to rest for a couple of weeks for any irritation to really settle down.
It is also advisable to avoid activities that put a lot of strain on this area, such as kneeling or squatting.
Step 2: Rehab
You may find that simply using a knee brace or taping helps to improve your pain. But usually, the underlying cause of the problem has not been addressed and you may find your knee pain returns.
a) Reduce quad tightness
The quadriceps (quads) are a group of 4 muscles at the front of the thigh. One of them passes over the top of your kneecap and attaches below your knee at the top of your shin bone. These muscles are commonly tight with runners knee. This increases compression of the knee cap on the groove beneath and can contribute to pain.
Quad stretch
Bend one knee and bring your heel to your bum.
Reach back and grab your foot and pull it towards your bottom. Make sure your knees are together so you get the most out of this stretch.
You should feel a pull in the front of your thigh.
Hold for 30 seconds and release.
Complete 3 times, twice a day.
Another great way to release quad tightness is to use a foam roller. If you don’t already have one, we recommend the Edge Sports 2 in 1 Foam Roller and ball - see the link to buy from Amazon.
It’s a good idea to work the roller up and down the front of your leg to target your quads, but also down the outside of your leg to target a structure known as your ITB - iliotibial band. This attaches into the outside of your knee and can also contribute to increased pressures through the kneecap.
*This is the equipment that we use and recommend fully. You won’t pay a penny more, but First Line Physio will earn a small commission if you purchase the equipment following this link. This contributes to the running costs of the blog.*
b) Strengthen glutes
Your gluteals (glutes) are a group of 3 muscles that make up your bottom area. Gluteus maximus makes up most of this area (hence the name!) but we are going to focus on a smaller muscle deeper in your bottom called gluteus medius (glute med).
Weakness in these muscles has been found to be linked to Runner’s knee. This is due to the stability that this muscle brings to the hip and the impact this has on the forces through your knee.
Side lying hip abduction - This has been found to be the best exercise to strengthen glute med.
Lie on your side with the affected leg on top. Bend the underneath leg so that it is out in front of you.
Slowly lift the top leg up. Lift as far as you feel able to, without pain. Then slowly lower. You may find that you are only able to lift the leg a little to start with. Don’t worry about this, as it will still be working the muscle, and you should find that you can increase this slowly as your knee starts to improve.
Complete as many of these as you feel able to within pain free limits, up to 30 repetitions.
If the knee is very sore, you may want to complete these “little (less than 10) and often (a few times a day)” and build it up. You should feel this working into the side of your bottom muscles. If you feel it down the outside of your thigh or knee, stop, change position and try again. Make sure that your hip doesn’t roll backwards as you lift your leg. Speak to your physio about this if you are unsure or need any advice on your position.
Once you are able to complete 30 repetitions of this without pain, it’s worth trying a more challenging version of this with a resistance band.
If you don’t already have some, you can get a great set from Gritin Resistance Bands - see the link to buy from Amazon. This is a set of 5 bands with varying resistances, which is great as you can work your way up.
*This is the equipment that we use and recommend fully. You won’t pay a penny more, but First Line Physio will earn a small commission if you purchase the equipment following this link. This contributes to the running costs of the blog.*
Straighten your underneath leg and put the band around your ankles. Bring your top leg up to the ceiling as previously, as far as you can without pain. This will feel harder so reduce the amount you do, and then build it up slowly. Aim for up to 30 repetitions. (see the second half of the video above!)
The great thing about strengthening your glutes is that this improves your hip stability. This should mean that you are less susceptible to future re-occurrences of Runner’s knee.
A large proportion of people with runners knee get significantly better with these exercises. Complete them every day for around 6 weeks, making sure that you are not aggravating your knee during this time.
If you have ongoing knee pain after this time, it’s recommended to see a physiotherapist. There are lots of other factors that may be contributing to your knee pain and they will be able to assess these and help make your rehab more specific.
This is absolutely not written to substitute medical advice and it is always important to see a qualified health care professional for a formal diagnosis. If the exercise cause pain during or after completion, discontinue and consult a physiotherapist.
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