Runner’s Knee: Causes, Management and Rehabilitation

Running is an excellent form of exercise to help improve your fitness, prevent chronic conditions, and maintain your mental health. However, many mid to long-distance runners often find that they experience knee pain at some point.

Under most circumstances, this is not a serious problem. Although if not managed appropriately, you may find that the pain can remain unimproved or worsened.

“Runner’s Knee” affects up to 22% of the population and is more frequently seen in women.

Below we have some useful advice on what may be causing your pain and some tips I recommend for my patients.

Runner's knee

Why does my knee hurt?

There can be many reasons why your knee hurts. Cases can vary from minor irritation of the knee joint to tendinitis or even ligament tears. However, one of the most common conditions seen in runners is “Runner’s Knee” or medically known as patellofemoral pain syndrome.

“Runner’s Knee” affects up to 22% of the population and is more frequently seen in women. Typically, this condition is due to overuse which can be related to a sudden spike in activity, such as the intensity and frequency of your training. When we quickly increase the amount of activity performed without rest, the structures of our knee will not have time to recover. Similar to how our muscles ache after exercise, we need to for it to rest, or else our body will continue to be sore.

Other more uncommon reasons for “Runner’s Knee” include direct injuries (e.g. falling onto the knee) or even after surgery.

What is “Runner’s Knee” (Patellofemoral Pain Syndrome)?

Runner’s Knee” is a fancy way of saying that there is irritation, pain or swelling around the kneecap (patella). Often, it presents as a dull ache that is felt behind or around the knee cap.

The condition can be aggravated when sitting for prolonged periods, deep squatting, and going down the stairs. In some cases, the knee may swell up and you may hear clicking or grinding as you move the knee.

Under many circumstances, “Runner’s Knee” is caused by misalignment of the patella, which causes it to inappropriately move within the knee joint.

Patellar injury

Does Runner’s Knee go away?

If you continue to run without rest or seeking a professional opinion, your symptoms will most likely not improve. Without modifying the activity you are currently performing, this will continue to aggravate symptoms and restrict your physical activity. Seeking the opinion of a physical therapist will fast track your recovery with specific strategies and rehabilitation plan. To help assist your recovery, we have two simple recommendations.

1. Modify your training load

One of the best ways to manage overuse injuries is to adjust the amount of running or training you’re performing. An easy strategy I implement for runners is to reduce the distance run by half and gradually build it back up. Alternatively, you can decrease your intensity, speed, or even take more regular breaks in between.

2. Strengthening your leg muscles

Strengthening of the muscles around your knee will allow you to keep running and gradually increase your running capacity. Muscles such as the quadriceps and hamstrings are vital for improving your knee’s ability to tolerate stress. Other points of weaknesses that may contribute to “Runner’s Knee” include weak hip muscles (e.g. gluteus mediums), poor foot posture, and insufficient calf strength.

For a more streamlined and effective rehabilitation program, we would recommend that you be assessed by a physical therapist to find your specific point of weakness. The correct exercise program will help ensure you continue to run without any flare-ups.

Strengthening of the muscles around your knee will allow you to keep running and gradually increase your running capacity. Muscles such as the quadriceps and hamstrings are vital for improving your knee’s ability to tolerate stress.

What are some exercises that could help prevent knee pain whilst running?

By improving the capacity of the muscles that surround the knee and hip, we can improve the function of the kneecap within the knee joint. Optimizing the movement of the kneecap will reduce the stress through your knees and desensitize your knee pain. Below are three simple exercises I regularly use to help patients with “Runner’s Knee”.

1. Box Squats

This exercise is designed to strengthen all of your leg muscles, particularly your quadriceps, hamstrings, and gluteus maximus. By having the box behind you, this helps take the stress off the kneecap. To minimize the risk of pain, you should try to prevent the knee from moving too far forward in front of the feet. If this is too difficult, you may want to reduce the depth of your squat.

2. Crab Walks

This exercise targets the outer hips muscles called the gluteus minimus and medius. These muscles attach to the kneecap and are crucial for its stability. One of the more common characteristics seen with “Runner’s Knee” is the lack of strength and endurance in these muscles. A comprehensive rehabilitation program for “Runner’s Knee” will always contain exercises that strengthen these muscles.

3. Banded Glute Activation Bridges

Based on my clinical experience, a common comment I hear from those who have “Runner’s Knee” is that they “don’t feel their bottom muscles working.” Even when performing an exercise such as the box squat, you may feel your thighs work more than your bottom muscles. One exercise that can help activate these muscles is the banded glute activation bridge. This exercise should be performed prior to your exercise program to ensure you’re performing them correctly.

Does footwear affect my running pain?

Footwear can most definitely affect your pain. What we wear on our feet has a very important role in changing the forces that transmit through our knees. A poor choice of footwear can place higher levels of stress on our knees, increase pain, and lead to more chronic problems.

For example, recent research has shown that shoes with a high heel of 3 cm or more can increase stress on the knee by 15%. On the other hand, flat footwear without heels can also be harmful.

To ensure you are wearing appropriate footwear, you should see a podiatrist who will be able to perform a foot postures assessment, provide advice on suitable footwear, and determine whether or not you may need orthotics.

Running shoes
A good pair of running shoes can help tremendously with sore knees.

Is it safe to run with knee pain?

The only way to know whether running is harmful for your knee is to seek the guidance of a physical therapist. However, if you are experiencing pain whilst you are running, you may be delaying your recovery.

It’s important to listen to your body and modify your running as appropriate. Keeping active is still vital, so other alternatives might include more low impact activities such as swimming and walking. However, for those with “Runner’s Knee”s, I would recommend trying these two strategies for helping reduce knee pain.

1. Patellofemoral Taping

This can be a short term technique that can be used to provide immediate pain relief. Taping the kneecap towards the inside of your knee can help with its alignment and reduce stress through the joint. However, taping is not a long-term solution and should be used in conjunction with an exercise program. Specific sports and rigid tape should be used.

2. Reducing your stride

Taking smaller steps by just 5-10% has been shown to reduce the stress and pain through the knee joint. One way to measure this is to see whether you can take more steps within a certain period. The higher the step rate, the smaller the steps will be. If you experience knee pain whilst running on a treadmill, measuring your step rate will be even easier.

Disclaimer: The content written on this page was created for educational purposes. Information on this page should not be used as medical advice or a substitution for seeking the services of a health professional. Anyone suffering from knee pain should book in a consultation with their primary healthcare practitioner (e.g. physical therapist, family doctor, etc.).

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Leon Mao
Leon Mao

Leon is an Australian physiotherapist who specializes in working with musculoskeletal conditions. He graduated from the University of Melbourne with his Doctorate in Physiotherapy before entering the workforce. He is now consulting from Top to Toe Health as a clinical and telehealth physiotherapist and primarily works with office-based workers and athletes. For any inquiries or further information, please visit Digital Physio.

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