Runner’s Knee is a broad term for a handful of conditions that often afflict runners, and is also known as patellofemoral pain syndrome. It is considered one of the most common running injuries.
However, non-runners are not immune to this condition. Anyone that lives an active lifestyle, works a physically demanding job, or has poor knee health for other reasons can develop this condition.
When ignored or left untreated, runner’s knee can lead to chronic pain and discomfort, as well as a loss of strength and mobility.
Understanding what causes runner’s knee pain, the associated symptoms, and applying the most effective treatment approaches can help people at all activity levels protect and maintain good knee health.
What is Runner’s Knee (Patellofemoral Pain Syndrome)?
A dull ache or pain around the front of the knee – the patella – where the patellofemoral joint connects with the lower end of the thighbone – the femur – is known as patellofemoral pain syndrome.
While anyone can develop runner’s knee, middle-aged women who lead active lifestyles are more susceptible to developing misalignment issues in the knee, according to a study published in the journal Gait and Posture.
Like other nagging aches, pains, and injuries that come with age and overuse, such as jumper’s knee, the pain from runners knee is likely to subside a little as a person’s body gets warmed up, at least in the beginning.
Unfortunately, people often assume this was just a fleeting ache that won’t reoccur instead of recognizing the early symptoms of patellofemoral pain syndrome.
Typical Runner’s Knee Symptoms
One of the primary symptoms of runner’s knee is a dull ache around the kneecap during, or after activity. Similar pain may also occur after long periods of sitting or having the knees bent.
Other common symptoms of patellofemoral pain syndrome can include:
- A sensation of weakness and instability in the knee
- Pain with activities like walking, running, kneeling, or squatting
- Discomfort when going up or down stairs
- Instability, weakness, or pain while carrying heavy objects or in the midst of training that involves weighted front or back squats, as well as deadlifts
- Grinding, clicking, or rubbing sounds or sensations in the kneecap as the joint moves through its range of motion
- A kneecap that is tender to the touch, or shows apparent inflammation and swelling
With any of these symptoms, or a combination of them, it’s a good idea to review your daily activities, especially any strenuous movements that may be causing runner’s knee pain.
What Causes Runner’s Knee?
Runners knee is a condition that can appear after a sudden injury or a structural defect in the body. It is more often the result of continued stress on the patellofemoral joint by repetitive movements causing knee pain.
Some of the most common causes of patellofemoral pain syndrome include:
- Poor running, jumping, or other training mechanics and techniques
- Overly tight thigh muscles that pull the kneecap outward while walking or running
- Poor fitting shoes or inadequate foot support
- A kneecap that is too high in the knee joint
- Excessive training
- Age-related degeneration
- Sudden injury
- Tight hamstrings or Achilles tendon, as well as weak thigh muscles
- Excessive bodyweight that takes a toll on the joints, especially the knee
With a little understanding of what causes runner’s knee, anyone can take measures to protect and prevent against developing the condition.
How to Prevent Runner’s Knee
While prevention is never a foolproof means of protection against sudden injury or other issues that can cause knee problems, it’s a great way to increase awareness of the possibilities and minimize the downtime and discomfort that can come with runner’s knee.
Runners knee prevention methods can include some of the following:
- Stay limber by regularly practicing runner’s knee stretches that keep the muscles and soft-tissue that support the knee flexible and strong. These should be practiced before and after activity
- Perform strength training for weak thigh muscles
- Practice proper techniques by staying focused on form, and keep the body leaning forward with knees bent while running
- Get fitted for proper running shoes and foot support
- If needed, lose weight or maintain a bodyweight that supports healthy knees
- When recovering from runner’s knee, slowly increase activity levels over time
Even with prevention, it may be necessary to treat the symptoms of runner’s knee.
Runner’s Knee Treatment
Patellofemoral pain syndrome can only be diagnosed by a physician, who will ask about activity levels, perform a physical examination and likely order imaging X-rays or an MRI to rule out any other structural or soft-tissue problems.
Runner’s knee treatment will generally start off with conservative approaches, such as immediately reducing stress on the knee by limiting activity.
Other runner’s knee treatment methods may include the following:
1. RICE Method
The RICE Method (Rest, Ice, Compression, Elevation) is an approach for injury treatment that is typically the first step when a runner notices pain in or around the knee. Though it might seem basic, just giving the body a break by resting the injury, icing the area to increase blood flow, and reducing inflammation can be extremely effective.
If possible, wrapping the knee with a compression bandage and elevating it on a pillow or cushion above the heart while lying on your back also helps.
2. Anti-Inflammatory Pain Medications
Over-the-counter, non-steroidal anti-inflammatory pain medications, such as ibuprofen (Advil) or naproxen (Aleve) should be used as directed to reduce pain and inflammation, while resting the knee.
3. Physical Therapy
Physical therapy may be called for during recovery. A physical therapist can help educate runners about proper techniques, appropriate gear to use, as well as effective stretches and warm-up exercises that will lessen the likelihood of aggravating runner’s knee pain.
Physical therapists may also suggest knee braces or taping, as well as proper foot support and orthotics, if needed, to ensure greater support and stability for the knee.
4. EPAT / Shockwave Therapy
EPAT Therapy is formally called Extracorporeal Pulse Activation Technology and it successfully treats pain caused by acute or chronic injuries such as runners knee.
EPAT is sometimes referred to as Extracorporeal Shockwave Therapy (ESWT), or simply Shockwave, because it delivers high-energy sound waves (Shockwaves) to the injured area to decrease inflammation, increase blood flow, and promote healing and new blood vessel growth.
EPAT / Shockwave Therapy is an effective, non-invasive treatment approach that speeds up healing, improves recovery, and reduces injury-related down time.
As an added benefit, this type of therapy treatment can also be administered while a person is in the resting phase of RICE, during physical therapy, or even while continuing normal activities.
5. Cortisone Injections
In very specific cases, some physicians may suggest cortisone or steroid shots for swollen or inflamed knee joints. Corticosteroids are a very powerful anti-inflammatory medicine.
However, this minimally invasive procedure can cause side effects, such as damaging surrounding, healthy soft-tissue that may actually increase the chances of further injury. Most runners will fare better in seeking alternatives to a cortisone injection that is only a temporary fix.
Surgery is usually reserved for the most serious cases of runner’s knee, such as cartilage that is heavily damaged and unlikely to heal properly, or a kneecap that is badly misaligned.
Obviously, surgery is the most invasive approach to treating runner’s knee and is not recommended unless absolutely necessary because of the inherent risks. Even successful surgery involves significant downtime for the healing process.
Understanding and practicing prevention techniques can help many people avoid the pain and symptoms of runner’s knee from ever happening. At the very least, they can minimize some of the severity if it does occur.
For those who develop patellofemoral pain syndrome, the treatment methods outlined here can help overcome the pain and accelerate the recovery process.