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Runners Knee Guide

Runner’s knee is an umbrella term which is used to describe one or more causes of pain or irritation of the knee. Some of the more common types of runner’s knee include, but are not limited to:

  • Iliotibial band syndrome
  • Patello-femoral pain syndrome (PFPS)
  • Anterior knee syndrome

A session with a physio can help to quickly identify the specific issue which is causing your runner’s knee, and a treatment plan can be put in place to get you back on your feet in no time.

What are the causes and symptoms of runner’s knee?

Someone suffering with runner’s knee will often complain of aching pain around the knee area. Depending on the specific condition, the pain may be felt across varying areas of the kneecap, including the top, bottom, inside or outside. 

Two of the more common areas of pain are around the bottom of the thigh bone and the knee, as well as the outside of the knee, which commonly relates to ITB syndrome.

The pain of runner’s knee is likely to be more obvious when doing anything strenuous, such as sports or exercise, but can also be felt when doing more simple things, such as kneeling down or having your knee bent for long periods of time, such as sitting in a car or train for a long journey.  

Runner’s knee can be caused by several things, but most commonly these include overuse due to repeated bending and loading of the knee joint, an accident or trauma of the kneecap, or a muscular imbalance of the thigh muscles.

 

How to treat runner’s knee?

Specific treatment will vary depending on the exact cause of your runner’s knee, but generally speaking the following things will help:

  • You need to decrease your load, but still keep your CV fitness up – rowing and biking are great substitutes.
  • You need a little first aid by controlling the amount/distance you run and importantly increase your cadence (for a while) ie take shorter steps and no over striding.
  • You also need to improve the control your leg when running, and really amp up your glute control – this is key stuff
  • Tape, ice and anti inflams can also help – even giving a quick squirt of steroid before the run is an option, too.

Do the simple things well – control your load (go backwards to go forwards) and improve your glutes. It may hurt but it won’t cause harm.

Common knee injury / problem types

ITB friction syndrome

What is ITB friction syndrome?

This is where tissue that runs from the outer bit of your hip, down the outside of your thigh and attaches into the outer portion of your knee, becomes irritated and compressed.

What are the causes and symptoms of ITB friction syndrome?

If your body is starting to creak with the constant repetitive load you’re putting through it – it sounds like you’ve got a classic ITB friction overload issue at your knee.

Every time you bend and straighten your knee, when loading, your ITB flicks across a bump of bone on the outer part of your knee. It gets compressed and irritated and painful.

This can happen for a few reasons – and even though you may feel pain after a specific incident, it’s more likely to be a cumulative effect of these few things: 

  • Poor gluteal control
  • Overactive muscles (things like TFL)
  • Restricted hip movement may preempt ITBFS. 

Having symptoms when running is really common, it’s the repetitive nature that’s the issue.

How to treat ITB friction syndrome?

Get a foam roller and roll your ITB daily – morning, noon and night. Stick some ice on your painful bits for the next week or so for 20 minutes (no ice burns, so use a bit of oil) – may also be worth knocking back a few Ibuprofen (if you can take them). Try to increase mobility in your thoracic spine and make sure you’re sitting well at work – no slouching, screen the right height and make sure you use the back of your chair (if necessary bring your screen nearer to you).

Most importantly improve your gluteal control – this is a must! When you run, and your knee rolls in underneath you (worse uphill) you put massive amounts of excessive load throughout the outer bit of your knee – you need to control this excessive movement to stop your ITB becoming the fall guy.

Lunges, squats, dynamic split squats and ballistic hops are the way forward – functional, realistic and pain free. Use a mirror to make sure you’re not cheating and keep A1 form. This isn’t an overnighter, but you need to start doing it

Patellofemoral pain syndrome (PFPS)

What is Patellofemoral pain syndrome?

Patellofemoral pain syndrome is a common term relating to pain or discomfort around the kneecap (aka patella). There are several reasons why you might be experiencing patellofemoral pain syndrome, which a physio can help to diagnose and treat.

What are the causes and symptoms of Patellofemoral pain syndrome?

It happens due to either your knee cap tracking poorly or because there is a tiny amount of swelling on the back surface of your kneecap, or commonly a bit of both.

How to treat Patellofemoral pain syndrome

Try taking some anti inflams (if you can take them) for the next 3-5 days, roll on your ITBs with a foam roller and avoid squatting (unless sitting the loo ;).

Tracking issues

What are tracking issues?

Normally your kneecap sits in a little groove on the front of your femur (thigh bone). When you bend your knee, your kneecap tracks up and down the femur like a train on its track.

What are the causes and symptoms of tracking issues?

If the patella gets pulled to the outside – by poor glut control or leg and foot rolling in then it becomes painful. If the patella tracks up and down with too much force being applied through the patella, without enough conditioning, then both of these “incidents” can cause pain.

How to treat tracking issues?

Keep running but as you start to train for the event make sure you do some interval training get stronger, do some control biased work and perhaps get in a pool or on a bike.

Keep your CV status tip top condition by doing other things apart from running…oh an foam rolling your ITBs wouldn’t go a miss…or making sure your runners are in good nick too!

Meniscus tears

What are meniscus tears?

The meniscus consists of two areas of cartilage which sit within the knee joint, between the femur and tibia. Meniscus tears, which are common injuries, can occur for various reasons, but are usually associated with a significant twist or rotation of the knee area. Heavy lifting can also result in a torn meniscus.

What are the causes and symptoms of meniscus tears?

A torn meniscus can cause pain in the knee area with varying levels of severity. Other symptoms include swelling and a feeling of tenderness across the knee. Some people may notice a locking feeling when the knee is bent, or have trouble bending their knee altogether. 

How to treat meniscus tears?

Go easy on the stretching. It may well make the knee feel better, but over stretching the knee is likely what caused the cartilage tear in the first instance. So without gaining more control around the knee, just blasting on and stretching (despite feeling better!) may have inherent longer term risks.

Stability, control and strength are key – not just of your knee but of your entire leg from the pelvis down and the foot up. You try to make all the other bits around your knee work more efficiently to allow your knee to heal correctly.

Spongy knee pain

What is spongy knee pain?

Spongy is a really key word – nobody ever mentions it unless they feel it. Only a few things feel spongy; fat pads at the front of your knee can feel spongy when you lock your knee back.

This fat pad is like a bursa (a fluid filled sac) and there are lots of them around your knee and they can make your knee feel spongy.

What are the causes and symptoms of spongy knee pain?

There are many causes of spongy knee pain, ranging from sporting injuries and ligament tears, to an overload of weight on the knee and repetitive strain. As the causes can vary widely, it is recommended to see a physio as soon as possible, who through consultation, will be able to identify the exact cause and offer a treatment plan to recover.

How to treat spongy knee pain?

I think it may be worth getting an MRI of your knee to have a look and see what’s going on inside.

 

Common areas of runners knee pain

Inner knee pain

If you have pain in your inner knee (also known as the medial knee), which is the part of the knee which sits closest to your other knee, there are a number of reasons why this may be.

Inner knee pain could likely be due to an injury from exercise or sporting activity. It could also be due to inflammation in the bursa tissue or a sprain or tear.

More serious causes of inner knee pain can include a torn meniscus or osteoarthritis.

Outer knee pain

Pain in the outer knee (aka lateral knee) can be common with long distance runners, and can often spread up towards the thigh.

Two of the most likely causes of outer knee pain in runners include iliotibial band syndrome and meniscal injuries. 

Iliotibial band syndrome is often caused by the tissue, which runs down the side of the outer knee, being stretched or torn. 

Meniscal injuries are a result of the meniscal cartilages being damaged, which sit inside of the knee area.

Bottom knee pain

If you have pain in the bottom of your knee area, this is most likely due to an injury to your patellar tendon. The patellar tendon is the part of the knee which joins your kneecap to the shin bone.

Injuries to your patellar tendon (sometimes referred to as jumper’s knee) are often caused by over training, stop / start sports such as tennis or football, and not jumping correctly during sports or exercise.

Upper knee pain

One of the more common causes of pain in the upper knee (which may actually feel like it’s above your knee) is quadricep or hamstring tendonitis. These are likely caused by over training or not getting the right form with exercise.

Symptoms can include tenderness and swelling around the area, as well as an aching pain when your leg is in motion and the kneecap is bending.

These conditions can be addressed by resting the leg with the injury, and eventually trying some light exercise and stretches. 

Runners knee certainly covers a wide range of injury types, symptoms and causes. If you’re still unsure of the specific reason behind your knee pain, consider booking a session with one of our physios to get a full diagnosis and treatment plan, to get you back on the road in no time at all.

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