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Runner's Knee

This refers to pain in the front of the knee behind, or around, the knee cap also called patellofemoral pain syndrome.

What is Runner's knee?

Runner’s knee is another name for patellofemoral pain syndrome and refers to pain in the front of the knee behind, or around, the knee cap. It is a very common injury for people that participate in sports that involve a lot of running or jumping. It often feels like a dull ache with sharp pain in certain movements such as running downhill. When you rest the knee can feel swollen like an overfilled water balloon.

 

The pain from runner's knee is caused by irritation under the knee cap and is typically caused by one of two factors:

  1. A tight quad muscle causes the knee cap to deviate from its intended path
  2. Mechanical issues in the lower leg, such as flat feet, altering your gait and biomechanics when running.

 

Understand the anatomy to understand your pain.

The knee cap (patella) is a small bone in the front of the knee and it has 2x jobs;

  1. Help provide movement in the knee
  2. Protect the knee joint

 

On the surface, the knee cap feels flat and round to touch but underneath it is actually a triangle in shape. This triangle sits in a groove in the bottom of the leg bone called the femoral groove and, like a train on its tracks, makes sure that the knee cap moves up and down in a straight line.

 

Runner’s knee happens when the tracking is slightly off centre and causes friction and irritation of the underside of the patella and the structures beneath.

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Tests for Runner's knee

We always recommend having a medical professional examine your knee if you are experiencing any pain.

 

Test 1 - Clarke's test.

  • Sit on a chair with your foot resting on a stool in front of you with your leg straight, with no knee bend.
  • Take the hand from the same side (e.g. right knee : right hand) and place it at the top of the knee cap so that the webbed area between the thumb and index finger is cupping the top of the knee cap.
  • Apply a mild to moderate force as though you are trying to prevent the knee cap from sliding up.
  • Contract your quads so your knee cap moves towards you and under the hand.

If you experience pain and/or grinding under the knee cap it is likely that you have patellofemoral pain syndrome (Runner's knee).

 

Test 2 - Single leg dip.

  • Stand next to a wall so you are able to place a hand on it for balance. Ideally, this test should be done on a step but it can also be done on a flat surface.
  • Place one foot out in front of you so that you are standing on one leg, the leg with the painful knee.
  • Keeping your leg out in front lower yourself down so you are doing a single leg dip.
  • Stop when your knee reaches about 90 degrees of bend.
  • Hold it for 45 seconds.

An increase in pain behind the knee cap is an indication you may have patellofemoral pain syndrome (Runner's knee).

What does runner's knee feel like?

You will feel the pain at the front of your knee, although it will be difficult to put your finger exactly where it hurts. It will feel sore behind the knee cap sometimes one side is worse than the other depending on the tracking of your patella.

Runner’s knee will feel like a dull pain around the front of the, it may start off as a mild irritation but if left untreated it can increase in severity. You may also experience a rubbing sensation, clicking or grinding and when the knee is at rest it can feel swollen and “puffy” around the sides of the knee cap.

 

Aggravating factors

  • Running on an incline or decline gradient, worse on a decline.
  • Walk up or down stairs
  • Kneeling or squatting
  • Sitting with your knee bent for long periods of time

 

What causes runner's knee?

  • Training increase. A sudden increase in the volume or intensity of training without adequate build-up can place excessive stress on the knee cap and surrounding muscles. Equally, ineffective recovery can have the same impact.
  • Overuse injury. This normally occurs with a combination of high endurance exercise and inadequate recovery time and can affect even the most well-conditioned athlete.
  • Lower limb injury. An injury to the ankle, hip, or knee can change the overall biomechanics of your gait patterns increasing the load through the knee or changing the way that the leg moves.
  • Muscular weakness. Any weakness or muscular imbalance around the hip or thigh muscles can increase the stress through the knee cap. An underactive quad muscle can lead to the knee cap mal tracking resulting in friction and pain.
  • Flexibility or more specifically tight quads can lead to runner’s knee. Tight quad muscles increase the pressure on the kneecap leading to friction. If a single quad muscle is tight then it can lead to mal-tracking of the patella resulting in friction on one side of the knee.

 

How to treat runners knee. 

For an acute flare-up of pain and swelling using the P.O.L.I.C.E. protocols will help;

  • P: Protect the area. This can be changing footwear to something more supportive like a knee brace.
  • OL: Optimal Loading. Take as much weight as you can without making things worse. You may need rest, different footwear or crutches.
  • I: Ice the area for 20 minutes at a time to relieve inflammation.
  • C: Compress the area with a soft wrap to reduce swelling.
  • E: Elevate the area by putting the foot on a few pillows.

 

Insoles & footwear

Changing your footwear to something with more cushioning or more support may be all that is required to help alleviate your symptoms. Corrective insoles provide arch support and can help to correct foot mechanics such as flat feet. Correcting lower limb mechanics will alleviate any excessive stress on the knee.

 

Exercises to help with runner's knee

Quad stretch

  • Lie on your front on the ground.
  • Bend your knee behind you and support with your hand.
  • Gently pull your foot towards your bum.
  • Press the front of your hip and knee into the ground

Frequency and duration 

  • Hold for 30 seconds for each leg
  • Complete this frequently throughout the day or for a more structured approach, 3 sets of 30 seconds on each leg 4 times a day.

Alternatives

  • Easier - use a towel around the foot
  • Harder - perform in standing or side-lying

Hip flexor stretch

  • Kneel on the ground with one foot out in front of you
  • Bend your knee behind you and support with your hand.
  • Gently pull your foot towards your bum.
  • Press the front of your hip and knee into the ground

Frequency and duration 

  • Hold for 30 seconds for each leg
  • Complete this frequently throughout the day or for a more structured approach, 3 sets of 30 seconds on each leg 4 times a day.

Single leg step up

This exercise is designed to improve leg strength and neuromuscular control.

  • Stand with one foot planted on a step or a block and your arms by your side
  • Step onto the block driving your knee through to 90°.
  • Hold at the top then reverse the movement lowering your leg back down till your foot is back on the floor.

Frequency and duration.

  • Step up for the count of 2 seconds.
  • Hold at the top for a count of 2 seconds.
  • lower down for a count of 2 seconds
  • 3x sets of 10 on each leg

Alternatives 

  • Easier - step on to the box then step down off the box like marching.
  • Harder - hold weights in your hands

Hamstring Curl

This exercise is designed to strengthen the hamstring muscles on the back of the thigh.

  • Stand on one leg with one foot behind you.
  • You can lean on a pole or wall for stability.
  • Raise your heel to your bum making sure to keep your knees aligned.
  • Lower your foot back down until your toes are touching the ground.

Frequency and duration

  • Raise for a count of 2 seconds.
  • hold for 1 second.
  • lower your foot for a count of 2 seconds.
  • 3x sets of 12 on each leg.

Alternatives

  • Easier - reduce the height you lift your foot off the ground.
  • Harder - add weight to the ankle.

Ski squats

This exercise is designed to improve single-leg strength.

  • Start with your back against the wall and your knees slightly bent in a half squat position.
  • Lower into a deeper squat and at the same time shift your weight over to the right leg.
  • Return to the centre in the half squat position
  • Lower into a deeper squat this time shift your weight over to the left leg.

Frequency and duration

Starting from the centre:

  • Lower for a count of 3 seconds
  • Hold for a count of 2 seconds
  • return to the centre for a count of 3 seconds.
  • 3x sets of 12 on each leg

Alternatives 

  • Easier - reduce how far you slide over to the left/right
  • Harder - Make the squat deeper and hold for a count of 4 seconds.

 

The information on this site is intended for educational purposes.

You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider. If you have any specific questions about any medical matter you should consult your doctor or other professional healthcare provider. If you think you may be suffering from any medical condition you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.

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