Understanding Runner’s Knee

Runner’s knee is the common term for any one of several conditions that cause pain in front, behind or around the kneecap, or patella. The most common of these conditions is patellofemoral syndrome, patellar tendonitis and anterior knee pain syndrome.

Runner's Knee

As the name indicates, this condition is often associated with running; however, it can also result from other athletic activities that place significant stress on the knee, such as basketball, skiing, soccer and cycling. Runner’s knee is one of the most common chronic knee injuries and is more often seen in women than in men.

What Causes Runner’s Knee?

Runner’s knee often develops as a result of overuse of and repeated stress on the knee. A change in the frequency, intensity or duration of physical activity, such as running or cycling longer distances or exercising more days per week, can also bring on this condition.

Poor exercise practices or improper sports training or equipment may also be risk factors. Muscle imbalance or weakness, misalignment in the kneecap or leg, and problems with the feet are associated with a higher risk for developing this condition as well people who are overweight. In some cases, direct trauma to the kneecap or dislocation of the knee can lead to runner’s knee.

What Are The Symptoms?

The main symptom of patellofemoral pain syndrome is knee pain, especially when sitting with bent knees, squatting, jumping, or using the stairs (especially going down stairs). Some people with runner’s knee may also experience occasional knee buckling, in which the knee suddenly gives way and doesn’t support your body weight. People with runner’s knee may also describe popping, catching or a grinding sensation in the knee when walking or moving.

How is Runner’s Knee Diagnosed?

After taking a medical history, the doctor will perform a physical examination to evaluate the knee’s stability and alignment, and to determine the location and scope of the pain and swelling. An X-ray can reveal abnormalities in the position and alignment of the kneecap, and if instability is suspected, a CT scan may be ordered. An MRI can also be useful in diagnosing runner’s knee, as it can determine the extent of softening or injury to the cartilage in the kneecap.

Options for Treating Runner’s Knee

  • The RICE technique – rest, ice, compression and elevation – is the first step in the treatment of runner’s knee. If you just can’t rest then try relative rest and decrease your overall volume of activity.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help to decrease pain and swelling. Read and follow all label directions.
  • Avoid bent knee exercises such as squats and deep knee bends.
  • Strengthen the muscles the help you control your knee. This includes strengthening the quadricep muscles (focus on the medial thigh doing seated straight leg raises with your toe out) and hip abductors (gluteus medius). Working with a skilled physical therapist can be very helpful.
  • Controlling the kneecap with tape or bracing may be helpful.
  • Evaluate and modify the way you run. Try increasing your cadence and shortening your stride.
  • Most cases do not require surgery. However, if the cartilage in the kneecap is damaged or the runner has misalignment issues, surgery may be recommended. Most of the time the surgical procedure will be minimally invasive, using arthroscopic surgical techniques.

Return to Running

When you return to running start slow and be patient. Remember the rules for returning to run:

  • Pain that increases during a walking or running sessions should be avoided and the activity should be reduced or stopped.
  • Joint pain should not persist or increase by 24 hours after exercise.
  • If you have pre-existing mild joint pain (>3 points out of a 10 scale), the pain should not worsen during the exercise session or last into the next day.
  • If the pain causes a limp or a compensatory gait change, the exercise volume should be reduced or the exercise stopped until a normal gait pattern occurs.

Good luck and Happy Running!

By: Stephen Kirk, MD
Sports Medicine Specialist, Comprehensive Orthopedics & Sports Medicine