Runner’s Knee: Fix Pain Around Your Knee Cap

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The knee is not just a regular joint, especially not for runners. Basically it’s there to flex your leg and one could compare it to the elbow joints.

However the knee is by far more complex than the elbow and most other joints. This complexity is obviously needed in order to move the body and all it’s weight forward and give you a wide range of motion.

Also this complexity can result in a lot of different injuries. Torn ACLs and MCLs are something that can be seen in many sports like soccer, american football or alpine skiing.

These ligaments are fairly safe in running. In endurance running another part unique to the knee joints can cause issues: The knee cap.

What Is Runner’s Knee

The injury widely named runner’s knee is also called patellofemoral pain syndrome (PFPS). This is a term used for pain around the joint between the knee cap and the femur (upper leg bone).

Both the joint itself or the soft tissue surrounding it can be the source of the pain. The pain arises due to the knee cap not moving correctly in the femoral groove and therefore friction of the tissue behind your knee cap occurs. There are several different reasons for that:

  • Overuse
    This is probably the main cause for knee pain for runners. A sudden increase of mileage or changed activity patterns like excessive downhill running, running upstairs or something alike.
  • Muscular Dysbalances
    If the different upper leg muscles are not in balance, your knee cap can be pulled inward or outward and therefore doesn’t move nicely in the femoral groove anymore.
  • Weak quads or hip muscles
    If your quads or hip muscles are too weak for the running you’re doing it can also affect the alignment of your patella
  • Tight muscles
    If your muscles are tight and not properly recovered, it impacts your running form, the movement of your knee joint and can then lead to runner’s knee as well

In some cases runner’s knee can also be caused by a trauma or a misalignment of your bones. But for most runners it is one or a combination of the reasons mentioned above.

Runner’s knee is considered as one of the most frequent running injuries. A lot of endurance runners experience knee pain at least once within their running career.

And if you think about it, it’s no surprise. The force on your knee, especially the patellofemoral joint is huge when you land with your body weight on your foot. Apart from the foot, the knee is the joint that takes the most impact force when running.

And if you are into long distances, this force is applied on your knee thousands of times on any training run.

So it’s quite obvious that when it comes to your knees, everything has to work properly to prevent any injuries.

Before going into treatment and how to avoid runner’s knee, let’s have a look at the symptoms and the diagnosis.

Symptoms And Diagnosis

The main symptom that you can notice as a runner is just pain. Usually in patellofemoral pain syndrome, the pain is in front of your knee cap. The pain can also be felt behind or around your knee cap.

You will have difficulties to bend your knee and squats, walking and running cause some amount of pain.

One of the clearest signs of runner’s knee is when the pain increases when you walk down stairs. So if you’re not sure, walk down one or two floors in a building or use a staircase outdoor. If with that pain increases around your knee cap, chances are you suffer from runner’s knee.

We are runners and no doctors. Of course with time you learn to interpret the signals and forms of pain your body sends out. However runners usually don’t have a deep knowledge of the entire body and we certainly don’t have the equipment to do a proper diagnosis.

There are several other issues that can cause your knee to hurt like patellar tendinitis. So if you’re not sure and the treatment outlined below doesn’t make your knee pain better, I strongly recommend you to see a physician.

Treatment of Runner’s Knee

The first thing an avid runner thinks about with a runner’s knee is: Can I keep working out?

Well the first advice I can give you for treating runner’s knee is obviously one that you don’t want to read: Rest your knee as much as possible!

Can I Keep Running?

Of course it depends on the stage of the injury and in how much pain you are. Some recommend to just cut back on mileage and running intensity. Others will tell you to stop completely and avoid any activity that is uncomfortable for your knees.

I would recommend that you stop running for some days and focus on recovery. If you see that the treatment works, you can slowly get back into running. Start with a short easy run with the focus that your knee doesn’t hurt. If it does and pain increases then stop!

Recovery Activities

Every runner is different, every body is different and so is any injured knee different. I can’t give you a perfect recipe that you can do and it will get better for sure. Some might even need surgery.

But for most runner’s knee issues, there’s a set of things you can do to recovery and prepare your knee again for running:

  • Rest
    This one is obvious. At least cut back your mileage and rest your knee as much as possible.
  • Icing
    Ice your knee to fight the inflammation as well as pain and swelling. You can do this for 20-30 minutes several times a day for the first couple of days or until the pain is gone.
  • Stretching
    Do a daily stretching routine. Focus especially on your quads and hips but I recommend to do a wide arrange of muscle stretches including calves, hamstrings, quads, hips and lower back muscles. Stretch each muscle group for 30 seconds at least three times.
  • Foam roll / massage
    Loosen up tight muscles with foam rolling of with massages if you can afford it or have someone to give you a proper sports massage.
  • Strengthening
    The gold standard of any runner’s knee treatment is muscle strengthening especially your quads. This is to sort out any dysbalances you might have. Focus on your quads and hip muscles.

What Else Can I Do

The things mentioned above are what works for most runners. However there are a few more things I like to mention here.

First you can tape your knee with kinesio tape. This can give your knee more stability and move your patella in position so it doesn’t cause friction anymore. Check out this video on how to tape your knee correctly.

If the pain is very severe you can also take non steroidal anti inflammatory drugs (NSAID) like ibuprofen. However you shouldn’t take meds so you don’t feel pain and can keep up your regular training. This will just make it worse.

Also you can elevate your knee when you are sitting. This works especially well when your knee is swollen. Try to put a pillow beneath your leg when you go to sleep at night.

How to Stay Fit During the Injury

If you need to cut back in running or have to stop running for a few days or weeks, you probably still want to stay fit. This of course is especially the case if the injury happens while training for a race you want to do.

The normal cross training sports for runners would be cycling. However cycling also requires your knee to be bent. So in the beginning of treatment cycling might not be such a good idea.

The best to maintain your endurance is probably to go to the pool and swim a few laps. I’ve also tried rope skimming but go easy on it as this can be pretty hard on your calves.

Injuries can also force you to be creative. Swiss cross-country skier Dario Cologna once torn his ACL three month before the Olympics. He built himself a tool to train his arms and upper body and maintain fitness while recovering from the knee surgery. Three months later he won the gold medal.

Just try different things that work for you. But try stuff in the beginning that won’t put load on your knee and require it to bend and stretch often.

Running Comeback Routine

Coming back from an injury can be very dangerous. By all means you want to avoid that you get injured right away again.

So the golden rule here is to take things slowly. Start with easy and short runs every other day. Choose routes that you can shorten should you knee hurt again.

Keep doing the treatments that worked and also start slowly to incorporate habits that will avoid your knee to hurt again. I will give you some advice on preventing runner’s knee in the chapter below.

How to Avoid Runner’s Knee

So how can runner’s knee be avoided in the first place? Some might tell you to just don’t run at all.

Well that’s not an option right?

Having a look at the causes of runner’s knee already give you hints in how to avoid it. The best advice here is to slowly increase your mileage if you wanna do more running. Generally an increase of no more than 10% week after week is a good rule for most.

Also add proper stretching and strength training to your running. Stretch thoroughly after every run and do strength training especially of your quads and hips on the days you are not running.

Do a recovery week every third week and foam roll or massage your muscles regularly so they don’t tighten up.

To reduce the force that is put on your patellofemoral joint, also keep your weight down. Remember the force is a multiple of your body weight, so every pound you can get rid of is great for injury prevention.

Also it’s a good idea to check out your stride and get shoes that suit your style and biomechanics.

Go easy on changing terrain and excessive downhill or mountain running and try to run on soft surfaces like forest trails and avoid concrete and road running.

Resources

To wrap up this post on runner’s knee, I’ll encourage you to check out these additional resources on running injuries.

How to Deal With a Running Injury

The Naked Truth Why You Get Injured

10 Secrets That Help You Prevent Running Injuries

Happy running,
mikula

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